 So, good afternoon, I'm Philip Burgess and myself, Petrus Kangae and Nick Bear, would like to present some highlights of our research collaboration through the Liverpool-Blantyre link. This has been a strong international research collaboration. I've listed some of the highlights of our research in the recent past on this slide and now I'd like to hand over to Nick who's going to take you through in a little bit more detail some of the studies we've performed recently. So, yeah, I'm just going to talk about a study of cost-effectiveness of screening for diabetic retinopathy and laser treatment which we did in Blantyre and this is part of the Malawi diabetic retinopathy study but we thought it was important to demonstrate that this model of screening and looking for patients with diabetic retinopathy and treating with laser was cost-effective because of the rapid increase in people with diabetes in sub-Saharan Africa. Essentially, we found that it was cost-effective, 400 US dollars per quality adjusted life year and that meets a WHO definition of cost-effectiveness which is linked to GDP and so for Malawi is low but it still was cost-effective and that's great because it shows this is a useful and cost-effective approach to managing diabetic retinopathy in sub-Saharan Africa. And another area of research has been involved in this YouTube it's some of you be less familiar with which is malaria retinopathy. Yeah, so we've been researching malaria retinopathy in Blantyre for many years and showing that it's diagnostic for a child in coma with a parastemia even though parastemia is common in the population and it also has prognostic information the worst the malaria retinopathy the higher the risk of death from seromolaria but it's quite difficult to visualize particularly for a physician with a direct ophthalmoscope you can see the hemorrhages but you can't see other features well because they're too peripheral or too subtle and you really need an indirect ophthalmoscope to see it well. So we are developing automated grading so that physicians can access the information from the malaria retinopathy using a low-cost fundus camera and we're in the process of optimizing the image analysis at that time with our collaborating US company VisionQuest who are developing the software for that. And as well as academic achievements it's important for us to demonstrate impact of our research we're focusing on the case of diabetic retinopathy we've increasingly be able to develop links and relationships with the Malawi and governments of the Malawi Ministry of Health to affect changes in policy we're really delighted to see that through hopefully with the help of international collaborations including ours but also importantly the Scotland Longway link that screening and referral systems for diabetic retinopathy are now operating successfully in the central hospitals in Lanthire and the Longway and there's a strong training pipeline coming through overseen by Petrus Kangi and in partnership with the German groups and other international collaboration developing training ophthalmologists and future research leaders in Malawi. We've also developed excellent relationships with the Diabetes Association of Malawi and got our message out to the public through events that involve national newspaper coverage. So Nick's now going to talk a bit about the shared learning that we've been able to achieve so mutual benefits for both individuals and institutions. Yes so we've really found particularly in the sphere of diabetic retinopathy that the service provision has grown out of research projects the research projects provide sustained funding at the beginning to get clinics going and then as the demand has grown so services have grown and taken over from them and research projects provide a kind of mutually beneficial goal for both parties we know this is in a great collaboration working together and allowed career development for both sides of the link. Thanks very much so that's just hopefully a few of the highlights from our strong international partnership we've developed and we're looking forward to continuing over the in the future and myself Nick or Petros would be happy to answer answer questions on Friday about that. Thank you very much. Thank you. We have some of the great things that are happening you know to do with tackling the issue of diabetic retinopathy you know the shared learning the enhanced partnerships we we've also you know had quite a lot about you know the continued networking that is coming out from there and of course just to put everyone in perspective of what the diabetic retinopathy network is all about we are just going to go into the next presentation that is going to give us an overview of the DRR network links and of course just to give everyone an understanding of what the network is all about. In a previous session this morning we had about the retinoplastoma network and I am now going to give an overview of a second network the diabetic retinopathy network the VNET which also came about as an extension of the vision 2020 links program. As we heard earlier the original remit of the vision 2020 links program was to establish training partnerships with the objective to improve the quality and the quantity of ICAR services in Africa. The links have since become a platform for other programs and for the networks and the vision 2020 links program started in 2004 and now has 30 UK link partnerships 17 of them with African countries. In 2013 we realized that over 20 of the links had chosen as their priority condition to train either pediatric ophthalmology or diabetic retinopathy and there was a clear