Successful Operation

A little history
The story of Israel's involvement in Africa's battle against blindness began in 1959 when the late Professor Isaac C. Michaelson, then head of the Eye Department at the Hadassah-Hebrew University Medical Centre in Jerusalem, designed an innovative two-pronged program that would repeatedly prove its effectiveness.

Prof. Michaelson's concept was based on a formula by which Israeli specialists in ophthalmology would be dispatched to start and help staff new eye departments in a developing country while, at the same time, doctors and nurses from that country would undergo specialized ophthalmological training in Jerusalem. On their return home they would take over and run eye-care units that had been set in motion by their Israeli colleagues.

This pattern first took shape in 1960 when MASHAV and the Hadassah Medical Centre sent six Israeli physicians to establish and staff a 30-bed eye hospital in Liberia's capital, Monrovia. During that period, seven Liberian doctors and nurses were brought to Israel for training, before returning to Monrovia to replace the Israeli personnel.

In subsequent years, under the guidance of Professor Hanan Zauberman, today head of the Ophthalmology Department at Hadassah, this formula would be extended and expanded to nearly all other African countries (and other continents), such as Malawi. Until 1964, Malawi - as other African countries - had no eye-care facilities whatsoever. That year, Israel set up a series of eye clinics staffed by Israeli doctors while, at the same time, providing ophthalmological training in Jerusalem for Malawian doctors and nurses.

In 1974, with this eye program in full swing, this reporter had the privilege of interviewing Dr. Moses Chirambo of Malawi, then doing his medical residency in Israel, part of the ongoing eye training program begun and maintained by MASHAV and the Hadassah Medical Centre. Young and modest, but enthusiastic and ambitious, Dr. Chirambo proudly told me that he would be the first native-born ophthalmologist in his country.

"Malawi's main problems," I remember Dr. Chirambo saying, "are - as in many other parts of Africa - cataracts and blindness, both partial and total, due both to malnutrition, as well as to infections that aren't properly treated."

Dr. Chirambo was eager to finish his training in order to return home "to help my people." He was aware of the importance of screening for blindness and potential eye problems and equally aware that, as he said, "until the Israeli doctors had come to Malawi, our lack of manpower meant that little in the area of preventive work could be done."

Today, Dr. Chirambo, now National Eye Consultant and working at the Central Hospital in the capital city of Lilongwe, can tell a different story. He tells, for example, of the teams of Israeli instructors who come to give four-month-long "on-the-spot" courses, some of which include training ophthalmological assistants, a program he initiated. "We need these people," he explains, "since the majority of the population of Malawi lives in remote rural areas and are unable to get to proper medical care. Outreach, i.e., going out into the bush, is the only way to give them the care and treatment they need."

Our doctor in Malawi today
Israeli doctors also come to Malawi on long-term missions of two to three years. 0ne of these doctors was Dr. Shai Kaplan, an ophthalmologic surgeon from the Beilinson Hospital in Petach Tikva who was in Malawi from November 1995 until the end of February 1998, based in Lilongwe where he worked at the Lilongwe Central Hospital as Chief Ophthalmologist.

A long-term mission usually includes more than just one major commitment. Innovative projects that require much travelling and long hours of dedicated work are part of the package. Dr. Kaplan's stay in Malawi was no exception. In addition to his work at the Lilongwe Central Hospital, he conducted a mini-eye-service in Mzuzu, a small town 400km north of Lilongwe to which he travelled every month - consulting and performing operations.

In Malawi, Dr. Kaplan also collected donations for the establishment of a new examination room for the Eye Department of the Lilongwe Central Hospital. This department also received four air-conditioning units - a gift from the Israeli government.

Going outside of Malawi, Dr. Kaplan, along with two other Beilinson Hospital doctors - Dr. Dov Weinberger and Dr. Moshe Luski - ran an eye camp in Namibia for three weeks in the middle of August 1996. At the camp, organized by the Namibian Ministry of Health with the cooperation of the Israeli Embassy in Harare and located at Oshakati, 70Okm north of Windhoek, the three doctors operated on 300 patients, implanting more than 200 intraocular lenses - and all of this within the space of three short weeks.

Mozambique also benefited from the medical and administrative expertise of Dr. Kaplan who, while stationed in Malawi, made four visits to its capital, Maputo. On his first visit he was accompanied by Prof. Yuval Yassur, the head of the Eye Department at his hospital, Beilinson. On a second "solo" visit, Dr. Kaplan lectured at the Medical School of the University of Maputo and also inspected the needs of the Eye Department of the Maputo Central Hospital. During a third visit he conducted operations at the hospital. This Maputo Eye Project culminated in a week-long visit in the middle of November 1997. For this short-term mission, Dr. Kaplan was joined by two Beilinson Hospital colleagues, Dr. Dov Weinberger and Mrs. Dvora Goland, an operating theatre nurse. All three worked with their Mozambique counterparts, helping these local doctors and nurses progress from old-style cataract operations to modern cataract surgery performed under a microscope. Mrs. Goland also helped to organize the ophthalmology nursing and support staff to function more effectively.

