Establishing a School of Optometry in Uganda took more than ten years of intense planning and negotiation, which almost ended in despair several times. Now, the first six students have emerged from Makerere University in Kampala with Bachelors Degrees in Optometry. mivision met with graduate Godfrey Wanok and one of the School’s main proponents, Mr. Anguyo Dralega to hear about their fascinating journeys into the world of optometry and academia.
Makerere University’s inaugural graduates of optometry have been eagerly awaited since plans for the school were first conceived 14 years ago.
The young optometrists are the building blocks for a sustainable eye care service in Uganda, which has a population of around 39.5 million people.1
The situation was dire. I met up with my colleague, Naomi Nsubuga, who returned from the United States to Uganda with the same intention as me to make a difference, and we asked each other, what should we do?
They will relieve the country’s 45 ophthalmologists (around 29 of whom are active) from the management of basic and common eye conditions, allowing them to focus on their areas of specialty – medical and surgical treatment. Additionally, the optometrists will help save sight by detecting the early stages of serious eye conditions and diseases, which may need referral.
LINING UP FOR AN UNKNOWN PROFESSION
At 23 years of age, graduate Godfrey Wanok says he’s looking forward to making a difference to eye care in Uganda.
“When I finished school I asked myself what I wanted to do in my life and I realised that I wanted to be part of the life-saving mission in our country, so I started looking for the best ways to help,” he told me.
With a father who works as a police officer, Godfrey’s childhood involved frequent moves from town to town. One thing he’d noticed in the process, was the lack of medical care outside the major cities, especially when it came to eye care, an area of health management that interested him.
Most of Uganda’s 29 active ophthalmologists serve in the cities. They are supported by around 207 ophthalmic clinical officers, most of whom are only trained to do presbyopic corrections. There are just three registered optometrists based in the capital of Kampala and Ruharo Eye Centre in Mbarara; all are in private practice and have received their training outside the country. Finally, there are just two ophthalmic nurses in the entire country.
Despite this dire situation, Godfrey was not convinced that he wanted to complete a degree in ophthalmology.
“It would have taken many, many years – first, I’d have to do five years of medicine, then practise for two or three years, then go back to studying to complete my qualification. I did some research and luckily enough, after some time, I saw a newspaper advertisement saying that Makerere University had introduced 21 new courses. Optometry was available from the College of Health Sciences. I found out what an optometrist does and I decided to apply. Most people apply for six courses at different universities, but I knew this was what I wanted, so I only applied for optometry. People told me I was taking a risk but my dad was happy because he knew it was what I wanted to do.”
Most students in Uganda who go on to undertake tertiary study do so at Makerere University in Kampala, which is the oldest university in East Africa. Others attend more than 20 private universities and a smaller number of non-university institutions. Mr. Wanok explained that, thanks to a Women’s Emancipation Program, the number of women undertaking courses at university continues to climb, however, there’s still a way to go. His class of six students comprised two women and four men; the second cohort comprises two women and one man, the third has three women and one man and the fourth has just three women and 16 men. The school of optometry is expected to grow, especially now that the government has recognised the importance of eye health and has committed to sponsoring 10 students every year for the programme.
MEETING THE CHALLENGES
For Mr. Wanok, attending university was challenging right from the beginning, when he had to travel 330km from his home, in a small upcountry town in Northern Uganda, to Uganda’s capital city to live. Fortunately, although he was unsuccessful in acquiring a government scholarship, he did secure private scholarships, which helped support living and study expenses. With lectures from 9am – 5pm, five days a week, and study into the evening, part-time work was not an option. Navigating a new course also presented challenges and opportunities. “We don’t have a full time faculty at the University and we only have a few lecturers because we were the first students to go through the course. They were often busy with administrative duties and they had to make a lot of decisions along the way.
“In my second year of university, I formed the Makerere University Optometry Students Association (MUOSA) and together with medicine and pharmacy student associations, we’d run outreach clinics on the outskirts of town. Sometimes we’d travel all night to get to our destination then we’d set up and offer refraction, diagnostics, and medication. We’d see up to 300 people in a day with practising optometrists supervising.
