Case studies: Impact

Irfan Aslam Khattak FCPS (Ophth), MSc (Lond), 2014-2015 Consortium MSc PHEC Scholar

Irfan Khattak
After completing my Masters degree at LSHTM in Public Health for Eye Care in 2015 (sponsored by CEHC), I joined back my parent institute i.e. Alshifa Trust Eye Hospital Kohat. With the knowledge and skills gained at London, I wrote up a proposal to my hospital’s headquarters at Islamabad to start working towards the goal of making Alshifa Kohat a tertiary care institute one day. They luckily agreed and we started with opening up sub-speciality clinics of oculoplasty, paediatric ophthalmology and also a diabetic eye clinic which has initially been equipped with a retinal laser facility only.

Since I have an interest in taking on Diabetic Retinopathy on the clinical as well as public health side, I applied for a second fellowship in retina at a center of excellence in the nearby city of Peshawar and was luckily selected for the post. I am currently working as a fellowship trainee in retina since January 2016 (ending December 2017) at Khyber Institute of Ophthalmic Medical Sciences, Peshawar, Pakistan which is a tertiary eye care facility. Besides I am also a visiting eye surgeon at a 100 bedded secondary eye care i.e. Alshifa Trust Eye Hospital (ASTEH) facility in a relatively remote town named Kohat.

In the near future, after completion of my retina fellowship I plan to raise awareness about diabetic eye disease in the public. My initial idea is to start the awareness campaign from the undergraduate medical students, who can be very effective ambassadors. Building upon this, would do advocacy for a comprehensive diabetic retinopathy screening and management program at the governmental level.

Dr Desirée Murray MB.BS. (UWI), FRCOphth, MSc (Lond), 2014-2015 Consortium MSc PHEC Scholar

Desirée is an Ophthalmologist and Lecturer in Ophthalmology at the University of the West Indies (UWI), St. Augustine, Trinidad and Tobago. She was awarded a scholarship by the Commonwealth Eye Health Consortium to study for the Masters in Public Health for Eye Care (MSc) at the London School of Hygiene & Tropical Medicine (LSHTM) 2014-2015. Desirée is committed to the elimination of all avoidable blindness, with a special interest in prevention of blindness from glaucoma, a leading cause of blindness in the Caribbean. For her Masters dissertation, she analysed glaucoma services in Trinidad and Tobago. She has been disseminating her MSc research findings through presentations at the UWI and the Ophthalmological Society of the West Indies, including a glaucoma mini-symposium hosted by the West Indian Society of Glaucoma Surgeons, of which she is co-founder.

As a university lecturer, Desirée has continued to teach undergraduate medical students and postgraduate ophthalmologists in training at the UWI. Her teaching style has been greatly influenced by her experiences in London, including the use of educational technology for blended learning via the Moodle platform. In the delivery of her courses, she now places greater emphasis on the Public Health aspects of blindness prevention, including the integration of eye care in to primary health care to facilitate early detection and treatment of eye diseases in the community.

At LSHTM, Desirée was able to interact with the Peek team and learn about all the good work that they are doing in making eye examinations accessible to persons living in remote communities. She was inspired to develop a research proposal and to apply for a research grant and recently received funding to conduct research in Trinidad and Tobago to screen for glaucoma and diabetic retinopathy at the primary healthcare level, using digital smartphone imaging.

During her time at the LSHTM, she also had the opportunity to interact with staff at the Consortium, the ICEH (International Centre for Eye Health) and the IAPB (International Agency for the Prevention of Blindness). She has a much greater appreciation of the important role of rehabilitative services in improving the quality of life of the blind and visually impaired and has been supporting calls for the improvement of rehabilitative services in Trinidad and Tobago. She is a proud contributor to the IAPB Essential List for Glaucoma – first edition (March 2017).

Acquisition of the MSc has had a major impact on her approach to eye health matters in Trinidad and Tobago. Her advocacy skills have been enhanced, allowing her to confidently express concerns to policy makers about inequities in access to eye care and to advocate for the inclusion of eye health in the local sustainable development goals agenda. Armed with the skills acquired during pursuit of the MSc and in collaboration with a consultant attached to the Ministry of Health, she is currently in the early stages of developing a national eye care action plan to be implemented and monitored by a national blindness prevention committee. Universal and equitable access to eye care remains the ultimate goal.

Dr Emmanuel Kobia-Acquash, O.D., MSc (Lond), FLVPEI, 2014-2015 Consortium MSc PHEC Scholar

The opportunity to pursue my Master’s degree at LSHTM was one of the greatest moments of my life. It had always been my dream to study public health since I believed will enable me have a wider impact on eye care in Ghana. I was in Malawi in 2014 as a visiting lecturer at the Mzuzu University when I received an email from Romulo confirming the award of the Commonwealth Eye Health Consortium (CEHC) scholarship to study at LSHTM. I must admit that it was a dream come true and I’ve not looked back since. I will forever be grateful for the unique opportunity given me courtesy the Queen Elizabeth Diamond Jubilee Trust Fund through the CEHC scholarship.

