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In July 2025, I had the privilege of spending two weeks at the Kabgayi Eye Unit (KEU) in the Muhanga district of Rwanda, leading a “Glaucoma in a Day” workshop for eye care professionals. I also ran a hands-on trabeculectomy simulation course and joined the local team for their clinical and surgical glaucoma activities. KEU is a referral eye centre in the southern province of Rwanda and serves a wide population, drawing patients from across Rwanda and neighbouring countries like Burundi, Uganda, and the Democratic Republic of Congo.
How it started
When I received the invitation from a colleague and friend, Dr Mikhail, to take part in a glaucoma training exchange in Rwanda, I hesitated. I felt honored but also quietly unsure. What could I really bring to the table? Was I experienced enough to meet expectations? As an early-career consultant from the UK, what knowledge could I share in a region bearing one of the highest burdens of glaucoma worldwide? With these questions in mind, I accepted the challenge. I reminded myself that careful preparation and an open mind were the least I could offer.
Pre-departure preparation
In the weeks before departing, I sought advice from senior colleagues experienced in global health. They kindly offered practical tips and perspective. Their central message: travel with humility and curiosity. So I packed model eyes, teaching slides, and a few near-expiry surgical instruments that my hospital could no longer use but were still functional. When I arrived and walked through KEU for the first time, I saw hundreds of patients waiting quietly to be seen. There was no noise, no frustration—only calm and patience. Their composure and faith in the care they were about to receive stayed with me.
Bridging the training gap
Glaucoma remains a leading cause of irreversible blindness, particularly in sub-Saharan Africa, where opportunities for subspecialty training and surgical mentorship are limited. Trabeculectomy, still the gold standard for advanced disease, demands both training and precision.
Together, we designed a one-day trabeculectomy simulation course using Gagné’s Nine Events of Instruction and Peyton’s Four-Step Approach, with the ICO-OSCAR checklist guiding feedback. 1-3 Seven participants took part, practising first on apples and later on Phillips studio eyes. Participants’ self-reported confidence scores rose from 2/5 (‘a little confident’) to 4/5 (‘confident’), demonstrating a clear gain in readiness and assurance.
The Glaucoma in a Day workshop focused on comprehensive diagnosis and management. Alongside Rwandan ophthalmologists, we covered early detection, difficult diagnoses, and the full spectrum of management options. The event attracted over 70 participants, including highly motivated residents from the two active residency programs in Rwanda, and later featured in local media for its emphasis on glaucoma awareness.
The daily routine
Each morning began with a 30-minute glaucoma-focused session on recognising early glaucoma signs: clinical clues, optic disc and macula changes on OCT, and visual field interpretation. Afterwards, we headed down to the clinic to review the postoperative patients before heading to the operating room. The number of patients on the list was never fixed; it depended on how many patients we listed from the day before. Sometimes ten, at times twenty- training everyone to stay flexible.
In theatre, alongside traditional glaucoma surgeries such as trabeculectomy and tube shunt implantation, I introduced the team to GATT (gonioscopy-assisted transluminal trabeculotomy) – a minimally invasive, cost-effective angle surgery performed with a 5-0 prolene suture. 4 It offers an affordable, realistic option for patients with glaucoma in Rwanda as part of cataract surgery. Dr Mikhail has since reported encouraging early outcomes.
We headed for a brief lunch after the operating list, before returning to the clinic to review the remaining glaucoma patients who had already been seen by the ophthalmic care officer.
Lessons beyond the microscope
KEU showed me what truly sustainable, patient-centred care looked like without the burden of bureaucracy. There were no waiting lists; patients were reviewed and surgery performed the same or next day. The unit performs up to 45 eye surgeries a day, covering cataract, vitreoretinal, glaucoma, squint, and trauma repairs. Despite the workload, the doctors were looked after as well- A balanced lunch was served in a quiet room where they could take time to pause and breathe before returning to clinical responsibilities.
Leadership, humility, and purpose
As an early-career consultant, I learned that our duty extends beyond the patient in front of us. We care for the one who sits before us, but we also hold a responsibility to the unseen: to raise awareness of eye health, to share knowledge, and to build sustainable systems of care. Our goal was to create capacity so that the impact would be long lasting. It strengthened my perspective on adaptability and open-mindedness- to listen, and to recognise that often there is more than one ‘right way’ as long as our actions are evidence-based and thoughtful. In KEU, practicality and creativity prevailed, shaping a mindset I will carry throughout my career.
Looking ahead
Being ‘junior’ became an asset rather than a limitation. It helped me bridge the anxieties of learning and the responsibility of teaching, and made me relatable to my colleagues. But beyond facts, what remains are the human moments: the pride in a perfectly constructed scleral flap and a well-performed GATT, the realization that knowledge exchange, when done with humility, transforms everyone involved.
It was such a privilege to be part of the incredible work the team were doing at KEU. The openness, curiosity, and drive to keep improving, even across subspecialties, speak volumes about the culture of the unit. I’ve come away with a new perspective, quiet inspiration, and a renewed purpose. I look forward to returning to the unit in the coming years.
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