“That’s how I realised I had a serious refractive error. I’d be asking people to read me the bottom line of the eye chart and I’d have to move closer to see what they were reading!” Mr. Wanok said working in outreach clinics was an experience that made him even more aware of the overwhelming health challenges experienced by people living in rural Uganda. It also helped him build clinical confidence, which will put him in good stead as he moves into the next phase of his journey in eye health.
A BACK TO FRONT JOURNEY
The School of Optometry, at which Mr. Wanok has completed his degree, was established as a result of a collaboration between Brien Holden Vision Institute, the Uganda’s Ministry of Health, the Department of Ophthalmology at Makerere University, Light for the World, and the Optometrists Association of Uganda. Funders for this long-term project include the partners mentioned above plus the Australian Government and Optometry Giving Sight. In 2016, the University of New South Wales signed a MOU with Makerere University and the Institute, committing to a long-term relationship between the faculties.
The principal drivers were Ugandan optometrists Anguyo Dralega and Naomi Nsubuga, who co-founded the Optometrists Association of Uganda together in 2004. In 2006 Naomi Nsubuga was employed as the sub-regional program manager East Africa with Brien Holden Vision Institute.
While the School took 10 years to establish, Uganda may well have still been waiting, had it not been for Mr. Dralega’s life experience, which took him on what he describes as a “back to front” journey to optometry.
Mr. Dralega grew up in Uganda close to the borders of Sudan, and Zaire at a time when Uganda was being led by the notorious dictator, President Idi Amin. Mr. Dralega was a teenager when President Amin’s government had been disbanded and its remaining soldiers were being driven by guerilla soldiers into the north of the country. As he explained, “unfortunately for my brothers and me, we were sandwiched in between the old soldiers and the new ones coming from behind. If the new soldiers found you, they’d think you were an informer. If the old ones coming through found you, they’d think you were a rebel. We were warned to leave.”
I found what an optometrist does and I decided to apply… I knew what I wanted, so I only applied for this course
Under instruction from their father, Mr. Dralega and his brothers snuck away from home at four o’clock one morning and commenced the long walk to Sudan and now live as refugees. However, they didn’t last long in the refugee camps, which offered them no opportunity for education, something that they were committed to acquiring.
Mr. Dralega moved to the town of Juba, where he became one of several children adopted by a woman. With no government support, other than the provision of meagre rations of rolled oats, she struggled to feed them.
“In the beginning we were given oats with milk, which was good, and then after about a month or two, the milk ran out. We ate dried oats for lunch, for supper and after a while, I’d really, really had enough. I sometimes don’t want to remember those days, they were really hard times,” he said. “It took me a while to start eating oats again.”
Eager to earn money and continue his education, Mr. Dralega managed to find himself a day job in a printery. At night, he attended school within the Sudanese education system. Little did he know that this would lead to a series of ‘back to front’ educational experiences that would eventually lead him to optometry.
“I completed my Sudanese schooling, and was offered a scholarship at Khartoum through the Council of Refugees. My strength was sciences, so they put me into the Institute of Optometry, although at the time I would have studied anything. I’d had no experience with optometry, I didn’t even know what it was.”
Impressively, while undertaking his course in optometry, Mr. Dralega also completed his ‘O’ Levels by correspondence.
“In Uganda, you leave with ‘O’ Levels, however in Sudan, leaving school gave me the equivalent of two years of ‘A’ level study. I knew this was a very weak certificate, so I decided to enrol to do my Cambridge ‘O’ Level by correspondence.”
With English as his first language, Mr. Dralega achieved solid marks and completed his O Levels and his diploma in optometry. He practiced for a year as an optometrist in Sudan before being offered the opportunity to study at Bradford University in England. He was accepted to study his Masters in Optometry/Vision Science, however, once he’d completed the course he discovered that he was still unable to practice as an optometrist in the UK.
“By that time I was married and there was a baby coming along. I needed to work, I needed some money. But the British system required that to become a registered optometrist, you need to pass their Professional Qualifying Exams (PQE) and a prerequisite to complete the PQE, was a Bachelor of Optometry… so, back I went for another three years, to do my Bachelor’s and eventually, my PQE.”
Mr. Dralega practiced in optometry for a few years before moving back to Uganda with his young family. “By that time, Idi Amin was long gone and a new government was in place. Things had changed, and I wanted to give back to my country,” he said.
And so he has, again and again.
BUILDING A PROFESSION, STARTING A SCHOOL
Mr. Dralega returned to Uganda in 2004 to discover the country’s eye health was terribly under-served.
