Facing Logistics of Cataract Surgery: The Moka Hospital Experience in Mauritius

Author(s): C. Tabatabay*1, A. Fong2, B. Gruson2
Affiliation(s): 1Medical practice, 2University Hospitals of Geneva, Switzerland
Keywords:

Ophthalmology, cataract, humanitarian, teaching, eye, surgery, Mauritius, competence, waiting list, Moka Hospital

Background:

1 – The only ophthalmic hospital in Mauritius lies in Moka and has a large surgical activity including about 2500 inpatient cataract operations per year in two operating rooms out of the three existing ones. But there was a waiting list of about 3500 cases which represented a waiting period of over one and a half years.
2 – By opening a third operating room already equipped but not yet fully operational, we would be able to increase the amount of cataract surgery realised. The waiting list for cataract surgery problem would then be solved within the next coming months.
3 – The ultimate goal is a better use of the human and local resources to upgrade the Moka Hospital to a local and regional referral centre.

Summary/Objectives:

We have set two major objectives for our missions in Mauritius concerning cataract surgery:
1 – The training of the surgical staff towards modern cataract operation techniques, i.e. phakoemulsification, is mandatory. We have emphasised progression in the organisation of the operating theatre and a move towards a specialisation of the operating theatre nursing staff. This will be accomplished only by dedicating operating theatres nursing staff for exclusively O.R. activities.
2 - The surgeons’ consultation should include less refraction for outpatient that could be more effectively performed by non surgical doctors. Another possibility would be to use the competence of private opticians of Mauritius for the refractions. Although there might be some resistance in learning phakoemulsification by part of the surgeons, there should be an incentive by positive actions to motivate surgeons to perform phakoemulsification on a higher scale. A period of about 2 years is indicated to move from extracapsular cataract to modern phakoemulsification.

Results:

The surgical transfer of competence for cataract surgery has started in January 2006 and was at its stage of initiation with teaching surgical techniques during one year. The next stage was progressive handover by the training team to local surgeons in a step by step approach during the surgical procedure during 2007. The waiting list has dropped from 3500 to 2500 within 4 months (reference: Medical Hospital Moka, 2008).

Lessons learned:

1 – The ophthalmic surgeon has to be mostly dedicated to his continual learning in modern cataract surgery. This better use of the specialist staff is the only possibility for Moka to catch up with the huge cataract waiting list.
2 – The total commitment of the whole medical team is essential to melt down the waiting list. Furthermore, new nurses should be trained for surgical activities only.
3 – The strategy for the Moka Hospital should turn towards the organisation of modern facilities for cataract outpatient surgery: reception, nurses, transport and follow-up.

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