This morning I was picked up by the Head of Department of the Kilimanjaro Christian Medical Center College of Optometry. His name is Focus Maro, a perfectly appropriate name for an optometrist, and one of the most industrious and motivated optometrists I have met in Africa. Not only does he run the optometry department at this large university, he has a private clinic that is associated with the medical center and helps to train optometrists. He told me that the college was started by Swedish optometrists and they often return to visit, continuing their supportive relationship. I met many of the six full-time optometry faculty at this active institution.

The KCMC College of Optometry offers a three year diplomate program and teaches 15 to 20 students per class. With six faculty it is possible to offer a high quality program. Tanzania has regulated optometry, with optometrists required to register with a state-run authority. This gives the College some leverage to require a high level of competence, and they will fail students who do not show the required level of knowledge and skill. They have a high quality optometry and ophthalmology library with several lecture halls and internet-linked classrooms where each student has a computer. They have the ability to run remote training sessions, with lecturers from all over Africa and the world.

The KCMC College of Optometry is closely linked with the Department of Ophthalmology. They jointly run a busy clinic and I saw perhaps 100 patients waiting for eye exams. One interesting point is that Dr. Maro told me they used to see patients by appointment, but that system did not work very well. Now they accept patients all morning and work through the afternoon to see them all. Unfortunately, I forgot to bring my camera during this part of the morning so I don’t have any photographs to share. I will not make that mistake tomorrow.

KCMC is located in Moshi, Tanzania, on the flank of Mt. Kilimanjaro, the highest peak in Africa. The weather now is warm and dry, and attracts trekkers from all over the world. Moshi is known as the cleanest city in Tanzania. This morning as I was waiting to be picked up, I could see homeowners and businesses cleaning up their properties and the streets. The traffic circles have manicured bushes with flowering plants. The College is no exception, offering a clean and beautiful campus, with workers keeping the place up very nicely.

I met the Head of the Ophthalmology Department and we chatted for 10 minutes. He described the program and the many challenges. One challenge is treating patients with dense corneal scarring leading to blindness in that eye. A corneal transplant could correct the blind eye. But corneal transplants using artificial materials do not work well, and culturally it is difficult to obtain human corneas for transplant. He said it was not for a lack of available donor tissue, as there are many cases of traffic accidents and other casualties. It is almost impossible to convince family members, however, in the midst of emotional trauma and mourning to release tissue to harvest. It is not culturally acceptable to gain release in advance, as is relatively common in the United States.

The optometrists and ophthalmologists work together to treat the patients in the busy clinic. The optometrists work seeing the routine patients that need spectacles and eye drops, while the ophthalmologists treat more complex medical eye issues and surgical cases. They have an optical laboratory to make high quality spectacles. One challenge is contact lens care, because they do not have the instruments and laboratory equipment to fabricate rigid contact lenses. Apparently, soft lenses through international contact lens companies are not readily available either.

Dr. Maro and the Head of Department of Ophthalmology briefly discussed the program I work with at the Masinde Muliro University of Science and Technology (MMUST) in Kakamega, Kenya. The Kenyan program offers a four-year bachelor’s degree with 30 students per class. In contrast, we only have three full-time faculty, whereas the recommended faculty to student ratio should require eight or nine faculty lecturers and professors. As I left our meeting, the Head of Department of Ophthalmology told me that we should hire more Kenyan faculty. I reminded him that the Kenyan system requires a Master’s or Doctoral degree to be a full fledged faculty member, and no one in the entire country met those requirements. It prompted me to concentrate on training the most talented newly graduated Kenyan optometrists to get their advanced degrees, so that they can run their own department in the coming years.

The KCMC College of Optometry and Department of Ophthalmology accept many foreign students including those from surrounding African countries. As I have mentioned, the entire academic setting here offers an exceptionally high level of training. Today’s experience made me question what strategy might be best for training optometrists. Would it be best to develop new programs such as MMUST, where I am teaching and where we face many challenges including the lack of a spectacle fabrication facility, or would it be best to send Kenyan students abroad but close by for training? I see advantages to both scenarios. Even though Kenyan and Tanzanian cultures seem similar, there might be national rivalries and/or barriers to travel that would inhibit Kenyan students from moving here for several years. Clearly, the powers that be have decided that developing a regional hub in Kakamega, Kenya at MMUST, despite the challenges, would be best. I will continue with that goal in mind. Tomorrow I will start the lectures on slit lamp and ophthalmoscopy for the optometrists on the faculty. The Head of Department for Ophthalmology requested a lecture on refraction for the ophthalmology residents and faculty, and I will do that on Wednesday.

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