The Optical Foundation makes eye care accessible in Ghana through screenings, education and research. Below are the results of our projects over the past few years.
The Optical Foundation was all geared up for its first project in Gambia which, as one of the poorest countries in Africa, has an extreme shortage of eye care specialists.
Teamed up with the Dutch foundation 'Stichting Zienderogen Nederland', our volunteers were all prepped and ready to take on this challenge when the project had to be cancelled due to the unstable political situation after the December 2016 elections in Gambia.
Our volunteers' safety was our first priority, so the decision was made to divert the support to an alternative eye examinations project in Ghana instead.
We teamed up our four volunteers with Sister Aba and her team for the project in Ghana. Sister Aba is the founder of the Jachie Eye Clinic, which provides exceptional eye care in the Ashanti region through the clinic and its outreach programs.
Travel & Accommodation
Preparing for the project, the team had been in contact via email and had met once in person prior to flying out of Schiphol airport (Amsterdam) on February 17th.
Equipped with a case with slides, an auto refractometer, a tonometer, a mirror, a retinoscope, two vision cards, as well as a large suitcase full of small frames, ready-made reading glasses and sunglasses, they set off on their journey. They flew into Accra (the capital of Ghana) late that evening, so they had to spend the night in Accra, before catching the bus for a 4.5 hour ride to Kumasi the next morning.
On arrival in Kumasi, they were picked up by Sister Aba and were taken to the monastery in the village of Jachie, which would be their accommodation for the duration of the project. They were each given their own room and every day they would share breakfast and dinner together in the dining room.
Every morning around 7.30-8.00 our volunteers would get picked from the monastery. Then the driver would pick up Sister Aba's outreach team of 6 at the clinic before setting off to the day's screening destination (mainly schools). The outreach team was made up of an optometrist, student optometrist, 2 student opticians, and 2 administrative assistants.
On arrival at the screening sight, the team would first find a suitable spot (in the shade) where they would be able to perform vision checks and refraction and they would also need to find a dark room where the retina could be examined.
Sjieuwke and Vera were teamed together and Ellen worked with Frank (a student optician), both teams performed refractions where necessary. James (a student optician) helped translate as not all patients spoke and/or understood English.
Refraction was performed when a patient did not get a binocular visual acuity of 1.0 or higher, monocular visual acuity of <0.8 or at age 35+ for possible addition determination.
Johan was teamed up with Richmond (a 5th year optometry student) and Bright (an optometrist) for retinal assessment. A big focus was on signs/indicators for glaucoma as this is a very common eye disorder in Ghana and a leading cause of blindness. If diagnosed on time, glaucoma can be treated.
The other students would help explaining to the patients how to fill in personal details on the data form and on how to take the visual acuity using the landolt C or an illiterate E card. The administrative staff would take the research forms of the study at the end and keep track of which patients had to go for further checks at the clinic and which patients had no issues.
With the exception of the screening day at Ateiku, most screening days would usually go till 14:00-15:00, as the schools close at 14:00. Although they weren't exceptionally long days, the extreme heat and the large number of people being screened made the task at hand very exhausting.
Over the course of 3 days since arriving in Ghana, our volunteers had screened 624 people (of which 500 were children). Relatively few children needed glasses compared to the number of cases of suspected glaucoma.
Below is an overview of the number of patients screened and how many were referred to the clinic (with suspected glaucoma, cataracts, refractive disorders or cycloplegic refraction).
Screening day at Ateiku
Getting to Ateiku (in the Western Region) took a 3.5 hour bumpy ride over dirt roads. On arrival in the village there were already a lot of people waiting for our volunteers, mainly adults. Having established a routine with the previous days of screening, the team quickly set up and commenced screening. When performing the visual acuity and the refraction, it pretty soon became apparent that many people had cataracts, corneal dystrophies or other eye diseases, and many of these patients only had a maximum vision of 0.12.
Fundus screening was a huge task in itself. A makeshift tent was meant to create a darkened room, but the daylight conditions made it very challenging to screen the narrow pupils and eyes that often had blurry vision.
Some patients were referred to the hospital for surgery (when a patient doesn't have money for this, Sister Aba pays for the operation of one eye, so that they can at least see something, and if the operation is successful the family can collect money for an operation of the other eye).
Most of the 120 patients screened couldn't speak English and someone would help translate during the screenings. Also it was very confronting to see that many of these adults were illiterate.
At times it was very disheartening for our volunteers because early detection of some of these eye conditions could have made all the difference but now there was very little they could do for some of these people (who had had their hopes up that our volunteers could do something to fix their conditions).
