Making a Difference in Low-Resource Settings

By Nathan Douthit

In February, 1999, the World Health Organization partnered with more than 20 non-governmental organizations involved in eye care to launch VISION2020: The Right to Sight. The goal of this initiative is to eliminate the main preventable and treatable causes of blindness by the year 2020. The threefold strategy involves disease control, human resource development, and infrastructure and appropriate technology development. Despite major improvements, there is still work to be done.^[1]

In "Management of a rhegmatogenous retinal detachment in a low-resource setting: treatment options when there is no vitreoretinal surgeon," Emsley et all highlight the difficulty in management of opthalmological problems in low resource settings, where no subspecialists are present. The patient presented with a treatable retinal detachment and retinal tear, but, "Unfortunately, no access to any vitreoretinal trained personnel or vitrectomy equipment currently exists in Sierra Leone…. [T]he nearest facility in Ghana is 2018 km away and beyond the financial means of the patient." Despite presenting with vision acuity of 20/30 bilaterally, "At review 8 months later, the visual acuity had dropped to 6/36 and the retina had completely detached.

In the discussion, the authors present the incidence of rhegmatogenous retinal detachment in sub-Saharan Africa and Sierra Leone. Despite the growing prevalence of this disease and the "late presentation with advanced disease and secondary complications" in the developing world, only 15 subspecialty trained vitreoretinal surgeons practice in the region of Senegal to Kenya and Ethiopia to Tanzania. The lack of equipment and continued training for opthalmologic specialties is a well documented problem.^[2] The need to develop a system for screening, referring and transporting patients to well-equipped tertiary care centers is also well-described.^[3]

Despite steps in these directions, however, there are still countless patients suffering with no access to the necessary specialties—in this case, a vitreoretinal surgeon. Rather than forgoing any care, healthcare professionals with appropriate training can optimize the treatment with the resources they have available to them. Emsley et al excellently describe several interventions in there article that would have helped this patient without the need for a vitreoretinal surgeon. They focus on pneumatic retinopexy, "[T]he ideal treatment option for the case described above in this setting."

BMJ Case Reports invites authors to submit global health case reports that describe feasible interventions that could alleviate disease in low-resource settings. These cases could focus on:

•  Interventions that have been successfully instituted in a low-resource area
•  Potential interventions to help a vulnerable population
•  Challenges to instituting an intervention in a low-resource setting
•  Low-resource interventions that have aided individual patients

Manuscripts may be submitted by students, physicians, nurses and allied health professionals to BMJ Case Reports via the submission system. For more information, review our guidance on how to write a global health case report and look through our online collection.

To read more about interventions in low resource settings at BMJ Case Reports, please review:

•  Treatment of complex infantile hemangioma a in a resource-poor setting
•  Management of paediatric head injury in remote Nepal
•  Penetrating cardiac injury: sustaining health by building team resilience in growing civilian violence

To read more about opthalmologic care in the developing world, please review:

^[1] World Health Organization. What is VISION 2020? [internet] Prevention of Blindness and Visual Impairment. WHO 2018. Accessed from: http://www.who.int/blindness/partnerships/vision2020/en/ on 3 May 2018

^[2] Courtright P, Ndegwa L, Msosa J, Banzi J. Use of our existing eye care human resources: assessment of the productivity of cataract surgeons trained in eastern Africa. Archives of ophthalmology. 2007 May 1;125(5):684-7.

^[3] Sommer A, Taylor HR, Ravilla TD, West S, Lietman TM, Keenan JD, Chiang MF, Robin AL, Mills RP. Challenges of ophthalmic care in the developing world. JAMA ophthalmology. 2014 May 1;132(5):640-4.

Competing Interests

None Declared

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