Training Nurses in Eye Care
 One of the most important aspects of our medical work is teaching. In the interior of the Congo, where professionally trained physicians cannot earn the kind of wages that inevitably attract them to the large urban areas, medical practice is done almost exclusively by nurses, many of whom have very limited academic and practical training. We cannot appreciably change the general state of nurse education in the Congo, but we can and do offer a place where nurses in our region can learn in particular the basics of ocular health-care. This page describes how and why we do it, with an excerpt from our grant-proposal-in-process giving a summary of our vision for nurse training, and some captioned photos showing our present activities in this area.



Fifteen thousand people are blind in the Sankuru, located in the Kasai Oriental province of the Democratic Republic of the Congo. More than 75% of these are blind because of preventable conditions, such as cataracts, advanced glaucoma and other treatable diseases. Only 3 of the 300 health centers in the district offer eye care, and only one offers more than eye washing, vitamins and simple antibiotics.

The Centre Médico-Chirurgical Lukumu L’Ololo, with its medical and surgical ocular service, is that one. Administered by the Foundation for the Development of the Sankuru, and directed by International Outreach Ministries missionary Dr. Timothy Henry, it is leading the way toward effective change in the treatment of preventable blindness in the Sankuru.

How grievous it is to send a patient home blind because the boiled-leaf eye drops used by a traditional healer to treat his simple conjunctivitis have destroyed his corneas. Or to explain to an otherwise healthy man that the glaucoma which could have been surgically arrested years ago has gradually and permanently stolen his sight. Or to treat a raging eye infection as vigorously as possible, but not be able to save the vision because the patient waited weeks before seeking help beyond the vitamins available at his village clinic. Because of these and countless other patients whose lives could be changed with basic but effective eye care, Dr. Henry has established a medical and surgical eye care service in Lodja, with the vision of expanding it into a reference center of eye care, as well as a place of eye care training for nurses from throughout the region. Here is an outline of the vision.

 

 

Blindness in the Sankuru can be effectively reduced by an increase in health workers trained in ocular care and by the creation of a well-equipped and functioning surgical eye care service in the district. The surgical eye care service of the Centre Médico-Chirurgical Lukumu L’Ololo, inaugurated in April 2002, is the first step in this direction. It is presently limited in function by its physical facility, a rented 5-room building built as a single-family residence, with no running water or electrical system.

FODESA has therefore conceived plans for and begun construction of a 15,000 sq. ft. regional referral and training center for medical and surgical eye care. Construction began in August 2004, and is estimated to require several years for completion, given the challenges of construction in the interior of a developing nation.

 

 

The Centre Médico-Chirurgical Lukumu L’Ololo will offer a full-time schedule of eye care consultations and interventions, addressing such needs as cataracts, glaucoma, eye trauma, ocular infections, ocular manifestations of systemic diseases, and refractive corrections. In addition to consultation rooms, surgical suite and post-op ward, the center will also include lodging for eye nurse trainees drawn from the district and possibly from throughout the Congo. These trainees will follow in-house training sessions in ocular care varying in length from 3 to 12 months, after which they will return to their centers of clinical activity with the equipment and reference materials necessary to provide ocular care at the local level. The medical center will also continue to offer general outpatient medical care to the local community, and a pharmaceutical depot which will stock not only in-patient medicines but also basic primary care medicines for sale at cost to all public health care centers in the Lodja health zone.

Click to enlarge photos    Because the Centre Médico-Chirurgical Lukumu L’Ololo already offers a surgical eye care service, its full-time nurses have been receiving on-going training in eye care at the treating and – for some – surgical assistance level since 2002. They have access to basic textbooks in ophthalmology, with text discussions and exams, and receive practical teaching from Timothy almost daily during consultations, surgeries, and medical and post-operative follow-ups. Their progress is recorded in what Timothy refers to as their ‘passport’ – a booklet documenting each pathology seen and procedure done, and textbook exam results before, during, and after their clinical training time.
Timothy requires at least 3 months clinical training and written exam results which show competency in ophthalmology appropriate to the district hospital level before granting certification at the IFO (infirmier formé en ophtalmologie) level recognized by the Congo national committee for the development of eye care; a certification intended for treating nurses who do not assist in surgery. By 2007, 6 nurses have received this certification at CMCLL, and most have well over a year of physician-supervised clinical experience. In 2006, the clinic sent 2 of these nurses to Kinshasa for a year’s course at the national eye care training hospital; necessary for the TSO (technicien supérieur en ophtalmologie) certification, intended for treating nurses trained in surgical assistance. Although both of these nurses had surgical experience before beginning the Kinshasa TSO program, they will return to CMCLL in late 2007 to complete the year of post-academic practical surgical experience required for the TSO certification. Other nurses will follow for this practical internship at CMCLL, including some from our province not originally sent to Kinshasa by CMCLL.
The first time the CMCLL nurses took a comprehensive written exam, Timothy took up the tests after four hours, and the percentage of correct responses ranged from almost 70 to less than 40%. A couple of years later, every one of those nurses turned in a similar exam with a percentage of correct responses over 80%, unheard of here in the Sankuru where any result over 60% for the state high school diploma exam is considerably applauded. Sharon was chatting one day with one of the nurses, a personal friend, who had an interesting testimony about her training at CMCLL. She was hired as the nurse-pharmacist, because she had had work experience in a commercial pharmacy in downtown Lodja.
"When I worked in the pharmacy, before I came here," she said, "whenever a person came in with an eye problem, I just turned around and looked on the shelf for something that said ‘ophthalmic’ and gave them that. Now I know what those drops do, and I realize that some of the things I gave those people weren’t what they needed, or even harmful." Another nurse, in a scene that happens daily, brought to Timothy the chart of patient for which he’d done the initial consultation and diagnosis, then listened with great interest to Timothy’s explanation, complete with textbook referral together, of an eye problem that the nurse had never before encountered. Afterwards he said, with quiet appreciation, "Every day when I come here, I learn something new from you." We hope that many will come, will learn, and will change the way eye care is done in the Sankuru.



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