After a long day of screenings in the intense heat, the return trip to Jachie took 4.5 hours, with our volunteers reaching the monastery at 23.30. Although it was a very taxing day, from a professional perspective this practical exposure was an exceptionally educational experience.
School of Optometry at the University of Kumasi
After their last screening day, our volunteer team went to the School of Optometry at the University of Kumasi. They were given a tour of the school and the clinic, and were introduced to the students in their 5th year of study. There is no Orthoptics education in Ghana so our Orthoptist volunteers gave a lecture on the subject, which was greatly received by the students.
Donation for Jachie Eye Clinic
On behalf of Stichting Zienderogen, our team of volunteers donated a large suitcase full of small frames, ready-made reading glasses and sunglasses, to the Jachie Eye Clinic.
Introducing our four volunteers
Vera van Uum, Sjieuwke Koorevaar, Johan Franken and Ellen Blom made up the team of volunteers, who took time away from their family and friends, their jobs, studies and social environments to make eye care accessible for some of the poorest communities in Ghana (and especially the children).
Vera van Uum (20 years old) is in the final year of the Orthoptics program at the Hogeschool Utrecht. Along with her studies, she had been working for Eye Wish Opticiens for the last 3 years. This volunteer project was Vera's very first visit to a country outside of Europe.
This whole experience in Ghana of sharing insights and knowledge about screening young children and orthoptics with Sister Aba, the outreach team, and the 5th year students, has triggered in Vera a desire to want to regularly return to Ghana to share her orthoptic knowledge once she has completed her training.
In conclusion Vera says, 'I learnt a lot from this mission. I was really touched by Sister Aba's care and the gratitude and appreciation of the people. Despite the good health care we have in the Netherlands, the healthcare system can learn a lot from this. I hope to take part in more future eye health care missions to help the people and to really make a difference for them. Now that I have seen and experienced Africa, I have no doubt that I will be returning there again!'
Sjieuwke Koorevaar (24 years old) had only just graduated from the Orthoptics program at the Hogeschool Utrecht prior to leaving for Ghana. She had been working on Saturdays at 'Gijsen Optiek' alongside her studies.
Born in Johannesburg, South Africa, it really meant a lot to Sjieuwke to able to take part in this mission as a freshly certified orthoptist because she could finally do something for the people of Africa (the continent where she was born) who need it most.
In describing her experience in Ghana, Sjieuwke says that the project was not only very educational, but also an incredibly beautiful and rewarding experience.
Having screened almost 2500 people as a team, it gave her an immense sense of fulfillment to hear that the children, who during the screening were referred to the Eye Clinic, made sure they were there the next day!
She was impressed with the ease of working with the Eye Clinic and commented on how beneficial the collaboration was for both parties (i.e.: our volunteers and the clinic employees) in terms of the exchange of knowledge and the opportunity to learn from each other.
Sjieuwke concluded in saying: 'I am grateful that I was able to help people in a country where health care is far less accessible than it is in the Netherlands. I fly back to the Netherlands with a great sense of satisfaction. This is an unforgettable experience that no one will be able to take away from me. I will definitely put myself forward to go on another mission to help more people again.'
Johan Franken (50 years old) has been married for 22 years and has two children (11 and 13 years old). Passionate about his profession he is constantly looking for new challenges in his field of studies. He has been working in optics since 1987 and in 2000 he transitioned from an MBO optometrist to an HBO optometry graduate. Since then, his interest in eye research is the driving force for all his carrier development choices. For the last 20 years he has worked at Optiek Oostman in Hoofddorp as a contact lens specialist/optometrist.
This was Johan's first ever participation in an eye health mission and, other than a short vacation in Tunisia, this was his first time really being able to experience Africa.
He described the experience as confronting because it had him working outside of his comfort zone: performing eye examinations in daylight in a small space with a corrugated iron roof on which the sun has been pounding all day as well as being exposed to mostly advanced eye disorders in adults as well as the presence of glaucomatous papilla in young children. This was a very educational, challenging and rewarding experience.
What had also contributed to this enriching experience for him as an optometrist, was the close collaboration with the three orthoptists. This has not only allowed the screenings to be performed very thoroughly and efficiently, but also promoted the mutual exchanged of knowledge that could immediately be put into practice. Johan adds: 'In my opinion the collaboration between orthoptists and optometrists will be very valuable in allowing us to develop our skills within the health care in the near future!'
In closing Johan says: 'Even though we were performing the field work with limited resources, we took great satisfaction in still being able to help others.'
