Information for International Students
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Introduction

 

To the fresher international residents in Ophthalmology

 

It is my pleasure to welcome you into this M. Med. (Ophth.) course.  It is my hope that the next three years or so will be both enjoyable and beneficial to you.

 

As you may already know this is a full time course in which two University examinations are offered – one at the end of your first year in basic sciences related to Ophthalmology and the second as an exit theoretical and clinical Ophthalmology examination at the end of your third year.  The course will also include learning experiences outside Kenyatta National Hospital during outreach safaris and elective term rotation.  Apart from carrying out community services both surgical and medical, you get a chance to visit several interesting areas in Kenya that you may never  otherwise have seen.  The department is involved in various VISION 2020 activities in training, research and prevention of blindness where you will participate. 

 

During the course International College of Ophthalmologists (ICO) exams are offered and although voluntary, we encourage  all of you to take them as they act as a bench mark.The Department has some of the latest state of the art facilities both in clinical and in communication areas.  For the keen student, the sky is  the limit.  You will meet a number of students from many parts of Sub-Saharan (SSA) and elsewhere. This  will  give you an opportunity to establish and foster  lasting friendship that will be useful beyond your student life.

 

The Department is a founding member of the Eastern Africa College of Ophthalmologists (EACO), and is proud to continue this association that carries a lot of benefits.  We encourage all students to join EACO upon completion of their M.Med course.

 

The department collaborates closely with the University Eye hospital of the University of Munich, CBM,SSI and others. This collaboration has been on going for more than 30 years, and  has seen exchange of lecturers, postgraduates, research activities and learning facilities. In an effort to get South-South Link the department has recently established collaboration with L.V. Prasad Eye Institute (LVPEI) in India. We hope this “marriage” will also be long lasting.

 

The success of the Department has been made possible by support from many partners including Christian Blind Mission (CBM), Sight Savers International (SSI), CIM, Bavarian  Lions International (LHBS), Light For The World (LFTW),German Academic Exchange Programme (DAAD)  Kenya Society for the Blind, Ministry of Health, EACO, to mention a few.

 

It is my hope that your stay here will be fruitful.

 

Yours sincerely,

 

 

Prof. Dunera  R. Ilako

Chairperson, Dept Of Ophthalmology

 

 

 

 

 

Accommodation:

 

One of the major problems encountered by foreign students coming to Nairobi for the M. Med Ophthalmology programme is that of accommodation. Not only is it difficult to get accommodation in the vicinity of Kenyatta National Hospital, (KNH)the rents are usually quite exorbitant. It is possible to obtain accommodation at the Doctors‘mess in KNH. However, the waiting list is usually long. It is thus wise to apply as soon as you get to Nairobi.

 

Following are some addresses, which could offer temporary or permanent accommodation, depending on how much you are prepared to spend.

 

 

1)                  Flora Hostel, 5th Ngong Avenue, P.O. Box 49865 Nairobi.

Tel.: +254-2-723087; Fax: +254-2-720770

Furnished single room including 3 meals a day: 1200 KSH.

There is a high turnover of guests at Flora Hostel, but the rooms are calm and clean and the meals quite good.

 

2)        Jaribu Holdings Ltd and Milligan Co. Ltd

Hurlingham Shopping Centre

Argwings Kodhek Road

P.O. Box 48706 Nairobi

Tel.: +254-724012/4 or 724011

Furnished 1-bedroom apartments: 14,500 KSH per month. It is,

however, advisable to start negotiations well before reporting to Nairobi as

the waiting list can be long.

 

3)            Hostel of the Institute of Diplomacy and International Studies (IDIS)

Harry Thuku Road (Between Norfolk Towers and Boulevard Hotel)

Furnished bed-sitter for 1500 KSH per month. It is quite quiet here.

Apply in person to the Senior Administrative Officer, IDIS, 8-4-4 Building, University of Nairobi Main Campus.

 

4)         Advanced Nutrition Programme (ANP) hostel, College of Agricultural and Veterinary Sciences, Upper Kabete Campus.

It is one of the most comfortable hostels for postgraduate students in Nairobi, offering a furnished Bedroom for 5000 KSH per month. Only disadvantage is that it is pretty far from KNH. Kitchen and toilet facilities are shared.