pattern that these two issues were becoming quite relevant in the strategic plans of many links. So the DRNET as a network was then set up in 2014 and it was based on existing link partnerships that were already working towards improving diabetic retinopathy services. Forming a network allowed all these links to meet together to share learning to grow and eventually to also extend to 23 links over the five years with Pacific and Caribbean countries joining in. In many cases the DRNET services in some of the countries were either non-existent or they were rudimentary or they had treatment services but they were looking to establish a better way of screening people with diabetes. The links through the UK partners were able to tap into the experience of the national diabetic eye screening program in the UK which screens over two million people per year in the UK. This program has one of the world's highest coverage for the air screening at national level. Just like the individual links the networks are also about teamwork and both interprofessional multidisciplinary teams and in diabetic retinopathy the team is really essential. This team approach includes the obvious professions that we need for the air screening and treatment like the screener graders, the nurses or the ophthalmologist but just as important are the data technicians, the endocrinologist, the managers and even Ministry of Health officials. And these applies both to the teams from the UK and the teams from Africa, the Caribbean or the Pacific Islands. So when the network was formed the first meeting was used to agree a target and a way forward for action. And it was agreed that every link in that network would treat at least one person a week more for the first five years of the network. And we calculated this would equate to saving 37,500 blind years. This was done through different ways. There were more than 92 training, reciprocal training visits where the teams from Africa came to the UK from the Caribbean to the UK and also the UK teams went to the direct training in the country. We also had four large international workshops where all the link partners were invited. More than 90 ophthalmologists were trained in laser treatment across the network. And we have more than 80 screener graders being qualified with the international eight month qualification for screening and grading run by the Gloucester group in the UK. This is an online qualification. This original target that was to treat about 3,750 extra patients collectively as a network was actually doubled and more than 8,000 patients were treated and approximately 8,000 years of side saved. As a collective the network increased the screening capacity by 88% in these countries and as a total the treatment increased by 47%. Another of the aspects that was a key work of the network was to include Ministry of Health officials and policy makers in the teams. And this often catalyzed the work of the individual country teams to produce national guidelines. For example the Kenya DR guidelines, Uganda, Tanzania, Zambia and others that are underway like in the Caribbean, Malawi or Ghana. And the value of developing appropriate guidelines for diabetic prognopathy that are context specific and implemented ensures quality across the programs. I'm going to leave it here and we are going to hear now from several of these links. The Malawi and Fife link in Scotland. The link between Zambia and Frimley Park Hospital in the UK. The link in Calabar, Nigeria with Wolverhampton and the link with St Lucia in the Caribbean and Frimley Park. And each of them are going to present their experiences with the program and the partnership, their achievements and the way forward for the future. Thank you. Thank you. So the first of these presentations coming is the St Lucia Frimley Park link and we're going to hear from that team now. The diabetic retinopathy program is funded by the Queen Elizabeth Diamond Jubilee Trust through a two-year grant held at the International Center for Eye Health at the London School of Hygiene and Tropical Medicine. The Vision 2020 links program is an initiative to give eye institutions in low and middle income countries the skills and resources to develop high quality eye care services for the populations they serve. The diabetic retinopathy program was launched on February 5th 2018 in St Lucia. St Lucia, a small developing Caribbean country with an incidence of diabetes of 11.5% did not have the capacity for diabetic retinopathy on Ireland. Patients who required that service traveled overseas at very high costs to them. Many patients who did not have the funds to seek care sadly went blind. This program has given us the human resource capacity to provide services to our patients integrated into our primary care services and free of charge. The program consisted of training of health care workers within the primary care system to include nurses, health aides, consultants of terminologies to provide the service. The provision of equipment to support the service, health education support and technical support and monitoring. The program has been implemented by training our public health officers to ensure sustainability. One of the highlights of the program was the many opportunities for human resource development. It commenced with the workshop for the steering committee for the planning of the national program. The biomedical engineer, the screeners, the graders and oftalmologists, they were also trained in 2017. In May 2020, the Vision 2020 exchange was facilitated with Frimley Park Hospital. Frimley Park Hospital's team was also instrumental in training in country our screeners