In a village in Tanzania, a man in his early 20s has walked for hours in the sun to reach a John A. Moran Eye Center eye care camp.
His mother holds his hand. His eyes occasionally dart side to side. They are noticeably bulging as he fidgets with his blue sports jersey. He cannot work, she says. He cannot see.
A technician measures the pressure inside his eye and finds it extremely high. Following an exam, doctors explain there is nothing to be done: he has glaucoma, and his vision is permanently gone. To his mother, they say, even if the disease had been caught earlier, it is difficult to treat, and there are no glaucoma specialists in the country.
The knowledge is small comfort.
As variations of this scene have played out over the years, Global Outreach Division Medical Director and glaucoma surgeon Craig J. Chaya, MD, has been devising a plan to change it.
While the Division has long been one of several non-profit organizations successfully working in Africa to eradicate blindness caused by cataracts—a clouding of the eye’s lens that can be cured with just one surgery—few are taking on glaucoma. The unpredictable disease requires a lifetime of care with prescription eye drops and surgeries to keep high eye pressures that kill the optic nerve at bay.
Africa has the world’s highest rates of glaucoma, and an estimated 500,000 people are already blind from it. Glaucoma tends to be more aggressive and has an earlier onset in African populations.
But in 2023, Chaya led the first steps toward change.
That year, he traveled to Mwanza to establish a glaucoma fellowship training program at Bugando Medical Center, where the outreach division has regularly taught cataract surgery. Chaya and other former Moran Eye Center glaucoma fellows now regularly provide in-person surgical training to local ophthalmologists Nuru Mwambola, James Shimba, and Frank Sandi.
To date, Mwambola is the furthest along in the fellowship curriculum, which includes book work, a month-long, hands-on microsurgery training for each physician at Aravind Eye Care System, a journal club, and regular video calls.
“This is the very beginning of a pathway forward toward ultimately having a training center that is administered and managed by local Tanzanians. The beginning of creating hope.”
The Mwanza physicians will be able to provide the same glaucoma care provided in the U.S.: laser procedures, incisional surgeries such as trabeculectomy, and minimally invasive surgeries. Each has regular evaluations, must complete a requisite number of logged surgical cases, and take an exam to graduate. The Division is also training nurses and technicians at Bugando for glaucoma cases.
Once Mwambola, Shimba, and Sandi are fully trained, they will be able to train others, further increasing access to care in line with the outreach division’s commitment to creating sustainable eye care.
“Right now, there is only one fellowship-trained cornea specialist in the entire country of 65 million people,” says Chaya. “Obviously, that’s not sustainable. By the time that we’re done, we will have produced three more for the country. It may seem small, but it is a start to having people with rigorous training be able to train more people.”
Once the fellows are trained, Chaya says, the Division can begin utilizing technology that can make training and screening patients for glaucoma easier: AI, telehealth, and teleophthalmology.
“We really couldn't do that until we had people who understood how to manage glaucoma there, so this was the first step forward,” Chaya says.
The fellowship program has also broken with traditional training models that may send physicians abroad for a year or more.
“We felt that it was important for them to train in a community where they'll be working and seeing similar types of patients and pathology,” explains Chaya.
The effort has been so well-received that the division is receiving requests from other physicians in Tanzania for similar training.
“This is the very beginning of a pathway forward toward ultimately having a training center that is administered and managed by local Tanzanians,” says Chaya. “The beginning of creating hope.”