Sightsavers stories

A day in the life: the only ophthalmologist in Karamoja

Gladys Atoo in her Doctor's uniform, smiles at the camera

My name is Dr Gladys Atto, and I live in Karamoja in northeast Uganda. I wanted to be a doctor since I was a child, and I am very proud to be an ophthalmologist and have an impact on people’s lives.

I started my ophthalmology training in 2015 at Mbarara University of Science & Technology. For my master’s degree, I got a scholarship supported by Sightsavers; I then worked on their projects for three years.

I still work with Sightsavers as part of an inclusive eye health programme that aims to improve access to eye care for people with disabilities, as well as other groups who traditionally face barriers to accessing health services. Through training provided as part of the programme, I’ve learned a lot about what it means for health to be truly inclusive, especially for people with disabilities.

In a community such as Karamoja that has low education, poor health-seeking behaviour, and skyrocketing unemployment and poverty, impaired vision only worsens the status quo. Children bear the brunt of parents with visual impairment by becoming caretakers, leading to them dropping out of school, and spouses are equally affected.

Access to eye care services provides a ripple effect, improving people’s quality of life by boosting their economic productivity, as well as enabling them to carry out their day-to-day activities independently. It also keeps them safe from unnecessary injuries due to falls, and improves mental health. All these collectively contribute to a vibrant society.

My daily routine

I usually wake up quite early, do my aerobics and make breakfast. By 9am I’m usually at the hospital. My clinicians arrive at the hospital before me and start seeing patients.

In Uganda, untreated cataracts are the main cause of blindness – 43.8% of all cases. A lot has to be done to improve eye care in Uganda, and we rely on donor funding. If Sightsavers had not supplied me the microscopes and everything that I use for surgery and for diagnosis, I would be a very redundant ophthalmologist here.

As the boss, I see any patients with challenging conditions. Our team sees about 50 patients for consultations and treatments, and book them in for cataract surgery.

If it’s a theatre day, we work on an average of 10-12 patients each day, and end at around 3pm or 4pm. If it’s a normal working day, we close the clinic at 5pm. I’m usually free at the weekends, but we work on call in case there’s an emergency, and then I’m there.

Some days are interrupted with hospital activities such as quarterly performance review meetings and quality improvement meetings. But I try to balance them and ensure that everything is running as required.

Reflecting and relaxing

Before I started at the hospital, there were no records or data. I set up a system on the computer where we enter our department’s patient records. So now we can track how many patients we see and what conditions are the most common.

At the end of the day, I usually reflect. Sometimes, during surgeries, things go wrong. I get some complications, and that stresses my head a lot. I don’t know how to let it go easily. What did I do wrong? Did I do my best? Was it avoidable? My colleagues call me a workaholic as I’m always thinking about work! I’m the kind of person who loves to work.

Here in Karamoja, I’m growing professionally and I’m also pulling my socks up and helping other people. But I do like to relax in my free time. I love reading biographies and I like music. My music choice is very personal, and I like Adele’s music as it’s about her own experiences. I like life stories, whether in books or music. I find it very relaxing. I also have a puppy called Pfizer who I talk to a lot – if he starts talking back, I know there’s a problem!

I have to look back at the work that I do, if I saw a patient and I couldn’t come up with a diagnosis. Or if it’s a good day, then I just sit and relax, then shower, eat and go to bed.

The challenges – and the rewards

There are many challenges in my work. One: being female – it’s hard. There’s always a tendency to overlook females who are in positions of leadership and who head up a department. It’s challenging to manage people who can’t imagine how I, as a young woman, can come in and tell them what to do.

Another challenge is that I’m also the only ophthalmologist in Karamoja – I keep hoping that with every year, I’m not still saying this. When I go on leave or if I fall sick, service delivery is cut and this disadvantages the patients who have travelled from many kilometres away. Imagine if someone is referred from another district of Karamoja that is more than 20km away, and they come in and find I’m on leave. I’m trying to do as much as I can, but it’s not a nice situation.

Before I came, Karamoja subregion had never had an ophthalmologist. My job comes with a lot of responsibility and a lot of work because I oversee the entire eye care service in the subregion. Karamoja has a population of around 1.2 million people and the catchment area is approximately 2 million people.