and graders. The screeners and graders also participated in the certificate of higher education in diabetic retinopathy screening with the Gloucestershire Royal Hospital online course. Under the diabetic retinopathy program, screening services were made available in the north of the island and also in the south. The treatment services was also developed at one of our wellness centers with a well-established referral system for care. As of April 2020, a total of 2,855 patients have been screened and 328 patients have received laser treatment. As we continue to strengthen the national diabetic retinopathy program in St. Lucia, we aspire to expand screening services to other communities in crystal numbers being screened and treated and to continue training new screeners and graders to ensure sustainability. Hi, I'm Professor Geetha Menon and with the team from Frimley Park Hospital, we were a part of the link that actually went to St. Lucia to develop diabetic retinopathy screening in the island. The team along with me went to then through reciprocal visits so we went to the island and we also had the team from St. Lucia come to visit Frimley and what we did was develop a really good competency-based screening, a training program for screening the graders and screeners in St. Lucia. We also trained the ophthalmologist in laser treatment and I think that the best bit of this link has been the fact that through the link we were actually able to get the Ministry of Health in St. Lucia to be involved right from the beginning. The Ministry actually therefore owned the program. They made sure that they had enough screeners and graders trained within the program and now we actually have a very good screening program for diabetic patients across the whole island. We've also had the additional advantage that they've had laser treatment available for all the patients which is meant that this program actually has the highest treatment rate as well. I still remember going to the island for the first time to teach screening and grading and the patients that came on that particular day, there was quite a lot of patients with proliferative diabetic retinopathy. Setting up the screening program here has meant that we were able to save a lot of patients from going blind. Good day, my name is Dara Bhut. I'm the consultant of Talmology St. Lucia with the diabetic retinopathy screening and treatment program. The other team members include screeners, graders and optometrists, a family nurse practitioner, HMIS team and various stakeholders from the Ministry of Health. The collaboration with the Vision 2020 links partnership has been very beneficial to us especially in boosting our human resource development. So far we have 13 fully qualified screeners and graders with the program. We have screened over 2800 patients. We have lasered over 300 patients and now St Lucia can effectively treat and manage diabetic retinopathy. Thank you and we're looking forward to continue collaboration with the Vision 2020 links partnership. The partnership with the Vision 2020 links program in St Lucia has been amazing. It has facilitated the development of our primary healthcare team to support the establishment of our own diabetic retinopathy program in St Lucia with screening services, grading and laser services to all of our diabetic patients. These services are provided free of charge to all our patients. The collaboration has been extremely useful as it has reduced blindness due to diabetic retinopathy in St Lucia. Thank you very much to the teams in St Lucia and Frimli for the presentation which is very very interesting and thorough. We're going to move on to another team that also works in diabetic retinopathy as part of a link and that is the Calabar in Nigeria with Wilbur Hampton in the UK link and we'll hear from them. Good afternoon. Thank you for asking the Calabar-Wilbur Hampton Vision 2020 link to present today. I am Nick Price, the links UK coordinator at the Royal Wilbur Hampton NHS Trust. And I am Afil Iban, I have a links Nigeria Coordination Council since I have University of Calabar to do more for you. The link Memorandum of Understanding was signed off in 2014. We are grateful for the support, the Vision 2020 links program and the senior management of both institutions have given us throughout the two three-year activity plans. Four priorities for training had been identified and have been undertaken. Medical retina in particular diabetic retinopathy, glaucoma, pediatric ophthalmology and leadership skills. Although training many other spheres such as biomedical engineering, optometry, nursing and clinical governance have also featured in the partnership. In Calabar we are particularly fortunate to have the driving force of Professor Dennis Nkanga who leads the diabetic retinopathy service. In cooperation with the Lagos group and with the support of the Vision 2020 links program progress is being made towards establishing a national diabetic retinopathy screening program. Prof, over to you. Thank you Nick. The Calabar Diabetic Retinopathy Screening and Treatment Service commenced in January 2015. It is a facility-based call recall annual screening program. Every patient with diabetes 12 years and above is invited for screening. The links program has given priority to the training of staff both for screening and treatment. The service is delivered by a multi-disciplinary team from the Lyons UCTH Diabetes Center, a one-stop service point for diabetes care. One of the major priorities of our team has been raising awareness, collaboration within the community and advocacy. We have worked together with primary care physicians, community