Apply in person to the Registrar, College of Agricultural and Veterinary Sciences (CAVS), upper Kabete Campus.


 

 

Registration at the University and applying for the Pupil‘s pass

Once in Nairobi, it is important to complete the registration formalities with the Board of postgraduate Studies of the University of Nairobi. As soon as your student ID is ready, proceed to the Immigration authorities at Nyayo house for the pupil‘s pass or get in touch with Mr Ongoro at the main campus.

 

 

On arriving in Nairobi

If for one reason or the other you find yourself stranded with nobody at the airport to pick you up, our advice would be to call Flora Hostel and find out if they have a free room. Alternatively, you should call Nairobi Youth Hostel. A taxi from the airport to Flora Hostel, the youth hostel or Kenyatta National Hospital should not cost more than 1500 KSH.

 

 

Opening up a bank account

There are many banks in Nairobi. Based on experience as well as most postgraduate students, the bank I recommend is Standard Chartered Bank. For this, you need a letter of introduction (contact the Administrator, Dept. of Ophthalmology), 3 passport size photographs, your travel documents, and depending on the type of account you wish to open, a refundable deposit.

 

 

On Insecurity in Nairobi

Nairobi is unfortunately insecure as any of the cities in Africa.. Your best bet is to know how to avoid getting into trouble. Here are a few don‘ts and do‘s that could be of help in the beginning:

1)      Avoid being outdoors when it is dark

2)      Avoid asking for information from strangers

3)      Avoid anything that could easily reveal your identity as a foreigner

4)      Avoid walking about with more money than you need

5)      Especially in the beginning, it is advisable to always keep somebody informed of your movements.

6)      Always have with you a photocopy of your passport, your University of Nairobi student ID as well as a photocopy of your pupil‘s pass.

7)      At times, you might get “arrested”. In my opinion, there is no point trying to resist, even if you believe you did nothing wrong. Be sure you are really dealing with the police and not just thugs, though this might at times be difficult.

 

 

Kiswahili

The two main languages in Kenya are English and Kiswahili. However, the majority of patients coming to Kenyatta National Hospital, which is our main teaching hospital don‘t understand English. In such cases, the language of communication is often Kiswahili. Usually, there is somebody to assist in translating. However, I believe it is better to be able to communicate directly with the patient.

Its strongly recommended that students coming to Nairobi try to be conversant with the basics of Kiswahili before coming here. Some Universities offer evening classes in Kiswahili. Alternatively, there are quite a good number of good books on the market for self-study.

 

Textbooks

The following are the standard books used for the M.Med. Ophthalmology programme at the University of Nairobi and ideally, each first year student ought to own a copy of the first three (a, b & c) at the start of the course. While some students might be happy with using photocopies of the books (weighing the costs), it is usually easier to study with the originals.

 

a)                  Wolf’s Anatomy of the Eye and Orbit. Edited by Anthony J. Bron, Ramesh C. Tripathi and Brenda J. Tripathi. Latest edition.

b)                  Adler‘s Physiology of the Eye. Edited by William M. Hart, Jr. Latest edition.

 

c)                  Clinical Optics. By AR Elkington and HJ Frank

 

d)                  Practical Ophthalmology. A manual for beginning Residents by Fred M. Wilson II. American Academy of Ophthalmology.

- An excellent guide for beginning Residents, especially those with very little exposure to ophthalmology prior to joining the department.

 

e)                  Clinical Anatomy of the Eye by Richard S. Snell and Michael A. Lemp. Latest edition, 423 pages.

„ The most stunning aspect of this book is that the authors serve the needs of all levels of expertise… this format greatly aids the clinician … and aids the beginner…“– American Journal of Ophthalmology, on the first edition.

 

f)                    Anatomy and Physiology of the Eye by Khurana & Khurana.

Although some of the facts are out-dated, it is very easy to understand and does not leave the reader lost in unnecessary details, as is often the case with Wolf and Adler.

 

 

g)                  Clinical Ophthalmology by Jack J. Kanski. Latest Edition, 1999

Ideally, the student should be in possession of this book the very day he starts the programme. Because of financial constraints, thought, he might chose to buy it toward the end of the first year, in which case the Manual of Ocular Diagnosis and Therapy or Will‘s Eye Manual  (see below) could do initially during year I.

