By Soni Daniel, Regional Editor, North
Dr. Uduak Christabel Udom, the immediate past President of the African Council of Optometry, has just been elected the President of the World Council of Optometry (WCO). In this interview, she speaks about the problem of optometry in Nigeria and Africa and what can be done to move the profession forward. Excerpts:
Many Nigerians don’t know much about your profession. What is Optometry all about?
Optometry is a younger healthcare profession and not as old as Medicine, Nursing, Dentistry, etc. But a lot of people are getting to be aware of the profession. In the country, we have what is known as Optometrists and Dispensing Opticians Registration Board of Nigeria, ODORD, which regulates the practice of Optometry in the country.
Again, the Nigerian law defines Optometry simply as the art and science of vision care. In a layman’s language, our scope of practice includes a comprehensive eye examination, treatment of minor ocular diseases, correction of errors of refraction using glasses and contact lenses, orthotics which has to do with the management of vision imbalance between the two eyes and muscular imbalance between the two eyes, contact lens practice and general eye care.
Now that contact lenses are going more cosmetic these days, is your profession involved in cosmetic practice too?
Contact lenses have gone cosmetics because of the variety of colours but you can still have contact lenses correcting errors of refraction while also combining the cosmetic aspects.
There are people who use contact lenses merely for the cosmetic appeal. But I must warn that it is dangerous because such action may result in infection, especially when people get such lenses off the counter without knowing the proper way to fix, clean and remove them. Some leave contact lenses for a longer period, work under dusty environment where dust gets trapped in the lenses thereby leading to infection. Even for people considering plain contact lenses, it is advisable for them to see an optometrist.
Are you implying that it is safer to use the conventional lenses to the contact lenses?
No. I am saying that using contact lenses without professional guidance and attention can be dangerous. If you want to use contact lenses for merely cosmetic appeal, it is advisable to see an optometrist or contact lenses expert to guide in fixing, removal and cleaning processes. To get the prescribed contact lenses, it is very necessary to meet a professional.
Is the practice of Optometry embedded in the Nigerian healthcare delivery practice across board – from the primary to tertiary healthcare levels?
Yes, it exists across board from the primary to tertiary level of our healthcare delivery system.
But we don’t often see such services especially at the level of primary healthcare delivery in the country?
That is true. In some states, we see Optometry mostly at the secondary and tertiary healthcare centres. We still need to do some advocacy to get the practice down the ladder. We have seen people who have simple infections that could have been treated at the primary healthcare level and they don’t have the money to go to the eye clinics in the cities.
Sometimes, they go to general hospitals where there are no eye clinics leaving them with the option of going to the teaching hospital. Some of such people won’t bother to go all the way to get treatment and would go back to the villages and use herbs. Somebody will tell them to use urine or other substances that could further damage the eyes.
Having served as a volunteer during eye care outreaches in several local communities, I have seen so many go blind because of a simple infection that could have been treated at the early state that caused the blindness. When you ask them, was there a time your eyes were red and painful and they would answer yes. When you asked why they didn’t go to hospital, they tell you they didn’t have the money. If there were services at that level, the blindness could have been prevented.
Does it mean that Optometry is not a part of primary healthcare services in Nigeria?
It is supposed to a part of the primary healthcare system but it hasn’t yet been integrated into the system in Nigeria.
Why is it so?
That is why I said that we need to do more advocacies. You rightly said that a lot of people in Nigeria don’t know what Optometry is all about.
Besides, our healthcare policy makers may not also understand the role of Optometry in the healthcare system. For instance, before I became the President of the African Council of Optometry, I was the President of the Nigeria Optometry Association and we tried to take advocacy to the level of meeting the Senate Committee on Health.
We booked appointment and tried to make presentations to make them understand the role of optometry and the need for us to start a school eye services. Many children are not doing well in school today because they have some eye problems and the parents don’t know. I have been with the wife of governor in this country whose children had eye problems and she didn’t know.
So it is not even the question of enlightenment. It was the teacher who sent a note to her that it appeared the children were not seeing properly. She took the children to an optometrist and it was discovered that they were short-sighted and glasses were recommended. The children picked up immediately and got tops of their classes after that and the mother became so passionate about issues of eye care. It is not a matter of saying my parents are educated and so they will know.
