Eye Department
Annual Report
2010
Introduction
The year 2010 saw the change in our Medical Records software, which was implemented starting from 1st January, the previous software was no longer satisfactory. So far the new software seems to be working well. A number of our staff had reached retirement age in this year; these were Evangeline Kweka, Helga Selemani and Sifaeli Moshi. At the same time there have been new comers, Charisma Olotu, Serapia Ottaru, Filbert Haule and Rehema Lyimo. Howard Kitonka was trained as a visual field technician and is now doing all of our perimetry. We have started to train him to do the Optical Coherence Topography and Fundus Photography.
Clinical Services
Eye Clinic
Diagnostic Services
The Eye Clinic provides consultation for every working day of the week, currently there are seven ophthalmologists and two assistant medical officers ophthalmology manning the clinics. There are two specialized clinics, the Retina Clinic and Laser Microsurgeries on Fridays and Paediatric Ophthalmology Clinic everyday. Lee Woodward and Furahini Mndeme are manning the Paediatric Ophthalmology Clinic. Since February 2009 flourescein fundus angiographies have become available, thanks to the University Hospital Birmingham who donated digital components to our existing fundus camera. In 2009 a total of 86 flourescein fundus angiographies were done, this number has increased to 111 in 2010. The same team also helped in setting up our Zeiss Automated Visual Field Analyzer, by December 2009 a total of 408 fields had been done. In February 2010, the Zeiss Stratus OCT became operational and since then up to the end of the year 182 tomographies have been done. This instrument together with others mentioned have increased our diagnostic abilities and improved patient care.
Table 1: Consultations
Total Number of Consultations 22284
Males 13358
Females 12001
Children (< 15 yrs) 4027
New Consultations 10156
Return Visits 12128
Table 2: Top 10 Diseases
1 Refractive Errors 4760 (21%)
2 Pseudophakia 3404 (15%)
3 Normal Eyes 3131 (14%)
4 Cataract 2952 (13%)
5 Conjunctiva disorders 2794 (12.5%)
6 Glaucoma 1897 (8.5%)
7 Retina Diseases 936 (4%)
8 Other Ocular 906 (4%)
9 Keratitis 601 (2.6%)
10 Chorioretinitis 591 (2.6%)
Table 3: Top 10 Ocular Diseases in Children
1 Normal Eyes 734
2 Allergic Conjunctivitis 564 (736)*
3 Refractive Errors 478
4 Pseudophakia 440
5 Cataract 214
6 Cornea Scar 212
7 Glaucoma 131
8 Conjunctival newgrowth 121
9 Strabismus 112
10 Keratitis 109
*All Conjunctival Disorders
Therapeutic Services
Minor Theatre
Minor Theatre is where minor surgical procedures are done, as well as laser microsurgery for diabetic retinopathy or capsulotomy. Also fitting of prosthetic eyes is done. For the minor theatre to operate it has got to have a nurse manning that station, usually one of the Eye Clinic nurses fulfills this duty. The room is equipped with sterilizers that sterilize instruments used in minor surgeries. Off hours it also serves as a wet lab for trainees.
Table 4: Top 10 Minor Theatre Procedures
1 PRP 226
2 YAG 166
3 Bevacizumab inj 162
4 Focal / Grid Laser 129
5 Minor Surgeries 91
6 CPC 83
7 Prothesis Fitting 67
8 Gancyclovir inj 43
9 Triamcinolone inj 39
10Retrobulbar EtOH 19
Eye Pharmacy
The Eye Pharmacy dispensed drops to all our patients and has run successfully in the past year. Mrs. Mzava has managed the pharmacy well, during the year it was shifted from its original location to its current location in Room 16.
The Eye Department Low Vision Therapist, Zenobia Mkenda who is also the paediatric optometrist has been providing Low Vision Devices and Optical Rehabilitation for our Low Vision patients.
Preventive Medicine
Momentarily the Eye Department is not involved in Preventive Ocular Medicine, however with the launching of Diabetic Retinopathy Screening by Kilimanjaro Diabetic Project in collaboration with Tanzania Diabetic Association, soon ophthalmologists and residents will be involved in fundus photography reviewing and grading.
Eye Ward
The maximum bed capacity in the ward is 90 beds, however momentarily there are 71 beds available, the rest being on loan to other departments. There are four private rooms with a total of 8 beds. There are 23 canvas beds and 28 normal hospital beds in rooms 1 to 5, while there are 12 more beds in room 6 reserved for infectious and contagious eye diseases. However the ward should have 68 beds for patient comfort. In the course of the year, both male and female washrooms were repaired including floor tiling.
