Diabetic eye screening in Swaziland

Mentoring for the success of diabetic eye screening programme in Swaziland.

BCPB funded a research mentorship between Professor Tunde Peto of Queen’s University Belfast and Dr Jonathan Pons of Good Shepherd Eye Clinic in Siteki, Swaziland. Professor Peto reports:

In Swaziland, currently 60% of those presenting at the eye clinic with diabetic eye disease do so due to sight loss in their second eye, so they are desperate for treatment. Currently, in Swaziland there is no countrywide provision for structured diabetic retinopathy screening (DRS) to find early, treatable cases before sight loss sets in, but a pilot DRS service has been established for detection of sight threatening disease.

Reciprocal visits were held between the mentor and mentee to train staff, evaluate current DRS provision and plan for provision of sustainable service. Ophthalmic cameras were put in place and training given both on how to take the photographs and analyse the images, and what to tell the patient. The images taken by the Swaziland staff were reviewed by the UK and the Swaziland teams together to provide reassurance and quality control. There was a lot of interest both from the patients and the staff in this new activity and so additional staff members received structured DRS screening/grading training, and were enrolled into the relevant international training course. Specific software was designed and was successfully integrated into clinic/grading workflow. Protected DRS time and space were available and regular DRS imaging and timely grading took place. Of those 400 people with DM screened, 100 (25%) required laser treatment, most for sight threatening proliferative DR (92%); these were duly carried out without complications, saving the sight of those affected.

Due to this project excellent progress is now being made in Swaziland, definitely helped by the mentoring opportunities provided by the UK-team. Screening for sight threatening diabetic eye disease is now offered to everyone with diabetes on the new database. Trained staff are seeing patients, freeing up scarce medical resources to deal with more severe cases and are carrying out laser treatment and other necessary operations.

The impact on staff and patients has been very positive, and is contributing to the efforts of reducing blindness amongst those with diabetes in Swaziland. The immediate effect on staffing level is one of the positive aspects of the project. Historically, nurses and technicians are moved around at short notice, and individual teams have little control over the move. Since the inception of the DRS, a highly-motivated technician stayed with the team and his skills with the camera and his excellent inter-personal skills made this project possible, together with the dedication of the lead clinician and the lead nurse. He is getting to know individual patients, has a good relationship with the rest of the team and is an anchor to the whole service. It is wonderful to see how a whole team grew around this mentoring project.

An update about this work will be added soon