Ellen Blom (50 years old) has been married for 25 years and has 3 sons (aged 22, 20 and 13 years old). Since becoming an orthoptist in 1988 she has worked at the Academic Hospital in Groningen (3 years), the Flevo Hospatal in Almere (9 years), in Hospital Amstelland in Amstelveen (15 years) and for last 1.5 years she has been working at Eyescan Eye Care Clinic in Amstelveen. Her very first volunteer project with the organisation Stichting Zienderogen was a mission in Romania in 2012. It was such a profound experience that it became a catalyst for her to sign up for more volunteer projects (including Suriname in 2014 and this 2017 Ghana project). It is the joy of being able to make a difference in people's lives by doing something you are very well equipped and comfortable at doing and the insights you get into the country and culture you are exposed to, make it a truly inspirational and enriching experience.
Ellen was the team leader on this project, which was her first mission in Africa. In her experience every mission is different and each one has something very special. What made this mission particular special for her, was experiencing the level of care Sister Aba provided and the collaboration with her outreach team at the Jachie Eye Clinic. After initially getting used to working with each other on their first screening day, they became a tight knit team that worked perfectly together like a 'well-oiled machine' Sister Aba's 'DREAMTEAM' as Ellen called the collaborating teams.
In conclusion, Ellen said 'I am grateful that we were able to do our bit in a country where we were made to feel very welcome. The country and the people of Ghana now hold a special place in my heart and I hope that one way or another there will be a continuation of our mission in the future.'
Our chairman, Carolina Kunnen, visited Ghana in October 2014.
University of Cape Coast
Since our last project in Ghana, there have been a few changes at the University of Cape Coast. Dr. Godwin Ovenseri-Ogbomo, our previous project coordinator was unfortunately no longer working in Cape Coast but was now focused on his PhD research in Nigeria. Also Dr. Owusu, who was the director of the optometry school, had since moved into a different position.
The Optical Foundation has always stayed in touch with our former students. We were proud to hear that one of our top-students, Heinz Otchere, had completed his masters at the University of Waterloo, Canada and immediately returned back to Ghana. Heinz organised an appointment for Carolina with the new Director of Optometry Training, Prof Natalia Mensah. This was the start of a productive and fruitful collaboration between Heinz, the new Director of Optometry and The Optical Foundation, all sharing the common goal of improving the quality of optometry education in Ghana.
Ghanaian Optometry Association
While studying in Australia, Carolina met Dr. George Afenyo, who at the time was a part-time Masters student at the University of New South Wales in Australia. George lives in Accra and in addition to doing his masters, he is working as an optometrist in the largest university hospital in Ghana - the Korle-Bu Hospital.
On this visit Corolina was introduced to George's colleague, Dr Samuel Asiedi, the chair of the Ghanaian optometry association. Dr Samuel was very impressed with the work of The Optical Foundation and expressed that he would like to start collaborating with our Foundation. Through this partnership, the Foundation is able to further accelerate the development of the Ghanaian national eye care and optometry education.
Carolina also travelled to the Ashanti Region to visit the Anglican eye clinic in Jachie (a village near Kumasi). This eye clinic headed by Sister Aba - a Ghanaian ophthalmic nurse - now has a total of 25 staff members, including three optometrists. The eye clinic offers free eye care to communities around Jachie. Our volunteers offer the clinic a helping hand from time to time. Currently, The Optical Foundation, Sister Aba and the three optometrists are in the process of setting up a scientific research project.
On November 4th Carolina gave a seminar on her PhD research into the influence of the influence of meibomian gland morphology and function on ocular comfort. The presentation was very well received and attended by the provost, dean and director, as well as the optometry, chemistry and physics students. It had made a suitable impression, because after the seminar, a journalist of the university interviewed Carolina.
Prof. Natalia Mensah (the new Director of Optometry Training) found the seminar very inspiring for the students and she was hoping The Optical Foundation would organise more of these seminars in the future. This is exactly in line with the foundation's plans.
While in Ghana, Carolina met with George Weir, the president of the 'Tomorrow Stars', which is an organisation that provides scholarships to Ghana's top students. George mentioned that one of his top students was a third-year optometry student at the University of Cape Coast. Francis, the student in question, proved to be very involved and wanted to organize a screening in his village. Carolina couldn't help but become very excited by this local initiative and really wants to encourage and support this kind of initiative. In collaboration with Tomorrow Stars, The Optical Foundation is going to facilitate these screenings, however Francis will be in charge of the important organisational responsibility of this project. This opportunity will give him a platform to significantly grow professionally under the guidance of The Optical Foundation.
