 All right guys, we're gonna go ahead and get started on this second half. So if you find your way to your seats Okay, so I'm gonna be specifically talking about Mons during the first kind of assessment that we did there We also did the screening which you all heard about already well, and Avni did more of an assessment of Bugondo Medical Center and so This is a map of Tanzania right here So Bugondo Medical Center is one of only five tertiary hospitals in Tanzania and this Map only shows four of them, but where we were located is right here, which is basically on the shores of Lake Victoria And so as you can see basically this entire region, which is called the Lake region Serves as the only tertiary hospital there and its catchment area is about 16 million people And an interesting dynamic about this hospital is it's privately run and the the staff is Government salaried and I'll talk more about the implications of that in a different slide But there's a whole history regarding this hospital Just fact that it was you know initially privately funded and then the government's kind of subsidized the workers there And so the personnel that work there, so dr. Christopher Mwan and so Which some of you may have met Back when he came in December of 2017 He is currently the only working ophthalmologist at Bugondo Medical Center so one ophthalmologist for a catchment area of 16 million people and I think I have a picture of his Smiling face somewhere it'll come up hopefully and then dr. Everista so she was unfortunately not there when we visited back in November, but she is Currently completing her pediatric ophthalmology fellowship in India right now And so she'll be joining back at Bugondo Medical Center in September and then dr. Christopher actually has two Ophthalmologists who are just completing their residency that will be joining them Also in September-October time so basically it'll grow from one Ophthalmologist to four four times the amount Coming this September in October They have two optometrists, which really At this point when we saw them in November This is all kind of talking about our trip in November and not the Moran outreach trip in February But really acted more as refractionists and not really doing any Diagnosing using the slit lamp that sort of thing And then they have two clinic nurses and the important thing about these clinical nurses is they're not specifically ophthalmic Trained and so they're general nurses and so in the operating room they aren't trained with the The ophthalmic equipment that is used for cataract surgery that dr. Christopher does And then there's two ward nurses There's a registrar and basically what a registrar is is it's Basically a person who has completed medical school and is acting as an intern So an intern to dr. Chris And then there's medical school students which is actually pretty vital because in the operating room They are the ones that are handing the instruments to dr. Christopher when he's operating So a lot more stress on these medical school students than what we have here at Moran And then there's also two AMO's now these AMO's assistant medical officers They are not apogando medical center. They are actually in the community of Monza They did not complete medical school. They completed a two-year surgical training And they perform cataract surgery out in the community So what is a week in clinic look like apogando medical center so And just to kind of belabor the point this is back in 2018 Dr. Shaw will talk more about kind of the current status because some of this has changed But when we did our visit in November, this is what it looked like so three days of clinic and two days of surgery and During those three days of clinic they saw anywhere between 150 and 200 patients and So surgery there costs a total of a hundred and forty dollars and this is any surgery This is a flat rate. So whether someone's getting a minor ocular plastics procedure Or they're getting cataract surgery to regime removal chelazion Everything is a hundred and forty dollars which you know for a middle-class Tanzanian citizen Who makes about three dollars per day is pretty pricey And then once a week they do an outreach activity and so what this entails is dr. Christopher will go out into the community and he will Have donated IOL lenses that He will be able to use on the patients and the patients can then have the surgery performed apogando For a discounted price and these IOLs are just standard IOLs. These are not fit to this particular person So what do they have now so there's two refraction rooms for optometrists and so that's kind of what this picture is of There's one exam room for both doctors when dr. Everista returns right now. It's just dr. Christopher with three slit lamps And that's this room right here And then they have a laser room with a pascal Two top cons and one indirect and this pascal and top cons they were actually donated by an organization a diabetic research Department has donated this pascal and two top cons to bugondo to kind of help with diabetic screening and treatment Although I'm pretty sure when they first received the pascal There was really no instruction given on how to use it um And then they do have equipment to grind lenses, but unfortunately they as of 2018 they were not doing this So the optometrists would refract the patients and then the patients would be sent out to the community private clinics to buy glasses Um, and that is that machine right here in the corner Um, and then in terms