Table 5: Admissions
Total Number of Admissions 2548
Males 1376
Females 1072
Children (< 15 yrs) -
Table 6: Top 10 Diseases in Eye Ward
1 Cataract 1332
2 Retina Detachment 178
3 Injuries / Trauma 172
4 Cornea Ulcers 153
5 Glaucoma 137
6 Conjunctival Neoplasia 112
7 Squints 37
8 Orbital Cellulitis 35
9 Retinoblastoma 14
10 - -
Eye Theatre Since the new theatre became operational the surgeries are not limited by capacity any more. Currently there are seven operating tables that have pushed our daily capacity in excess of 30 surgeries a day (theoretical maximum capacity of 50 surgeries a day). The theatre is well equipped with operating microscopes and vitrectomy machines. With exception of occasional nursing shortages in the theatre the surgical services have run smoothly in the year.
Table 7: Surgeries
Total Number of Surgeries 2251
Males 1309
Females 942
Children (< 15 yrs) 428
Table 8: Top 10 Ocular Surgeries
1 Cataract Surgery 1317 (1609)*
2 Retina Surgery 110
3 Trabeculectomy 104
4 Cornea Repair 102
5 Conjunctiva excision 82
6 Lid Repair 31
7 Evisceration 27
8 Lid Reconstruction 22
9 Squint Surgery 17 (55)
10 DCR 15
*Including Outreach Surgeries
Table 9: Top 10 Ocular Surgeries in Children
1 Cataract Surgery 117
2 Cornea Repair 54
3 EOM Surgery 37
4 Glaucoma Surgery 27
5 EUA 19
6 NLS Probing 15
7 Retina Surgery 11
8 Cyclophotocoagulation 10
9 Conjunctival Excision 9
10 Evisceration 6
Eye Outreach
Table 10: Outreach
Number of Visits: Direct Referral Site 37, Surgical Safari 10
Number of People Screened: DRS 5418 Surgical Safari 2628
Number of Patients Operated: DRS 341, Surgical Safari 292
Training Services
School of Optometry: Dustan Kiwelu is the basic ophthalmic sciences and clinical ophthalmology tutor of the school, had 72 hours of lectures in academic year ending in 2010. A total of 12 optometry students rotated in the eye department for their practical training.
Ophthalmic Nursing: Furahini Mndeme is engaged in teaching basic ophthalmic sciences and clinical ophthalmology to advanced diploma ophthalmic nursing students. He was recently part of the team to review the curriculum of that course. He lectured for 20 hours and 18 students rotated in the eye department for their practical skills training. Valeria Matei is another part time tutor in that School.
Assistant Medical Officers Ophthalmology: In 2010, a total of 11 Assistant Medical Officers Ophthalmology graduated, seven of them had done a two year course including cataract surgery, these were:
Francis Kifutumo (Nkinga - Igunga)David Manento (Heri - Kigoma)
Godfrey Kajimbwa (Vwawa – Mbozi)
Erick Myonga (Makete)
Festus Mhagama (Rufiji)
David Mbewe (Zambia)
Edward Ole-Motika (Olkusmet – Simanjiro).
Four did a one year course of clinical ophthalmology only, they were:
Zuberi Semkuya (Kagera)
Kileha Kampehehe (Kasulu)
Naomi Shayo (Mawenzi – Moshi)
Gloria Ndossy (Huruma- Rombo)
One Ophthalmic Nurse from Uganda Paschal Nsekuye converted from ICCE to ECCE in three months ending in July 2010.
Table 11: AMOO Training
AMO-O I 2010-2012
John Ngaa (Singida)
Ashraf Mlanzi (Mvomero)
Muhoja Jibalo (Kwimba)
Elias Mwakasita (Kyela)
Upendo Abedi (Mtwara)
Allico Mwajute (Mbeya Referal Hospital)
Argent Moonga (Zambia)
AMO-O II 2009-2011
Fariji Kilewa (Ilembula)
Nganyanga Sosoma (Nzega)
Hhangali Hhangali (Mbulu)
Susan Malangu (Mvumi)
Frank Mbewe (Malawi)
Patrick Kibe (Kenya)
Undergraduate Teaching: There was a total of 10 hours of lecturing to MD1 students, two hours for MD2 and 10 hours to MD3 students, also 90 hours of tutorials were administered to MD3 students during their clinical ophthalmology rotation. A total of 87 MD3 students rotated through the eye department between May and July 2010.
