June 2017 – RBNET
The highlight for June from the Networks was the establishment of the Retinoblastoma Network. The Retinoblastoma Network (Rb-NET) involves seven institutions in three countries in Africa (Kenya, Tanzania and Uganda) partnered with four institutions in India and the UK – LV Prasad Eye Institute in Hyderabad, Sankara Netralaya in Chennai, and the two UK centres that treat children with retinoblastoma (Rb) – the Royal London and Birmingham.
The Network got underway with a workshop in Hyderabad attended by 64 people. As well as teams from Kenya, Uganda and Tanzania, small teams from Malawi and Indonesia had also managed to find their own funding to attend. A further country – Zimbabwe -wanted to join but was unable to attend and was represented by Ashwin Reddy from the Royal London, who has been working with them for some years.
Photo – participants at the Rb-NET workshop in Hyderabad, June 2017
The teams that attended from Kenya, Uganda and Tanzania included ophthalmologists, paediatricians, oncologists, pathologists, nurses and Ministry of Health. Likewise the teams from India and UK were well-represented with ocular oncologists, a paediatric oncologist and ocular pathologists as well as ophthalmologists specialising in treatment of children with Rb.
Ministry of Health participants included Maternal and Child Health (MCH) as well as ophthalmology. This was important because the level of awareness of Rb is low in African countries and there is a great need to strengthen primary health care and public awareness so that children with white pupil (leukocoria) are referred to an ophthalmologist immediately.
The workshop took place over four days and was facilitated by Allen Foster and hosted at LV Prasad Eye Institute which was started 30 years ago by Gullapalli (Nag) Rao and has grown to a network of primary, secondary and tertiary eye centres serving a population of 50 million people.
March 2017 – DRNET
Jamaica – The theme for this year’s Ophthalmological Society of Jamaica Conference held on the 19th March was ‘Diabetes and the eyes: diabetic retinopathy’, and was led by Dr Lizette Mowatt, President of the Ophthalmological Society of Jamaica. There was also a workshop on DR screening. Guest speakers included Zubin Saihan and Dawn Sim, ophthalmologists from the LINK with Moorfields; Gohar Beint, manager of the NE London DR screening programme run from the Homerton, and Marcia Zondervan, DR-NET Programme Manager. There were 180 participants drawn from all over Jamaica and there was great appreciation of the input from the LINK with the UK, and the funding from the Trust, to enhance DR services in Jamaica.
Photo – Dr Zubin Zaihan receiving an award from the family of the late Dr. Denis Degazon after giving the first annual eponymous lecture. Dr Degazon is considered the ‘father of ophthalmology’ in Jamaica.
Zambia – Professor Geeta Menon and the team from Frimley Park Hospital have won a prestigious award from the Royal College of Physicians for their work in developing DR screening and treatment, initially through their LINK with Kitwe Central Hospital and then expanding across Zambia. Besides the Copperbelt region, diabetic screening is now taking place in Lusaka, Livingstone and most recently Mongu.
February 2017 – DRNET
The DR-NET is benefiting from input from Chloe Cornes, a screener and grader in Staffordshire’s Diabetic Eye Screening Programme. She has offered her experience to help advise and support screener/graders in the Commonwealth LINK partner institutions who are undertaking the Certificate of Higher Education in Diabetic Retinopathy Screening (from Gloucestershire). Some of the modules are quite challenging and her mentoring and support will be very valuable.
Charlotte Wallis, a screener from Dorset Diabetic Eye Screening Programme, has started development of an online learning resource for screener/graders. She has joined DR-NET and is participating in the ICEH working group for a DR MOOC/OER that is about to start development.
The team from Frimley Park Hospital has carried out a national DR training event in Zambia, with all ten provinces represented. There were presentations from the visiting team on the theoretical aspect of diabetes register database management, administration and development, image acquisition, reasons for diabetic screening, grading the image and counselling the patient. This was done over the course of a three-day training workshop and was underpinned by a number of practical workstations which brought these areas into an operational aspect using the theory learned. Existing programme teams from Kitwe and Lusaka shared how it is used in a clinical setting. Patients were counselled, screened and treated to bring the subject to life and demonstrate how the teams should be operating the equipment, using and developing a robust database and managing the patients under their care. The attendees were then tested on all these areas at the end of the three days (a practical and written exam) to ensure knowledge and learning had been embedded for practical application on returning to their provinces.
January 2017 – DRNET
The DR-NET team has developed a three-month follow-up questionnaire to obtain feedback from the participants of the DR-NET Workshop and assess progress with their action plans. This has been sent out and responses are awaited.
An experienced UK screener/grader has come forward and would like to be a mentor to DR-NET staff undertaking the DR Screening and Grading online course run by Gloucestershire Hospitals. A second screener has volunteered to help the e-learning team at ICEH to develop an open educational resource (OER) for DR screeners.
A database development group was established at the Durban workshop. Its work is progressing: a meeting was held with the Peek team to discuss development of an in-house database.
October 2016 – DRNET
In November 2014 a workshop was held in London at which each LINK developed a two-year action plan to strengthen their DR services, specific for their national or regional situation. In addition, the resolve was made by LINKS teams to increase their treatment outputs by at least one patient per week. Over the five years of the project this would equate to the prevention of 37,500 years of blindness.
This October, almost halfway through the 5 year initiative, a DR-NET planning and review workshop was held in Durban, South Africa, alongside the Queen Elizabeth Diamond Jubilee Trust’s DR Advocacy Workshop. At this workshop each partner reviewed and built on the progress made in 2015 and 2016. They further developed their local and national activity plans for 2017-2019 using the DR Toolkit guide, and all shared learning so that practical improvements can be made in 2017-2019.
Each delegate was provided with a practical Toolkit guide to help develop their country’s DR services and contributed to an action plan specific for their LINK, including training visits over the next two years.
Some 70 invited participants from 15 individual institution-to-institution VISION 2020 LINKS partnerships (between Africa, Caribbean and Pacific countries and their UK partners) worked together to develop and implement their local and national plans for DR services.
Nairobi-Coventry LINK update
Muchai Gachago has recently returned from his one-year CEHC vitreo-retinal fellowship at LV Prasad and is reviewing DR services with key colleagues Patrick Nyaga, Joseph Nyamori and Michael Gichangi, Head of Ophthalmic Services, MoH, and the rest of the DR team. They are also sharing the learning from the Durban DR Symposium. There was a strike in December so the number of patients seen and treated has fallen.
Planning is underway for the next training visit by the LINK team to Nairobi in March and also for a medical retina observership in Coventry for an ophthalmologist from the Rift Valley Provincial General Hospital. One of the Nairobi screener/graders is currently undertaking the DR Screening Certification online course run by Gloucestershire Hospitals. It is hoped that a second person from Kenya will undertake the Gloucestershire course starting this year.
Tackling diabetic retinopathy globally through the VISION 2020 LINK Diabetic Retinopathy Network
Nick Astbury, Philip Burgess, Allen Foster, Denise Mabey, Marcia Zondervan
Eye News | February/March 2017 | Vol 23 No 5