pharmacists, laboratory scientists, nurses, the State Primary Healthcare Development Agency to create awareness of the program within the community. The statistics is shown in the next slide. So far we have registered about 37% of the people living with diabetes in our city. Screening rates are still low because we have an ophthalmologist sitting down to do sleep-lamp examination once in a week on these patients. We believe that when we deploy photographic screening the numbers will increase even more. We have worked together with our colleagues in Lagos and the Lagos University Teaching Hospital to agree on unified screening protocol, unified treatment guidelines. We have worked with the ophthalmology society to raise awareness on diabetic retinopathy. Last year the National Diabetic Retinopathy Steering Group met. With the leadership of Dr. Ocala in the Federal Ministry of Health, we are in a state ready for the National Steakholders Meeting. Every other aspect of our ophthalmology service has been affected by the links and that has been shown in this slide. Back to you Nick. Thank you Prof. Of course there should be mutual benefits to a partnership. Comments made by members of this team after a visit to Calibre show how partnerships can be a win-win deal. I value more our spectacular NHS and how lucky we are to work in this environment. I improved on my ability to deliver lectures and facilitate workshops. It taught me to repair equipment with limited spare parts to get the equipment working. It increased my awareness of prevalent conditions in different countries and focus on preventative high care. So a final word from Matthew. Thank you Nick. We have come a long way since 2014 in this partnership. All we have shared today will not have been possible without all the institutions and individuals listed on this slide. We are grateful to everyone of the people who have been a part of this journey. We have benefited immensely from this partnership and we therefore would strongly recommend partnerships. We'd like to say a big thank you to everyone. Thank you. Robert you're muted. I hope I'm back on now. Okay yeah so I was just saying I mean we can see that some of the challenges that we are you know highlighted in the morning when Elaine Foster presented and highlighted some of the key challenges that we need to to address as we continue to work and improve high care services through these links programs we are already on the road to actually making or addressing some of these challenges and of course we continue to celebrate some of the great outcomes from these partnerships and without wasting much time I would like to introduce the next link which is the Malawi and five feet link and they are going to give us a highlight of some of the key achievements in the in the past few years. Okay I'm from Fife in Scotland and we're twins with La Longwe and Joseph from Sosa has been a key part of developing these services but unfortunately there's some technical issues we think can't join me today to give this presentation. So La Longwe's in the central region and I first went there in 2014 and Joseph showed me around the eye hospital here and his main concern about diabetic eye disease was that patients didn't come to the eye hospital unless they had symptoms by which time it was often far too late to help them. Just across the road is the diabetes clinic and we had a visit there so here all the patients waiting to be seen the most impressive thing for me was the patient education that's delivered by nurses every morning before the clinic however this diabetes education talk didn't include anything about the importance of eye screening in diabetes eye care in general eye diabetes care. So we decided that education was probably the best way to start off a diabetic eye service in Malawi and since 2014 we have been running courses involving lectures small groups patient examinations and we have now taught over 200 healthcare professionals including optometrists, ophthalmic clinical offices and nurses to screen for diabetic eye disease what to refer and how to teach patients how to manage their diabetes as well because quite often their contact with the eye healthcare professional can be a very important one for for education as well. In 2015 we had a visitor that's Sophie Castle of Wessex who's a patron of the Queen Elizabeth Dunn Holden Jubilee Trust and she's the Queen's representative and she came to visit us and this is her she spent probably about an hour and Joseph will tell you all the builds up to that took many days but she spent about an hour with us and here she is chatting to a patient you can see the delegates here and they're holding their arc lights which is the ophthalmoscope and that costs about five to ten pounds and it's provided to all of our delegates so that they can use that for direct ophthalmoscopy and it's been kind of instrumental to us being able to deliver this. So Sophie came for about an hour as I said and then afterwards when we finished the course we had a look on news websites to see what they said about her visit so and most of it was really about her hair clip and her shoes and not very much about the projects that she's been to visit but that's how it is. The highlight of the course for me is Olive here she's a very experienced diabetes nurse and she gives a talk to delegates with Moira who's a patient representative and they talk about how to give advice to patients with diabetes regarding food, foot care the highlight for most of us is her she acts out as an impotence scenario which is unforgettable really and I also enjoy how innovative everyone has to be with diabetes