Another local initiative was started by Hakeem, a former student of The Optical Foundation. Esma, who had trained Hakeem in 2011, was very enthusiastic about him at that time. His World Eye Foundation provides eye screening in Ghana. The Optical Foundation would like to collaborate with Hakeem and his organisation, by organising screenings together. It is very nice to observe that there are many new initiatives from the Ghanaian optometrists themselves.
Unfortunately it took longer to ship the screening equipment than expected, and since Carolina had to return to Australia, Salem Alameddine, a friend of the foundation, taking on all the organisational efforts to ensure follow up and receipt of the incoming shipment of equipment. The Optical Foundation is extremely grateful to Salem for him organising this all at such short notice. In the meantime all the equipment has arrived in Ghana and is ready for the next volunteer.
From the July 10th to August 1st of 2011, Esma was sent to Ghana on behalf of The Optical Foundation to continue the Glasshopper project. Esma is a Dutch orthoptist and lecturer at the University of Utrecht.
Dr Godwin Ovenseri-Ogbomo
During the period Esma was in Ghana we appointed Dr Godwin Ovenseri-Ogbomo as a project coordinator, to start the necessary preparations on the ground in Ghana. Dr Godwin Ovenseri-Ogbomo is an optometrist and lecturer at the University of Cape Coast. In 2007 and 2008 he helped Carolina to establish The Optical Foundation's Glasshopper project. Carolina and Godwin published the results of these screenings in a Dutch Optometry Journal.
The program during Esma's stay in Ghana was as follows: Monday to Friday Esma, Godwin and the Ghanaian optometry students (varying anywhere between 6 to 13 students per day) would visit elementary schools and/or an orphanage to perform eye exams on the children. The Ghanaian students obtained practical experience, while at the same time eye test where being performed on children, who if need be would get glasses. The lenses would usually be ordered in Accra and the university technician would mount the lenses into the frames. All this allowing The Optical Foundation to contribute to one of its objective of stimulating the local economy in Ghana.
Esma and her team had worked extremely hard conducted screenings at the St. Lawrence Catholic school, Abura Ahmadiyya School and the New Life International Orphange. In total Esma and her team had screened a total of 470 children, of which 25 children and four teachers were prescribed prescription glasses. Following is an excerpt from the Esma's report dated Friday, July 15th, 2011, of the findings at St. Lawrence Catholic School:
" 15th of July 2011, St Lawrence Catholic School Today we saw a child with strabismus. This was very interesting for the optometry students. Due to the severity of the abnormal ocular alignment, I took some photos of his eyes. Based on the light reflex I could show the students the misaligned eye. It would have probably been a very funny sight, seeing us all huddled around the camera. I suspected an accommodative strabismus and immediately took the opportunity to incorporate a quick lesson on this subject."
It was a busy day, we screened lots of children again and had those requiring prescription glasses, choose a frame they really liked. Even some children, who don't require glasses, would come by to say that they also wanted spectacles."
University of Cape Coast
In addition to performing screenings, The Optical Foundation also aims to contribute to the theoretical education by providing guest lectures at the University. On July 22nd, Esma gave a guest orthoptics lecture on light reflex, cover test and amblyopia, followed by a practical lesson. Esma's comments about the teaching;
"The students were very eager to learn and in wanting to know everything about the orthoptic disorders, their questions were almost endless. Very nice!"
Esma's stay in Ghana coincided with the holiday period at the University, however all the optometry students voluntarily stayed on campus to help with the Glasshopper project. This indicates the enormous enthusiasm of the students in wanting to become specialists in their own country and to contribute to the improvement of eye care in Ghana. After taking part in the 3 weeks of screenings, each student that participated, received a certificate with the number of days they had worked for The Optical Foundation. This is not only a display of our appreciation, but it also reflects well on them providing them with opportunities for their future careers. In addition, it is most likely that two students from this enthusiastic group will become project coordinators of the next The Optical Foundation project.
After a very successful deployment in May 2007, Carolina returned to Ghana in November 2008 for three weeks. During her 2007 Ghana visit, Carolina didn't have enough time to screen all the children at the Rev. Alec Jones School in Nkanfoa, so she returned to be able to finish the screening of those remaining classes that missed out.
The screening process was similar to how it was conducted in 2007. Carolina had a team of 9 optometry students who would perform the screenings at the school. Each child was given an extensive eye examination, which was performed entirely by one student. The importance of this is that a student feels totally responsible for the patient when performing all tests and coming up with a diagnosis and treatment plan by them themself.