Postgraduate Teaching: Three residents graduated in August 2010, Emmanuel Byamukama (Rwanda), Jason Nirwoth Pithuwa (DR Congo) and Furahini Mndeme
(Tanzania). All the residents passed their Final University Examinations in August.
Table 12: MMed Ophthalmology Training
MMed I 2010-2014
Frank Sandi - Tanzania
Mchikirwa Msina - Tanzania
Sob Laurianne - Camerron
Etienne Ndembele - Mali
Chansa Kayula - Zambia
Chelu Chisanga - Zambia
MMed II 2009-2013
Felida Mwacalimba - Zambia
Blanche Nguena - Camerron
Elisante Muna - Tanzania
Japhet Mbaga - Tanzania
MMed II 2008-2012
Chantal Giramahoro - Burundi
Adubango Udendere - DR Congo
MMed IV 2007-2011
Amadou Alfa Bio - Benin
Marvice Okwen - Cameroon
MMed Graduated 2006-2010
Furahini Mndeme - Tanzania
Jason Pithuwa - DR Congo
Emmanuel Byamukama - Rwanda
Retina Fellowship: Joseph Msosa from Malawi finished his Vitreo-Retina Surgery training in August. He was the seventh person to be trained at KCMC. William Makupa started his training in August.
Research Services
The department supervised eight research projects for the undergraduate programme, this is an increase from five research projects supervised in 2009. Postgraduate Dissertations are still been supervised by KCCO personnel, Paul Courtright, Susan Lewallen and Matthew Burton. The Eye Department is not involved in Research Thesis of the Allied Health Sciences School of Advanced Diploma in Ophthalmic Nursing.
Future Plans
1. In line with the current efforts to improve patient care and the training of ocular subspecialities, the Eye Department seeks to have one ophthalmologist trained as Oculoplatic and Orbital Surgeon. Other subspecialities considered are Glaucoma, Uveitis, Neuro-ophthalmology, Ocular Pathology, Medical Retina and Cornea. The training in Oculoplatic and Orbital Surgery may be achieved in collaboration with Univeristy Hospital Birmingham through the LINKS programme.
2. Improvement of our diagnostic capabilities call for acquisition of some diagnostic tools, these are Pachymeter, Cornea Topography Machine, B-scan Sonography, Synoptophore, Bagollini glasses and TNO Stereotest.
3. A high speed vitrectomy machine is necessary for the vitreo-retina surgery, possibilies of obtaining one through donors has got to be looked into.
4. Consolidation of teaching activities by adopting a more traditional approach based on Dogma, Didactism and Pedagogy. Formation of Departmental Academic Committee with its constituent sections; Postgraduate Didactical Section, Undergraduate Didactical Section and AHSS AMO Ophthalmology. Also partition of teaching into Basic Ophthalmic Sciences, Clinical Ophthalmology and Ocular Surgery Training.
5. Improve the ambiance in the Eye Ward, increase the number of hospital beds, and reserve the camp beds for emergency use in case of overcrowding. Change of ambiance also calls for painting the walls, floors and washrooms.
6. Militate for development of a legal framework by Tanzania Government through the Ministry of Health for harvesting and transplantation of human corneas in KCMC.
On behalf of the Eye Department I would like to express our sincere gratitude for the conducive environment, support and guidance afforded to us by the Executive Director and the administration of KCMC in pursuance of our daily activities in the department but also the in participatory departmental development planning. Most of the planned equipment acquisition and building improvements are relying on expected donor support; I would like to recognize the fundamental contribution of CBM to the department over the years and also of the European Union through EACO more recently. Prevention of blindness measures through screening for eye diseases and transportation for intervention are financed through KCCO facilitation, whose contribution to this cornerstone of medical care cannot be overstated. Other development partners are Light for the World (Austria) who has enabled a number of doctors to train as ophthalmologists increasing the number of eye care cadres in the country, Eye Care Foundation (The Netherlands) and University Hospital Birmingham to which the department is paired under the Links Programme. UHB has provided equipment, training and examination support to the department since 2007.