in Malawi this is how you keep your insulin cold if you don't have a fridge. Hasn't all just been in Malawi there've been visits to Fife as well here Dorothy and Eric receiving the Topcom camera that was donated to them when they came for their visit and then here's Eric behind the wheel in Malawi using it and that's been really good for diabetic ice screening in the Longway and this is another two visitors to Fife unfortunately they chose the moment when the beast from the east was just arriving you can see the snow just starting in the background they assured me when they arrived but they were very used to cold because they come from the north of Malawi however I don't think they wish to experience anything like that nor do we really especially when you think this is our fourth the fourth day of our three day course and these are the shores of Lake Malawi I'm sure they were dreaming of that while we were battling through the snow it's a big team effort so we have created this across the whole of Malawi have the same screening criterias and teach everybody across the whole you'll see that the map of Malawi here everybody puts in where they come from they come from the very top of Malawi along from extreme south as well so and there's a big team effort and it now involves lots of registrars from the UK and from Malawi as well as the consultants three consultants from the northern central and southern regions of Malawi and it's been a privilege for me to be part of that thank you in the next presentation we're going to listen to professor Gita Menon from the Frimley Park as well as Dr Mu Mamlengah who is the national Ikea coordinator for Zambia as they share insights on the Zambia Frimley Park link that started way back in 2011. Hi I'm professor Gita Menon and me myself with the team from Frimley Park Hospital in Saree developed a link with Kitwi Central Hospital through the Vision 2020 links program and this is special to me because this was our first link that from we had we've had many more links after this Kitwi Central Hospital wanted us to actually look at developing diabetic retinopathy screening because lots of the patients coming to that hospital at that time were going blind because of diabetes so we set up a competency-based training program to train screeners and graders in the hospital as well as train them for laser treatment through the Kitwi Central Hospital the National Eye Coordinator was keen that we actually roll this program out through the whole of Zambia and also managed to get some support from the Ministry of Health. This has meant that we managed to get equipment in the form of funder's cameras in laser machines and OCT machines in five of the main central hospitals in Zambia. Like I said this link is special to me and with the reciprocal visits that we've had it has meant that this program has taken off really well and this is a trailblazer as far as diabetic retinopathy screening and treatment is concerned in Zambia. So thank you so much of course we've just had a highlight from the from Professor Kate Minon on the Zambia Frimley link and building on from that we also want to get perspectives on that link from the Zambian side and of course joining me is the representative from the Ministry of Health Zambia who I'll ask to introduce themselves. Hello everyone how are you? It's nice to participate in this program. Kanguamle Ngamumama, my name is from Lusaka Zambia representing the Ministry of Health. I'm the National Health Coordinator I've had the chance to work with Professor Gita Minon on the link between the Frimley Park Hospital there and now the Frimley Park NHS Trust I think with Zambia. Thank you so much Dr Mooma for that. Of course building on what Professor Minon has said can you just tell us a little bit more the background of the Zambia Frimley link how did this link come up and when did it start in Zambia? Yeah so the link started in December 2010 it was initially between the Kittway Teaching Hospital iDepartment that time and the Frimley Park Hospital and so as you may be aware the Kittway Teaching Hospital iDepartment is now there is now a hospital it's now called the Kittway Teaching iHospital. So that link started with the two institutions and they collaborated for about three years that's when we got to know about it as the Ministry of Health and by then there was a study that had been done on the copper belt on the diabetic retinopathy. It was to do with the prevalence of diabetic retinopathy in the copper belt problem so so we got to know about it and the results were quite alarming. It is at that point that we decided that we needed this program to come to Lusaka and from there it gets to the to all parts of the country. Okay so talking about the Zambia Frimley link program so how was the program delivered how was it implemented and are you also maybe just share with us some of the key highlights in terms of the activities that were implemented under this particular link? Yeah so this program had particular areas of interest which we had to do with the service the human resource capacity building in terms of training and also research and also community involvement of the program. There was also an element of advocacy and indeed the link or collaboration between the KiTwe Teaching Eye Hospital and the Frimley Park NHS Trust. Okay talking a little bit more about the link I mean it's like a lot of activities that were done and right can you just highlight you mentioned that a lot of partners a lot of medical people involved in this just give us examples of the key staff and the key partners that you worked with in the implementation of all these programs. Yes