October 12, 2004 Page 1 PROVINCE OF KWA-ZULU N ATAL HEALTH SERVICES ISIFUNDAZWE SEKWAZULUNATALI EZEMPILO PROVINCSIE OF KWAZULU NATAL

GESONDHEIDDIENSTE

Stanger hospital eye care centre

Stanger Provincial Hospital Phone: 032-4376039 or 032-4376188 Private bag: X10609 Fax: 032-5522767 / 032 5521336 Stanger. 4450 Email: AZIM@telkomsa.net Enquiries: Dr. R A Chowdhury MBBS, Diploma Ophthalmology (S.A) Chief Medical Officer (Ophthalmology)

Business plan for Stanger eye care centre:

Ophthalmology is a rapidly advancing speciality in terms of technology. With this rapid development in technology and changes in eye care at all levels we consider these developments will be a shift in care. i.e. what is secondary care today; may be it will be primary care tomorrow. Following future development trends were identified. More complications of HIV together with a normal increase of cataracts and glaucoma for the next ten years more funding for cataracts better primary screening system might increase cataract numbers more cataract surgery with intraocular lens implant reduced cataract backlog. Better screening for: * Diabetic retinopathy and Hypertensive retinopathy * Glaucoma screening * Paediatric screening Telemedicine and Tele-ophthalmology Training for cataract surgeon and training for CSO and ophthalmic nurses.

Prioritisation: Any advances in cataract, glaucoma, diabetics, childhood blindness and corneal blindness. Refractive blindness has been covered under primary care.

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Quality of care: Shortcoming and limitations:

* Lack of qualified Ophthalmic (Eye) surgeon (Ophthalmologist / Ophthalmic CMO) * Long waiting lists. (Cataract backlog) * Lack of adequate secondary hospitals.

Lack of community service rotation post to strengthen primary and secondary care and nursing staff. Dedicated ophthalmic nursing staff. Supplies: Ophthalmic microsurgery equipments, intraocular lenses, ophthalmic drugs and disposable. Optimising available IT infrastructure.

Service delivery requirements for effective education:

Service delivery must permit postoperative follow-up and outcome measurements. Appropriate planned and equipped out patient, inpatient and ophthalmic surgical facilities. Optometrist: With support of stanger hospital eye care centre. Effective education of
optometrists in basic pathology recognition in order to promote appropriate and timely referral.

With support of ICEE. optometry training. Medical: One week exposure / rotation through ophthalmology department. Nursing: Two weeks practical ophthalmic exposure. CME: Once in a month.

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Organization of services:
Primary eye care: 1. 2. 3. 4. 5. 6. Vision screening; e.g. visual acuity, pinhole, auto refraction etc. Cataract, glaucoma, diabetic and hypertensive retinopathy screening. Screening for squints and amblyopia. Refraction. Routine intra ocular pressure check up and Visual field. Prosthesis fittings, contact lenses etc.

Secondary eye care: 1. 2. 3. 4. 5. Routine cataract surgery with intraocular lens implant. Routine glaucoma surgery. Routine trauma surgery. Yag capsulotomy. Routine horizontal strabismus and amblyopia treatment.

Stanger hospital (Regional Hospital):

A regional hospital provides predominantly level two ophthalmic care as defined in the hospital strategy project, i.e. care that requires the expertise of general specialist-led teams. The aforementioned are provided on a full time basis.

Regional hospital: Stanger.

Which services to be provided?
Diabetic, cataract and glaucoma screening. Routine glaucoma surgery. Routine cataract surgery. Routine horizontal strabismus (Squint) and amblyopia treatment. Routine trauma. (Lid, cornea, sclera)

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Which personnel required?

1 1 1 1 3 2 2 1 x x x x x x x x General ophthalmologist. Chief medical officer (ophthalmology) Principal medical officer. Principal optometrist Ophthalmic Professional nurse. (OPD) Ophthalmic Professional nurse. (Theatre) Staff nurse. (OPD) Clerk (ophthalmic trained)

Which resources required?

(Equipment, diagnostic facilities, inpatients, out patients and drugs )

Out patient clinic

(Three separate room)

Snellen chart, pinhole, reading card, trial lens set, trial frame, retinoscope. Auto-refractor. Direct and indirect ophthalmoscope with 20 D lens and Fundus camera. Slit lamp with inbuilt digital camera. Field analyzer and hand held tonometer. Minor out patients ophthalmic surgery; e.g. chalazion excision. Dedicated Ophthalmic ward
(2X ophthalmic nurse; 4x staff nurse)

Male ophthalmic bed (15) Female ophthalmic bed (15) Paediatric ophthalmic bed (10) Infected ophthalmic bed (5) Operating room Operating microscope X 1 Operating bed X 1 Surgeons operating chair X 1 Portable ophthalmoscope X 1 Different microsurgical instruments.

(Cataract set x 2, Glaucoma set x 2, Lid set x 1,corneal set x 1, enucleation and evisceration set x 1)

Which other linked /supporting services on site?

Tele-ophthalmology International centre for eye care education student (ukzn) (ICEE) and training for optometry

Which teaching / training function can be conducted by level?

Rotation for CSO and nurses. (At least to identify, manage and deliver primary eye care). Cataract surgery training for interested medical officer.
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Achievement of Stanger hospital eye care centre:

We have started with our newly established Stanger eye care centre in March 2004 and we have achieved more than we can expect. Followings are our achievements within this period from March 2004 to September 2004. First ever cataract camp successfully held on 27th to 29th of September 2004 and 25-cataract extraction with intraocular lens implant were performed without help of any provincial health department. Proper appointment system. Setting up proper eye out patient department. Proper diagnosis and dispensing of effective management at eye OPD. Proper control over dispensing of ophthalmic medications. Total number of patient screened approximately 6000 (March to September) at our OPD. Only two emergency referral to St.Aidans hospital at Durban since March 2004. Admission of eye patients. Management of all kind of eye trauma and if necessary telephonic consultation at St.Aidans hospital. Regular cataract and glaucoma surgery. We are performing 8 to 10 cataract and glaucoma surgery per week. Total 80 cataracts with Intra Ocular Lens implant done from mid July 2004 to Septeptember 2004. Setting up of proper diabetic and hypertensive retinopathy clinic and total 50 patients were benefited by receiving laser treatment because of early detection of diabetic and hypertensive retinopathy. Proper referral for diabetic and hypertensive retinopathy to St.Aidans hospital. Setting up proper and effective glaucoma clinic. With support of stanger hospital eye care centre. Effective education of optometrists in basic ophthalmic pathology recognition in order to promote appropriate and timely referral.

Regular cataract camp will be held every 4 month interval if proper assistance obtain.
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