The ECWA Eye Hospital in Kano, Nigeria, is a mission hospital started by Dr Hursch, an American ophthalmologist, in the early 1940s. Although there are no surviving records from the time of Dr Hursch, I would venture to say that his practice of ophthalmology in Nigeria was not much different from his practice in America. Since the cutting edge tools of his day were loupes, and a small set of instruments, those items could easily be purchased, transported, and maintained in the setting of a developing country. Now, 60 years later, the situation is very different.

The eye hospital in Kano remains a bright spot in west Africa for surgery and treatment of eye diseases, and gives invaluable surgical experience to ophthalmologists in training. However, when I arrived in Kano in 2003, I expected that my practice of ophthalmology would be very different from what I was used to in America, and I was not disappointed.

Consider the differences.

Just a few years ago in America, I attended a seminar about improving outcomes of cataract surgery. One presenter boasted (rightfully so!) about his accurate selection of IOL (intraocular lens) power …