William Makupa
Head of Ophthalmology Department
30th January 2011
List of Staff
Ophthalmologists
1. Anthony B. Hall (Head of Department)
2. Irma Makupa (Ocular Oncologist)
3. Honest Maro
4. William Makupa
5. Furahini Mndeme
6. Lee Woodward (Head of Postgraduate Training)
7. Heiko Phillipin
8. Brian Savage (Part time)
Assistant Medical Officers Ophthalmology
1. Honest Kitingati (AMO-O)
2. Dustan Kiwelu (AMO-O)
Administrative Personnel
1. Domina Maro (Administrator)
2. Odilia Kessy (Secretary)
3. Grace Oforo (Accountant)
4. Humphrey Nderengo (Accountant)
5. Helga Lyamuya (Cashier)
6. Godson Mng’ale (Medical Records)
7. Sia Kisanga (Office Attendant)
8. Sifaeli Moshi (Driver)
9. Filbert Haule (Driver)
10. Baltazar Mosoi (Outreach Coordinator)
11. Rehema Lyimo (Medical Records)
12. Judith Mzava (Eye Pharmacy)
Optommetrists/Opticians
1. Upendo Mmari (Head of Section)
2. Bibiana Allagwa
3. Aimbora Kimaro (Away for studies)
4. Hidegard. Mushi
5. Filbert Mlay (Optical technitician)
6. Zenobia Mkenda
Nurses
1. Valeria Matei (Coordinator Eye & ENT)
2. Geneva Mchau (In Charge Eye Clinic)
3. Hilda Mafole (Ag In Charge Eye Ward)
4. Rosemary Lyaro (In charge Eye Theatre)
Eye Clinic
1. Evadrisila Silayo
2. Flora Peter (C)
3. Mary Machange
4. Christina Mollel
5. Elitrude Lyimo
Eye Ward
1. Cecilia Minja
2. Apaisaria Kiwia (Away for studies)
3. Rachel Massawe
4. Praxeda Moshi (Away for studies)
5. Asha Msuya
6. Nsia Ndossa
7. Cresensia Mshana
8. Valentina Minja
9. Winifrida Mosha
10. Rose Towo
Eye Theatre
1. Adelina Shayo
2. Rose Shirima
3. Fidea Mussa (C)
4. Pulkeria Marandu
5. Felista Makundi
6 Agatha Lihanda
Medical Attendants
Eye Clinic
1. Howard Kitonka (C)
2. Ruwaichi Makundi
3. Charisma Olotu
4. Grace Tesha
5. Anna Mlay (Councellor) (C)
Eye Ward
1. Anna Ngowi
2. Aurea Msaki
3. Lilian Kimambo
4. Agnes Chami
5. Chenkela Mnzava
6. Anyesi Kasambala
7. Beatrice J. Kilenga (C)
Eye Theatre
1. Grace Mvula
2. Evetha Kimaro
3. Grace Tumaini
4. Leah Tarimo
5. Serapia Ottaru (C)
List of Graduated MMed Ophthalmology Students
Kazim Dhalla (2001) Tanzania
Bernadetha Shilio (2002) Tanzania
Joel Ndembele (2002) Mali
Judith Mwende (2004) Tanzania
Hemed Kilima (2005) Tanzania
Emeritus Chibuga (2005) Tanzania
Hassan Gelema (2006) Tanzania
Sidney Mwala (2006) Zambia
Musonda Mumba (2007) Zambia
William Makupa (2008) Tanzania
Elijah Munachonga (2008) Zambia
Honest Maro (2009) Tanzania
Ahmed Al-Attas (2009) Tanzania
George Kabona (2009) Tanzania
Celestine Habyakare (2009) Rwanda
Furahini Mndeme (2010) Tanzania
Emmanuel Byamukama (2010) Rwanda
Jason Pithuwa (2010) DR Congo
List of Retina Surgery Fellows
Kazim Dhalla 2004 (Tanzania)
Amos Kibata 2006 (Kenya)
Samwel Rotimi 2006 (Nigeria)
Emeritus Chibuga 2007 (Tanzania)
Ludovika Tindiyebwa 2008 (Uganda)
Asiwome Seneadza 2009 (Zambia)
Joseph Msosa 2010 (Malawi)
List of Former Heads of Department
Joseph Taylor 1971-1982
Marylyn Scudder 1982-1993
Walter Jana 1993-1994
David Hunter 1994-1999
Mark Wood 1999-2000
Anthony Hall 2000-2011
William Makupa
Head of Department - Ophthalmology
30th January 2011
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