of surgery, so there's no operating table and so they basically use gurneys During the operation the only operating room that they had at that time was shared between obi-gon and ortho So very busy operating room Uh, there was no faco. No a scan. No iol power calculation So as I mentioned before everyone That gets cataract surgery or that did get cataract surgery use standard iol measurements They had an autoclave This is a picture of the operating room They had an autoclave, but I don't know if you could really appreciate this There's a piece of tape Or several pieces of tape that are used to kind of keep that autoclave closed so that obviously can become a problem Um, and then as I mentioned most cataract surgeries are s i c s using standard iol's Um, and the surgeries that they performed, um, like I said, it's mostly just the cataract and the tourigiums and some minor oculoplastic surgeries And so in terms of progress So just to give you guys some numbers in 2016. So this is when Moran and Cornell were first visiting bugondo this site. There were just about 27 cataract surgeries performed and then as of 2019 this year, there's already been over 400 cataract surgeries And we're just halfway through the year And a lot of this has to do with a couple of things. So back in 2016 There was an older ophthalmologist that was working really didn't operate too much and now we have two very motivated energetic and kind of like Just amazing ophthalmologists. Dr. Christopher here and Dr. Everista That are now working at Bugondo. Everista will be coming back And then also new equipment Which Avni will talk about more And this is a picture of Dr. Ben Thomas. He actually visited I'm not sure. I think it was last year a couple years ago And actually was there to teach them how to use the Pascal. So I think what they're holding up Maybe is a picture of retina that they've lasered, but I'm not exactly sure there what they're holding up Um, and so I'm gonna quickly go over this because I have the labor at this point sound like a broken record So basically when we went there, we did five days of screening screened over a thousand patients So preliminary findings in terms of we were looking specifically at vitro retinal disease my study, but Obviously we're going to find other things and so as you can imagine the major causes of visual impairment in this region are cataracts refractive air glaucoma AMD and during that screening over 50 of the patients that we actually Uh screened and examined Were referred back to begondo medical center clinic for ongoing clinical care and surgery um, and so Say the least we completely overwhelmed dr. Chris with the amount of patients that we refer to him I'm pretty sure he's probably still seen some of the patients that we refer to him Um Okay, and so ovni is going to talk about What kind of happened back in 2019 when they came? with moran okay, so, uh Basically since that trip in november, there's been a construction of new operating rooms at bugondo That was just about starting. They were breaking ground for that when we were there in november And it finished literally the day we landed. Um in february So that was great. There's one or that's dedicated strictly to ophthalmology. So they now have their own room to operate in Um, and it's pretty good Uh, they've hired another optometrist and another registrar since then and the new optometrist is actually quite good. He's Um, he's still Isn't using the equipment in bugondo to make glasses. They're working on getting some new equipment He's making glasses outside, but he's bringing them back to the hospital and selling them in the hospital So the hospital is making the money from those glasses, which is important um and uh, the other registrar also helps take some work off of Dr. Mon and sows hands um It a lot goes into actually being able to hire more staff So like brad alluded to this is a privately owned privately managed hospital But it is government salaried and what that also means is that the hr is also done centrally So if the ophthalmology department decides that they need another optometrist They have to submit a proposal to the federal government The federal government then decides if they think that's a good idea They then do their own search find their own optometrists Say you're going to go work at bugondo and send them there. So it's quite a process Um, we went back in february um with cornell And like I said like a representative came with us as well We brought with us and a working autoclave They also at the same time got an a scan and an auto refractor so they can do iol calculations So we did iol calculations for the first time and put in You know non-standard iol's We did provide him with an operating table and more importantly a lot of training so Um dr. Christopher and some of his amos received surgical training A lot of his uh clinic nurses that were functioning as scrubs received some really good scrub training And then some cRNAs learned how to do blocks for him He was doing all his own blocks and then dr. Dix petty came with us as well and did some training with the optometrists there So it was really a training heavy trip Uh, these are the recommendations from lyco and the ones in italics are the ones that christopher has already implemented So he um suggested a very different flow in the clinic to be more efficient. That is already ongoing Um, he also wanted christopher to be operating every day Um, and that's a common theme among lyco assessments is try to do a