The Gambia – Swansea Vision 2020 Eye Link

I’m one of a team of 8 professionals who visited The Gambia for a week in November 2011.

The team consisted of David Laws, Consultant Ophthalmologist; Stella Elliott, Link Co-ordinator; Suzanne Martin, Orthoptist; Susan Williams, Theatre Sister; Jatinder Singh, Pharmacist; Constantin Magurean, Medical Engineer; Martin Wasik, Ophthalmologist and me – Elinor Laws.

We wrote this blog during our visit…

Saturday 12th November 2011

We all arrived at breakfast completely exhausted after 16 hours of travelling, thankfully the baobab juice revived us. We were picked up by ever obliging Musa (the main man) and driven to The Sheik Zayed Regional Eye Care Centre (SZRECC) with Martin, Jat and Constantin (now known as the back seat boys) riding in the back of the pick up truck. On arrival at SZRECC the two teams exchanged greetings and introduced new members of the link. We then had a very productive meeting led by Clare Walker of the International Centre for Health who was joining us for part of the visit to see how we were progressing.

After the meeting we were taken on a boat trip up the Gambia River where we saw the beautiful birds that the area is famous for and also dolphins. Eventually we arrived at Kunta Kinteh Island which is important historically to the country. During the slave trade, Gambians were captured and kept on the island in awful conditions until they were transported to the Americas or Europe.

We then visited Juffure village where a guide showed us around a museum dedicated to the history of the slave trade. In the yard there was a replica slave transporter boat which we all climbed upon to experience what the conditions of traveling were like.

On our journey back everyone marvelled at the beautiful sunset whilst exchanging amusing stories to make the four hours back to Banjul pass quicker. As darkness came we were nearly home when disaster struck. We ran out of fuel! Luckily the anchor worked and we waited for a further hour whilst two crew members rowed to shore. After two attempts they finally caught a taxi through Banjul to a local garage. Eventually we were on the move again although by now the moon had risen and the crew were navigating using Constanin’s torch! Despite this we arrived safely back at the hotel where everyone rushed for a welcome Julbrew beer.

Everyone enjoyed our first day making friends, experiencing the culture of The Gambia and looking forward to the week ahead.

Sunday 13th November 2011

After a hearty breakfast the group convened to discuss the activity plan for the next 3 years. Claire explained the new reporting system for the links and how there needed to be closer monitoring of progress made.
The afternoon was free time where we played a few tense games of table tennis and spotted some exotic birds in the grounds of the hotel. We were then picked up and taken to Isatou’s house to join her in a family celebration. Her stepmother had recently returned from a visit to Mecca. The Gambian tradition is to have a party for anyone who returns from such a trip. There were bright colours, loud music and interesting food.

On returning to the hotel we edited the staff questionnaires before retiring to bed full of anticipation for the busy week ahead.

Monday 14th November 2011 – Suzanne’s Blog

The Swansea team arrived at SZRECC to be greeted by Isatou and Mr. Sillah, Director of the National Eye Care Programme. We then had a meeting to outline our objectives for the week. Mr. Sillah was very enthusastic about our plans especially Constantin’s suggestion to start a local radio station at SZRECC to raise awareness of eye care and generate income. The team then handed over all the equipment that we had brought with us which included toys for the playarea, knives for theatre,  a vitrector, copies of the British National Formulary and an ultrasonic cleaner.

Isatou then gave us a tour of the hospital which included the brand new hostel for students and the private wing. Isatou explained that SZRECC puts on various courses including one for refractionists which was currently running. As the tour continued everyone was allocated their area to work in for the day. At last we could get down to work.

Later in the afternoon everyone met for a late lunch and shared their experiences. The mood was positive and everyone was full of ideas for the week ahead. Elinor was enthusiastic about her interview with Mr. Sillah where she found out his thoughts on the progress of the link over the last three years. Sue was delighted that many of her suggestions to improve theatres had been acted upon and Dave was looking forward to his operating list the next day and in particular working with Dr. Ernest, the new Consultant.

