Developing Child Eye Health Services

 On World Orthoptic Day, Claire Studley Scott, Orthoptist and a volunteer for Addenbrooke’s Abroad writes about the importance of early detection and treatment for children & her work in Botswana.

Claire (second from right) with nurses in Botswana

Happy World Orthoptic Day everyone!

Orthoptics is a paramedical profession, primarily involved in the diagnosis and management in defects of using both eyes together. Eg an infant with poor vision requiring glasses, a child with a turn in one eye, an adult with double vision. Orthoptists may also specialise in other areas of diagnosis and management eye health, including Stroke Management, glaucoma, and Macular Degeneration.

Orthoptists are particularly adept in assessing children and this is an area that we can support and develop as part of a growing eye health service. The early detection and management of sight threatening conditions in children can combat avoidable blindness and is a World Health Organization priority. Prevention of these impacts a child’s education, social and economic development and minimises the lifetime of blind years if untreated from childhood.

Through my professional body, The British and Irish Orthoptic Society, I have started a Global Development and Volunteering Special Interest Group. This group of Orthoptists are interested in supporting the development of eye health globally. Some orthoptists have already volunteered in various locations and others are interested in doing so in the future.

VISION 2020 Link: Addenbrooke’s Abroad, Cambridge University Hospitals and Botswana

Who would have thought that a VISION2020 Links programme could bring me friends and colleagues across continents!

I have been involved in the Addenbrooke’s Abroad (AA), Cambridge University Hospital VISION2020 Link since 2010. A chance conversation with the founder of this link, Mr Malcolm Kerr-Muir led to a whole plethora of learning – mostly for myself! Mr Kerr-Muir was talking of the existing Ophthalmology link and, as an Orthoptist, I asked him ‘what about the children?’ This question led to me to my first visit to Botswana in the autumn of that year.

I went with a colleague, Mary Telfer, and we did not know what to expect. We discovered that unless a child could perform the ‘E’ Test that their vision was not assessed, the importance of early detection and treatment for children was not clearly understood. We had taken some donated equipment with us and prepared some presentations on how to assess children’s vision and why early referral was very important.

Developing Child Eye Health Services in Botswana

My experience in Botswana led me to study for a Masters Degree in Public Health for Eye Care, at The London School of Hygiene and Tropical Medicine. This equipped me with additional knowledge to support Botswana in developing its Child Eye Health Services. I was delighted to be a part of a Seeing is Believing and the Addenbrooke’s Abroad project with Botswana’s Ministry of Health in 2013. The ophthalmic nurses involved named this project ‘Pono Letlotlo’, which means sight is treasure.

As part of this, I trained 13 nurses in 2013 in understanding why child eye health is so important. In 2014 we went on to train 532 teachers and health workers. The main emphasis was that poor sight affects a child for a lifetime; their education, social development, and their futures. A child would not know what was normal and that not see was abnormal. The most joyous response to this, was a group of health workers and teachers singing loudly and dancing to their song about Pono Letlotlo!

The project has now finished and I am proud to say that services are much improved and the awareness of this services’ importance recognised. There have been many achievements; Child Eye Health Services are now a part of the National Plan, four of the nurses have gone on to train 75% of their ophthalmic nurse colleagues about child eye health and the assessment of children. The tertiary hospitals are now running a weekly paediatric clinic. A Vision Centre established by “Vision Aid Overseas” provides glasses subsidised by the government for children free of charge and there is a vision prompt in the child healthcare card. The Dutch Charity ‘Visio’ is also addressing the needs of children with low vision, integration of child eye health into Child Health, School Health and the Ministry of Education.

Things take time, but small steps lead to big strides – and these strides are happening!

In Botswana I am often called the ‘Mother of Children’s Vision’, which I find amusing and a little overwhelming! I am in contact with many of the various clinicians on a regular basis and count many as friends. I have visited their farms and families. What started as a simple question in 2010 has led to friendships over 6,000 miles today.

Claire Studley Scott

Orthoptist

DBO, MSc