HCP Supports Strengthening of Ophthalmology Residency Programs in sub-Saharan Africa

According to the International Agency for the Prevention of Blindness (IAPB), in 2014, Ethiopia had only 150 ophthalmologists, a mere one per million patients. Ghana reported having only 70 ophthalmologists, or three trained ophthalmologists per million. Additionally, the Cataract Surgical Rate (CSR) - or the number of cataract surgeries performed per million people annually - was 150 in Ethiopia and 710 in Ghana, much lower than the incidence of cataract blindness in either country, a significant contributor to the national backlog of cataract blindness.

Furthermore, residents from both Ethiopia and Ghana were graduating without the ability to perform ophthalmic surgeries due to a lack of hands on surgical training. So together with in-country partner institutions and other organizations working in global eye care, HCP has spearheaded and continues to support residency training efforts in the following ways.

Hands-on Training

HCP encourages ophthalmology residents to participate in the high-volume cataract campaigns, often providing support to make this possible. Residents are able to observe and participate in each step of the process, from screening to preparing patients for surgery to practicing surgical techniques. Not only do residents get the opportunity to practice performing surgery with skilled ophthalmologists, but they also become invested in the outreach model, making them more likely to continue providing outreach care following completion of their training.

Residents from the five teaching hospitals in Ethiopia are given the opportunity to do surgical rotations at in-country institutions, including at Quiha Zonal Hospital and the Sinskey Eye Institute. These rotations provide residents with the one-on-one instruction they need to hone their surgical skills and gain confidence in the operating room. Residents from Menelik II travel regularly to the Tigray region to train with SICS expert Dr. Tilahun Kiros and others from St. Paul’s Hospital, Hawassa University and Jimma University have recently begun rotations at Sinskey with Dr. Allehone Ayalew.

In Ghana, residents from KATH and Korle Bu travel to the Tamale Teaching Hospital to participate in rotations with Dr. Judith Simon. Additionally, Ghanaian residents are also sent to Tamale for a month long rotation where they receive intensive training in small incision cataract surgery (SICS). In both Ghana and Ethiopia, HCP coordinates workshops, conferences and lecture series for the benefit of residents and staff at the training institutions in both basic and subspecialty ophthalmology.

ICO Exam Sponsorship

In 2017, HCP began sponsoring ophthalmology residents in Ethiopia and Ghana to sit for the International Council of Ophthalmology (ICO) Basic Science and Optics & Refraction Exams.The ICO Examinations are the only worldwide medical-specialty examinations. They are independent and free of any outside influence and can be taken in the candidate’s own country. Each year, the ICO offers examinations throughout the world to help ophthalmologists evaluate their knowledge in the basic science and clinical sciences related to ophthalmology.

The 2017 results in Ethiopia 12 residents and in Ghana nine residents passed both exams, providing a solid performance baseline for the residency programs. In Ghana, HCP awarded kits to residents who passed both exams as an incentive for future residents to invest time and energy in studying for and passing the exams.

Based on the success of this initiative, HCP continued to sponsor ophthalmology residents to take these exams in 2018. HCP supported 64 residents from Ethiopia and 13 from Ghana to take the exams, with the addition of the Clinical Science Exam for those who passed last year. In preparation for the exams, HCP International fellow, Dr. Neda Nikpoor and Emory Eye Center’s Global Ophthalmology Fellow, Dr. Fran Wu led a preparation courses to review test taking and content. We hope to be able to provide resident equipment kits to the 44 who passed exams this year.

ASCRS Residency Program Coordinator Initiative

In 2017, HCP and the American Society of Cataract and Refractive Surgery (ASCRS) Foundation collaborated to develop a distinct Residency Program Coordinator position at the five main teaching hospitals in Ethiopia (Menelik II, St. Paul’s, Hawassa, Jimma and Gondar) along with the Sinskey Eye Institute. The aim of this initiative was to establish program coordinators who would be responsible for overseeing the ophthalmology residency program within their respective hospitals and ensure the quality of didactic and clinical education, resident selection, and evaluation and patient management, with the ultimate goal of strengthening ophthalmology education within Ethiopia.

Each institution selected a faculty member to serve in the role of Residency Program Coordinator who would be responsible for attending meetings and implementing agreed upon initiatives at their own institutions. The initiative included support for non-cash incentives for selected individuals at these institutions, including sponsorship for conferences (ASCRS Annual Meeting, College of Ophthalmology of East Central and Southern Africa (COECSA) Conference and Ophthalmological Society of Ethiopia Meeting) and teaching materials. A chairperson was also selected to develop meeting agendas, organize in-country activities, and ensure accountability.

Dr. Meseret Ejigu, the elected chairperson, has been a tremendous help to HCP and Dr. Liknaw in coordinating programs for visiting Volunteer Faculty as well as helping to identify participants for upcoming conferences and events including:

• Residency Program Coordinator Meetings - Developed agendas and led each of the three meetings, including setting and following up on action steps geared towards residency program strengthening.
• COECSA Curriculum - Encouraged full implementation of the COECSA Curriculum at each of the five ophthalmology residency programs to ensure standardization of high quality training.
• Cornea Workshop, Dr. Yuri McKee - 35 residents from St. Pauls and Menelik II were able to attend lectures on various cornea-related topics.
• MiLoops Workshop, Dr. Barb Erny - Reached out to all the docs with previous Mi-loop training to confirm her schedule in Addis (including Sinskey) and Gondar.
• Uveitis Conference - Worked with conference organizer Dr. Kempen along with the other coordinators to identify the 20 resident candidates for participation.

World Class Equipment

In collaboration with Orbis International, the HCP Procurement team was able to purchase 10 new Ignami microscopes (two per teaching institution) for use in both the wet labs and for outreach activities. These scopes will be utilized to teach and strengthen surgical skills. HCP is also in the process of arranging shipment for a new phacoemulsification machine for Sinskey Eye Institute. This will provide an opportunity for Sinskey to serve as a Phaco Training Workshop site, including for the residents who have begun rotating there.