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HomemifeatureLessons from Malawi

Lessons from Malawi

If someone had asked me three years ago, what it meant to be an optometrist, my response might have been seen as somewhat ‘myopic’. I was three years qualified and working for a chain of retail practices in Dublin, Ireland.

I enjoyed my job but sensed there was something more rewarding out there. This realisation prompted me to ask myself: What drives me? What am I passionate about? How could I use my qualifications and experience in a more fulfilling way?

So I became a volunteer, travelling to developing countries for two to four weeks at a time to set up eye clinics, provide eye exams and spectacles for as many people as possible, and provide training for local healthcare workers. My first project took me to India where I saw the impact that visual impairment due to uncorrected refractive error was having on the lives of many thousands of people in the developing world. It was a rude awakening that sparked a passion in me.

In 2009, I was introduced to the International Centre for Eyecare Education (ICEE). At the time, the ICEE, in collaboration with other partners including Optometry Giving Sight and Sightsavers International, was in the process of founding a number of optometry schools in Africa. One of the newly established schools was in Malawi, a landlocked country in southeast Africa, and they were recruiting lecturers. This was the opportunity I had been searching for.

There is no passion to be found playing small – in settling for a life that is less than the one you are capable of living-Nelson Mandela

The Warm Heart Awaits

I arrived in Malawi in May 2010 ready to take on my new post as lecturer, head of department and course co-coordinator for the Malawi School of Optometry Degree Program at Mzuzu University. The job was hugely challenging to say the least but I learned more in 15 months than I could ever have imagined possible.

The Republic of Malawi is among the world’s least developed and most densely populated countries. Its population – estimated at almost 14 million – is largely rural and the country’s economy is heavily based on agriculture.

Malawi is known as the ‘warm heart of Africa’ and one of the things I loved most about being there was the sense of joy and happiness that radiated from the people I crossed paths with every day. It would not be unusual to hear a Malawian singing aloud to no one in particular as they strolled past you with a smile. I remember a day I travelled on a typically crowded bus for the five-hour drive to the capital city, Lilongwe. Suddenly some of the passengers began singing a religious hymn and one by one, more and more passengers began to join in. It wasn’t long before the entire bus was singing together in perfect harmony. It was a really beautiful, emotional moment and a memory I cherish.

Education a Privilege

It is difficult to paint a picture of what it is to be a student in one of the poorest countries in the world. Malawi has a very low rate of university enrollment and the vast majority of students come from large families living in rural villages where in many cases they have no electricity or running water. For these people, education is an absolute privilege, and often, just a distant dream. Some students who show a degree of academic promise during secondary school may be lucky enough to find a sponsor willing to pay their school tuition fees. One of my students, 23-year-old Leavson, was one such lucky young man; a very bright student who would never have been able to afford to pay for his own education had it not been for an Irish lady who offered to sponsor him through secondary school. Leavson is now on his way to graduating with a Bachelor of Science Degree in optometry in less than two years.

During my time in Malawi, I often reflected on my own experience as a student attending university. I had as many as 10 different lecturers delivering my optometry program in Ireland. I had access to hundreds of reference books in our comprehensive library. I was provided with my own set of notes for each and every lecture. Printers and photocopiers were easily accessible. The university had its own swimming pool and gymnasium as well as countless other amenities and facilities. This was what I expected as a university student in Ireland; and I took it all for granted.

Mzuzu University, with almost 2,500 students, is government run and therefore survives on minimal funding. There are not enough resources to employ an adequate number of lecturers. Often class numbers are so large, students spill out the door and are forced to listen to the lecture from outside the windows.

This year, the University was closed to almost all students for four months because there was simply not enough classroom space to teach. Students are lucky if they have a desk upon which to write an end of term exam. Most of the library books are either outdated or simply not relevant and the remainder in short supply. The provision of individual lecture notes for every student is unheard of. Photocopiers and printers are an absolute luxury. Even if a printer is found, it is unlikely the cartridge will have any ink in it. The government continues to make budgetary cutbacks and reduced funding for public institutions such as Mzuzu University means further austerity measures continue to be implemented. While the intention is to save costs, the impact of these cutbacks on education – and ultimately on the students who are the future of the country – may prove more costly in the long run.

A grim picture one might say, but, in truth, it only motivated me all the more.

Persistence and Enthusiasm

At the end of the day the students were there to learn and it was our job to teach them. We focused on keeping morale and spirits high. We learned that achievement came with persistence and so we persisted. We learned that a voice was louder than a memo and so we spoke up at every chance we got, and we succeeded! We secured funding for a clinical teaching space and ophthalmic workshop. We received a number of books for the department, we were given an extra classroom for our students and the Medical Council of Malawi approved the program curriculum. Progress, although slow, was made and this was what made it all worthwhile.

But it was only through contact with real patients with genuine vision problems that the students could fully appreciate the value of their skills and knowledge. We established an eye-testing centre at the local hospital, which opened two mornings a week.

The students arrived in their white coats full of energy and enthusiasm and it was at these clinics that they were exposed to a range of various eye diseases, infections and many uncorrected refractive errors. It was quite humbling to share in these early experiences of these soon-to-be optometrists as they determined spectacle prescriptions and restored patients’ vision with their skills in refraction. Those two mornings a week bestowed reward and fulfillment and inspired the students to be more focused on their end goals: to graduate as optometrists and contribute to the global effort to eliminate avoidable blindness due to uncorrected refractive error.

Through the Malawi School of Optometry program, we are providing these students with the skills and knowledge they need to be professional optometrists of the highest standard. I believe we have instilled in them an appreciation for the value of and the need for continuing research and the importance of working in collaboration with others. It is only through collaboration that goals can be achieved. While the financial burden faced by Malawi and the world today may mean that belts have to be tightened, we must continue to seek support for programs such as the Malawi School of Optometry.

Hope for the Future

2012 will be a very important year for Malawi with the graduation of six of its first optometrists. Work is underway to establish an official Association of Optometry and, in the meantime, the program has the support of the Medical Council of Malawi. 2013 will see the graduation of 13 optometrists and 15
in 2014. It is hoped that some of these early graduates will return to Mzuni to take up lecturing posts themselves so that the program will, in time, become self-sustainable.

I miss Malawi every day. I miss the simplicity of life there. I miss the appreciation I developed for things I had previously taken for granted such as running water, electricity, fuel and the Internet. I miss my job and the sense of fulfillment it gave me. I miss my students and their enthusiasm. I miss the people I worked with and the wonderful friends I made.

But I feel very hopeful and confident about the future of optometry in Malawi because I believe in these future optometrists and have faith in their dedication. I am very grateful and feel privileged to have had the opportunity to work as part of such an ambitious and inspiring program. A program that will see the lives of many thousands of people change dramatically simply because they will have access to quality and affordable eye care services delivered by competent and professional optometrists in well-equipped vision centres.

Elaine Quinn has been working in the area of healthcare for 12 years. Working first as a nurse she then pursued a career in optometry and graduated from Dublin Institute of Technology, Ireland in 2005. She has worked in the field of refractive surgery and for a number of practices in Dublin. Most recently she held the position of lecturer and course coordinator for the Malawi Schools of Optometry Program. She has been a member of the national committee for Optometry Giving Sight, Ireland, and will soon travel to the States to continue her contribution to the
Vision 2020 global campaign.