Welcome to Nkhoma, Malawi

Together with the rest of the world, Nkhoma celebrated World Glaucoma Day last Friday.

Glaucoma is the second main cause of global blindness, after cataract.  It is a condition that slowly affects the optic nerve at the back of the eye, and is often associated with high pressure in the eye.  Untreated, the high pressure destroys vision causing tunnel vision, and perhaps eventual blindness.  People here in Africa tend to be affected by a more aggressive form of the potentially blinding condition than say for example in USA or Europe.  Sadly though, because it is so slow to progress, people often become blind before they seek help here.  At Nkhoma last year I looked at all the glaucoma operations we did, and two-thirds of patients who we operated on were already blind in the other eye.  We are trying to start a screening program to detect glaucoma in the early stages, when we can treat it and stop the loss of vision.

All the same, what I basically do is to treat the high pressure, and thereby stop the loss of vision.  Here we do this with an operation called a trabeculectomy, which adds a little drainage outlet at the top of the eye to continuously relive the pressure.  It’s a lot more tricky than cataract surgery, but we get good results.  Another tricky thing is that I need to keep a close watch on the eye after the operation, for weeks and months.  We ask people who have this operation to stay at Nkhoma for a full two weeks after surgery, and then when they go home, we ask them to come back after a month, then after another couple of months.  But Nkhoma is far from some peoples’ villages; and less than half actually do come back.

Mr Edward Richard did come back.  In fact he kept coming back every month for the past 6 months since I did both of his trabeculectomy operations at Nkhoma in September and October 2009.  Mr Richard is a businnesman, and importer and shopkeeper in Lilongwe.  At 35 he is married with 3 children.

Mr Edward Richard

When I saw Mr Richard last year, he said the vision in his Left eye had been deteriorating over the past 3 years.  In fact he was nearly blind in this eye.  His right eye also showed signs of glaucoma.  Without any warning or pain, glaucoma had been robbing him of his vision.

Both operations went well, and when I saw him last week, World Glaucoma Week, the pressure in his eyes were well down, and his vision was stable, and in fact actually improved a little (which is unusual).

We had carefully explained to Mr Richard, as we do to all people who need a glaucoma operation, that the surgery will not give them back their vision, like cataract surgery; but will prevent their vision from getting worse.

I had 4 patients for glaucoma operation on the list for World Glaucoma Day.  Nkhoma Ophthalmic Nurse (and Nkhoma Eye Hospital employee of the month for February !) Vincent Saka counselled them, answered their questions, and put their minds at rest, that although we may not be able to restore what sight they may have lost; we could offer an operation to prevent blindness.  They all accepted and the operations went well.  I will be heading into the hospital this morning to see them all, as they are staying in for a couple of weeks.

Glaucoma patients at Nkhoma on World Glaucoma Day

Finding people with the early stages of glaucoma, and then treating them before they lose their sight is a huge challenge in rural Africa.

We are training medical staff in primary health centres in surrounding districts & villages as far as 100 miles away, to perform vision screening on people over the age of 40.  We hope to be able to reach many more people with glaucoma, before, for them it is too late.

Happy World Glaucoma Day from all at Nkhoma!