That is not true but if there is a school eye care programme in the country where the teachers would offer training to one or two teachers in a school free , they would identify children with eye problems and refer them for treatment early enough at the primary healthcare centers.
But even if they have to go to the secondary healthcare facility, such teachers would book appointment for the children to see specialists. We also took the advocacy to local government chairmen at the time and what they told me was that they don’t have money to employ optometrists at the heath centers. We, however, insisted that they could employ at least one professional per council area. Some states bought into the idea. For instance, we had a meeting in Imo State at that time and over 33 optometrists were later employed and sent to all the local government areas of the state. It’s all about understanding the need for optometry services by policy makers.
You were talking about taking your advocacy to the Senate. Did you succeed in meeting them after all?
Well, we did to some extent. Some members of the Senate Committee on Health at that time said they were tired and couldn’t sit down to listen to our presentation on the day they gave us an appointment.
They told us they had a long meeting before then. So majority of them left and we ended up addressing the chairperson and three other members only. We gave them examples of states that bought into our programme including Bayelsa and Lagos states.
One of the members was biased that we mentioned Lagos state which is controlled by an opposition party, thinking that we were supporting that state government. We took time to explain to them that we do not belong to any political party but that we were concerned with what would benefit the children of Nigeria. We told them that many children drop out of schools because their eye conditions were not detected early enough.
Do you think the senators who walked out of you feigning tiredness understood the import of your services to the nation’s healthcare delivery system?
I can’t say, but I know that some of them do have problems with their eyes and they get the best treatment. They probably don’t think this thing about the children is important. I don’t know please.
But that is a subtle indictment on the part of the senators who are paid with taxpayers’ money to make laws for the good of the people of Nigeria including the children?
I don’t know about that.
Currently, where is Nigeria in the practice of Optometry?
Nigeria is ahead in optometry practice in Africa.
Are you sure considering what is happening in South Africa and Ghana?
We are ahead and I am going to explain that to you. Optometry around the world has different competency levels. The reason is that some countries never had optometry before. Nigeria is actually ahead of the United Kingdom in optometry training. UK had three year post A-level which is like the four year programme we have here which is BA Optometry.
The reason is that UK has two types of opticians, that is the ophthalmic opticians and the dispensing opticians. The ophthalmic opticians’ scope of practice was restricted to eye examination and prescription of glasses while the dispensing optician does all the technical work leading to the issuance of the recommended glasses.
But optometry started in the United States about a hundred and three years ago. It progressed from one level to the other until they started using therapeutic drugs which was introduced. To qualify in the US, you do a science degree in the related area and move straight into the Optometry School for another four years, making it a total of eight years. But in a few schools in the US, there is a straight six-year optometry programme that offer OD, that’s Doctor of Optometry.
Nigeria started the UK way with a BSc Optometry before we reverted to the system in the US. In Nigeria, we have a six-year straight programme leading to the award of Doctor of Optometry. Ghana started with a BSc in Optometry but with the help of Nigerian lectures, they have now been upgraded to doing a six-year programme leading to the issuance of OD. These are the only countries in Africa that is following the system in the US. South Africa is still doing BSc and is still struggling to upgrade to a straight programme for OD.
In terms of numbers, South Africa has the largest number of Optometrists in the continent with over four thousand registered practitioners followed by Nigeria with over three thousand registered practitioners. The last time I made enquiry, I was told Ghana has about four hundred registered practitioners. I don’t know how many people they have graduated recently.
With about three thousand practitioners in a country with over 170 million persons, don’t you think we are still lagging behind?
It is inadequate but we are still producing more professionals. The World Health Organisation, WHO, in collaboration with the International Agency for the Prevention of Blindness, IAPB, has come up with the ratio of optometrist per population. The ratio is one optometrist to 250,000 persons.
But there is an issue with what we call “mild distribution.” Right now, we do enough based on the international ratio because many of our colleagues are not absorbed into the public health system. Majority is into private practice and of course, you wouldn’t want to take your private practice to a rural community for any reason.
Private practitioners would always go to cities where there are infrastructure and where they would easily break even. That is why you see many people opening clinics in Abuja, Lagos, Port Harcourt and other big cities. This situation has deprived the public service of professional optometrists.
