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British Council for the Prevention of Blindness

Boulter Fellowships

The BCPB's Boulter Fellowship Scheme was set up in 1982 to enable eye care professionals from the developing world to train in Britain and achieve the specialist skills needed in their country of origin.

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Prevention of Blindness Fellowships

BCPB Prevention of Blindness Fellowships provide training and important new research outcomes at Doctoral level, and are designed to provide low income countries (LICs) with tomorrow's leaders in blindness prevention.

Following on from the BCPB's success in funding Boulter Fellows, who train at Masters level in Public Health for Eye Care, the Trustees decided to set up a Prevention of Blindness Fellowship Programme in 2006, to train people to Doctoral level and to provide important research outcomes leading to better treatment programmes in LICs.

The Fellowships are fully funded by BCPB and lead to the award of PhDs and MDs. The aims of this project are:

  • to provide top level eye care personnel in developing countries, in order to build knowledge and skills in eye care where they are most needed. For example, in Africa as a whole it is estimated that there is one ophthalmologist per million population (Source: International Centre for Eye Health). Fellows from developing countries will be selected partly on their ability and ambition to disseminate knowledge and skills through teaching and training;

  • to foster links between UK institutions and those in developing countries, in order to facilitate a mutually beneficial transfer of knowledge in eye care.

Juliet's Story

This is the story of Juliet Adhiambo...

Juliet was not one of our survey patients but at every centre we stopped to see our survey patients we encountered an average of 50 other people wanting eye services which were otherwise unavailable. We therefore always held a separate clinic for these patients even though these clinics put a big strain on the survey resources both time-wise and financially.

Juliet was born in 1985 in the west of the country. Her parents died when she was very young and she was brought up by her grandmother, also a widow. Aged 13 she gave birth to her first child, a boy called Kennedy. The child's father disappeared as soon as Juliet discovered she was pregnant. She met her current husband when she was 16. They had a daughter, Roselyn, in 2002, and she moved from Nyanza to Nakuru in 2003 to join her husband who by then had got a job at the University.

Juliet started noticing blurring of vision soon after this and her left eye finally lost sight in 2005. By December 2006 she lost all sight in the right eye too, which lead to her losing her job. Her daughter Roselyn stopped attending nursery school soon after her mother lost her sight, to be her mother's guide. At that time the cause of Juliet's greatest distress was that her daughter Roselyn was not going to school. Juliet felt that she was a failure because she could not look after her family.

When the Egerton University Health Centre staff knew that we were visiting the area for the Nakuru Eye Survey funded by BCPB, they sent for Juliet from her home in a shanty village next to the University. She came led by the hand by Roselyn.

Examination revealed that Juliet could barely detect hand movements an inch in front of her eyes. She had very dense cataracts in both eyes. Fortunately all else seemed normal. We decided that though she was not part of the project we would ask BCPB through the project to pay for her surgery. We just could not bear leaving her behind. The University staff arranged for her to be brought to the Nakuru Eye Unit 2 days later and over one week she had cataract surgery in both eyes.

As soon as one eye could see, the transformation was instant - especially for Roselyn. She would hide from her mother in the ward and say "Can you find me mama?" And whenever her mother held her hand out of affection she would snatch her hand away and run ahead saying "Come on mama no more hand holding! You can walk on your own now!"

Childhood Blindness In Malawi: Identifying Children In Need

The Fellowship will provide around £150,000 of funding to help save the sight of children in this part of Africa. In 80% of cases the blindness is avoidable - preventable or treatable. But the children do not get the help they need - partly because they are simply not identified and referred for treatment.

Dr Kalua's research project will test a new method of identifying blind children in the community using 'key informants'. This involves training people from the villages who know their community well, are willing to help identify blind children, have time to do the job - and are happy to do it without payment.

In a pilot study, Dr Kalua himself trained a group of key informants for a day, and in the following 6 weeks they successfully identified around 40 blind children, who were then referred for treatment. The new method will be tested against another method using trained primary health care workers. Alternative methods of referral will also be evaluated.

The project will not only treat many more blind children, but will also help to develop sustainable systems and procedures to prevent childhood blindness in Malawi. The lessons learned will be applicable elsewhere in Sub-Saharan Africa, where there are some 320,000 blind children at present.

As well as providing these important research and treatment outcomes, it will enable Dr Kalua to attain skills in prevention of blindness at Doctorate level. This will equip him to lead the development of eye care programmes in his country and the surrounding region. Dr Kalua aims to establish a fully operational community eye department at the University of Malawi, which will have a big impact in national blindness prevention.

Henderson's Story

Henderson Koloko is 8 months old and his parents are peasant farmers from Jali, in Zomba District, Malawi.

Having 5 older children, Henderson's parents knew from early on that all was not well with the baby boy's vision. They brought him to the nearest health centre a few kilometres away, but the medical personnel there were not trained in eye care, and advised the parents to wait a few months before coming back for a full examination at the hospital.

His parents were worried, noticing that Henderson could not follow light and objects with his eyes, and that there was something white in both pupils. They went back to the hospital when Henderson was 7 months old. The staff referred the child to the tertiary hospital in Zomba, 20 Km from their home, and here Henderson's mother was informed that she would have to take her son to the main hospital in Blantyre 60 km way from Zomba.

Henderson's mother managed to get to the hospital in Blantyre one month later, and fortunately the child was attended to immediately.

Henderson was diagnosed with congenital cataract. Dr Kalua and his team carried out surgery to remove this. Henderson will not have a lens implanted until he is at least two years old. In the meantime he will be given glasses.

The chances of him one day having normal vision are now good.

Before Henderson went to theatre he could not follow light or respond to smiles. After surgery: Henderson can do both of these things.

It is vitally important that childhood cataract is diagnosed and treated early. Any delay carries a risk that the child will develop a condition called ambylopia, which results because the brain has not been 'trained' to see. This can mean that the child may not see even after surgery is performed. Treatment of ambylopia is complex and it is harder to achieve full vision.

The data from this project will guide Dr Kalua and his team in setting up the most effective systems to ensure that all children with congenital cataract and other conditions affecting sight get to hospital for speedy treatment, avoiding the delays which affected Henderson.

Juliet, Roselyn and Matron Rose on arrival at the hospital

Juliet reading the newspaper for the first time in 5 years

Before Henderson went to theatre he could not follow light or respond to smiles

After surgery Henderson can do both of these things