Thursday 31st August – Part 1

We went to Mulago hospital, to visit the main national referral hospital. The most obvious problem was that the unit was badly organised from a use of space perspective. The rooms were badly laid out, and full of filing cabinets, yet the corridors were vast and under utilised. Half of the eye unit was on one side of the hospital, and half on the other, so it was difficult to optimise the position without taking a holistic view of the whole hospital.

Mulago was rather a depressing place – the wards were very large, with rows of patients like a military hospital. The eye unit operating theatre was of a much lower standard than at Mengo, and whilst they also had access to the main theatre, they didn’t use it because it was too far from the wards, and they would also have to move equipment each time.

That said, the hospital’s main ophthalmologist was clearly a very dedicated man, and we learned that they work closely with Mengo, and have some specialised lasers enabling them to do more advanced work than Mengo. We didn’t see this – it was in yet another part of the hospital. It was clear that the hospital as a whole needed replanning – I couldn’t believe that it was only the eye unit that was so disjointed.

Wednesday 30TH August – Part 3

Finally we visited the Jinja Ophthalmological Clinical Officer (OCO) training school, led by the legendary Dr Binta. He gave us a great presentation marred only by a terrific thunderstorm which blew in the windows and half the building. A chunk of this went in my eye – at least I was in the right place!

The school has trained 161 OCOs over a number of years, and of these only 12 are no longer in practice. 3 have left the country, 1 became visually impaired and couldn’t continue, and the rest have died. This is a pretty good record. All OCOs are registered nurses with at least 2 years of experience, and the course lasts a year. Apparently it is getting harder to recruit people, and they have now started to offer courses for Ophthalmological Assistants, who are less qualified and the course lasts 3 months. We met a number of OCOs trained by Dr Binta in the hospitals we visited, and they were all extremely complimentary about the training.

The training included information on refraction and low vision. One issue was over cadres – at the moment there were no low vision cadres in government, and there was also confusion over refractionists / optomotrists. Another issue was that the government was keen that at least 60% of students should be private and fee paying. At present there were next to none, and it was clear that Dr Binta preferred it that way.

Dr Binta is clearly a highly respected man who had achieved a great deal for sustainable eyecare in Uganda.

We travelled back to Kampala – not quite such a beautiful place as the source of the Nile.