Gambia Swansea Eye Link logo  The Gambia – Swansea Vision 2020 Eye Link

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BMA Humanitarian Fund Project Report

The link was successful in securing funding from the humanitarian fund of the British Medical Association last year. See below for the report submitted which describes the two visits to The Gambia in November 2013 and March 2014:


1. Objectives of the project and reason for the funding application The Gambia –Swansea Vision 202 Link is a partnership between the Ophthalmology Department, Singleton Hospital, Swansea and Sheikh Zayed Regional Eye Care Centre, Banjul, The Gambia. (SZRECC). We aim to provide training and education to the staff of SZRECC and follow three yearly activity cycles. Funding allows us to fulfil our commitment to SZRECC as per MOU
2. Report of the visit Visit to SZRECC 15th -22nd November 2013

Objectives for the week,

Glaucoma training

Theatre Training

Equipment service and repair

Formal lectures

Nurse Administration

Attend local Rotary meeting

Meet with the Seeing is Believing team from Standard Chartered Bank


Glaucoma surgical training provided in trabeculectomy, antimetabolites and cyclodiode

Theatre training in instrument care, sterilisation and disinfection.

Training in equipment maintenance. Equipment repaired and serviced in three outlying Secondary Eye Centres as well as in RVTH and SZRECC

An hour’s lectures provided each morning for up to 40 people, all on different courses and some staff from outside of The Gambia

Nursing documentation discussed, certificates of nurse post training courses to be put on file, vaccination records, appraisal forms and competency documents.

Attended Rotary meeting 20/11/13 and ‘Seeing is believing’ charity meeting 21/11/13


Visit to SZRECC 21st -28th March 2014

Objectives for the week

Development of paediatric cataract surgery

Assessment of staff undertaking paediatric visual acuity

Teach practical Orthoptic skills

Teach standardised way of writing Orthoptic reports

Nurse Administration

Collect data for Paediatric Cataract audit

Optometric teaching

Meet with SiB team at Standard Chartered Bank



1 nursing assistant and 7 refraction students taught to;  Assess children’s visual acuity using a range of vision cards, e.g., Cardiff, Keelers, crowded Kays and crowded LogMAR.

How to do a Cover Test and test ocular movements.

Measure vertical and horizontal squints

Write Orthoptic reports

Optometry students, Teaching on Low vision assessment and Indirect Ophthalmoscopy with direct and indirect lenses. Binocular refraction

Meeting with other NGO area managers

Classroom teaching every day

Surgical management of adult and paediatric squint and adjustable squint suture.

Surgical training for paediatric cataracts.

Nursing administration support given


3. Outcomes of the projectEstablish a paediatric service to treat avoidable blindness.

Establish a Glaucoma clinic

Medical engineer support, repair and servicing of equipment, provision of electronic notebook to facilitate email access for discussing problems and for prospective maintenance programme

Developing clinical audit,

Theatre training, infection control, sharps disposal, waste disposal, safe practice, role of scrub nurse

Development of Lens Bank

Preoperative Biometry to allocate correct lens for cataract surgery

Support nurse administration


4. Provide details about any barriers or problems faced by the project and how they were overcome. Delays in visas being approved – raise awareness of the importance of the Links programme

Unsuccessful grant applications – improve quality of information collected regarding the performance of the link

Communications – Highlight the importance of regular transmission of information

Equipment purchased by hospital did not include commissioning – met with purchaser to improve this

5. Sustainability of the work: short, medium and long term – how has this progressed as a result of this project? The skills transfer has been previously agreed between the The Gambia and Swansea with sustainability in mind. We only provide training where the manpower resources, technical support and finances will allow continued provision of appropriate interventions. These are in agreement with the WHO Vision 2020 objectives which include sustainability as central tenet. We have reduced support in areas that have not proven sustainable in the past (e.g. pharmacy).

The economy of the region is expected to grow at 5.6% for the next few years adding support to the development of health care

6.  Describe any lessons learnt by the project

1.  How to manage with fewer resources

2.  How to collaborate with different cultures

3.  How to produce short, medium and long-term objectives in the development of a medical service.

4.  How to delegate within a team

5.  How to assess performance

6.  How to rationalise non productive activities

7.  How to apply for grants

8.  How to organise coordination of several NGO’s


6. Benefits of the visit for the NHS and for NHS staffEquality and diversity.

Wales is relatively monocultural and of limited range of ethnicity compared to other parts of the UK. Staff involved in links get the opportunity to work with people of differing backgrounds and experience what it feels like to be in an ethnic minority.


Learning is two way.

For example. Hi tech suture less cataract surgery has been a big advance in developed countries. In response to this a new low cost, low tech cataract operation (manual small incision cataract surgery) was developed. This procedure is not appropriate for the majority of UK cataract patients but is actually a better operation for very mature cataracts which occasionally still present to our clinics. Ideally one or two surgeons in each UK department should attend training in a developing country to learn this technique.


Avoid complacency

For example. The day case unit in Singleton Hospital has not had a case of postoperative endophthalmitis in eight years since it opened. There is a danger that a low incidence of this complication could lead to a more relaxed attitude towards avoiding it. Working in a resource restricted environment makes us more aware of infection risk.


Spectrum of pathology

The variety of disease is totally different and extensive experience can be obtained of conditions uncommon in the UK. During our last visit we operated on twenty children blind from cataract, training the local surgeon but also increasing our experience of this condition which is uncommon in British children.


Team building

Our link has developed a network between various professional groups that have had limited contact in our usual job. The link has allowed people in pharmacy, anaesthesia, biomedical electronics and HSDU to easily contact each other if need arises improving efficiency at work.


Morale/staff retention

Having faced the difficulties of working with very limited resources makes us appreciative of the things we usually take for granted back in the UK. Instruments that work, highly trained colleagues and of an appropriate environment. Increased job satisfaction will help to retain staff.















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