Moses Orwe is an ophthalmic nurse at Homa Bay County Referral Hospital in Kenya’s southwest. The hospital sees an average of 75 patients a day, 10 of whom will need eye surgery. The Foundation spoke with Moses about his work in eye health and some interesting challenges he faces.

“In Kenya, people don’t really understand eye health because we have few trained eye personnel and few eye facilities,” Moses said.

“As eye health workers, we’re trying to create awareness so they can avoid bad cultural practices – but the lack of awareness is quite challenging.”

Those ‘bad cultural practices’ is the reliance on traditional medicine.

“People crush leaves and mix it with water to create a paste they put on the eyes,” Moses said.

“They also use charcoal ashes and even smoke from firewood: they hold a burning stick near the eye and let the smoke go in the eye.”

Not only are these treatments ineffective, they can also worsen eye conditions and delay people seeking professional medical help.

Moses’ role therefore requires a high level of community education. But despite best intentions, providing essential eye health messages to a regional population of 1.2 million people just within Homa Bay county is problematic.

So, for Moses, it is all about getting out to the people. He assists with outreach campaigns, goes to ‘Chief’s meetings’ – where he talks to community leaders about eye health and the services available – and conducts activities around World Sight Day.

“World Sight Day activities are role play and drama. It’s community health education where we set up the activities and invite people to come. It is supported by The Fred Hollows Foundation,” Moses said.

Moses Orwe confirms details with the surgeon prior to surgery. Homa Bay District Hospital, Kenya.

Meanwhile, Homa Bay has a significant public health concern: it has the highest HIV prevalence rate in Kenya. The national HIV prevalence rate is six per cent, Homa Bay’s is 27 per cent (UNICEF 2013). Yet despite this, eye health does not get lost amongst greater public health messaging for one simple reason:

“The HIV infection also negatively impacts eye health,” Moses said. “The virus brings about complications on the eyes such as CMV retinitis, squamous cell carcinoma, herpes zoster ophthalmicus, conjunctival growths and so on,” he said.

“The main problem comes following surgery as HIV slows down the recovery process.”

C-KenyaMosesOrwe3.jpgTools of the trade. The ball temporarily flattens the eyeball making cataract surgery easier.

Moses’ interest in eye health came about via a common scenario: seeing a need but also seeing the direct link that eye health has with patients and their futures.

“I was working as a general nurse but had a friend who was an ophthalmic clinical officer. I used to help him,” Moses said.

“I helped with visual acuity, would arrange and manage patients, collect medicine from the pharmacy. I developed an interest in ophthalmology so went for training. That was for one year, from 2006 to 2007.”

Moses Orwe takes the blood pressure of a patient prior to cataract surgery. Homa Bay District Hospital, Kenya.

Moses now works as one of two ophthalmic nurses at Homa Bay County Referral Hospital.

His work in ophthalmology has also put Moses on the front lines of eye health in Kenya.

“My job now is management of eye patients which involves assessment of visual acuity, measuring intraocular pressure, screening of eye patients to identify those that need eye surgery, carrying out outreach eye care screenings and assisting during eye surgery,” Moses said.

And follow up.

“It is important to follow up a patient after surgery to monitor and assess the progress of recovery and rule out impending infections and assess the incision site or operation site for signs of good healing process,” Moses said.

“I follow up a patient first day post-operative, then one week post op, two weeks post op, one month post op, two months post op and finally three months post op.”

When asked what was the most valuable part of his work he immediately said: “Screening eye patients. You interact with patients directly and it helps me know and gain experience in different eye conditions.”

And when considering what he would like to change, Moses is quick to respond.

“Bad cultural practices need to be changed,” he said. “And I want to make people aware that cataract is an avoidable blindness. And the general awareness of eye health services at the hospital…”
See more of our work in Kenya.