In early March 2021, as the world slowly emerged from the standstill caused by the Covid-19 pandemic, Megan Webber, Co-Founder of KnowTheGlow, connected with three influential doctors: Dr. Clare Gilbert, Dr. Richard Bowman, and Dr. Aeesha Malik who were involved in initiating a pilot training module for pediatric eye health in Tanzania. Fast forward to the present, Megan eagerly seized the opportunity to meet Dr. Milka Mafwiri, a pediatric oriented ophthalmologist at Muhimbili National Hospital and professor at Muhimbili University of Health and Allied Sciences, in Dar es Salaam Tanzania who was on the ground implementing the training module for the pilot program. Together, Dr. Mafwiri along with others are working on educating healthcare workers about checking children’s eyes during routine immunizations and weight checks, as part of their broader goal to enhance primary healthcare for children. Dr. Milka Mafwiri enthusiastically shared the significant progress that has been made in improving pediatric eye health with Megan.
Dr. Milka Mafwiri’s journey from her residency, in Germany to her esteemed roles as a general ophthalmologist and later as a pediatric oriented ophthalmologist, Community Eye Care Specialist and professor at Muhimbili University of Health and Allied Sciences in Tanzania is a testament to her unwavering dedication to advancing eye care. After completing her three-year residency to specialize in ophthalmology, she pursued collaborative studies in microsurgery in Germany, enriching her skills. Returning to Tanzania, she began her practice at an eye clinic in the north, where she immersed herself in diverse ophthalmic procedures, including anterior segment surgery. Recognizing the need for specialization and a desire to share her expertise, she transitioned to the Christian Blind Mission NGO ( The Comprehensive Community Based Rehabilitation in Tanzania) hospital for four years, broadening her experience and witnessing firsthand the clear need for focused training in ophthalmology. This prompted her decision to return to academia to become a trainer, ultimately fostering a new generation of eye care professionals.
Joining a university 21 years ago marked a pivotal moment in her career. Driven by her observations of deteriorating infrastructure and funding shortages, she leveraged opportunities through Vision 2020 The Right to Sight Global initiatives and collaborated with institutions like the London School of Hygiene and Tropical Medicine (LSHTM) through the Vision 2020 Links Program to establish the East Africa College of Ophthalmology (EACO) whose aim was to increase the quantity and quality of ophthalmology training in the Eastern Africa region. Muhimbili with other 4 universities in EA were the founder members of this virtual college. This endeavor led to improved shared funding and harmonization residency training curriculum to achieve the common aim. In 2012, EACO was transformed into COECSA comprising 13 countries in Eastern, Central and Southern Africa. The V-2020 Links program enabled institutions in the north to go into partnerships with those in the south, where Muhimbili collaborated with Guys-StTthomas in UK, an opportunity that led to the growth of specialized clinics, notably in pediatric ophthalmology, retinal and glaucoma care through transfer and sharing of skills, facilitated by international partnerships. However, during her tenure, Dr. Mafwiri noticed alarming trends in late diagnosis of eye conditions in children, a situation that compromised outcome of treatment. A pivotal conference encounter in London sparked her interest in further studies, despite initial reservations about age, leading her to pursue a program focused on community eye care at LSHTM, where she dove into the research surrounding late diagnoses of eye conditions in children and the low survival rates for children with eye tumors.
Her profound insights into the challenges faced by young patients, coupled with guidance from her inspirational supervisor Dr. Clare Gilbert culminated in her groundbreaking thesis. Dr. Mafwiri advocated for empowering primary healthcare workers with critical knowledge to identify and prevent avoidable blindness through the World Health Organization ten key messages for prevention of blindness in children.. Her thesis not only encapsulated her dedication but also laid the foundation for widespread education on preventive measures, ranging from basic eye hygiene to the timely identification of eye abnormalities in children.
Her research revealed a critical gap in primary eye care at the grassroots level. Determined to address this, in 2018, she and Aeesha Malik from LSHTM, eye health stakeholders and Tanzania ministry of health developed an eye health module, incorporating it into the Integrated Management of Childhood Illness (IMCI) training program. The pilot training of IMCI including the eye health module in Bahi district in central Tanzania showcased promising results, with over 3,000 primary health workers trained to-date. Despite challenges including, at the time, the lack of the Arclight tool, progress has been substantial. Dr. Mafwiri highlighted the ongoing collaboration with Dr. Godfrey Mndeme to train on how to use the Arclight as a cheaper equipment to use not only for external eye examination but also testing the red reflex at primary health facilities to enable early identification and referral of children with complex eye conditions. She expressed satisfaction with the positive practices observed during her recent visit, emphasizing the need for continued collaboration and to address health system issues that are likely to slow down the progress towards full integration of primary eye care into the broader healthcare system.
Looking ahead, Dr. Mafwiri envisions expanding the eye care module nationally, integrating it into growth monitoring programs. Her focus extends to post-delivery education and nationwide Retinopathy of Prematurity (ROP) screening. Engaging with the government on ROP concerns and considering use of the Arclight for further training, she remains dedicated to ensuring pediatric vision concerns are part of routine healthcare. While accomplishments have been notable in two regions, Dr. Mafwiri is determined to extend these initiatives to all 8,000 primary healthcare facilities in Tanzania, fostering a comprehensive and sustainable approach to pediatric eye health. Dr. Mafwiri’s unwavering commitment to transforming eye care in Tanzania embodies her enduring quest to safeguard vision and enhance the quality of life for future generations. We look forward to charting her progress and know that the groundwork that has been laid will lead to tremendous steps forward in vision care throughout the country thanks to Dr. Mafwiri and her team and the whole team led by Dr. Clare Gilbert from the LSHTM and for the Ministry of health in Tanzania for adapting the change of policy by agreeing to incorporate the eye health module into IMCI in the country.
Seeing how much change has occurred in the two decades since she began this journey she is excitedly anticipating just what awaits the world of pediatric vision care in Tanzania in the years ahead! We know that with Dr. Mafwiri leading the charge, a bright future is sure to follow!