 

h)                  Manual of Ocular Diagnosis and Therapy by Deborah Pavan-Langston.

Pocket book that provides a good introduction to the basics of clinical Ophthalmology.

 

i)                    The Will‘s Eye Manual, Office and Emergency Room Diagnosis and Treatment of Eye Disease.  Edited by Mark. A Friedberg, Christopher J. Rapuano et. al.

A very nice guide especially when you are 1st on Call.

 

j)                     American Academy of Ophthalmology, Basic and Clinical Science Course, Sections 1-12.

 

k)                  Ophthalmic Ultrasound, a practical guide by Hatem R. Atta.

Though not comprehensive, an excellent introduction to Ophthalmic Ultrasound.

-          These books are available on CD-ROM for the 2004 version which usually suffice. The latest edition of this in hard copy can be read from the Department library.

 

Some interesting literature on Kenya

1)      How to be a Kenyan by Wahome Muthahi

2)      Kenya, a lonely planet travel survival kit by Hugh Finlay and Geoff Crowther

3)      Teach yourself Swahili by Joan Russell

 

 

 Relationship with Senior Students (a student’s experience)

When I was in first year, we (first years and even some 2nd year students) used to complain very often among ourselves that our senior colleagues did very little to teach. Though it is clear that not everybody is a good teacher, I came to realise that much of the problems usually lay not in the seniors but in us the juniors. It all depends on how much interest we show and how much we are prepared to sacrifice for the smooth running of the ward or the clinic. I don’t think anybody would be motivated to teach somebody who disappears from the ward or the clinic when there is work to be done. True to say, some of the work has nothing to do with Ophthalmology (bleeding patients, putting i.v. lines, running after laboratory results etc.) but it has to be done. How would you expect the 3rd year ward doctor to discuss the management of an interesting case with you if he has to bleed the patient, take consultations to the oncologist, work on his dissertation when you can’t even help make sure the results you both need to this effect are available? The pretext that you have or had a tutorial or that it is the duty of the ward clerk clearly does not hold much water.

I think it would be a good idea, if we registrars could start a system of mentors whereby each first year student has a senior (second year student) as mentor to initiate him into the secrets of Clinical Ophthalmology. Both 1st and 2nd year residents in turn have a third year student as senior mentor. I believe this would make studying and working in Ophthalmology more fun.

Another idea that has kept on haunting me ever since I joined the department is that of having the registrars organise themselves into specialised work groups. Each group would work on a specific clinical condition commonly encountered in our department (e.g. vernal, retinoblastoma, diabetic retinopathy, amblyopia etc.), do a literature review and come out with a set of guidelines for their management in our setting. I am sure most of our lecturers would be very happy to supervise such an initiative. Also, such guidelines would make our learning easier and the management and subsequent follow-up of patients more organised. I hope you will join in these initiatives, once they become operational.

 

Facilities offered by the Department of Ophthalmology.

Our programme is one of the best equipped and best organised in the University of Nairobi and there is very little to envy Eye Departments in European and American Universities. Unfortunately, this equipment and facilities are under-utilised, to the detriment of the student and the patient. A mistake most first-year students make is to concentrate too much on the basic sciences and to neglect learning clinical skills and the use of various diagnostic and therapeutic procedures (echography, laser, automated visual fields, gonioscopy, indirect fundoscopy etc.) The argument very often, is that these will be learnt in year II. Unfortunately, this is often too late, because at this stage you might occasionally have to carry out these procedures or interpret results thereof without assistance from a senior. In fact, you are expected to teach undergraduates and first-year postgraduate students.  It is thus advisable to start learning these procedures under supervision from a senior colleague while in year I.

NB: You are free to give your comment on the above.

 

While learning how to use these instruments, it would be worthwhile to learn how to handle them correctly and how to do simple preventive maintenance (using dirty loupes for fundoscopy or dirty refraction bars, for instance can be pretty tedious, let alone result in erroneous findings).

We are living in the 21st century, the computer age and It can be said without qualms that anybody with a first degree who is not computer literate ought to consider himself illiterate! Fortunately, we have excellent computers in the department with a CD-Rom version of Duane’s Ophthalmology. It is possible that in the near future, the number of computers will be increased with more CD-ROMs,but there is internet access..

