resident ophthalmologist gives update on Robert M. Sinskey Pediatric Eye Clinic in Ethiopian
The Robert M. Sinskey Pediatric Eyecare Clinic in Addis Ababa, Ethiopia, is undergoing an
Patients line up outside of the clinic in the mornings
Source: Kefyalew Regassa Gobena, M.D.
A 2-year-old girl awaits treatment at the clinic
Source: Donald Bell
During the 2011 ASCRS• ASOA Symposium and Congress in San Diego, EyeWorld staff writer Faith A. Hayden sat down for a one-on-one interview with
Kefyalew Regassa Gobena, M.D., the ASCRS Foundation's resident ophthalmologist at its Robert M. Sinskey Pediatric Eyecare Clinic in Addis Ababa, Ethiopia. Dr. Kefyalew was traveling to the U.S. for the first time to attend the meeting and observe surgeries. The interview focused on the status of eyecare in Ethiopia, the clinic's achievements and remaining challenges, and the upcoming expansion. Below is an excerpt from their conversation.
EyeWorld: Tell me about yourself, Dr. Kefyalew. How did you get into ophthalmology?
Dr. Kefyalew: I was born to a family of farmers. We're not used to school; there is no education in our area. But one of my brothers was a pioneer in education in our area by just going to school. I followed him. I wanted to join him in learning. When I was in my clinical year at the medical school, I saw my ophthalmology teacher managing cataract cases and was excited. What astonished me was that patients were blind today and then tomorrow they were able to see. It was completely amazing. I saw that and said, "I think this must be my area of interest, to study ophthalmology."
EyeWorld: Is cataract surgery your favorite thing to do?
Dr. Kefyalew: Yes, I enjoy cataract surgery. You can change people's lives. Sometimes patients will tell us that they have been blind for many years. I encountered one patient who had been blind from cataracts for 9 years. She was totally desperate. I did small incision extracapsular surgery, and the next morning she was counting fingers. She said, "This is my birthday! I was just born again!" Now she is able to see 20/100.
EyeWorld: To go from completely blind to 20/100 is incredible.
Dr. Kefyalew: Exactly. Her life was changed. Of course, you can do many things in ophthalmology to change people's lives, but cataract surgery is a dramatic change. Some people tell me they've been eating with cats and dogs because they are blind. When you intervene and they are able to see, they say they are born again.
EyeWorld: I understand you do glaucoma surgery in the clinic as well. Glaucoma is a difficult disease to manage everywhere, but especially in your part of the world. What are some of your strategies?
Dr. Kefyalew: In Ethiopia, we have few medical treatments for glaucoma. For almost 10 years, there were no medical treatments other than timolol, acetazolamide, and pilocarpine available in Ethiopia. Eventually they started to import prostaglandin analogs. Doctors are not doing glaucoma surgery right away because outcomes are not good. Patients want their vision to recover, but that's impossible. I try to explain that and they will not accept it. We don't have shunts in the clinic, but we are doing trabeculectomy.
EyeWorld: Tell me about the clinic, how is it doing?
Dr. Kefyalew: We are doing well and progressing. We are doing phacoemulsification and most of the outcomes are very good. We have many patients. I joined the clinic in May 2006 and we did 168 cataract surgeries that year. The second year we did about 200. Last year, we did 528 cataract surgeries. At present we are charging about $68 per eye and still patients come. Patients are satisfied and the outcomes are good.
EyeWorld: What are some challenges the clinic faces?
Dr. Kefyalew: Most challenges we face in the clinic are the different constraints. We cannot go and get what we want for our patients. Of course we have the basics, but we don't have everything. We cannot find any consumables locally. For example, different viscoelastic materials we cannot get in Ethiopia. There is no organization that is importing these goods. We have to depend on the Foundation's support.
EyeWorld: Does the government understand the importance of eyecare?
Dr. Kefyalew: Of course they understand. They say they are trying to improve the conditions of eye management. For example, they say they want to accommodate more ophthalmology residents, but no one is applying because of the economic problems. To set up an ophthalmic clinic is difficult. It requires a huge investment, but no investors are interested in those areas. So when ophthalmologists go out to work, they have no job opportunities. They cannot support their families.
Everyone is shying away from ophthalmology. [The government] said it could accommodate 15 to 20 ophthalmologists in at least one of the medical schools in Ethiopia, but no one is going. This last year only two people applied. That's the problem.
EyeWorld: What does the clinic need?
Dr. Kefyalew: The first and most important thing is to maintain a continuous supply of lenses, viscoelastics, and other materials. Second to that, we have to have optical centers. We don't have any optometry service in the clinic and we need to establish that. About 14% of our patients are visiting our clinic because of refractive error. Now we are sending them to other clinics and losing them. We have to service them totally.
The other important thing is different equipment. For example, we don't have a visual field analyzer and we have to have one. We again have to send patients to other places to undergo those investigations. We don't have an auto refractive meter, and that's very important. Most of the equipment sent to our clinic has no maintenance manuals. It's difficult to fix things. If our phaco machine fails, who is going to fix it?
We are on our way to expanding. Our clinic is very small. In the morning there are many patients, more than 100 with their families standing outside. But the expansion is underway. In the future this problem will be solved.
EyeWorld: What is the expansion adding?
Dr. Kefyalew: We'll have more rooms. Our operating room is very small. It has no sterilization area. We sterilize our instruments and other materials in other buildings. The main thing is to expand the operating room to accommodate two operating tables at a time. The other thing is to have a recovery area, which we don't have right now. We are going to have exam rooms, and in addition to that an optical workshop and display. We are going to have some offices. It's really exciting.
When we start optometry we're going to need additional manpower, like optical technicians to take care of patients. More patients will come to us. Maybe we'll have additional ophthalmologists because the demand is there. The magnitude of eye problems in Ethiopia is very high. The prevalence of blindness in Ethiopia is 1.6% and that's very high.
EyeWorld: What's next for you training wise?
Dr. Kefyalew: I don't know. I don't have the capacity to go and get training for myself because I can't afford it. But I would like to do glaucoma training combined with cataract. That's my interest. That's one of the reasons to travel to the U.S., to observe these types of surgeries. But I cannot get hands-on training here. If I go to India I can get hands-on training and continue to serve the needy people in Ethiopia.
Editors' note: The Robert M. Sinskey
Pediatric Eyecare Clinic has a constant need for surgical supplies to serve its Ethiopian patients. Items such as foldable IOLs, reusable surgical knives/instruments, and antibiotic/steroid/ anti-inflammatory/glaucoma eye drops are unavailable in Ethiopia and must be purchased and shipped from overseas. Individuals interested in donating such equipment should contact Donald Bell, ASCRS associate executive director, at 703-591-2220.