Intercontinental Medicare project in Ethiopia
In 1999, the Rotary Foundation of Rotary International undertook a project which was named the Intercontinental Medicare Project in Ethiopia. Rotary clubs from India, Ethiopia and the USA participated in this unique project which was a resounding success, not just in terms of the number and quality of the operations done, but also in bringing people of India, Ethiopia and the USA closer to each other and so fostering understanding and friendship amongst them.
The matching grant and new opportunities grant project was planned in order to perform 400 introcular lens implant surgeries in Ethiopia (along with polio-corrective and plastic surgeries). In Africa there are about 3 million cataract blind to which 50,000 new cases are added each year. A huge backlog has accumulated in rural areas and low-income urban slums. India faces similar problems. Indian surgeons are trained in performing cataract operations with limited resources and with reasonably good outcome. We are experienced in doing many operations in a short span of time.
Project funding and implementation
Funding for this project included the cost of surgery, transport and food for patients in Ethiopia. Materials required for 400 operations, e.g., lenses, sutures, gloves, drugs, syringes and needles were taken from India. Packets of medicines required for the post-operative period of one month were distributed to all patients. The ophthalmic team included the authors and Rotary volunteers from the USA and India. Pre-operative examination, necessary investigations and selection of patients were done by the ophthalmic surgeons and residents at Menelik II Hospital (Addis Ababa) and GrarBet Hospital (Butajira). Post-operative follow-up and management were also carried out by them. Menelik II is a Government Hospital in Addis Ababa, while GrarBet is a rehabilitation centre in Butajira, a small village about 160 km south of Addis Ababa. Altogether, 444 operations were performed over seven days.
The patients and surgery
Tables 1 and 2 give the male/female ratio and age groups of patients presenting for care. Most of the patients had been cataract blind in both eyes for years. A few of them had a dislocated hypermature lens. Nine children had bilateral congenital or developmental cataract and 28 patients had traumatic cataract (Table 3). Paediatric patients were operated on under general anaesthesia.
Planned ECCE with a posterier chamber IOL implant was done in most of the cases (Table 4), except those who were aphakic in one eye for whom simple ECCE was done. In occasional cases of posterior capsule tear, an AC IOL implant was done. Manual irrigation/aspiration with a Simcoe cannula was carried out. In suitable cases, non-phaco, small incision sutureless surgery was used. All operations were done under operating microscopes. Associated presenting complications are given in Table 5.
Pre-operative and post-operative visual acuities are given in Tables 6 and 7.
The post-operative follow-up examination was done by local ophthalmic surgeons. Immediate post-operative follow-up examination was made for two days and, thereafter, on the 15th and 30th days. Whenever it was necessary, patients were admitted and monitored closely. The majority of the patients had expected results with a satisfactory visual outcome. Most of the patients had between CF 3 metres and 6/36 vision ‘unaided’ post-operatively and we expected all of them to improve after correction of residual refraction (Table 7). Most patients, in fact, did not return for refraction. Since A-scan biometry was not done pre-operatively, dioptric power was decided arbitrarily in all cases (Table 8). Basic refractive status was not known either.
Incidences of complications such as uveitis (20 patients), cortical remnants (14), posterior capsule opacity (14), wound gaping with uveal prolapse (7), were within acceptable limits. Four patients had suspected posterior segment pathology and a grey reflex was seen even on the operation table. These patients were advised about the uncertain outcome. All of them turned out to be cases of long standing retinal detachments. One patient had endophthamitis in the early post-operative period while one more patient had a similar complication after two months (Table 9).
On the whole, the project proved to be worthwhile and satisfactory. Apart from providing the much needed facility of free IOL implant surgeries of good quality to poor patients, it was a rewarding experience for all the persons involved. Long hours of hard, concentrated work inspired the local ophthalmic surgeons of Ethiopia where camp surgeries on a large scale have not been very common.
Table 1. Male/female ratio
Table 2. Age groups
Table 3. Type of cataract
|Type of cataract||No.||%|
|Congenital / Developmental||9||2.2|
Table 4. Type of surgery
|Type of surgery||No.||%|
|AC IOL Implant||15||3.5|
|PC IOL Impant||397||93.0|
Table 5. Associated presenting complications
Table 6. Pre-operative visual acuity
Table 7. Post-operative visual acuity (‘unaided’)
Table 8. IOL implant power in dioptres
|IOL Implant Power||Total||%|
|AC IOL Implant + 20||15||3.6|
Table 9. Post-operative complications