Malawi, once the stomping ground of physician David Livingstone in Southern-Central Africa, is home to a very large lake, 19 million people and 77 optometrists.
Sadly, it has few other resources and invariably scores low on healthcare compared to other countries. Most of the population are rural, half are below the poverty line and almost everyone has limited access to the 77 graduate optometrists or 128 diploma technicians providing eye care services throughout the country. The World Health Organization estimates 90% of visually impaired people live in developing countries, suggesting a link between visual impairment and poverty.
There are several schemes seeking to rectify this in Malawi, including the Schools of Optometry Project and a German scheme (One Dollar Glasses) to provide cheap lenses. Larger government hospitals can provide optometry services but none provide spectacles and Malawians must go to private facilities or charities.
In 2009, Mzuzu University began a five-year degree programme, which is followed by a one-year internship in a Central Hospital (Blantyre, Lilongwe or Mzuzu). Technicians train at a different institution, Malawi College of Health Sciences, in the capital city, Lilongwe.
The impact of good lenses in such an environment is life-changing. Optometry student, Alick Kachigwanda (pictured below) says his most memorable experience was prescribing spectacles to a 17-year-old.
‘I will never forget prescribing spectacles to a 17-year-old secondary school student who had problems of unclear vision when looking at the board in class, frontal headaches, painful eyes and eye strains when reading such that he could not read or study for more than an hour.
‘I diagnosed this boy with myopia and recommended spectacles. After having spectacles, all problems he initially presented with became history and his performance in class improved. Finally, his entire family came to thank me. I shall always remember this boy throughout my entire optometry career,’ Kachigwanda said.
Kachigwanda chose optometry because he saw the effect of glasses on his grandmother’s life. He is driven by the trust people place in him.
‘The exciting thing about optometry is the fact that people trust you with their eyes; you care for their sight and whole wellbeing. This trust invigorates me to work even harder in the career making a difference in the lives of many people. We are super-excited to see patients having their sight improved, restored or healed from different eye conditions. My zeal for optometry shoots from my desire and love to help people. Being raised by a generous mother full of love and care, I learnt to value and cherish the lives of others.’
Kachigwanda comments that the challenges he faces include a shortage of teachers, the tough technical skills he needs to learn and the lack of equipment to share among the students.
Tiwonge Phiri, a senior student at Mzuzu University, says her working day begins with lectures at 7.30am and continues with placements and more lectures until 5.30pm. If there is electricity, she studies into the night on a laptop provided by Medic to Medic, a charity dedicated to supporting healthcare students through their training by providing students with all the resources required for their studies. Phiri is excited that she is now able to do refractions and prescribe lenses for people whose lives are transformed by being able to see clearly.
Phiri says her biggest challenge is the cost of living and training. From a rural background, she relies on a grant from Medic to Medic to pay her fees and cover living costs. Even so, students share laptops, working shifts around the clock and also share optometry instruments at around two per class of 40 students. Many run small businesses to fund themselves and, as a parliamentary committee heard recently, some through sheer desperation turn to prostitution so that they do not need to give up on their dream of obtaining a qualification.
Having the opportunity to obtain professional employment and a modest sustainable source of income will break the cycle of poverty existing within families and transform the future prospects of the student. Their work is vital in developing countries where optometrists maximise the learning potential for children and employment opportunities for adults.
They are important and Malawi needs more of them.
- Tamsin Lillie is chief executive officer at Medic to Medic UK. For more information visit medictomedic.org.uk.