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Using a chart review, Nyamori and colleagues estimated the incidence
of retinoblastoma in Kenya to be 1:17,000 live births, similar to global
estimates.1 They observed that late presentation was common, often
attributed to poor awareness or socioeconomic barriers which hinder access
to care. We describe a recent project to improve access to eye care for
people living in Western Kenya.
IcFEM Dreamland Mission Hos...
IcFEM Dreamland Mission Hospital in Kimilili achieved hospital status
in February 20122. With the support of Sabatia Eye Hospital and the
Provincial eye surgeon we then began offering affordable eye surgery once
a month. Demand for eye screening was high with people travelling long
distances to obtain services. In order to reach as many people as
possible, IcFEM engages local stakeholders by setting up community
leadership structures called Local Transformation Units2. These helped us
to obtain the agreement of local Chiefs, Councillors and Public Health
Officers to set up outreach clinics in isolated villages and at local
markets. Before each clinic, posters were put up in shops, pharmacies,
market places and read at public meetings. A team of two nurses and our
resident clinical officer then set up a stall where people could have
their visual acuity tested (using a chart which did not require literacy),
obtain reading glasses or medication, have simple foreign bodies removed
or be booked for surgery at the Mission Hospital.
Between January and July 2012, 751 people aged 2 to 100 years were
screened: 154 at outreach clinics in the villages, 198 at markets in
Kimilili, Kamukuywa and Chwele, and 399 at the hospital. Those being
considered for surgery were booked for assessment at the hospital before
the monthly operating list conducted by a specialist eye surgeon. Overall
115 patients, mean age 68 years, (15% of those screened) underwent
surgery: cataract extraction 106, foreign body removal 5, excision biopsy
2, tarsorrhaphy 1, peritomy 1. In spite of electricity cuts and use of the
emergency generator, only one patient had a complication (dislocated lens)
requiring further surgery. Following an overnight stay, operated patients
were given a talk including use of eye drops and booked for follow up
after two weeks. Complex cases, including children requiring a general
anaesthetic, could be referred to a specialist hospital.
Nyamori and colleagues recommend increasing public awareness of eye
problems and availability of treatment. We hope that the return to remote
villages of mainly elderly patients, some of whom were previously blind
and are now able to see, help in the fields or care for their
grandchildren, will contribute to this.
Rebecca Nightingale BSc, Consultant Physiotherapist
Jane Dobbs FRCP, Medical Superintendent
Clement Kiprop Dip-CMS, Head Clinical Officer
IcFEM Dreamland Mission Hospital
PO Private Bag, Kimilili 50204
Correspondence: Rebecca Nightingale email:
1. Nyamori JM, Kimani K, Njuguna MW, Dimaras H. The incidence and
distribution of retinoblastoma in Kenya. Br J Ophthalmol 2012; 96: 141-143
2. IcFEM www.icfem-mission.org
We thank the staff of Sabatia Eye Hospital for their assistance in setting
up the eye department and Dr Simon Daniell for installing the hospital eye
equipment. We acknowledge the dedicated team of specialist eye surgeons
and theatre sisters who with our colleagues at IcFEM Dreamland Mission
Hospital run the eye service. Our thanks also go to Dr Pippa Oakeshott for
her helpful advice.
ROPE (Relief for Oppressed People Everywhere) www.rope.org.uk.
IcFEM ( Interchristian Fellowships' Evangelical Mission) www.icfem-mission.org