Back to the basics!

Pham Nguyen's Dream Derek Tole, FRCOphth is just wrapping up a 2-month stint at LVPEI. An accomplished surgeon at Bristol Eye Hospital, he came for a short-term training program to hone his skills in manual small incision cataract surgery (MSICS) as, he points out, many ophthalmologists today are "machine dependent", with phacoemulsification being the preferred procedure. "It was a steep learning curve," he smiles!

On his return to the UK, Derek will be part of a hospital team, headed to Mbarara in Uganda to train doctors in MSICS. Phacoemulsification, being an expensive procedure, calls for a large investment coupled with a high cost of disposables and is not suited to the country at this stage of their economic development. The training initiative is part of an exchange program, formalized between the University Hospital Bristol and other UK hospitals on the one hand and units in Uganda, Kenya and Tanzania on the other, under the aegis of the International Centre for Eye Health (ICEH), UK and VISION 2020: The Right to Sight for eliminating avoidable blindness worldwide.

"What strikes you here is the high number of infections, penetrating injuries, chemical injuries, trauma.the etiology of the infections is completely different from that in the UK." He observes that often delays on the part of agricultural laborers in seeking treatment for trauma and injuries, compounded by dependence on alternate remedies, leads to a higher number of fungal infections seen in the clinics, thus pushing up the number of corneal transplants required.

Derek is Medical Director of Bristol Eye Bank. Hence, he spent his second month in the stem cell and microbiology laboratories at LVPEI and the Eye Bank. "I'm impressed," he says, "this is probably the biggest eye bank in the world, processing over 1500 corneas annually, with over 1200 transplants being carried out at LVPEI - the largest by a single organisation."

Of his experience in the stem cell area, Derek cannot help but exclaim, "Geeta (Head, stem cell laboratory) is a phenomenal person! Her research protocol, published in Nature, breaks down the process so it's almost 'like baking a cake'"! He hastens to clarify that he does not mean this in a pejorative sense, rather it's the extreme precision and details that serve to simplify it.

He admits that the six-and-a-half-day work week "was a bit of a shock to the system! At home our day starts at 8, not 7!" One regret, perhaps, is that his brief sojourn did not allow him to visit the secondary centres and observe MSCIS cases in the rural areas.

For LVPEI too Derek's training has been very satisfying - the skill transfer will help extend much needed eye care to African nations, such as Uganda, Kenya and Tanzania.