We are 50 years today; a golden jubilee is in order! Historically we have come of age. From 3 universities I discussed in 2011 (b)
as the only facilities accredited by the board to train Optometrists in Nigeria, today there are 7 universities training optometrists in Nigeria (c).
ABSU, IMSU, BAYERO, FUTO and MADONNA. (d). Unilorin and UniBen offer Optometry training under Life Science Faculty!
I wrote in 2011 that NOA had a membership strength of 2130 (b)
today the membership strength has increased to 3997 and still counting! (e).
Registered Optometric Clinics currently stand at 776 (f).
The profession has not only upgraded itself to a Doctor of Optometry, it has started it's College/School of Optometry. Dr Roland Eyime is the President of the College and Prof. E.U. Ikonne is the registrar.
The college has 7 faculties:
1) Ocular health
2) Primary care Optometry
3) Orthoptics
4) Paediatric Optometry
5) Rehabilitative Optometry and Low Vision.
6) Public health Optometry
7) Cornea and Contact lens
(g)
While a lot has happened in the last 50 years of our existence, a lot is still not happening for us:
1) The association feels that it is not properly represented in the ministry of health.
2) The poor employment culture of Optometrists in the public health sector is another challenge!
3) The cost of setting up private practice,
4) The cost of getting trained in the various schools of Optometry in Nigeria etc are a few of the things not going our way in the last 50 years!
1) I was at BMH (Braithwaite Memorial Hospital) for an emergency condition, a child with Retinoblastoma, the large hall dedicated to the outpatient appointments in the Ophthalmology/Optometry department was full to the brink. I can bet my clinic that the Ophthalmologist:patient ratio was 2:100. The Optometrist:patient ratio of 5:300 is very much in order because majority in that hall were seen by the few Optometrists there. This is primarily because Ophthalmology is not a major player in the health circles here in Nigeria. No thanks to the in-fighting among eye care practitioners and the influx of ophthalmic assistants as a desperate buffer by the handful of practicing Ophthalmologists in the public practice sector!
Ophthalmology is not an appendage of medicine, Ophthalmology is at par with medicine. In Ophthalmology, Ophthalmologists, Optometrists, Opticians, Ophthalmic nurses, optical technicians etc are branches of one big tree, the tree of vision. That they should be a major stakeholder in the Nigerian health system is an understatement. In Ophthalmology, Optometrists, with over 3997 registered members, are major stakeholders. There are over 300 registered Ophthalmologists under the OSN (Ophthalmological Society of Nigeria) since its inception in 1969 [h]! It is expected of us to find leaders who will bring unity amongst eye care professionals. This will enable us pressure for a permanent stake in the affairs of the ministry of health in Nigeria. To pull off such feat, Ophthalmologist/Optometrist relationship should be the rallying point for our future leaders in our various associations.
The major disinformation that has widen the chasm of our divide (Ophthalmology/Optometry) is the unfounded purported threat Optometrists, who trains less years than a contemporary Ophthalmologist, pose to the Ophthalmologists. Instead of this cat and dog relationship, a symbiotic relationship akin to the Cattle and Egret is very much the needed catalyst to a unified Ophthalmology system.
Our stake in the health system through the ministry of health cannot be over emphasized. Favorable policies for Ophthalmology can easily be passed with our active presence in the affairs of the Nigerian ministry of health. Optometrists will become major proponents of the ministry of health. Legislation to improve our practice scope will easily pass through the National Assembly for the President's assent.
2) Ophthalmologists, few of them in the public sector, makes it seem as if employing more Optometrists in the public sector is a slight to their designation as Doctors. They also view us with this trepidation bordering on unnecessary hysteria. Optometrists must be Optometrists and not Ophthalmologists. Ophthalmologists must be Ophthalmologists and not Optometrists despite our overlapping roles. I believe this is what Association of Optometrists in the public health care of Nigeria (AOPHCN) is trying to work out. How much influence AOPHCN exerts in increasing the numbers of Optometrists in the public health sector from 180 in 2015 to 500+ in 2018 (according to Dr Obinna Osuji, a practicing Optometrist)? Is 500/3997 of Optometrists in the public health sector enough for the eye health care sector? Why is the entrenched antagonism between the Optometrists and the Ophthalmologists becoming chronic especially in Public health care?