Unfortunately, Carolina's Ghana visit coincided with the examinations period of the optometry students, so they weren't able to perform screenings every day. Nevertheless Carolina and her team managed to screen 52 children in that three-week period and Carolina was able to train 9 optometry students.
On February 10th 2007, as volunteer Carolina Kunnen setoff to Ghana to establish the first project of The Optical Foundation. Fellow board member Huub Villevoye accompanied her for first two weeks, so they could work on the initial setup together. Huub and Carolina travelled to Cape Coast, a coastal town about 3 hours west of Accra. They had heard that the university at Cape Coast was offering a course in optometry, however, since they had had no luck getting in contact with the director of the program prior to their departure for Ghana, Huub and Carolina journeyed to the university on spec. At the university they were warmly welcomed by Dr Owusu - the director of the optometry course. He was very enthusiastic about the plans of The Optical Foundation and promised full cooperation. He also introduced them to Dr. Godwin Ovenseri-Ogbomo, one of the lecturers of the course.
After Huub left, Carolina started lecturing at the University of Cape Coast while she was waiting for the equipment to arrive in Ghana. Carolina helped with the practical classes of the third year students and gave orthopic classes to the fourth year students. Carolina teaching orthopics was a godsend as the lecturer of this course had left half way through the course never to return and without being able to finish this course those students wouldn't have been able to proceed to the next year.
After all preparations, the point had finally been reached where eye screenings could start and on Monday, June 4th, 2007 the 'Glasshopper' project was launched. The screenings were organised as follows: In the morning Carolina would go with an average of 10 optometry students to a primary school and would screen approximately one class a day. These primary schools are attended by children of the poorest communities in Ghana, comprising of an average of 40 to 50 students per class. Each child was given an extensive eye examination, performed entirely by one student. In doing this, the students get to learn how to do a full examination and how to start thinking about the diagnosis, all while getting a real sense of responsibility towards the patient's treatment plan.
In addition to the screening at primary schools, Carolina organised for her team of students to also provide screenings for street children in Cape Coast. These screenings were performed at the Cape Coast Castle. This castle, which in the past was used for the slavery trade, is now a museum to remember this despicable chapter of Ghana´s history. It is also used as library and clean water collection point, making it a place dedicated to the service of the local community, so the proposal of The Optical Foundation to hold a screening for street children at the castle was warmly welcomed.
During the screenings in 2007, we screened close to 1,000 children and approximately 150 teachers. Of the 961 children examined, 71% were female and 29% male. The high rate of females is because the first school we visited was an all girl school. The age of the children examined, ranged from 1 to 19 years old. Only 6 of the 961 children had previously had an eye examination or already wore glasses. This while 55% of children were found to have an eye disorder. However, not all of these eye disorders need to be corrected with spectacles, because with young children the eyes are still developing and certain eye conditions are seen as normal.
Percentage of children who had a previous eye test
Percentage of children that we diagnosed with an eye disease
Percentage of children that needed glasses or referral
Aside from this, 60 children were referred to an ophthalmologist for ophthalmic treatment, or if there was a prognosis of a potential eye disease in the future, they were referred to the eye clinic of the University of Cape Coast. In seven of the 961 children a lazy eye was diagnosed. If it wasn't already too late, a treatment to correct the lazy eye was started for these children, who remain under treatment of University of Cape Coast´s eye clinic.
During this period, Carolina not only screened and helped many children, but also trained and provided practical experience to 35 Ghanaian optometry students. Students who joined the screening had clearly grown from the experience and their knowledge had expanded significantly. Educating the local population on the importance of eye care and training students to become specialists in their own country, is one of the main priorities of The Optical Foundation. The aim is for these local future specialists to eventually take ownership this project and focus on the eye care in their own country.
Carolina also took the initiative to put together an all female screening team to empower these women, with the aim of trying to break the cycle of the gender hierarchy bias.
The figures show that our work is desperately needed. Dr Godwin and Carolina published the results of the screenings in the Dutch optometrists trade journal'Visus' (2/2009, page 10-13. Through publications, we try to make the Ghanaian government aware of the need for eye screenings for Ghanaian children.
Some notable cases
A 10 year old had an eye disorder of -9.00. Without glasses she could see 1% and with her glasses her vision improved to 35%. Because of not having glasses over the years, her eyes were never able to fully develop and she will never see have more than 35% vision.
A girl of twelve required a corrective strength of +8.00. Her eyes were also never able to fully develop and she will never have more than 60% vision.
A timid and shy 13 years old girl had an untreated lazy right eye, with at most 40% vision for which no more improvement could be achieved. Her left eye required -3.00.