Prior to my studies in London, I was teaching at the Kwame Nkrumah University of Science and Technology (KNUST) as a Technical Instructor. My appointment as Technical Instructor was due to my background as an Optometrist after I had acquired a Fellowship in Clinical Optometry at the L.V. Prasad Eye Institute in India in 2012. Though I was able to teach core optometric clinical courses, I knew I had to improve my research skills to enable me conduct research that will have a wider impact on the country. I therefore decided that studying Public Health will help me achieve that goal. There were several programs and schools I considered, however LSHTM stood out as the most ideal institution to obtain a quality graduate education in the field of Public Health because of the uniqueness and direct focus on public health for eye care, and the reputation, quality and diversity of its faculty and research. Indeed, an MSc. in Public Health for Eye Care did not only serve to aid in the realization of my career goal to become a professor, but also acquaint me with the required knowledge and specific public health skills to make me an active participant in the training of future optometrists, and the quest to improve the eye care needs of the poor and needy in Ghana. My time at LSHTM was eventful as the experience allowed me to grow both as a researcher and as a person. I was fortunate to belong to a very diverse group of students in the 2014/2015 year group and the opportunity to meet and interact with people from varied backgrounds helped broaden my perspective about the different eye health systems in the world. The structure of the MSc. program curriculum at LSHTM enabled me acquire and apply skills in epidemiological and operational research, and critical analysis of strategies for the control of major blinding eye disease.

Upon my return to Ghana I was promoted from a Technical Instructor to a lecturer at the Department of Optometry at KNUST. I have been serving in that capacity since 2015. The promotion came with added responsibilities at KNUST, however, due to the training I received at LSHTM I have been able to deliver. Apart from my core duties of teaching and research at the Optometry Department, my other duties include: outreach and externship coordinator; member of the optometry clinic committee; liaison between Vision Aid Overseas (VAO) and KNUST; local organisation committee member for Ghana Science Association (GSA– KNUST chapter); and assistant examination officer. Externally, I was appointed as member of the Ghana Optometric Association (GOA) educational committee and a Board member of the Volunteer Optometric Services for Humanity (VOSH – Ghana chapter).

As an outreach coordinator, I have helped to re-orient our approach towards organizing outreach programmes and the impact on the local communities has been positive. Our outreach programmes have been more integrated into the communities where they are conducted. I have been able to develop a system that ensures that we have a more targeted/focused programme that seeks to reach out to underserved communities especially in rural settings. I have also developed a referral network that includes the community health care centre and the district hospital where patients are referred to after the outreach programme. Some of the community health nurses within the community catchment area have been given basic eye health education to be able to identify those with eye problems and referred promptly. These strategies have ensured that our outreach programmes have become more effective and sustainable. My role as a liaison between VAO and our department has strengthened our partnership in providing the needed community service. This has led to a decision by VAO to visit our institution twice a year instead of the once a year visit in the past. My presence on the board of VOSH has also facilitated a partnership between VOSH, KNUST and Rotary Club of Ghana to organize outreach clinics to two communities (Kitase in the Eastern Region and Apam in the Central Region of Ghana) in the past couple of years. Since my appointment as outreach coordinator, hundreds of people, often in hard-to-reach areas of the country have benefitted from our outreach programmes which includes free eye examination, ocular health education, medication, and either free or highly subsidized spectacles. Numerous blinding conditions like glaucoma, cataract have also been identified and referred to nearest eye clinics where they have received comprehensive eye examination, surgical and medical interventions and continuity of care.

As a member of the GOA educational committee I have played a key role in organising two continuous professional development (CPD) seminars for members of GOA. I was a co-presenter at the ‘Scientific Writing’ seminar where I gave a presentation on effective data collection, analysis and writing of scientific report at eye clinics. In my capacity as a member of the GSA local organising committee, I was able to submit a record high of six abstracts from the Department of Optometry during the Sixth GSA conference held at KNUST.

I have been involved in several research projects over the past two years since my return as a lecturer in Ghana. I have done this either through direct supervision of my students’ final year project or as an author/co-author of the research. The following are some of the research projects that I have been involved in over the years: 1. Knowledge, attitudes and practices of street vendors on ocular health within Oforikrom sub-metropolis; 2. Visual outcomes and complications of ocular trauma among patients at the KNUST hospital in Kumasi; 3. Ocular injuries among heavy industry workers in Tema, Ghana; 4. Attitudes and beliefs of KNUST undergraduate students to spectacle wear; 5. Profile of keratoconus in selected eye clinics, Accra: a retrospective study; 6. Clinical estimation of cup-to-disc ratio among glaucoma patients in Kumasi –  comparison between direct ophthalmoscopy and optical coherence tomography; 7. A new approach to optic cup and optic disc analysis for glaucoma screening using pulsed coupled neural networks and line profile analysis.

I am also working on a manuscript of my MSc research project on ‘Optometry services in the Ashanti Region’ for publication. I am correcting changes made by my supervisors at LSHTM on the first draft I submitted to them.

My career goal is to become a professor and to contribute fully towards the development of eye health in Ghana and Africa. However, in the next five years I intend to pursue my PhD and postdoctoral degree to enable me advance eye health research.  I am therefore actively searching for PhD opportunities to help me achieve this.