By Beatrice Nyangoma
On 27th June,2017, Gilbert Onegi 43 a resident of Oduk village, Abira West Parish in Zombo district trekked a distance of over 50 kilometers to Nebbi hospital to have his 3 year old Jonathan Rwot Omiyo treated of an eye complication.
Onegi’s travel to Nebbi hospital followed radio announcements that the hospital would be hosting a medical camp where several eye specialists would provide eye screening and treatment services at no cost.
To Onegi, this was a life time opportunity to have his son who had suffered for three years of an eye complication treated and have a new life free of pain. Onegi ensured that he was at the hospital by 8am so that he is among the first people to be attended to. However, by the time he arrived, he found over 50 other patients lined up for the same service.
Because of the severity of the condition of Rwot’s eye, the doctors made Onegi jump the line and he was seen among the first patients.
Rwot’s left eye is protruded from the ball, red in color and it is teary. His father says that the eye started swelling when he was four months. He says that efforts to get treatment from different medical facilities were futile as all the medicines prescribed were not helpful while the swelling continued.
“This boy has been staying with his mother who left me for another man. For almost a year, I have been sending some money to her mother for treatment but things never changed. But at the start of this year, I decided to pick him and I have since been looking after him. But he cries every night because of pain. When I heard about this camp I borrowed money to bring him.’ he said
But according to Dr. Ben Watmon an eye specialist from Gulu Referral hospital said the boy’s eye condition is one known as Retinoblastoma cancer which is in its advanced stages and may be difficult to reverse. He said that from the clinical observations, the tumor is already grown and is visible.
“This type of eye infection starts in babies as early as one month. During the night, the eyes close as that of a cat. This eye is now a burden to the child and therefore we have to remove it to reduce the pain but also prevent the suspected cancer cells from spreading into the body and then he will start on chemotherapy.
Ideally, chemotherapy should have been the first thing to do then the eye is removed but since it’s too late we shall remove the eye and then refer him to Ruharo hospital in Mbarara district which is the only facility in Uganda that gives chemotherapy services. This boy could have maintained the eye but because we have few eye specialists in the region, he could not get early screening.’ He said
Uganda is a signatory to the World Health Organization strategy for elimination of avoidable blindness by the year 2020. Figures from the Health Management Information System indicate that eye diseases are among the top ten causes of morbidity in Uganda. It is estimated that between 300,000 to 350,000 people in Uganda are blind and over 1.2 million have visual impairment.
However, despite the commitment, Uganda is faced with acute shortage of ophthalmologists (eye specialists). According to a 2012 report by Sightsavers International, a charity organization dealing in eye related illness in Uganda, there are only 41 eye specialists, of which 26 of them are in Kampala while only 15 are shared by the rest of the country.
Dr. Charles Keneddy Kissa the Nebbi Hospital Medical Superintendent says that the hospital has a fully equipped eye clinic but it is non- operational because it lacks a specialist. He says that patients with eye related complication are referred to Arua Regional Referral hospital which is over 70 kilometers away. He however adds that the hospital operates an outpatient eye clinic that manages minor eye diseases such as allergies.
The burden of eye diseases at Nebbi hospital
Dr. Kissa says that the hospital registers a big number of people with eye problems. He say in the financial year 2015/2016, the hospital recorded 1,180 eye patients out of the total 49,809 patients which is about 2.3 percent.
“This is a big number of people most of whom end up losing sight which could be reversed if we had an eye specialist. We now depend on well -wishers who offer to treat our patients through medical camps.” he says
During such camps like the one that started on 26th June Monday and ended on Friday 30th July, very many people turn up because there is a service delivery gap.
The camp was organized by Ministry of Health with support from Amref Health Africa, attracted a total of 106 patients of which 42 underwent corrective surgery. “We had planned for round 80 patients from Nebbi district. However, we got more patients coming from as far as Zombo, Pakwatch, Arua while others come from as far as Democratic Republic of Congo.” He said
He adds that due to logistical challenges, many of the patients go unattended to nd instead priority is given to those who have higher chances of recovery.
Information obtained from the Health Management Information System indicates that between 300, 000 to 350, 000 people in Uganda are blind and over 1.2 million others have visual impairment.
Dr. Wotmon noted that of these, 170, 000 are blind due to cataract and that the number increases annually by 20% representing 34, 000 new cases every year.
Cataract is the clouding of the eyes. The clouds change the lens of the eyes leading to sight loss or reduction. Cataracts are common among the elderly but children and other age groups can also succumb to this condition. Patients suffering from cataracts can regain their vision only if they undergo a minor surgery. However, Watmon notes that many of the patients resort to using traditional herbs instead of seeking medical attention.
In order to deal with this, Dr. Wotmon said, the country needs to carry out at least 34, 000 cataract operations annually. But he said that unfortunately government is currently able to conduct only 10, 000 cataract operations annually, leaving the lives of the eye patients at big risk.
However some of the causes are preventable. The preventable causes of blindness and visual impairment include cataracts, trachoma, Onchocerciasis (River Blindness), vitamin A deficiency, measles, and injuries on the eyes, bacteria, viruses and fungus among others.
Dr. Kissa however appeals to the government to train more eye specialists such that the hospital can attend to patient on a daily basis.
“Whereas the medical camps are very important in service delivery to eye patients, they are not sustainable and they are expensive. For example the hospital has to feed the specialists that come to treat during the camp period and also provide some of the consumables. By the time the camp ends, we find the medical supplies are out of stock.” he said
He also adds that in cases where partners support medical camps, the health ministry should also support more by providing consumables that are very expensive such as the artificial lenses that cost round 1,000 dollars each which is about Shs.3, 500,000.
The Ministry of Health notes that vision impairment is the leading cause of disability. Worldwide about 45 million people are blind while 135 million others have visual impairment.