Sussana Coleman
Sixty-year-old Thoko Ndlovu has just seen an optometrist for the first time in her life. For five years she has had excruciating headaches and each time she sees a doctor she is referred for an eye examination.
Living outside Stanger on the KwaZulu-Natal North Coast, her only option was the R60 round trip to a Durban hospital twice, if she had to fetch spectacles. Ndlovu, a retired domestic worker, could not afford it.
The International Centre for Eyecare Education (ICEE pronounced “I see”), based at the University of Durban-Westville, aims to change that. Currently sponsoring a community optometrist programme to work at Maphumulo and Stanger hospitals, the ICEE hopes to produce a viable model for eye-care provision to all South Africans.
Yashika Inderjeet, an optometrist who travels 280km a day to serve areas outside of Durban, says: “Currently 1200 optometrists and 225 ophthalmologists provide eye-care to 40-million South Africans. Since the bulk of these practitioners are located in urban areas, there is the creation of a drastic rural-urban imbalance.
“Further, the previous [apartheid] government did not employ optometrists at state hospitals. Currently, there are only 15 optometrists in the public sector.
“As a consequence, children and adults lack access to eye-care and suffer severe health hazards. In South Africa 20% of the population use some form of vision correcting device, but at least 50% or more of refractive errors are undetected and untreated,” says Inderjeet.
By working within the public health sector, ICEE is committed to finding sustainable solutions to the problem of eye-care delivery in South Africa. So far, posts for four optometrists have been created in KwaZulu-Natal.
“The ICEE has undertaken to supervise those posts to bring committed community optometrists into the public sector. My job is to ‘model’ the concept so that at the end of one year I can say, ‘I serve a population of one million people, I’ve screened thousands of school children and adult patients and given out thousands of pairs of specs,'” says Inderjeet.
“We also have to institute a more efficient referral system, instead of sending all our patients to Durban. Soon Ghandi Memorial hospital will be able to take our cataract patients.
“It’s a question of capacity and being able to give government a system that already works. Then you can skip all the time-consuming debates around who, what, where, when, why and how at local government level. All government then has to do is provide posts for optometrists and the system can be adopted nationally without delay.”
Inderjeet has no doubt about the importance of giving every person in society access to an optometrist. “An uncorrected refractive error in a child can seriously set back learning and impede emotional development and behaviour. Later on, uncorrected refractive errors yield negative consequences in terms of lost education and employment opportunities, which ultimately result in an impaired quality of life as well as lost economy for the individual, family and society.”
Inderjeet is doing a masters in optometry. Her research will contribute towards finding the best range of workable low-cost spectacle prescriptions so that spectacles, while still being of the best quality, can be made even more affordable.
She leans out the clinic door to call in the next patient. Twelve eager faces turn in her direction. “It’s tiring, but that’s why I became an optometrist I wasn’t happy working in private practice. I know that there are many optometrists out there who feel the same way. It feels good to know that by working under the ICEE umbrella, they’ll be accommodated in public hospitals sooner rather than later. And that’s good news for the people too.”
Ndlovu is one happy lady. She is trying out frames for the pair of bifocals that will give her normal vision. “I can’t see nothing. When I go to the shops I can’t read the prices, and sometimes when I walk, I trip.” She will have to pay for them, but at least she hasn’t spent the money on taxi fare.
“Once she has her glasses, the headaches shouldn’t occur. Her eyes have been straining against the natural ageing process of losing one’s ability to accommodate for a long time. Virtually every person over 40 needs glasses to read. I’m sure that for Mrs Ndlovu relief is at hand,” says Inderjeet.
Programmes in progress
Train the Trainer programme at the University of Durban-Westville, which aims to supply the continent with the 60000 refractionists that Africa needs by the year 2020.
R1,2-million World Health Organisation/National Eye Institute study on refractive error. Of the 5000 children participating, those who need correction will get free spectacles.
One doctorate and two masters of optometry to ensure the optimum delivery of low-cost spectacles within the South African Public Health System.
Securing funding for supporting optometry schools in Africa. The first such project is in Tanzania, where a 10-year commitment is in place.