 

Taking Calls

            A few months after joining our department, you will start taking calls.Prior to taking calls, you’ll be expected to shadow the 1st on calls for sometime to learn your way around KNH and at sometime, expectations. As first on call, you are the first Ophthalmologist to review patients in casualty or on other KNH wards. Usually, a senior registrar backs you (second on call) and both of you are backed by the third on call (usually a consultant).

The first and most important thing is to co-ordinate your work very well with your second on call. You should both agree on how and when he should be contacted, should you need help (when to admit, what investigations to request, how to manage a particular case etc.). Otherwise, the call can be very frustrating.

Secondly, whenever you are called (or receive a consultation request), it is important to call back as soon as possible to enquire about the state of the patient. This has several advantages. First of all, it gives you an overall picture of what to expect and could guide you on what instruments you might need to take along. Secondly, you can assess the degree of urgency and order some investigations or some procedures. In the case of a patient with chemical burns, for instance, you could ask the nurses in casualty to start irrigating the eyes with normal saline while you make your way there. Thirdly, if you are not too sure of how to manage the situation you’ve just heard of, you can read up quickly or consult a colleague. Finally, calling back gives a very good impression and reduces stress. If you are nice to the nurses and doctors on the wards and in casualty, they will be nice to you!

After your telephone call, it is important to report to the patient as soon as you can, the earlier the better. Incase you delay; let the nurses know when you will be coming. Reviewing the patient early will save you the trouble of having to admit a patient who should be admitted by the neuro-surgeons! And while down in casualty, have a quick look to see if there is anybody who might require an Ophthalmic Review (padded eyes, bloody or swollen faces etc.) before retiring.

As first on call, you make your work much easier if during your call you live in KNH.Incase you live outside KNH, as first on call there is the doctor’s room in ward 9D where you can spend the night and rest during the day.

 

 

Admissions:

-          During your call, you will admit patients from the Eye Clinic or Casualty. Once you have clerked the patient using a continuation sheet, write ‘Emergency Admission to ward 9D’ on the Patient & Consultation cards. Don’t forget to fill in and sign the treatment sheet as well as have the consent for theatre signed by the patient or guardians when applicable. The clerks do the rest.

 

To carry along:

-          You should make sure you carry the following with you at all times: Your mobile phone(with batteries charged), a good torch, lid speculum or retractors, Flourescein, Tropicamide drops, Amethocain, antibiotic ointment and drops, eye pads. A direct/indirect ophthalmoscope would be an added advantage.

 

Common cases

-          Foreign Bodies; Ophthalmia neonatorum; burns (chemical and thermal), Lacerated/ruptured eyeballs (no topical medication); Eyelid lacerations (if infected, secondary repair i.e. dress and review in eye clinic), involvement of canaliculus or lid-margin; Herpes Zoster Ophthalmicus (discuss current management policy with your senior); Corneal ulcers (admit hypopyon ulcers, ulcers in children or ulcers > 30% of cornea); Orbital and pre-septal cellulitis; Conjunctivitis; sudden loss of vision, hyphema, acute EOM palsies etc.

 

Never hesitate to call your seniors; it is their duty to back you up!

 

Optional items that you might want to bring with you:

a)      PC, Notebook or Laptop and printer

b)      Robes for theatre

c)      Pair of comfortable theatre shoes

d)      Lab. jackets


 

 

Some useful telephone numbers and emails:

a)      Administrator

      Dept. of Ophthalmology

Tel. (direct): +254 -2-728756 or 723926

Mobile 0734514294

Tel. (via KNH exchange): +254 -2-726300 Ext. 43776

       Email: paulwanyika@yahoo.com

 

b) Ward 9D (Eye Ward)

Should you arrive Nairobi after 4.30 p.m. and are desperate, you can call ward 9D and ask to be connected to one of the Ophthalmology Residents living in Kenyatta National Hospital or one of the Class representatives.

Tel.: +254-2-726300 Ext. 43932, 43933

 

c)      Clinic 35 (Eye Clinic)

-          Matron/Clerk: 43430, 43057

-          Doctors’ extension: 43083

 

d)      Class Representatives:

Every organised group usually has a leader. As you start the programme, you will be expected to select among you a class representative.  The 3rd year class representative is usually the chief resident. You can obtain the chief resident‘s contact details (telephone, email etc. ) from the Administrator (see above).