A photo story about a community eye clinic at a church on the outskirts of Kampala, Uganda
Most of the congregation at St. Paul's of Uganda Church are originally from the north of the country and were displaced as a result of the recent troubles there. Many are elderly and diabetic and thus at risk of losing their sight if any diabetic eye disease goes un-diagnosed and un-treated.
Due to recent developments in diagnostic equipment and software, patients no longer have to visit a clinic to have an eye check-up. This allows us to screen for eye disease in the community and get to patients early. Unfortunately many patients with eye disease wait until it is too late to visit a clinic due the distances they must travel with the associated expense.
There is never a shortage of spectators at our clinics. The church also houses a school and children in attendance were curious about what was going on.
The fist step in running the clinic is measuring the patient's visual acuity with a range of eye charts to allow for different ethnicity and literacy.
The most un-comfortable part of the examination results from the eye drops administered to dilate the pupil. The drops do sting but our nurses comfort the patients and re-assure them that it will help with the examination.
Patients waiting patiently for the eye drops to work.
I always feel for our patients who are clearly disturbed by the drops,
Our nurse, Rosette checks for pupil dilation after the drops. When she is happy the drops have worked, patients can move to the next stage of the examination.
During this clinic, we were fortunate to have our consultant ophthalmologist, Clare in attendance who was able to check all eyes with a low cost direct ophthalmoscope designed specifically for use in such outreach clinics. Often there will not be an ophthalmologist available but all of our tests are designed to be carried out by non-specialist staff.
After dilation, patients wait for us to take pictures of the back of their eyes. From their images, we can screen for the presence of diabetic eye disease.
The camera we use works best in low light conditions so we found a dark space at the back of the church.
Paul, our retinal photographer takes a picture of the retina in both eyes and transmits them via computer to a cloud-based algorithm that screens for eye disease. This means the clinic can run without an ophthalmologist present.
We are developing a training programme on how to screen for diabetic eye disease in the community. This will include training on how to use the portable equipment and software now becoming available for such purpose.
After patients have been screened, we write referral letters where we have found patients with eye disease that needs follow up and treatment. We also advise such patients how important it is to visit a clinic as so many are lost to follow and will eventually go blind.
We screened 50 patients in a morning clinic and could have seen more if available. We referred 16 for follow up and picked up other conditions such as cataract in addition to the diabetic eye disease we were looking for. Two patients had serious disease that needs immediate treatment.
Credits:
All photos by the author with kind permission of St. Paul's Church of Uganda in Naguru, Kampala.