We returned to the hotel and reflected on progress made so far whilst planning our objectives for the week.

Tuesday 15th November 2011
Today we split into two groups. The first group arrived at SZRECC early to get ready for theatre. Two sessions took place, paediatrics in one theatre and adults in the other. Everyone was pleased with how it went despite the lack of sophisticated equipment. It was interesting to see that in one theatre there were two operations taking place at the same time! A lot of the children had been waiting months for the team to come so that they could have their operation because of the specialist equipment and knowledge needed. Dr Ernest was extremely pleased to be able to do his job properly and give sight to these needy children.
The other group presented to the students and staff at their weekly training session giving information about the pharmacy service in Singleton and binocular vision. The clinical teaching then continued in the out patient clinic. Constantin and Mr Cham, the chief engineer, continued to work together maintaining the medical equipment within the hospital. Jat spent the day in pharmacy making improvements on patient education whilst Stella met with key personnel.
After our busy day, Musa the driver kindly drove us to the local market where we experienced the local culture and purchased souvenirs. We then visited his home and met his family.

Wednesday 16^th November 2011

We arrived at SZRECC and went for lectures. Dave talked about biometry then Sue explained how a lens bank works and showed us photos of the sterilizing supply unit at Singleton. The staff were keen to learn in order to improve the outcomes for patients undergoing cataract surgery. Most of the team then went to help with the busy paediatric clinic, which takes place every Wednesday. There were so many patients waiting they overflowed into the gardens outside! Sue went to theatre and updated the staff on scrubbing technique and she gave advice on what to do if they received a needlestick injury. Constantin did some more work in theatre and repaired some vital equipment while Jat continued to work with Elliman the pharmacy technician.

In the evening Jat and Stella were invited to the Rotary Club of Banjul where Stella explained the work of the link and discussed ways in which they could help. The rest of the group shopped for souvenirs at the market and learned how to play the popular African game of “Wari”.

Thursday 17th November 2011

Thursday is another theatre day so half the team left the hotel for an early start at SZRECC. Dr Ernest and Dave operated on three children with cataracts assisted by Sue and Martin. Elinor was fascinated by theatre and was able to observe two of the operations. Suzanne gave tutorials to the refraction students on assessment of squint and then taught the Optometry techinicians how to test vision in children. Mr. Cham and Constantin tried to fix the visual fields machine without success. However whilst having a look round to see if there was another room to put the fields machine in they found another one in a store room . This one worked well so they swapped the machines over. Now patients in the glaucoma clinic would now be able to have fields done in future.

Jat, Stella and Isatou visited the Chief Pharmacist in Banjul who was able to explain to Jat how the supply chain for medicines worked. Stella and Isatou then visited the Standard Chartered Bank and discussed the future objectives of the link and funding issues.

On returning to the hotel there was a little time for relaxation and shopping at the local market in Kotu before welcoming the Gambian team who had been invited for a meal at the hotel. Everyone discussed how well the visit had gone and made plans for the return visit to Swansea in January.

Friday 18th November 2011

Friday was our last day so we sadly left the hotel and arrived at SZRECC for a debriefing meeting. Everyone gave a summary of their week, stating the future challenges and recommendations. Dr Ernest, Mr. Sillah and Isatou took our comments on board and stated how pleased they were with the visit especially Dave’s comments that it had been the most productive visit so far. Dr Ernest in particular had regained his enthusiasm as he often found the challenges of his role difficult as he is the only Ophthalmologist in the whole of the Gambia! The addition of the vitrector to the theatre equipment meant that he was now able to operate on the numerous children with cataracts in the country restoring their sight. He stated that this was a huge problem in the country and he saw approximately five new patients a week with this condition.

After lunch we all said our goodbyes after exchanging addresses and taking photos. On the journey back everyone reflected on their time in the Gambia and how lucky we all were to be part of the link.