In the United States, 19,216 practicing ophthalmologists serve a population of around 334 million, according to the AAO. That means there is one doctor per 17,381 citizens, a considerable caseload for any clinician.

Now, imagine that instead of this already high figure, you had to work with far fewer resources and provide ocular health care to 900,000 patients instead, an increase of more than 4600%. That is the current workload faced by ophthalmologists working in Tanzania, one of the most impoverished countries in Africa.

The urgent need to address this considerable treatment gap is now the raison d’être of Dr. Susan MacDonald, an associate clinical professor at Tufts School of Medicine and director of CORE, a national residency cataract training course.

‘TEACH A MAN TO FISH’

Dr. MacDonald founded Eye Corps in 2017 to provide sustainable eye care in rural, isolated communities. After traveling to Tanzania as a student, she decided to focus the organization’s efforts there due to the small number of working ophthalmologists, the high volume of patients and limited access to vital equipment. The organization now operates in three regions of the country, where less than 60% of the patients previously experienced an improvement in vision after surgery.

“We are a female-run group, and we really wanted to avoid the colonist approach of ‘we’re going to come in and fix your problem,’” says Dr. MacDonald, chair of the ASCRS Foundation. “So, we decided on adopting the ‘teach a man to fish’ proverb as a mantra to fix the barriers to treatment in Tanzania in a sustainable way.”

Dr. MacDonald and her colleagues have achieved this by focusing on the fundamentals of ocular health care. Eye Corps eschews complex equipment as it presents too steep a learning curve for doctors on the ground. The combination of simple but reliable equipment and on-hand support has proven to be successful. EyeCorps provides long-term loans of microscopes, slit lamps and other surgical equipment made possible by donations from the organization’s benefactors.

EYE CORPS IN PRACTICE

In the region of Lindi, an area covering 25,500 sq. mi, Eye Corps set up a clinic that includes four operating tables, space for complex cases as well as a wet lab. Some equipment utilized includes A-scans and B-scans, keratometers, tonometers, direct and indirect ophthalmoscopes, gonioscopy lenses and topographers.

Over the course of one week at the Lindi location, around 400 patients were examined, and 130 cataract surgeries were performed. As part of Eye Corps’ drive to ensure health-care sustainability, five nurses worked with Dr. MacDonald’s colleagues under an intensive training program, and some patients began to work as treatment advocates.

“I operated on this amazing woman with six children, and she has been blind for four years at only 42 years of age,” Dr. MacDonald says. “We were able to successfully treat her, and as a result, she’s become a real advocate in her community. We actively try to identify women who, like her, have actually had cataract surgery and encourage them to become part of our screening process.”

For a number of reasons, Dr. MacDonald says it’s crucial to pay particular attention to female patients. “It’s often difficult for them to attend medical appointments due to family commitments, and they don’t want to cause financial issues for their families,” she said. “They often don’t realize that blindness, particularly in cataract cases, can be temporary.”

Two other locations are in operation in the Kilimanjaro and Ruvuma regions, with Dr. MacDonald and her colleagues providing an oversight role. This allows local staff to carry out most procedures under their supervision.

WHAT’S NEXT

Dr. MacDonald’s work — and that of her colleagues — to ameliorate the impact of such attitudes and to provide better access to treatment in Tanzania remains ongoing.

Eye Corps’ next project will take place in the Ruvuma region. In the meantime, the organization welcomes the support of the ophthalmology community. OM