thank you so much Bob for that question. Yeah so we had to collaborate with the other medical personnel who were the physicians, the nutritionists, the nurses who are non-othermic nurses. We had to collaborate with the Zambia Ophthalmological Society, the Zambia Diabetic Association and indeed the Zambia Medical Association. So we brought in a lot of stakeholders in order for us to be able to deliver the program and achieve the objectives of the program. Yeah and you mentioned that I mean the program was started initially in KiTwe and then it came to Lusaka and then you scaled it up. Just how widespread was the program, the Zambia DRS program implemented in Zambia? Yeah so when we came to Lusaka we started the program at the Investiging Hospitals Eye Hospital and then from there we went to the southern part of Zambia that is the Livingston Central Hospital. We went to the western part of Zambia at Lewanika General Hospital, the eastern part of Zambia that is the Jebada Central Hospital. And we had indeed scaled it up to the northern parts of the country that is Mansa and Kasama General Hospitals. Thank you, thank you Dr. Mooma for giving us an overview of the Zambia and Frimli Ling and this is all for this session. We're going to have now our participant Paul and I am not sure if we are keeping the questions for later or we should be addressing some of the questions now. I can see that there are a couple of questions in the in the chat. The end I think if that's okay. Perfect, right. So we've been hearing lots of good ideas about how sharing of material can be helping, how the partnerships work really well within the links and we want to ensure that everyone who's on the call here today actually gets the opportunity to contribute as well. So we've set up the participant polls, we've done a couple already this morning, we've got two more this afternoon and for all these polls the idea is that you can then get a feel of firstly who else there is around at the conference but also you'll be able to give your opinions about various things as well which will help us take the whole links program forward in the future. So we'll go into the first poll if we could just take that please Graham. So we want to know a little bit more about you. So what is your role? So you can start choosing the most appropriate button. So you're either an ophthalmologist, as a consultant lecturer, professor, independent practitioner, you may be a trainee or some other ophthalmic professional from nurses, clinical officers, optometrists, orthoptists, healthcare workers and then there are people outside the clinical sphere whether that be Ministry of Health, Government, Research Management, Admin, Finance, Health Promotion, Medical Students, Student Nurses. We want to know what you all are. So if you can manage to find the best button to press and when these bar charts seem to be growing no further I will then share the results with you. So maybe Robert you'll be able to share that. Let's end the poll now. Robert would you like to give us your comments on what the poll has shown? Yeah ideally I think we have a lot of ophthalmologists about 54 percent as expected which is a which is a good thing and also we have a lot of ophthalmologists who are in training, accounting for about 18 percent and ophthalmic professionals and it's good to also note that we have a good representation of other people, allied workers, I like to call them who are connected to ophthalmology. So really I think it's quite a balanced representation and we have quite a good mix of people who are participating in this meeting which is a which is a great thing. Great so let's go into the second question. So the second question where this really leads into next session. So we've been hearing a lot about clinical work at present but also the importance of all those other generic skills as well. So what type of additional training would you most like to have? Is it clinical skills training or surgical or skills type of simulation? Training the trainers or training in leadership and research? So you're still all clicking the buttons so we'll just give you a bit more time to do that. Right that seems to be slowing down so we'll end the poll. Maybe Kova you'd like to give us your views. Yes so this is this is quite interesting and we can see that about 43 percent of the I think about half of those present voted would like more training in leadership and or research followed by training the trainers and surgical skills simulation similarly and then clinical. So it does give a little bit of an idea of the sort of a scope of what a link can do and we heard earlier on that there have been links that have focused on leadership training and Claire Inkster had talked a little bit this morning about her work on that we also heard for example from the Malawi and Liverpool link that the one of the key areas for them was research so you know those are all things that are within the the remit of what link strategic plans can have and is very interesting to to see. Great well thank you very much Kova so we'll we will be having another poll at the end of the next session and also at the end of that session we'll be having small group discussions as well as going back to a whole group discussion so with those small group discussions we'll explain a little more about how those work at the time but for the large group discussion we would like some questions raised from the floor so if you've got any questions that you'd like to put into the chat use the chat everyone to submit those questions and then we'll be able to answer those a bit later on so thank you that's the end of the polls.