Are you saying that there are 3,000 optometrists in Nigeria’s public health system?
No. The 3,000 I talked about is the total number of registered members. Majority of these are in private practice. And this happens because the government has not created opportunities for them to be absorbed into the public health sector.
Based on your years of practice, can you tell us the major eye problems people face in Nigeria and Africa?
One of the major problems we have in this part of the world is glaucoma. African ancestry is a risk factor in glaucoma. There are different kinds of glaucoma but the most prevalent is the chronic open angle glaucoma also known as the thief of sight. We call it thief of sight because it steals a person’s sight without the individual knowing.
When its starts, the individual does not feel any pain while the pressure inside the eyeball continues to rise and as this happens, the sight nerves are being damaged gradually. The individual will still be seeing but the field of view is progressively narrowing.
By the time the individual realises that something is wrong, the damage has extended to the centre of the eye. At that point, nothing can be done to save the affected eyes; medically speaking. We also have refractive errors most of which are caused by hereditary factors. Some refractive errors are also caused by environmental factors including lifestyle.
It is also caused by age. As one gets to the age of 40, a lot of changes might have occurred in a gradual basis. At a younger age, the crystalline lens is jellylike. It changes shape easily for proper focusing when an object is brought closer and when it is taken farther; that is if there is no error of refraction. But as an individual grows older, the crystalline lens start thickening from the center and moving out gradually.
At age 40, it has thickened to the extent that the lens is no longer able to change shape and focus as before. It becomes difficult to read tiny prints at close range. When an eye problem begins, many people engage in denial and claim they can still see andso would not seek medical attention.
Denial is one of the major reasons why a lot of Nigerians suffer eye damage. I have seen a situation where a father has glaucoma and I advised the child to allow me carry out a test on her eyes free of charge because glaucoma is hereditary. She had brought the father to the clinic and I had checked and found that he is at the end stage of glaucoma and there is nothing we can do medically to redeem the situation. At that point, we may only refer the patient to an ophthalmologist for surgery but that again would not improve the vision.
It will only allow whatever vision available to remain for a while. Sometimes, after the surgery, the pressure goes up again and the cycle continues. I was shocked that even at that kind of situation; the child told me blindness in not her portion and would not allow a test to be carried out on her. This is a young girl who has a life to live but would not give herself the opportunity to live well. Denial is a major issue in our part of the world.
Are you saying that faith has no place in the practice of medicine and optometry?
Well, you are bringing something to my own lifestyle. I am a Christian. I believe in God and I know that God works miracles. But there is something called presumption and I have come to know that many people take presumption for faith. There is a story in the Bible where people disobeyed God when He told them not to go to a battle. The people said no, we are going to win. The Bible said they went in presumption.
They were defeated at that battle. A lot of people mistake presumption for faith. Faith is based on the word of God. I tell people who say they don’t want to use medication that there was a blind person that Jesus touched and he was healed. There was another blind person where he spat on the ground, mixed the spit with sand, rubbed it on the eyes of the blind man and asked the person to go and wash it off.
That was perhaps, the beginning of the art and science of optometry. The bible records that herbs are meant for the service of man. All the medications we have today come from herbs. When we were studying glaucoma in school, we came across a particular drug called Eserine. The textbook indicated that the drug was extracted from a particular beans found in the Calabar area of Nigeria.
This is a textbook written in the US. It is indicated that the drug originated from a bean found in the Calabar region of Nigeria. Right there, my classmates asked me to go and find the beans. I came back home and went to the market and asked whether people knew any beans called “Eseri.” They looked at me in amazement.
They didn’t say anything to me. Eventually I went to my aunt and told her I’m looking for a particular bean called “Eseri.” She told me I shouldn’t have asked for it openly adding that the bean is used in preparing charms. She took me to a place in Ikot Ekpene Market where they sell fetish items and she whispered to the seller that we needed “Ased.” That was what I was calling “Eseri” based on what I read from the textbook. The glaucoma drug Eserine is made from “Ased.”
There is a professor of Botany from the University of Benin who asked me to look for certain herbs and leaves from Akwa Ibom for him to use in his researches. When we got back from the market, I asked my aunt why people don’t openly ask for the bean and she told me it is used in arresting witches and wizards.