Malawi Trip April 2022 – Report 2

Malawi Trip April 2022 – Report 2 – Visiting existing eye units

Having recently returned from Malawi, Geoff Yeldham has written about the successes of the April 2022 trip. This is the second of four reports, report one describes the visit to Mulanje Mission Hospital. Report 3 – Transporting Equipment Report 4 – St Montfort School

With our goal of setting up a new eye clinic at Mulanje from scratch, it was important to gather as much information as possible about how eye services in Malawi are currently functioning. Having worked with the charity in Malawi for many years, Andrew already has a lot of experience in that regard. He was however keen for me to see the situation for myself and meet some of the key people in the ophthalmology community in Malawi who will be helping us to achieve our aim.

We visited Queen Elizabeth Central Hospital, a large, government run hospital in Blantyre. We met with Mr Petros Kayange, the head of the ophthalmology unit and discussed the challenges of providing eye care in Malawi and the burden of disease that he was dealing with at the hospital. It was interesting to hear that cataracts made up 80% of the clinic’s workload.

Mr Kayange kindly showed us around the hospital and told us about their regional paediatric ophthalmology service. They transport patients from across southern Malawi to the hospital for assessment and treatment, but importantly also ensure that they have appropriate local follow up. It not only means that the patients get good ongoing care, but also allows them to gather data on outcomes.

The hospital was well equipped and there were patients receiving retinal laser for diabetic eye disease at the time of our visit. Mr Kayange showed us the cameras used as part of the screening for patients with diabetes to look for early diabetic eye disease. He explained that they had moved this service from the eye unit to the main diabetic clinic to increase the number of patients who would receive screening. This demonstrated to me the importance of integrating the eye clinic we are developing with the rest of Mulanje Mission Hospital, rather than just viewing it as a separate project.

The clinic also had a visual field machine, but unfortunately it was not operational. Mr Kayange told us that it had been used for many years, but for the last six months it had not been working properly. One of the key challenges of running a clinic in Malawi is not just providing equipment, but also having agreements with companies or engineers to service and repair it. The costs involved in this can be very high, especially if a vital piece of equipment breaks and needs to be fixed at short notice.

We also visited the eye clinic at Zomba Central Hospital. I was impressed by the size of the eye unit, but unfortunately there was not much clinical activity happening on the day of our visit.

These visits certainly gave me a different perspective on our project in Mulanje. We have an impressive new clinic building and equipment to put in it, but that is only really the first step. We will need to find dedicated staff members to train to work in the clinic. It is also vitally important to create a service which is sustainable in the long term and to collect data to ensure that we are achieving good outcomes for our patients.