We were in a different district – Buyende – for our next clinic, so we had a different OCO working with us. OCOs are Ophthalmic Clinical Officers who are trained to give eye examinations following initiatives set up by Vision Aid Overseas. We worked with several different OCOs during the fortnight and they varied in calibre.
We had naively assumed that as the OCOs were giving eye examinations that were supposed to include a health assessment and a refraction (measuring the spectacle prescription), they would know what we know, with the result that on many occasions we were shocked by them not knowing things that, to a UK Optometrist, are fairly basic knowledge. That was actually rather naïve in hindsight – it takes 4 years of training to qualify as an Optometrist in the UK, and OCOs would be dependant on a volunteer Optom being sent over from the UK to train them. It wouldn’t be financially viable (or even sensible) to give them 4 years’ worth of training.
We met our new OCO named Elijah and a regional coordinator named Godfrey, who was blind and walked with a white cane. Godfrey’s English was exceptional, and he frequently acted as translator for us which could be slightly awkward when the children were generally somewhat overawed and would often reply with a nod or shake of the head, and we then had to let him know that they had actually replied!
At Nkondo Primary School it transpired that there were 400 pupils on our list. The idea was that prior to our arrival in Uganda, school children would have had their vision measured to identify all those with a visual issue, and we would then examine those children. In this case all the children had had their vision measured, but those with perfect vision and no complaints had not been filtered out. Having already discovered that the vision measured at pre-screening was frequently inaccurate anyway, we decided we’d simply have one of us re-screening whilst the other three tested, only to find out that Elijah had sent all those with decent distance vision home without telling us or checking if they had any other complaints. Hopefully there weren’t any with near vision issues in that bunch, but my sparse Ugandan experience told me there would have been. It was somewhat frustrating.
Later that day I examined a young girl who had a dense cataract in one eye, that reduced the vision in that eye to counting fingers at 1 meter. She had had it years, and was only 7 so that eye would be quite lazy due to visual deprivation (i.e. would have quite poor vision even if the cataract were removed). I was also unsure as to whether implants are used during Ugandan cataract extractions. If they are not, then she’d be left with a huge prescription of around +14.00 in the post-operative eye, which would actually leave the poor girl worse off than with the cataract. Additionally cataract extraction isn’t risk-free even in the UK with sterile theatres and high-tech equipment, which Uganda would not possess. I attempted to discuss it with Elijah and find out more, but he brusquely swept the girl away and announced that she’d be having surgery.
In hindsight this may have been down to my gender. Our team leader was female, but Elijah refused to deal with her and for the three days we worked with him, refused to have anyone but our male Optometrist take visions with him as he “doesn’t work with a woman”. Elijah provided the only experiences of sexism we encountered in Uganda however. Generally teachers and students alike were in awe because they viewed us as white doctors who could cure anything. I would that we could!
We moved on to Kidero Health Centre where Elijah and James had a stunningly beautiful terrace out in the sunshine to do screening, Noirin and I were cramped into a shoebox sized room to test alongside each other, and Wendy was stuck testing from a bench in a corridor with Godfrey translating, all three of us raising our voices over the racket of a baby in the adjacent room who screamed all the while! Somewhat different to testing in practice in the UK! We spent the whole 3 hour drive back to our hotel basking in the knowledge that our weekend off had begun!