Optometrists have always tried improving on their standards of practice. The CPD (Continuing Professional Development), the FOM (Family of Optometry Mentors) training, The College/School of Optometry for residency programs etc are some of the extent Optometrists are curving for themselves a niche in the temple of improved professionalism and instrumentation. Today they have a very effective Continuing Practice Education, Optometrist colleges are churning out consultant Optometrists in their bid to ensure improved delivery of eye care services and reduce blindness and other visual challenges. This is the nexus of our oath of practice.
There is need to have an entrenched Optometric practice in the public health care sector. For instance, we have come of age to demand for an exclusive department under the faculty of Ophthalmology because we now produce Optometric consultants. Funding all these process is a function of how Optometrists can generate IGR (internally generated revenue) and finding leaders with the right proportions of charisma and stealth. Both in the private and public sector, Optometrists are known to be good revenue generators in health care service delivery! If the remaining 3497 Optometrist mainly private practicing Optometrists are adequately stimulated in area of productivity and in combination with the remaining 500 in the public health sector, you can imagine the ripple effect in the health care system of Nigeria. There are need for leaders who will objectively find a balance between our numbers in the public health sector and our efficiency in the health care. Who will bail the cat?
3) Cost of setting up private practice in Nigeria is staggeringly too steep especially in the urban areas. The cost of running the place, the cost of powering the place, the cost of purchasing equipment, the cost of accommodation, the cost of registering the place, the cost of license renewals, the cost of providing subsidized health care delivery system (just like the module I'm working on), the cost of satisfying patients’ needs and expectations, the list goes on... They constitute the bulk of expenditure cost of starting a new Optometric eye clinic. We are in a country that is very hard to run a business and even harder to obtain loans for startups, it is therefore very important to find a solution to this unfortunate reality! There is no way the private Optometric practitioners can absorb the over 80% registered Optometrists without being able to float their businesses and run it efficiently.
We need an association with both an ideological and physical presence that will create an enabling environment on which to provide loans for budding and entrenched private practice Optometry.
Instrumentation and cost of the location is a major capital budget challenge! Stimulate private practice such that our demands on the public health system will be viewed from our position of strength than that of desperation! A good leader, leaders in our various schools and colleges remain sacrosanct for us to achieve a very effective and efficient Optometry practice!
I still reiterate that private practicing Optometrists remain the forte. There are only 12.51% of practicing Optometrists in the public health sector, the remaining 87.49% of the Optometrists are in the private practice sector! Take this statistics to heart, it is the most realistic fact at our disposal!
4) Abia State University Uturu, Imo state university Owerri (both state run universities), Madonna university (a private university) are comparatively more expensive than the cost of training in Unilorin, UniBen, FUTO and BAYERO mainly because the later are federal owned universities.
Madonna is deemed to be the most expensive because of its statue as a private university. The state run universities of ABSU and IMSU follows closely behind. The federal institutions (BAYERO, UniBen, FUTO and Unilorin) which Optometry training happens follow a distant last in the order of cost of training. This does not negate the over 60credit loads per session in the period of 6 years plus another 1 year of internship! Those cost so much money and there is need to have leaders who will subsidize these costs in an entrenched manner such that improved productivity becomes the default!
A student loan can be looked into especially if we are ready for an entrenched practice in the health care system.
Finally, there is need to sit down, in a deep sober reflection, look at how far we have gone and to come up with contemporary ideas and solutions on how to move forward from here!
Therefore as we wish us all a Golden Jubilee celebration, our gift of hindsight shouldn't be underrated. We should know where we started, how far we have gone and what is the way forward with the future always in sight! Long live Optometry in Nigeria. Happy 50 years anniversary!
Note: I wish to congratulate this present outgoing leadership under Dr Damian Echendu on the Nigerian Optometric Association (NOA) CSR initiative project aimed at providing over 40,000 children with eye glasses in Nigeria in commemoration of our golden Jubilee. [i]
Links:
(a) http://www.noang.org/about-us/
(b) http://optometrynaija.blogspot.com.ng/2011/05/vision-2020-and-role-of-optometry_11.html?m=1
(c) https://en.m.wikipedia.org/wiki/List_of_optometry_schools
(d) http://informationpoint.com.ng/list-of-schools-universities-in-nigeria-offering-optometry-as-a-course-under-medical-faculty/
(e) http://www.odorbn.gov.ng/optometrists-in-nigeria/
(f) http://www.odorbn.gov.ng/eye-clinics-in-nigeria/
(g) http://www.noang.org/college-schools-of-optometry/
[h] https://osnig.org/about-osn/
[i]http://www.noang.org/launching-of-nigerian-optometric-association-noa-csr-initiative/
