Documenta Ophthalmologica 81: 349-350, 1992. 9 1992 Kluwer Academic Publishers. Printed in the Netherlands.
The role of Western ophthalmologists in dealing with cataract blindness in developing countries M.C. C H I R A M B O Sight Savers, Lilongwe, Malawi
Accepted 9 July 1992 Key words: Cataract, prevention of blindness Abstract. Of the estimated 35-40 million blindness worldwide, 17 million is caused by cataract
and this proportion will double by year 2025. In Africa alone, it is estimated that there are about 3 million cataract blind. As life expectancy in Africa increases so will the incidence of cataract blindness. Existing resources of manpower and services cannot cope adequately with the present backlog of cataracts, let alone the anticipated increased load. The deployment of local ophthalmologists to deal with cataract load would be cost-effectivein delivering appropriate eye care but the scarcity of ophthalmologists makes the option ineffective. The role of Western ophthalmologists will be considered in the provision of cataract surgical services and training of ophthalmic assistants, cataract surgeons and ophthalmologists. Of the estimated 31 million blind worldwide, over 17 million is caused by cataract and this population will double by the year 2025. In Africa alone, it is estimated that there are about 3 million cataract blind, in Latin America 1 million and Asia (including China) 11 million. As life expectancy in developing countries increases, so will the incidence of cataract blindness. In many of the developing countries, existing resources of eye health m a n p o w e r and services cannot cope adequately with the present backlog of cataracts, let alone the anticipated increased load. In Africa, the major cause of backlog of cataract is due to lack of manpower and access to services; whilst in Asia and Latin America the problem is lack of access to services in rural areas and maldistribution of available manpower, with more ophthalmologists working in urban than rural areas. Therefore, the role of western ophthalmologists in dealing with cataract blindness will vary accordingly, from country to country and region to region. For Africa, and indeed in the other regions, it can be said that deployment of local eye health personnel (ophthalmologists or cataract surgeons) to deal with cataract load would be cost-effective in delivering appropriate eye care; but the scarcity of ophthalmologists particularly in Africa makes this option ineffective; therefore the role of western ophthalmologist is crucial in the development of eye services to deal with cataract blindness. The provision of cataract services by western ophthalmologists can be on a short or long term basis.
350 From experience, long term surgical visits have a more important role, especially if, in addition to provision of cataract surgical services, the ophthalmic surgeon participates in the training of local doctors, ophthalmic assistants and other eye health personnel, how to select patients for cataract operation and perform successful inexpensive cataract surgery with appropriate technology and limited facilities. This, of course, implies that the western ophthalmologist is familiar with the intracapsular cataract extraction procedure which is still commonly practised in Africa, South of the Sahara. However, short visits, by experienced ophthalmologists to conduct cataract surgical workshops/seminars for local ophthalmologists to update them in the 'state of the art' and even to provide appropriate equipment can go a long way in the promotion of continuing education. Having said that, caution should be exercised that short surgical visits to remote rural areas that are not coordinated with local national eye care managers should be discouraged because they do little for the development of sustainable eye care programmes. Last but not least, the western ophthalmologists have a role to participate in the design and conducting of cataract operational research.
The role of Western ophthalmologists in dealing with cataract blindness in developing countries M.C. C H I R A M B O Sight Savers, Lilongwe, Malawi
Accepted 9 July 1992 Key words: Cataract, prevention of blindness Abstract. Of the estimated 35-40 million blindness worldwide, 17 million is caused by cataract
and this proportion will double by year 2025. In Africa alone, it is estimated that there are about 3 million cataract blind. As life expectancy in Africa increases so will the incidence of cataract blindness. Existing resources of manpower and services cannot cope adequately with the present backlog of cataracts, let alone the anticipated increased load. The deployment of local ophthalmologists to deal with cataract load would be cost-effectivein delivering appropriate eye care but the scarcity of ophthalmologists makes the option ineffective. The role of Western ophthalmologists will be considered in the provision of cataract surgical services and training of ophthalmic assistants, cataract surgeons and ophthalmologists. Of the estimated 31 million blind worldwide, over 17 million is caused by cataract and this population will double by the year 2025. In Africa alone, it is estimated that there are about 3 million cataract blind, in Latin America 1 million and Asia (including China) 11 million. As life expectancy in developing countries increases, so will the incidence of cataract blindness. In many of the developing countries, existing resources of eye health m a n p o w e r and services cannot cope adequately with the present backlog of cataracts, let alone the anticipated increased load. In Africa, the major cause of backlog of cataract is due to lack of manpower and access to services; whilst in Asia and Latin America the problem is lack of access to services in rural areas and maldistribution of available manpower, with more ophthalmologists working in urban than rural areas. Therefore, the role of western ophthalmologists in dealing with cataract blindness will vary accordingly, from country to country and region to region. For Africa, and indeed in the other regions, it can be said that deployment of local eye health personnel (ophthalmologists or cataract surgeons) to deal with cataract load would be cost-effective in delivering appropriate eye care; but the scarcity of ophthalmologists particularly in Africa makes this option ineffective; therefore the role of western ophthalmologist is crucial in the development of eye services to deal with cataract blindness. The provision of cataract services by western ophthalmologists can be on a short or long term basis.
350 From experience, long term surgical visits have a more important role, especially if, in addition to provision of cataract surgical services, the ophthalmic surgeon participates in the training of local doctors, ophthalmic assistants and other eye health personnel, how to select patients for cataract operation and perform successful inexpensive cataract surgery with appropriate technology and limited facilities. This, of course, implies that the western ophthalmologist is familiar with the intracapsular cataract extraction procedure which is still commonly practised in Africa, South of the Sahara. However, short visits, by experienced ophthalmologists to conduct cataract surgical workshops/seminars for local ophthalmologists to update them in the 'state of the art' and even to provide appropriate equipment can go a long way in the promotion of continuing education. Having said that, caution should be exercised that short surgical visits to remote rural areas that are not coordinated with local national eye care managers should be discouraged because they do little for the development of sustainable eye care programmes. Last but not least, the western ophthalmologists have a role to participate in the design and conducting of cataract operational research.