"The Maputo Eye Project was," recalls Dr. Kaplan, "hugely successful, with many patients queuing up daily. At the end," he adds, "a ceremony was held at the Maputo Central Hospital where the Israeli Ambassador, Gershon Gan (resident in Zimbabwe and also non-resident Ambassador to Mozambique, Zambia, Botswana, Malawi and Namibia) on behalf of the Israeli government, handed over a donation of 500 intraocular lenses and other disposable materials for eye surgery."

Another highlight, perhaps one of the most exciting of Dr. Kaplan's entire mission, was his participation in Zimbabwe on the Eye Train, a project initially conceived and organized by the Zimbabwe Council for the Blind and the National Railways of Zimbabwe. Purpose of the project: to celebrate the centenary of the National Railways by bringing modern eye services to all citizens in Zimbabwe no matter where they lived.

In January 1998, a request for Dr. Kaplan's services was made to Israel by the Zimbabwe Council for the Blind. Israel, through Ambassador Gan and its Embassy in Harare (the capital of Zimbabwe), responded favourably. Israel also provided the train with a donation of intraocular lenses, disposable materials for the operations and medication.

The train, which operated from November 1997 until the end of February 1998, started at Harare and travelled all through Zimbabwe. Dr. Kaplan joined it for a ten-day trek - from January 22, 1998 until February 2, 1998 - going from Harare to Mutare, with stops in Marondera and Rusape.

Initial screening of patients was done by staff from the Zimbabwe Council for the Blind, whose clinical officers saw between 100 to 500 people everyday. Those whose condition warranted surgery were operated on in the train on the day following their examination.

On the train Dr. Kaplan performed approximately 10 to 15 operations everyday, as well as seeing another 10 to 20 patients each day for consultative purposes. He and his staff - a local doctor, two operating theatre nurses and two junior theatre workers - worked nonstop from early morning until late at night, with two to three shifts the norm. They worked, ate and slept on the train which had five coaches - two were used as bedrooms, one was the kitchen/dining room, while one was used as an outpatient clinic and one for the operating theatre.

Ninety percent of the operations were for removal of cataracts in which the opaque lenses were extracted and new silicon lens implanted. The remaining ten percent were trauma operations, glaucoma correction and small eyelid reconstruction. All the operations were performed with a local anaesthesia since there were no facilities for giving general anaesthesia. Dr. Kaplan, however, did take five patients to the Marondera District Hospital for operations he performed there under general anaesthesia. Three of these patients were children, two were adults. "Since each of these adults had only one existing eye," explains Dr. Kaplan, "I did not want to risk local anaesthesia."

Although most of the operations performed on the train were for people sixty or older, patients of all ages were seen for screening and consultation. Problems they displayed included cataracts, refraction difficulties, glaucoma, trachoma and eyelid problems. Those with cataracts and glaucoma were operated upon, while most of those with trachoma were treated with medication. Although plastic surgery was not done on the train, those who needed it were sent to hospitals with eye units.

In addition to on-site diagnosis and treatment, glasses were prescribed for those needing them, especially reading glasses which were sold very cheaply on the train. With the exception of a minimum charge for prescription lenses, all treatment, consultations and operations were given free of charge.

"Without a doubt," stresses Dr. Kaplan, "the eye train was a very successful operation. The level of execution went far beyond my expectations, starting from the highly qualified eye staff to the well-maintained equipment, sterilization levels and dedication of the local staff to their patients." In turn, local medical staff and government officials lauded Dr. Kaplan's participation "which brought eye care," they said, "to a level normally available only in major cities."

Dr. Kaplan also noted the overwhelming response of the people on the route. "Before arrival in each village, announcements were made over the radio and via a speaker from a car travelling through each village to announce our arrival. The result: At each stop villagers came in droves, eager and anxious to be seen and treated."

"With funding and international assistance," adds Dr, Kaplan, "this train could become an annual event, one which has proved itself, proved to be a valuable and meaningful way of reaching people in need and offering them high quality eyecare and treatment."

"It was, of course, really difficult to get to know the patients," admits Dr. Kaplan candidly, "due to the large numbers we saw and operated on each day, coupled with the fact that the train would move on to the next town the day following each consultation and/or operation. In addition, the patients were extremely modest and did not enter freely into conversation. Nevertheless, from the expressions on their faces, it was obvious that they were very grateful and appreciative of our efforts."

In noting his own involvement, Ambassador Gan captured the essence and significance of Israel's aid to Africa. "To witness people having their sight restored and listening to expressions of gratitude for the work of our Israeli ophthalmologists has been one of the most uplifting and emotional experiences of my work in the diplomatic service." Similar sentiments are shared by all the Israelis such as Dr. Kaplan, who are playing such a vital role in helping Africa fight the scourge of blindness.

After four decades of continuous cooperation and support, the work begun by the late Prof. Michaelson is continuing to bear fruit: treatment and correction of existing eye conditions; training of eye doctors and nurses in countries where such personnel were formerly nonexistent; and establishment of preventive frameworks for saving sight, including the control of infectious diseases, which - left unattended - lead to blindness.