By Jodie Sinnema,
EDMONTON — Dr. Sheila Marco heads home on Wednesday to Kenya, a country with one specialist to treat the 1.5 million adults who have advanced glaucoma, an eye condition that can lead to blindness.
The country’s 80 or so other ophthalmologists — in comparison, Canada has 1,200 and a smaller population — help out with basic techniques, but only one before Marco had in-depth training from an Edmonton eye surgeon into how to better treat patients with the condition.
Glaucoma, which creates a buildup of fluid that puts pressure on the optic nerve, occurs in about four per cent of Kenyans over 30 and about one in 1,500 children in East Africa. In Canada, the condition is far more rare, effecting one in 15,000 children and is most often diagnosed in people in their 60s or 70s. If diagnosed early, the condition can be controlled with eye drops, but once the optic nerve is damaged, sight can’t be restored.
Marco spent the last four months practising patient care, leadership skills and various surgical options with a team of glaucoma experts in Edmonton, including Dr. Karim Damji, a ophthalmological professor in the University of Alberta’s medical department. Marco is now heading home to the University of Nairobi to pass along her new skills to ophthalmology residents, ensuring the country can grow local talent and build awareness of glaucoma. Many of Kenya’s 38 million people live in rural villages haven’t even heard of the disease, and tend to seek help only after they have gone blind in one or both eyes.
“The advantage of coming here to Edmonton is that you get to have an experience from an ideal setup where everything runs like clockwork,” said Marco, noting that Kenya has fewer human resources and operating rooms, and not as many instruments. That forces the doctors to improvise. Instead of scrub nurses, for instance, the resident often serves as the main assistant during operations.
Until now, Kenyan ophthalmologists have only performed one type of surgery for glaucoma patients. Marco has learned several more techniques with lower infection rates. She’ll do the first clinical trial in Africa comparing results among the different surgeries.
“I’m very happy because I’m taking back a service to my country where it’s really, really needed,” said Marco, who brought her three-year-old son with her to Edmonton. “Of course, at times I feel overwhelmed because of the numbers and the cases and the situations we have to deal with. But I guess I’ll have to find a way of handling it. … It’s very sad and pretty devastating, especially when the patient is very young.”
Marco first recognized the urgent need for more specialists when she worked as a resident in 2006 in rural communities. There, she met blind people who couldn’t afford medication or surgery. While some babies born with genetic glaucoma were diagnosed immediately, many of their families couldn’t afford trips to the big cities for followup appointments. Some free surgeries are now performed by the first Kenyan ophthalmologist Damji trained when he was working in Ottawa. Now, Marco will double that number.
“I had that compelling desire to work more with glaucoma patients,” she said. “I’m going to use whatever I’ve gathered here and pass it on to the next generation.”
Damji, who performed surgery on about 15 children born with glaucoma in Kenya and Ethiopia in December 2010, said the partnership between Edmonton and Africa also benefits local patients.
“It keeps me on top of surgical techniques,” Damji said. “The very advanced cases that are much more challenging (and more common in Kenya), I get an opportunity to share techniques and again keep learning with (Marco) and her patients, so that I can be ready when we face a very advanced case here.”
Damji said the local team considers it a privilege to teach people from other countries.
He said he was drawn to Edmonton because of the strength of the Royal Alexandra Hospital Foundation, which is funding Marco’s training fellowship along with the International Council of Ophthalmology, the Eastern Africa College of Ophthalmologists and an international charitable organization focused on preventing and treating blindness worldwide.
“My hope is (Marco) can act as a catalyst so that there’s a multiplier effect over time,” Damji said. “That would make me happy when I can see individuals get better patient care there and prevent blindness.”