Kenya eye safari

British Medical Journal, Jan 10, 1998 by David Orr, Ingrid Cox

Time might not exactly stand still in Mudogashe but neither does it move apace. The river has dried up but will flow again with the advent of the seasonal rains. And the rains will bring the return of the cattle, which have been sent far away in search of grazing.

This is Kenya's north eastern province, a huge expanse of scrub and semidesert populated by pastoralists. We have flown to this desolate place with a medical team from Kenya's oldest hospital, the Presbyterian Church of East Africa Hospital established in 1908 at Kikuyu near the capital Nairobi On board are two British eye specialists: Dr Mark Wood, director of the hospital's eye unit, and Dr Roger Gray, a consultant retinal ophthalmologist from somerset who regularly visits Kenya to help train eye surgeons. They are accompanied by an ophthalmic assistant and a nurse.

The trip to Mudogashe is part of a programme of birmonthly flying safaris which brings the eye unit all over Kenya, as well as to Somalia and Sudan. The unit uses the word safari in its true Swahili meaning of journey Like much of the unit's work, this mission has been funded by a German aid agency, the Christian Blind Mission, which has a fund-raising and information office in Cambridge.

The patients wait quietly. There are many more people than expected but this is perhaps not surprising -- locals say that it was eight years ago when the last doctor visited Mudogashe. There is no public transport. The blind are led by a younger family member, the two connected by a long stick. Many of them have walked for days, carrying cooking utensils and food for the journey.

When the eye unit agreed to include the district in its busy schedule the various health officials were informed of the impending visit. Outlying dispensaries and health centres were requested to refer their ophthalmic patients to Mudogashe on the agreed date. Word of the visit was also spread on the bush telegraph by the district officer, the local chiefs, and village elders, letting people know that even if they had not been referred they could still turn up at Mudogashe.

The inhabitants of this region, a mixture of ethic Somalis and Boranas were until recently locked in a vicious conflict over cattle. Over the generations many Somalis have left their homeland, migrating to Kenya in search of more security and better economic prospects. By the time of our visit, the Boranas (an indigenous Kenyan tribe) and the Somali settlers had overcome their differences and were facing together their common enemy: drought.

In remote areas which are seldom visited by doctors, an affliction such as cataract can go untreated for years, reducing its victim to blindness. In Britain there is one ophthalmologist for every 30 000 people. In Kenya there is not even one eye specialist per million people.

More than 80 000 Kenyans are blind from cataract. Yet a simple intracapsular cataract extraction lasts only 20 minutes.

Great strides have been made in ophthalmic treatment in recent years. On some of these remote safaris the unit is now implanting intraocular lenses. But this type of surgery can be done only where there is an ophthalmic nurse who can deal with postoperative problems.

Having set up a consulting room, the doctors start their examinations. The majority of those seen have cataracts. Distributed among them are people with other conditions: pterygium, a malignant growth on the conjunctive associated with AIDS; glaucoma; and trachoma. In the cases of a couple of people complaining of great pain, eviscerations are required.

The lack of equipment and medicines attest to the neglect experienced by health centres in this country. Even the calendar. on the wall is six years out of date.

At the time of independence from Britain in 1963, Kenya inherited one of the best healthcare systems in Africa. But bad management, inadequate funding, and overcentralisation have reduced many public health institutions to near collapse. There are some hospital wards where patients lie two or three to a bed because of overcrowding. The main public hospital in Nairobi is so run down that seriously ill people often prefer to stay at home rather than risk treatment there. As for health centres like the one in Mudogashe, the Ministry of Health says that funds are simply not available to upgrade them.

Kenya's president, Daniel arap Moi, says that non-governmental development organisations should be encouraged to improve the health infrastructure in Kenya. Without their involvement the future for health care could be bleak. So many newly qualified doctors are leaving that there are now more young Kenyan doctors working in southern Africa than in Kenya's own district hospitals.

Mudogashe's police post is a decrepit couple of shacks, the school a sad collection of low huts without glass in the windows. Ironically, there is a lesson on the benefits of tourism scribbled on the blackboard of one of the classrooms. The schoolteacher says that he cannot remember ever seeing a tourist.