Recently, Megan Webber was able to speak with Dr. Rosie Brennan and learn about her incredible work in the Tanzania region. As a Global Ophthalmologist she has traveled far and wide and her story below written in her own words best encapsulates her work in Tanzania. We are delighted to feature her work in Tanzania and are thrilled to see she’s had such an impact.
Dr. Rosie Brennan, Global Citizen Consultant Ophthalmologist
NTC-H, Inverness, Scotland
(Reprinted with permission by author, Dr. Rosie Brennan)
In 2020 I was delighted to be appointed as a global citizen consultant in ophthalmology. Global citizen posts are a NHS Scotland initiative. There have been three such posts created, with one in ophthalmology so far. I work 10 weeks a year in a low- or middle- income country and divide the rest of my time between 3 hospitals in Scotland . I chose to commit to Tanzania where I was first linked with a government hospital in Mbeya in 2013 through a VISION2020 links programme. With permission from the Tanzanian Ministry of Health, I divided my 10 weeks there between 3 government hospitals: Bugando Medical Centre in Mwanza, Benjamin Mkapa Hospital in Dodoma and Mbeya Zonal Referral Hospital. I have been able to share the problems and solutions encountered in the different units to the benefit of all.
The first visit to a unit is a time for watching, listening and building a rapport. I’ve learnt about local rarities like rhinosporidiosis and xeroderma pigmentosa and autologous blood fixation of conjunctival autografts. The subsequent visits are much more intense for me and more productive as doctors, optometrists and nurses call on me to discuss cases and techniques. I have been very much supported by my home colleagues when faced with urgent clinical scenarios outside my expertise. Radiologists in the UK send me their opinions on images I send and plastic colleagues give me immediate advice.
My time is spent teaching in clinic and theatre, helping to set up new programmes and running workshops and tutorials. Projects have included getting a grant to get a fundus camera and then training and setting up a formal diabetic screening programme in Dodoma, simulated and then supported PRP training in Mwanza and Mbeya, cryotherapy for suitable retinoblastoma lesions in Mwanza (chemotherapy also used), gonioscopy training in two units in preparation for the acquisition of an SLT, paediatric visual acuity assessment, strabismus assessment and surgical treatment.
At one hospital we had 7 consecutive cases of endophthalmitis following intraocular surgery of both small incision cataract surgery (SICS) and phaco. The team was devastated. Pseudomonas aeruginosa, cultured from the patients and the infusion tubing, proved to be the cause of the fulminate endophthalmitis, which in some cases also resulted in orbital cellulitis and or corneal perforation. We worked through the whole cataract kit, sourcing more tubing, planning how to clean instruments correctly and to safely use vials on more than one patient. All the staff bought into the new protocols. Fortunately, there have been no further endophthalmitis cases.
I don’t do SICS. In theatre I offer procedures I’m proficient at. Oddly one of the approaches that has been most relevant is the lateral canthal sling. They have so much trauma coming through. I have found that the lateral and medial canthal sling has been a solution to many a poor cosmetic outcome.
Interest in research is high among the young ophthalmologists there. It is easy to help doctors to get posters and presentations together for meetings. Returning to the same places year on year allows us to plan long term projects. However, having a foreigner involved makes for more hoops and expenses in gaining ethical approval.
Back in Scotland I get at least one communication from my Tanzanian colleagues a day – videos and images of patients to discuss, updates on ongoing joint projects. It’s good for my Swahili and it’s lovely to still feel part of their system
