The Importance of Surgical Training in Sub-Saharan Africa

Susan MacDonald MD
MARCH 2019

One in three of the world’s 32.4 million blind people are blind due to cataracts. This proportion is closer to one half in sub-Saharan Africa (SSA). There are millions more who have significant visual impairment from cataracts.
The availability of cataract surgical services in SSA is by no means universal, but even where services are available, uptake has mostly been below the level required for elimination of cataract blindness.

Cataract surgical rates (CSR) of around 500 operations per million population, per year are frequently reported; this is well below the target of 2000 that has been suggested by the World Health Organization (WHO).

There are several barriers to obtaining surgery and one is fear of a poor outcome. Recent international studies showing that the proportion of poor outcomes is a particular problem for sub Saharan Africa.  If 20% of operated cataract cases fail to attain 6/60, it can be expected that this will generate some negative publicity in the general population that might then be discouraged from getting cataract surgery.

When an ophthalmology resident graduates from their surgical program, they are still on a learning curve. This is an important time to solidify surgical technique and develop safe habits and problem-solving skills. Our piece is to help these surgeons move along their learning curve and give them feedback. The key to fine tuning their technique is one-on-one training with an experienced surgeon, a mentor.  This enables them to observe, participate, and finally complete surgeries independently while building confidence and surgical skills.  This is the best way to reduce poor outcomes and thus increase the number of cataract surgeries performed.

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