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Strengthening Eye Care in Sierra Leone

Shiama Balendra

Specialist Registrar in Ophthalmology

23 September 2022

Ophthalmologist, Shiama Balendra, recently volunteered with King’s Global Health Partnerships in Sierra Leone, to conduct a clinical research project within the Department of Ophthalmology, Western Area Eye Care Project at Connaught Hospital. She tells us about the experience and how it inspired her to raise money for the eye department she worked in.

As a Specialist Registrar in Ophthalmology, normally based in London, I jumped at the opportunity to work in Sierra Leone with KGHP, on a research project called EMERGE (Aetiology and Management of Uveitis in a Viral Haemorrhagic Fever Zone). The research project looked into clinical presentations and causes of inflammation within the eye, known as uveitis, which is a topic last researched in Sierra Leone over 30 years ago. Within the UK, patients presenting with inflammation would generally have a panel of investigations to establish an underlying cause, however in Sierra Leone patients commonly have empirical treatment only.

Together with a US ophthalmology team, who funded and procured a significant amount of infrastructure and resources, and our local ophthalmology colleagues, we set up a new research eye clinic in the Eye Unit in Connaught Hospital, which was used to conduct the research project. This facility is an incredible asset to the ophthalmology services in Sierra Leone and will allow retinal images to be taken to document, monitor and teach clinical phenotypes of not just uveitis, but all ophthalmological conditions in the future.

I was fortunate to use some of my experience of working in research institutions and within the NHS to improve research skills, knowledge, clinical skills and collaborations across the ophthalmology services in Sierra Leone. We trained a research staff team to conduct EMERGE and then continue research projects in future, enabling sustainable change and progression within the ophthalmology service.

We also set up new lab equipment, including a plate reader and plate washer and provided reagents to enable investigations for uveitis to be conducted. Training was provided on the equipment, allowing for these laboratory techniques to be sustainably carried out in the future. I also conducted slit-lamp training and teaching for nursing, optometry and medical students, and trainee doctors.

My experience in Sierra Leone surpassed my level of expectations, in terms of the level of clinical knowledge I learned and the skills I developed in leadership, project management, teaching, cross-cultural communication, teamwork, community and staff engagement and lots of problem solving! – Shiama Balendra, Specialist Registrar in Ophthalmology

Fundraising for iCare equipment

During my placement, I spent time getting to know the clinicians and eye staff and the clinical pathways. It was evident how well patients are managed in spite of their advanced presentation and limited resources. I learned far more from the clinical acumen and the way that many advanced conditions were managed by our partner clinicians than I could impart.

What struck me the most was the prevalence and morbidity associated with advanced glaucoma in Sierra Leone. I have seen children and adolescents, as well as fit and healthy adults, presenting on their first ever eye check with severe advanced glaucoma, who are likely to spend the majority of the rest of their lives visually impaired. The impact of this on the rest of their families and communities is huge.

Upon discussion with the Eye Care team, we recognised one thing that could significantly help the department would be to purchase a device to check eye pressure, which is the single most important treatable risk factor for glaucoma. These devices could help ophthalmic nurses and doctors to detect patients at risk of glaucoma early, in order to start treatment early and reduce the associated visual morbidity.

I wanted to fundraise for the fantastic eye department I had been working at. As many of my friends and family know, I often like to participate in the odd sporting event whilst at home, however nothing prepared me for exercising in the heat and humidity and then the rainy season in Sierra Leone. Added to that, the palm oil, sugar and rice I consumed hadn't helped my athleticism or waistline...

So, with all these factors considered, I set myself a huge personal and physical challenge to complete the Makeni 10K Race. Through many generous donations from friends, family, colleagues and kind strangers, we managed to raise £2572! This was enough to purchase the latest iCare device in the UK and transport this to Mr Alhaji Koroma, the Eye Care lead, who received this very gratefully!

One of the highlights of my time in Sierra Leone was working with the individual eyecare professionals. They were supportive of me and my work, engaged with training and even taught me Krio and introduced me to amazing Salone food! Upon returning to the UK, the stark contrast between UK and Salone life and healthcare is sometimes a challenge to face, however keeping close contact with my Salone colleagues and friends helps to merge the two.

My experience also gave me a huge appreciation for the true resilience, passion and care of my healthcare colleagues in Sierra Leone, and I aspire towards incorporating those traits in my continuing practice.