SIGHT FOR ALL

The yearly incidence of paediatric ophthalmic disease in Vietnam is estimated to include nearly 1,000 cases of congenital cataract, 600 babies born with glaucoma and 100 new cases of retinoblastoma. Moreover, with a single neonatal intensive care unit with more than 150 beds, retinopathy of prematurity is also a serious issue in that country, James Elder MD, Royal Children’s Hospital, Melbourne Australia, told a session of the “My World, My Way†Symposium, during the Second World Congress on Paediatric Ophthalmology and Strabismus (WCPOS).

The current resources, both financial and human, are insufficient to deal with the magnitude of the problem. Few ophthalmologists are trained to treat children. Quality screening programmes and postoperative care have not been organised. For congenital cataract, barriers to good outcomes include late presentation, absence of contact lens services and difficulty obtaining aphakic spectacles.

Sight for All

It is in this context that Sight For All, a non-profit organisation, committed to reducing preventable blindness in the Asia-Pacific region, decided to experiment. Its approach was to start a “reverse fellowship†in which the trainers would travel to the trainees. This is the opposite of the traditional fellowship arrangement, in which the fellow travels to the trainer’s institution to obtain his or her education. This first reverse fellowship was held in the capital city of Hanoi. “The advantage of a reverse fellowship is that the fellows remain in a familiar environment. They avoid having to go abroad for a year or more, so costs are kept under control and family life is not interrupted. There is no language barrier between fellows and patients and the training can be tailored to the local situation,†said Dr Elder.

On the other hand, the logistics of a reverse fellowship are tricky. A 12-month fellowship must be condensed into 12 oneweek visits, leading to interrupted, episodic contact with various different teachers. This makes teaching complex surgical procedures a particularly difficult task, said Dr Elder. And in this situation, the trainer is outside his or her own familiar environment. “The most precious resource in this type of situation is time,†he said. Financial and logistical support are crucial, Dr Elder emphasised. He acknowledged the leading role played by chairman of Sight for All Dr James Muecke. Dr Muecke, an ophthalmologist, made two planning visits to Vietnam prior to the start of the training sessions.

Rewarding work

The effort is definitely worthwhile. The range and rarity of the pathology that Dr Elder saw on a single day is staggering. “On my first day in the clinic, we diagnosed cryptophthalmos, ablepharon, Rieger’s syndrome, FEVR, bilateral retinoblastoma and endogenous endophthalmitis. “The work is incredibly rewarding,†he said, citing positive reactions from both patients and fellows-in-training. And more challenges await. Sight for All is currently planning future reverse fellowships in Bangladesh, Laos and Cambodia.