Ophthalmologist shortage, AIDS/HIV crisis draw surgeon to Africa

John A. Hovanesian

When P. Jeffrey Colquhoun, MD, arrives at the Zimba Eye Clinic in Zambia, he is greeted by the many individuals waiting outside the clinic for ophthalmologic care.

“The day we arrive, there will be a line of a couple hundred people circling around the clinic who are hoping to get in that day,” Dr. Colquhoun said. “Sometimes it takes a couple of days before they get in.”

While people wait for surgical care, they camp outside the clinic, sleeping on concrete, he said. After surgery, they sometimes embark on a 2- or 3-day journey home.

“For a lot of folks, it’s a week out of their lives to get eye care. It’s really a phenomenal investment of time compared to what we’re used to here in the U.S. [We have] a short drive to the ambulatory surgery center, 15 minutes of surgery, home an hour later, out to lunch, and it’s barely a blip in your day’s schedule to get cataract surgery,” Dr. Colquhoun said.

The need

Volunteering at the Zimba Eye Clinic has been a continuation of Dr. Colquhoun’s outreach work since he graduated from medical school more than 25 years ago. He said he wanted to give back after earning a medical degree in ophthalmology. He has worked with numerous volunteer organizations and Christian missions as part of his faith and a personal and spiritual mission to help others.

Placement of an IOP amniotic graft post pterygium at the Zimba Eye Clinic. Image: Colquhoun PJ

“It’s a good thing to get out of our comfort zone every now and then,” Dr. Colquhoun said. “We kind of rise to a higher cause and learn a lot about ourselves and about our maker when we’re not in our comfort zone. There’s a lot of personal, spiritual growth when I’m on a mission trip, and I also feel I’m walking the walk that I should be when I’m thinking not just of myself, but of others.”

There is a great need for ophthalmic outreach work in Zambia, according to Dr. Colquhoun. The country is facing a shortage of physicians to meet the rising need for ocular care. Several years ago, it was estimated there were only eight to 10 ophthalmologists to care for the country’s 12 million residents, he said. Zambia compares in size with the state of Texas, which has nearly 1,000 ophthalmologists, he said.

In a 2-week period, surgeons screen 500 to 700 people, performing surgery in 100 to 200 cases. The most common eye condition that Dr. Colquhoun and colleagues treat at the clinic is cataracts, which accounts for about 75% of all surgeries, with trachoma the next most common. He and colleagues also perform lid repairs, glaucoma procedures, pterygium excisions, and removal of squamous cell carcinoma and other tumors.

AIDS/HIV epidemic

In addition to the other ocular conditions seen at the clinic in Zambia, the ocular manifestations of AIDS/HIV are also prevalent concerns there, Dr. Colquhoun said, adding that Zambia has one of the highest rates of AIDS/HIV in the world, at about 17%.

At the Zimba Eye Clinic, he and colleagues have treated a variety of AIDS/HIV-related eye issues, including conjunctival tumors, squamous cell carcinoma and cytomegalovirus retinitis. The AIDS/HIV epidemic has decimated certain age groups in Zambia, where the average life expectancy is 37 years.

“You don’t see that many older people, and it’s largely because of AIDS,” he said. “We see a lot of kids with grandparents — the grandparents escaped the HIV epidemic, but we see a grandparent, relative or sometimes an older sibling taking care of a younger sibling because one or both parents have died from AIDS.”

The international push to address the rising AIDS/HIV rate in Africa and in Zambia, specifically, has helped to reduce the rate from 20%, Dr. Colquhoun said. One of his first trips to Zambia was with Rick Little, co-founder of the outreach organization Friends of Zambia. That trip, a “Seeing is Believing” trip, highlighted the overwhelming need for eye care in the country.

Subsequent to that trip, the Bill and Melinda Gates Foundation, several pharmaceutical companies, the U.S. government and others have supported the initiative to supply antiviral medications to the country.

“That brought light to a dark situation,” Dr. Colquhoun said.

Many hats of volunteerism

Friends of Zambia is one of several groups that Dr. Colquhoun volunteers for in Zambia. His initial outreach work was with Medical Ministry International, mainly in the Caribbean. That group, based in the Dominican Republic under director Willie Hunter and physician Juan Battle, MD, is one of the largest short-term mission project organizations in the world, he said.

His work now with the Zimba Eye Clinic, through International Vision Volunteers, is somewhat different.

“This modern clinic built in 2003 is visited by about six teams typically for two weeks each visit during each year. The equipment was donated largely by Alcon, including a Legacy phacoemulsification machine, mechanical vitrectomy, YAG laser, and slit lamp. There’s a local staff that remain at the clinic. There’s a business director and a clinical officer, who acts like a physician assistant, screens, sees patients, and performs minor surgical procedures,” he said. “Also, the director will market an upcoming team’s member names and dates up and down the highways on signs. Apparently, that’s the most effective way for people to see when an eye team is coming.”

The balance between outreach work, private practice and his personal life has been challenging, but the rewards have been worth the struggle, he said.

“It’s not perfect. Things get out of bounds with my practice and family life here, but it’s something that takes a limited amount of time and energy that bears its own rewards,” Dr. Colquhoun said. “My observation is that anyone who goes once has a compelling urge to go again on a mission trip.” – by Erin L. Boyle

• P. Jeffrey Colquhoun, MD, can be reached at Southwest Michigan Eye Center, 3600 Capital Ave. SW, Suite 203, Battle Creek, MI 49015; 800-274-6699; fax: 269-979-6381; e-mail: jcolquhoun5@yahoo.com; Web site: www.swmeyecenter.com.