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Malawi is experiencing an epidemic in the numbers of people being diagnosed with diabetes. Current prevalence of diabetes in Malawi is 5.6% but this is rising rapidly in a similar fashion to Scotland. Unfortunately, however, the majority of diabetics in Malawi remain undiagnosed and develop complications such as diabetic retinopathy with resulting blindness without access to healthcare.
Severe diabetic eye disease requires treatment with advanced retinal surgery and this is not currently provided in Malawi, which has a population of approximately 15 million people. The only option is to travel to South Africa for treatment, which is extremely expensive and not an option for the vast majority of patients.
A team of ophthalmology specialists from the Princess Alexandra Eye Pavilion, Edinburgh, travelled to Kamuzu Central Hospital, Lilongwe in Malawi at the start of this year as part of the Vision 2020 global initiative for the elimination of avoidable blindness. The aim of the trip was to establish a diabetic retinal surgical service and diabetic retinopathy laser treatment clinics and low vision services both at the main hospital in Lilongwe and at outreach clinics.
Funding for this link has been provided by the Scottish Executive. For 150 years Scots have worked with the people of Malawi, helping them develop basic education and health systems. Like Dr David Livingstone’s expeditions up the Zambezi and Shire Rivers to Lake Malawi in 1859, the Edinburgh team’s pioneering visit for eye care in Malawi was the first ever retinal operation performed in the country.
Through the Edinburgh-Malawi eye link a retinal laser has been installed in the eye department at Kamuzu Central Hospital for the treatment of diabetic retinopathy in order to prevent blindness. On a recent visit patients with diabetes were screened for diabetic retinopathy and treated with laser by Dr Peter Cackett, Consultant Ophthalmologist at Edinburgh’s Princess Alexandra Eye Pavilion and private The Edinburgh Clinic. Ophthalmology assistants in Lilongwe were also trained by Dr Cackett to administer the retinal laser treatment.
The Edinburgh surgical team, which comprises surgeons Dr Jas Singh, Dr Rishi Sharma and theatre nurse Veronica Stewart all from the Princess Alexandra Eye Pavilion, helped to train the local surgeon Dr Joseph Msosa and his team of nurses. There are currently only six ophthalmologists (eye surgeons) in the whole country. This compares to one ophthalmology consultant per 50,000 people in Scotland. What’s more, retinal surgery equipment has been purchased for Kamuzu Central Hospital and the Edinburgh team carried out in the region of 12 operations during their visit. The Edinburgh Clinic donated knives, swabs, needles, and more to support the initiative and help provide much needed equipment and medical supplies.
Josie Grant, an ophthalmology specialist nurse from Edinburgh’s Princess Alexandra Eye Pavilion and private The Edinburgh Clinic, assisted the local nursing team to provide visual aids (magnifiers) for patients with visual impairment. This involved outreach clinics to rural blind schools (see photo).
The benefits of the recent trip are already being felt. One patient who underwent this pioneering retinal surgery commented: “I will never forget the week that people from Scotland came to save my sight, they will never be forgotten".