few cases every morning The rationale behind that is that patients that come in and are suggested to have cataract surgery If you tell them come back next tuesday for surgery Oftentimes you're going to miss them the family member that's bringing them in for their appointment Can't you know miss work again in a week Um to bring them there they might have traveled from very far and have to go back and come back So you actually lose a lot of patients that way whereas if you stay stay overnight and have surgery tomorrow You can get a lot of a retention that way and then just in terms of skills acquisition Operating every day and being able to really improve and perfect your skills by operating frequently was also part of that recommendation So he's now operating four days a week instead of two days a week Um, and then an in-house optical unit. So we sort of talked about that they're They're working on getting new optical equipment to start grinding their own glasses But for now they're at least selling glasses that they make in bugondo Um faco training more space just because there's going to be four ophthalmologists now And it's already kind of cramped and then a formal data entry system. They were using just sort of very Disorganized paper charts not really a chart just scribbling some stuff freehand on paper Um, and so now they're going to be using an emr, uh, which is not something we started It was something that was coming anyway Um, so what is the future going to be in wanza? So, you know, they are going to expand to four ophthalmologists in september. We'll see how that transition goes Um, hopefully do get optical an optical unit in house that will really help bring in a lot of money for the department um One that new optometrist is going to learn an orthoptic assessment to support avarista when she comes back to do Pediatrics and there's a team from kcmc. That's going to be coming to work with them on that um eventually faco training for um christopher or avarista or the other ophthalmologists Uh, a residency program would be natural there. There's a medical school already associated It'll be four ophthalmologists at that time And retina training for christopher, which um brad's going to talk about a little bit more Um, so I think I mentioned this may be in the presentation I talked about at resident alumni day But we basically now partnered with an organization called retina global And so their main goal is to provide sustainable solutions By increasing the amount of people that can treat retinal disease and the way that they do this essentially is that they find volunteer retina specialists from around the world really so The america's eu middle east whoever's really willing to go down and volunteer and so the idea is that um They they these retina specialists will go down and they'll work on very practical skills With dr. Christopher and dr. Everrester whoever's available to teach It's not you know this it's it's very focused. It's like okay today. We're going to talk about prp today We're going to be talking about injections and so Basically retina global and this picture right here. It's not just a random. This is dr. Auger wall He is the president and ceo of retina global So he's kind of been ovni nice contact and dr. Christopher's contact Trying to arrange this But the goal of this is basically that after Five years they have a five-year plan where they they will be sending retina specialists down every two to three months to work on these Specific skills at the end of those five years then dr. Christopher will be able To go to like a truncated fellowship After the fifth year so he'll he'll already have acquired enough skills to be a fairly competent vitreo retinal Surgeon and be able to diagnose those so maybe he only needs six months or a year And retina global will actually sponsor him to go to one of those fellowships Whether it be in the european union the middle east or wherever It might be I think a couple of retina specialists have been all over So they they have dedicated moanza as their next site And so in september october 1st, we're looking at the first retina specialist going We're still kind of in the planning phases to figure out who it is exactly that's going to go But what's really exciting in terms of moran is uh, dr. Calvo cj I don't know if he's in here are graduating retina fellow He has shown some pretty strong interest in going in march And so he'll hopefully be going and then dr. Shakura as well Will be going in in this summer of 2020 and retina global will actually Sponsor them to go to teach those very specific skills. So I think uh, there's a really Awesome great potential for a relationship between moran and moanza And it's all thanks to I mean dr. Christopher is just so motivated to learn and just So excited about these opportunities These are our references and I think uh, dr. Shaw has some pictures that she Just have some pictures So this is my outreach family during the year lindsay lorry and talis looking beautiful Lindsay's tape says I can't help you And some friends so That's arwa on the left. Um arwa and I are both joining the same practice next year. Well in october and um The people that work at our practice Actually thought that we were in a relationship And so I'm really tempted to send them that picture Um, this is a retina fellow dr. Hanson after he was roasted for his hair. Um At graduation. He's a little bit ashamed and going around like this now Brad sporting some beautiful sunglasses and And my landlady