by Dermot McGrath in Abu Dhabi, Eurotimes Volume 17, Issue 5
Ophthalmologists and associated eye care professionals need to adopt a more flexible, district-based model with a strong emphasis on teamwork in order to address the changing epidemiology of childhood blindness in Africa and other developing regions, Paul Courtright PhD told delegates attending the World Ophthalmology Congress. “With the changing epidemiology we need to take on different approaches such as developing more effective tertiary facilities and building stronger partnerships across all eye care support services,” he said. Dr Courtright, co-director of the Kilimanjaro Centre for Community Ophthalmology (KCCO) of the Good Samaritan Foundation in Moshi, Tanzania, noted that while child eye health in the past was usually based on single interventions, the reality now is that children’s needs in terms of eye-care are more complex and involve many different people at different points of time with different pieces of equipment. “We often look at childhood blindness as being a case of making an intervention and then stepping away and saying that our job is done. That is not true anymore. We really need to look at our programmatic approaches to take into account our interaction with these children throughout their entire childhood,” he said.
Low Vision Coordinator, Elizabeth Kishiki, working with a child with low vision at a school for the blind
In terms of planning, Dr. Courtright said that a district-based approach based on the actual needs of the population is the most effective means of reaching the maximum number of children. “We have to look at the Child Eye Health Tertiary Facility (CEHTF) as a kind of a hub around which the population can build spokes to ensure that the children can be reached within those communities with tertiary as well as primary and secondary eye care services,” he said. Once the hub has been established, it is vital to implement a strong population-based approach, based on the available data and evidence to guide ophthalmic services on the ground, said Dr. Courtright. “It is always very tempting to say that we have this lovely hospital and the services are there. However, if we don’t take a population-based approach the lovely hospital might be there but it will not be used as needed. There is a lot of good research that is going on and a lot of valuable data out there, so we need to use that information more effectively to make sure that those children have access to our services,” he said.
The key to building an effective hub lies in adopting a team approach to servicing the ocular health needs of the local population, said Dr. Courtright.
“We absolutely have to adopt more of a partnership approach that really brings into play personnel involved in education, rehabilitation, low-vision and so forth. Particularly important is the role of the childhood blindness and low vision coordinator, because that person is the key to making sure that all the various components of the team are properly harmonized and work well together,” he said. Finally, Dr. Courtright highlighted the importance of the child and the family being made an active partner in the healthcare process. “In the past, we tended to view children as recipients and we were there to provide a service. Now we have to bring the child and the family into the participant process. What this requires, in particular, is high-quality counseling. Parents have a very significant role in assisting their children and they need a lot of counseling at multiple time points to ensure that their child can utilize the best possible services,” he concluded.
Rose, a 3-year old Masaai girl with cataracts before surgery
Rose after cataract surgery