That means that despite my work here, I also have to make sure that the other smaller health facilities that have ophthalmic clinical officers are running well. I have to support, supervise and enhance their skills and ensure that they’re referring the patients. So generally, I am everywhere!

A boost to eye health

When I was doing my master’s in ophthalmology, there were just six students in my class and only two of us were from Uganda. That means that in my year, only two ophthalmologists graduated to work in eye health in Uganda. But now, things have improved: there are more than 10 per year group and many Ugandans are enrolled. This is giving a boost to eye health and young ophthalmologists are coming in.

One of the proudest moments of my career was last year when I was given an award by the Ugandan Medical Association for strengthening the health system in Uganda. I’m really proud of it! Here in Karamoja, we’re cut off from other regions and areas, but the association thought I was doing a really good job and that’s really important to me.

Since I joined, the ophthalmology department at the hospital is more established, referrals are improving, we’re building capacity, we’re working with other health facilities and we’re reaching out to make sure no one is left behind.

For me, the best part of my job is to find out the problem and solve it. I want someone to wake up the day after their operation and be able to see. This thrills me. Someone comes in, I solve their problems and they are happy the next day. They can do things on their own and their life is changed.

The inclusive eye health programme

The official name of the inclusive eye health programme I help deliver is ‘Improved access to affordable, quality eye care services for people with and without disabilities in South-West region, Malawi and Karamoja, Uganda.’ This is a three-year programme that aims to reach people who traditionally face barriers in accessing health care, including people with disabilities, nomadic communities, and women and girls.

Since it started in 2020 the programme, funded by the UK government through UK Aid Match, has helped more than 21,800 people access basic eye health.

There are lots of barriers that people with disabilities face when trying to get access to eye care. In many cases there is no one to bring them to the hospital and they cannot come on their own, so they often have to rely on someone else. This is really a very huge barrier.

To tackle it, we now work in collaboration with the division of disability and rehabilitation services; if people can’t reach the hospital, we can go to them in their homes and bring them to the health facilities.

A lot of people also don’t know about the services being offered. They think that because cataracts mostly affect older people, it’s just a normal disease and nothing can rectify it. This is a big lack of information.

Accessibility and empowerment

Women are really disadvantaged – not just here in Uganda, but in many parts of Africa. They need to know that they have rights to access health care and men need to learn about health care and the benefits, so they will be able to direct their families [to the services they need].

So everyone needs to be empowered with the information that health care is available.

As part of the programme, I took part in accessibility training. When I did the training, I must confess that I was really naive about many areas – I didn’t even know what accessibility really meant.

But then during the training I realised that I was actually playing a big part in people not having accessibility, especially people who come to me.

That accessibility training opened my eyes and actually does make me a champion now, in as far as accessibility in my hospital is concerned. We had many new buildings being planned and any time we were doing site inspection, people would not understand why I was so interested in the size of the ramp, the height, the disability toilets, and I was looking at the small details.

I’m really knowledgeable about accessibility now! We need to make sure that in every aspect of health care, no one is left behind.

The work still to be done

People think that I’m happy or proud to be the only ophthalmologist in Karamoja. On the contrary, I’m not. I need support; I need lots of support. At the hospital, there’s supposed to be at least two of us: I am supposed to have a more senior person and then me, being mentored by him or her, but now I’m just alone doing everything on my own.

We really need to do a lot as a country to see that human resource for eye care is boosted so that patients really get the quality care that they need. It’s indeed a lot – research, data, equipment – a lot to be done.

But hope is not lost. I’m actually very, very hopeful. Right now the government is working on the fifth eye care plan for the country, and I want to use it to develop a strategic plan for Karamoja subregion. Previously, when anyone who was having surgery here it had to be done by visiting ophthalmology staff paid by Sightsavers to come – now, the community knows that when you have eye problems, there is someone here who can work on you.

I’m really proud of the work that I’m doing, and I’m really full of gratitude for everyone supporting this programme. They’ve made sure that people they don’t know can see and that the Gladys they don’t know is growing professionally – it’s so impressive and it also tells me, you know, to pull my socks up and help other people!

Sightsavers has been working in Uganda since 1954

Our work in Uganda

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