Amde-Michael Ketema

Tackling the shortage of ophthalmologists in West Africa

In francophone West Africa, governments faced an acute shortage of ophthalmologists. The success of the 2-year Anglophone post-graduate Diploma in Ophthalmology (DO) course in providing ophthalmologists able to work in rural areas, led the West Africa Health Organisation (WAHO), supported by CBM and Sightsavers, to establish DESSO, an identical regional Francophone training programme in 2003. WAHO and the government of Guinea agreed to host DESSO at the University of Conakry Faculty of Medicine.

As there were no adequately qualified experts, CBM agreed to second Consultant Ophthalmologists. Dr. Ketema arrived in 2007 following the departure of another expatriate Ophthalmologist, Dr Mario Angeletti. Since then, DESSO has grown from very humble beginnings to its current status as a regional training institution of repute with good recognition for its value, surgical emphasis and quality of its graduates’ skills. To date, Dr Ketema has led a hard-working and committed team of 3 people to successfully carry out the training of 44 students – 24 from Guinea and 20 from Togo, Benin, Mali and Niger.

The challenges

The main challenge experienced by Dr. Ketema was that of pioneering an initiative without having a comparable model to draw ideas from seeing that the Anglophone diploma was quite different. This challenge had a multifaceted nature as described below:

  • The apparent initial success of the Anglophone Diploma Course in Ophthalmology, in Nigeria and Ghana, combined with advocacy by eye care agencies, had encouraged the WAHO Ministers of Health to request WAHO to organise a similar course for francophone countries. However it turned out that DESSO, which began as a direct copy of the Anglophone DO-course, did not fit well into the francophone higher education system.
  • The DESSO training course had a very slow start due to the complexities of the academic and administrative systems and the lack of available management capacity in Guinea. 
  • The infrastructure in the National Hospital in Conakry was much below standard in order to be able to host this regional training programme. 
  • As the number of students from foreign countries increased steadily, they were faced with a housing problem. The number of available teaching staff covering sub-speciality subjects was limited. The eye clinic was dependant on donations of surgical consumables from NGDOs like CBM & Sightsavers.
  • Even today, the 2-year diploma is not recognised as a full specialty by ophthalmological societies and in government salary grades. So to be classified as specialists, many graduates ultimately feel the need to complete the 4 year course.

The solutions

The excellent progress achieved by Dr. Ketema and his team included:

  • Establishment of “CADESSO”, a well-equipped, modern Practical Application Center of the DESSO programme. It uses a highly respected visiting foreign faculty, has a high practical content and exposure to different working environments and students are introduced to eye surgery early during the 2nd semester and trained directly in sutureless cataract surgical techniques ensuring good surgical outcomes. CADESSO helped address the challenge outlined above regarding the inadequate infrastructure at the National Teaching Hospital in Conakry.
  • Establishment of a Resource Centre thus overcoming the overdependence on external support and ensuring availability of consumables hence, the continuity of services at CADESSO and other eye units.
  • The nominee oversaw the expansion of DESSO facilities to guarantee more space for the activities of the programmes and to house students from various countries.
  • The nominee’s input does not stop at the operating table or in the classroom but also in forums and symposiums to advocate for DESSO. His efforts saw many financial and technical resources being allocated to DESSO.
  • Provided input leading to the harmonisation of the DESSO curriculum with the Francophone Masters in Ophthalmology programme (DES) to guarantee the recognition of the 2-year DESSO Diploma, thus ensuring that candidates can seamlessly finalise their full fellowship after a period in the field.
  • Introduction of a cost recovery system and optical workshop to generate local income. The clinic is now financially self-sufficient.

In summary, Dr. Ketema’s visionary leadership has seen DESSO evolve from an improvised and rather chaotic course to one that is well-resourced, orderly and rigorous. The course is highly recognized and accepted in the region with its graduates becoming the main contributors to the reduction of avoidable blindness in the region.