China

Agency
Orbis

Name and Location
Shanxi Eye Hospital in Taiyuan, China

Case Study Details

Sharing sight saving skills in China

Ken Nischal FRCOphth is a Consultant Ophthalmic Surgeon at Great Ormond Street Hospital for Children and Moorfields Eye Hospital. In his spare time he works as a volunteer surgeon for ORBIS travelling to developing countries and sharing his skills with local doctors. Ken has been volunteering with ORBIS since 2004 and has just returned from delivering an intensive training programme at Shanxi Eye Hospital in Taiyuan China, his fifth programme in China.

The aim of the training was to improve the knowledge and skills of local doctors in treating children with eye conditions and focusing on developing their skills in handling cases of strabismus*. Shanxi Eye Hospital is one ORBIS’s long standing partners in China and a beneficiary of Seeing is Believing. On his return from China Ken is strengthening even further the skills at the hospital by hosting Dr Junhong Li from Shanxi as she spends three months with Ken taking part in an observership at Great Ormond Street.

* Strabismus = A visual defect in which one eye cannot focus with the other on an object because of imbalance of the eye muscles. Also known as heterotropia, squint, tropias.

Ken Nischal

I arrived in Taiyuan on Sunday 23rd September to be met by Zhang Yu from the local ORBIS office and one of my trainees Dr Junhong Li who is a Consultant ophthalmologist at Shanxi Eye Hospital. Dinner that evening included a discussion of the schedule of the week ahead and their expectations of the programme and what we hoped to achieve.

On Monday morning I met the trainees who were going to be participating in the training programme:

Zhang Wei had done 4 years of ophthalmic experience and was based at Shanxi Eye Hospital (SEH) as were Wuan Lily and Chang Min both of whom had 10 years experience. Fan Zhen had 15 years experience and had come all the way from Ghanzou Province where she works in a Women and Children’s’ Health Hospital. Wu Hai Ling had 3 years previous experience at Quing Hai Xi District Peoples’ Hospital and Song Li Xia had 10 years experience ay Shanxi Datong Hospital.

The paediatric ophthalmology department is headed by Dr Zhang Li Jun who is helped by Drs Junhong Li and Feng Xue Liang.

The first day entailed spending time with the trainees, examining child strabismus patients and determining which ones would benefit from surgical intervention. The interaction between all of us was very heartening and I’d like to think enjoyable for all concerned.

One of the cases we saw was a 3 month old child with ‘very large’ pupils. The child had a condition called ‘Aniridia’. In this condition the coloured part of the eye is not formed thus making the pupils look very large. This condition is usually inherited in an autosomal dominant manner (that is, only one faulty gene is needed for someone to suffer from the condition). Sometimes the condition can occur in a child without the parents or any other family member being affected. In these circumstances there can be a chance that the child may also have a kidney tumour. This was something that the trainees did not know and was a good example of how in paediatric ophthalmology the child must be approached and examined as a whole.

The surgical sessions were very enlightening; the trainees and doctors at the Shanxi Eye Hospital are very skilled, however one of the main areas that they needed help in was deciding which operations to do when faced with a choice of procedures for a particular case. This is extremely important as choosing the appropriate procedure will massively affect the long term development of the child. What was very interesting was that being an eye hospital the emphasis is almost on the eye and not necessarily the child. What this meant was that there was no general anaesthesia available and so children as young as 5yrs old were having complicated procedures such as cataract operations under little more than sedation. This was the only area of patient care within the hospital that I felt really needed to be improved.

At the end of my stay in Shanxi I felt the trainees had learnt the basics of strabismus assessment and had learnt to consider that the child with an eye problem needs to be approached differently from an adult with an eye problem: the child‘s brain is still developing so you can manipulate a poorly seeing eye to improve the vision for the rest of that child’s eye. Also, a child must be approached holistically since vision in a child plays such a huge role in their overall development.

At the end of the programme we were walking outside the hospital and I saw a young child playing a game akin to a spinning top game. He had a piece of rope which he would strike on a wooden top to make it spin. It occurred to me that all we as eye care specialists want is that every child in the world has the opportunity to grow and play normally. ORBIS supported by Standard Chartered Bank and other organizations is doing its best to make this a possibility for all the children of the world.

 

Pictures courtesy of Orbis.

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