“The situation was dire. There were just three optometrists, all trained overseas and they were practising privately,” he said. “I met up with my colleague, Naomi Nsubuga, who came back from the United States to Uganda after seeking further training there, and we asked each other, what should we do? We decided, together with another colleague, Samson Wambuzi, to form an association that would formalise and regulate the profession of optometry.”
Forming an association was far more complex than it sounded and six months of pro bono legal services later, the idea was knocked on the head by a government official who explained that with just three registered optometrists in the country, there simply weren’t the numbers within the profession to justify the expense of forming a council.
Undeterred, Mr. Dralega and his colleagues decided to form the Optometrists Association of Uganda (OAU) regardless and then build the numbers by starting a school.
They approached several organisations for assistance and in 2008, a delegation visited the Vice-Chancellor at Makerere University to lobby for the course. The group included Dr. Bob Chapelle (then President of the World Council of Optometry), Prof. Kovin Naidoo (then Director of Programs at Brien Holden Vision Institute), and OAU Executives. Having gained the University’s support, they lobbied the Commissioner at the Ministry of Health. With their agreement, in 2013 they began developing a curriculum with Brien Holden Vision Institute.
Despite all the support they had, it was to be another 10 years before the first course commenced. The curriculum had to be green lighted by the University’s deputy principal, then the Academic and Libraries Committee and the University’s Council, which is the final governing board. The National Council for Higher Education and the Senate then had to review the entire course for quality assurance. It was a process that took years due to bureaucracy, complex administrative requirements, and each committee’s irregular sitting periods.
“We got to the point where we were on a knife edge, we didn’t know whether it would go ahead or not,” explained Mr. Dralega.
When finally the course was approved, the task became one of education and awareness building in order to attract students.
“We advertised the course but a lot of people didn’t know what optometry was and their parents were on their case saying, ‘No, this course is a new course. The students who complete it will go nowhere’.”
Eventually, eight top students who applied were admitted to the first course in the School of Optometry at Makerere University and this year, six of those students, including Godfrey Wanok, have graduated and commenced the six-month internship required for their registration as optometrists.
FOUNDATIONS FOR THE FUTURE
Mr. Dralega hopes three of the graduating students will continue on with the University to develop the faculty and the remaining three will move into the community to practice.
And while retaining half of the first cohort means there will only be three optometrists entering the workforce this year – a mere drop in the bucket when it comes to serving the needs of 39.5 million people1 – Mr. Dralega says to do so is important. “We are building the infrastructure for the future. Uganda has been waiting for optometrists for 52 years, another two or three years is not going to kill them. Anyway, we have three students coming along next year, another four students after that and then another 19 after that. We desperately need to build a locally grown faculty to support the emerging profession.”
GROWTH IN COMMUNITY EYE CARE
Mr. Wanok agrees with the plan and intends to remain on at the university. “I hope to continue either as a lecturer or as a post graduate student,” he said. Additionally, he plans to continue his outreach work and will practice at a community access vision centre at the Makerere University Hospital, recently opened as the Academic Vision Centre.
The Academic Vision Centre is active both as a practical training facility for the optometry students and as a much needed eye care service to the community. Additionally, it has the capacity to provide more community outreach projects to remote locations, and provide health promotion materials to schools, clinics, hospitals, and other high volume areas, to educate the public on the importance of eye health and regular eye examinations.
Mr. Wanok says, as a young optometrist, there is much he wants to do to change lives in Uganda by contributing to the University and the work of the Academic Vision Centre.
“There are some kids who have been sent to schools of the blind when they are not actually blind – all they have is high refractive error that has not been diagnosed because they have not received a comprehensive eye examination. If they’d been diagnosed and given glasses, they would have attended a regular school, they would not have spent their childhoods learning to live blind, and the spaces they took up would have been available to students who really needed them.
“There are also older people – 60 years of age – who cannot read and all they need is ready-made spectacles. I have seen the smiles on faces when I’ve been able to give people free glasses.
“With our knowledge, our diagnostic equipment, medications and, with help from sponsors, ready-made readers, we can really make a difference.
“These are just some of the changes that I want to fight for as an optometrist in Uganda.”
- www.cia.gov/library/publications/the-world-factbook/ geos/ug.html