They gave us visas despite our luggage of polystyrene heads (I’ll explain later). Considering one of our bags was lost, the hotel didn’t have our booking, and Merlin’s stomach was trying to eject itself from his body, this was quite an achievement on our first trip to Africa.
Ethiopia has recently undergone huge change with the election of a new Prime Minister. This man has set out to rebuild broken relations with Eritrea and the other nations on the horn of Africa. In an unusual manner, people spoke highly of their leader without prompt. In one story, he walked across the road from his palace to his neighbour who lived in a small corrugated iron shack, and rebuilt her home with his own money. While we were there, there were celebrations across the city to welcome an activist who had been invited back by the prime minister after 27 years of exile in the USA. It was an ideal time to host a conference that ran under the tagline of ’Stand up for action: eye care and sustainable development goals’.
The College of Ophthalmology for Eastern, Central and Southern Africa is a union of leaders in eye care who meet annually to present and discuss their most recent developments, from public health initiatives to intricate retinal surgery. It was an opportunity to meet with existing collaborators on the Arclight Tandem Africa Project and make new links that will increase its impact over the coming year. The congress was held at the United Nations in Addis Ababa, and with the polystyrene heads making it through the tight security scanners, it was their time to shine. The heads contain simulation eyes that have been developed to assist with training healthcare workers in the use of the Arclight. Students can practice looking into the plastic eye and diagnosing various diseases that are printed inside. Merlins final year dissertation had shown these eyes (£16) to be better than existing tools that serve the same purpose at a cost of £1200. Once his stomach had turned the right way round, he was able to present these results, showing once again that small is beautiful, and that by stripping equipment back to the basics we can reduce cost to something that is affordable, practical and effective.
Merlin’s presentation joined a string of voices that highlighted the unsuitability of some western medical practices in low and middle income settings. This includes the expensive and time consuming specialisation of health professionals. In contrast, limited resources could be invested in lower level primary health care workers who can cover a wider range of issues, effectively getting more done for less. For doctors in these countries though, the big bucks are made in specialist private practice, not public hospitals. This rolls into the issue of integrating eye care and all aspects of health care. One physician described a case where a patient’s eyes were treated for diabetic retinopathy but the underlying issue of diabetes was overlooked. The patient eventually died from a bone infection in her feet that was a result of the diabetes.
The aims of the Vision2020 goals present a similar predicament. Vision2020: The Right to Sight, was launched in 1999 with the aim of eliminating avoidable blindness by 2020. It focused on combating the leading causes of blindness: cataract and refractive error. This means that any other cases of blindness and visual impairment are left overlooked. It can be perceived as a nonsensical approach as the people involved in screening are often skilled in many aspects of health care but are focussing on only one issue. Such discussion drew into question the role of the World Health Organisation who roll out these initiatives, that are sometimes perceived as generalised solutions that do not meet the needs of each individual country. This highlights the importance of groups such as COECSA where countries have the potential to build on each others successes and share knowledge. It still leaves the problem though of a very niche area of healthcare working independently of others.
At our small exhibition space, the Arclight was met with admiration. People marvelled at its simplicity and even more at its effectiveness and utility when they tried it out. Many were interested in obtaining Arclights for themselves or their workforce. Getting the device into the hands of decision makers and demonstrating its benefits is a crucial step towards introducing it to healthcare systems.
Travelling between the airport, the hotel and the UN can keep visitors to Addis in a western bubble. The organisers were keen for us to experience Ethiopian culture so in contrast to our buffet lunches we were whisked off to the Amharic Restaurant for a night of injera and dancing. Alex discovered just how fast he could move his shoulders while on stage with a group of dancers (Theresa May eat your heart out!), and found out the next day just how strong honey wine is. It transpired there are 80 kinds of music in Ethiopia, each of which is associated with a specific dance. Alex stuck with shoulder shaking throughout.
Taking our experience of eye care in Africa beyond the white walls of the conference centre, we travelled to Minilik 2nd hospital. It was on this journey that our taxi encountered no less than three roadblocks: 1. Police were closing the road to welcome the aforesaid activist, 2. some children had blocked half of a dual carriageway to play a game of football, 3. a pack of dogs! Add to that the herds of goats and the man weaving his wheelchair through three lanes of traffic, and it became hard to imagine ever cycling through Africa’s cities! Following the example set by the prime minister, the hospital had arranged for people in all districts of the city with sight issues to be taken by minibus to the hospital for free screening and treatment. Yet another example of how change must be precipitated from the top.
Still feeling quite sheltered from the ‘troublesome’ parts of the city, we ventured to the Mercato – Africa’s biggest market. Our taxi driver’s main piece of advice: “don’t get lost, seriously”. We had arrived in Addis during the rainy season and the narrow walkways of this metropolis of wares were an open drain of mud and sewage. Spices, hinges, shoes, coffee, and iron nails of various sizes were some of the articles on offer, their vendors shouting “YOU! YOU! BUY! MONEY!”. We were a cache of currency waiting to be exploited and they would take any chance to catch our attention. It’s a shame I don’t have a wife, as I was guaranteed she would like many things. Nevertheless, we never felt threatened and our experience of Addis overall was of an exciting and bustling city where everyone has to find a very specific niche to make a life. There is little idleness, as you need to create opportunities and snatch any that happen to present themselves. It left us feeling positive about the year ahead, but we might go for some decent shoes after our last ones became soaked in what Merlin has coined ‘market juice’.