One of the standout events in the ophthalmological world in 2020 was the World Ophthalmology Congress (WOC 2020 Virtual), which was held online instead of its original location, Cape Town, South Africa. And although the location may have moved from the real to the virtual world, the congress maintained its theme and focus on the African continent with much time and content given over to a variety of Africa-specific topics.
WOC 2020 Virtual attendees were able to view papers, posters and studies on a national cataract campaign in Ghana, ocular syphilis and HIV co-infection in South Africa, and news of poorly resourced ophthalmology clinics in countries like Somalia. African ophthalmology faces numerous challenges in treating patients, ranging from poor funding to limited personnel training and geographic challenges. It is a difficult environment but it is also exciting too, as ophthalmologists can make a real difference there.
One of the greatest issues African ophthalmology faces is ocular trauma — indeed, its prevalence characterizes ophthalmology practice across the continent. A large rural population is one of the main reasons trauma rates are so high in the country, as patients cannot readily access emergency treatment. This is compounded by underfunded clinics and limited training.
A Segway into Surgery
Combine the prevalence of ocular trauma with the ongoing COVID-19 pandemic and you have two things: A difficult challenge and a fascinating topic for a seminar. What better segway into the Asia Pacific Ophthalmic Trauma Society’s (APOTS) webinar entitled Globe & Adnexal Trauma in Covid Era – A Global Perspective. Running more than three hours long, there was plenty of information to consume, so make sure to read some of our other articles on this webinar’s different sections, in particular, on the Latin America segment.
The Africa portion was led by Dr. Jan Talma of the Pretoria Eye Institute, South Africa. He began his presentation by emphasizing the peculiarities of ophthalmological practice in Africa, describing how economic and social issues impact the disease burden. This includes income levels and access to high-quality healthcare.
“If you look at violent deaths, you see they’re pretty high in Africa, which is a bit different compared with the rest of the world. This is related to dominant factors including the efficiency of governments, management, ability, corruption levels, and all other factors. Accidental deaths are slightly less reported than in India or China,” Dr. Talma said.
“Trauma accounts for 2.2% of new cases and 6% of outpatient clinic visits in the African public sector, so it is part of daily life. In the private sector it’s much more like Europe with 0.14% and 0.7%, respectively. Major injuries are common and this is managed from a registrar level,” he said.
Dr. Talma pointed out that the higher level of violence and ocular trauma coincides with Africa’s low numbers of ophthalmologists, at 31 ophthalmologists per million in Sub-Saharan Africa. There is also a clear discrepancy between public and private healthcare systems. Using his own country South Africa as an example. Dr. Talma said that the 45 million served by the public system receive care ranging from “first to third world level.”
Searching for the Silver Linings
These issues are now compounded by the ongoing COVID-19 pandemic, topped with a particularly virulent mutation, originating in South Africa. Thus, protecting vulnerable populations will require more resources, which may increase the strain on the already overstretched ophthalmological infrastructure in many African countries. For Dr. Talma however, while there are serious issues to overcome, there are ways to help mitigate the gaps in patient service.
“In Botswana, there are some patients who have to travel 500 kilometers to get to a reasonable facility. Now, this is for poor people and is obviously a death sentence on vision in the long-term. So, what can we do?” Dr. Talma said.
“This all sounds all doom and gloom, but we do have staff with excellent surgical skills. If we see someone with residents and they have not done 100 or 200 catheter operations, before they even start the training process, they will not be taken very seriously,” he continued.
“The macro environment solutions probably lie with governments. Dual systems, overwhelming workloads, logistical problems, human migration … these are things we can do something about. We can also raise awareness of the complexity of trauma cases, and this should be managed by the highest skilled professionals,” he concluded.
Editor’s Note: The Asia Pacific Ophthalmic Trauma Society’s (APOTS) webinar entitled Globe & Adnexal Trauma in Covid Era – A Global Perspective took place on Saturday, January 9, 2021. Reporting for this story also took during the webinar.