Why KCMC must have an expanded Eye Theatre

Home  /  Eyes of Africa  /  Kilimanjaro Centre  /  Why KCMC must have an expanded Eye Theatre

KCMC is the major eye department in Northern Tanzania, acting as a referral hospital for over 15 million people. It is also a teaching department with a 4 year Masters in Medicine programme in Ophthalmology (MMed), training ophthalmologists for Tanzania, Zambia, and Rwanda, training cataract surgeons (clinical officers), nurses and optometrists. Currently there are 10 residents MMed and 6 cataract surgeon trainees. Over 2 million people are directly served through community outreach programmes that bring cataract patients to KCMC. In addition KCMC eye department provides Vitreo-Retinal surgery to much of East Africa and we provide the only sub-Saharan vitreo retinal training outside South Africa.

The Table summarises our increased activity. Over the next 2 years the number of cataract surgeries is projected to increase to over 3000 per year with a concomitant increase in other surgeries.

Surgery at KCMC Eye Department 2001 to 2004

Indicator

2001

2004

# cataract operations

752 (68 of these were children)

2,026 (158 of these were children)

# total surgeries

1,420

3,005

Regional Cataract Surgical Rate

402/ million

1,124/ million

Cataracts/staff surgeon

188

492

These increased activities have sorely stretched the capacity of our existing theatre to cope with the demand for service delivery and training. The existing eye theatre is shared with the Ear Nose and Throat department on 3 days a week. We are unable to perform surgery on children on those days. Children regularly wait on the ward for more than a week for a slot on the overcrowded General Anaesthesia operating lists. In addition we have only one theatre on 3 days of the week in which to do all the other surgeries. The day that used to be reserved for retinal surgery is now crowded with blind cataract patients. On a typical Wednesday there will therefore be patients having routine cataract surgery at the same time as a retinal operation is going on. Inexperienced surgeons have difficulty finding time and space in which to learn surgery because of the time pressures induced by overcrowding. At the same time patients may have to wait for phaco surgery as there is no room in the theatre or the machine is being used.

A much larger theatre is needed to deal with the increases above and to help us reach VISION 2020 targets. The proposed expansion will:

  • Have a large theatre with space for 4 tables for high volume routine cataract surgery.
  • Have enough space for teaching of new trainees while high volume surgery continues uninterrupted.
  • Have the capability to provide safe General Anaesthesia for children 5 days a week.
  • Include a designated recovery area
  • Have a separate theatre to allow retinal surgery to be performed on most days of the week.
  • Cater for day case phaco surgery patients (many of these are high fee paying patients who generate income to help support poor patients.)
  • Have adequate central sterilisation facilities