U.S. Army Africa, in partnership with Mauritanian Armed Forces, conducted a joint Medical Readiness Training Exercise in Nouakchott, Mauritania, recently, which focused on familiarizing Mauritanian Ministries of Defense and Health personnel with U.S. medical techniques and procedures used when performing suture-less cataract surgery. Working closely with host nation health officials, U.S. medical and logistical teams deployed to get valuable real-world training, increase interoperability with regional medical providers, and help local citizens needing treatment.
During MEDRETE 13-2, U.S. ophthalmologists and Mauritanian doctors practiced a suture-less cataract surgical technique known as Small Incision Cataract Surgery (SICS) in an effort to reduce the high incidence of cataract blindness in Mauritania.
"The exercise better prepared U.S. military ophthalmologists to operate in an austere environment, simultaneously increasing the capacity of Mauritania's Ophthalmology capabilities and strengthening the relationship between our two nations," said Maj. Kevin Czarkowski, exercise officer-in-charge.
MEDRETE 13-2 is an example of how USARAF is helping to ensure a more self-sufficient, secure and stable Africa.
"This regional capacity building can be seen in the efforts of Burkinabe Ministry of Defense Dr. Jean W. Diallo who learned U.S. techniques and conducted more than 25 surgeries in last year's Burkina Faso MEDRETE," Czarkowski said. "Since then, he has conducted more than 200 surgeries, mentored his country's Ministry of Health doctors and joined USARAF efforts in Mauritania."
Dr. (Col.) Casey Carlton, lead surgeon during MEDRETE 13-2, said, Diallo has done remarkable work since he was taught SICS during a MEDRETE in Burkino Faso last year. Out of 111 surgeries in Mauritania, Diallo completed 40 of them.
What's unique about this MEDRETE is the participation of a host nation doctor from Burkina Faso who we trained last year -- I think it's incredible what Dr. Diallo has been able to do here," Carlton said. "In September he was learning this procedure just like anybody else -- he's as good as our best surgeon so we were giving him the more difficult cases. I think the presence of Dr. Diallo in West Africa might signal the dramatic change in the quality of cataract care, and hopefully we will be able to continue this partnership," Carlton said.
Diallo said he was very thankful for Carlton's team to teach him the SICS so he can continue to practice.
"I got an opportunity to train with Col. Carlton and his team last September. He took his time to help me learn how to do the surgery step-by-step, and I did 10 or 12 cases before they left. They left me some equipment to continue to practice this technique, and now after six months I did 200 cases. When I talked to Dr. Carlton, he gave me an opportunity to come here to see if everything is well and to continue to practice this technique, so I would like to thank Dr. Carlton and his team and also U.S. Army Africa for giving me that opportunity," Diallo said.
With Diallo helping to perform cataract surgery on patients, the host nation can continue to learn the technique after U.S. personnel leave.
"Dr. Diallo is working with us helping to develop relations and interoperability with the Mauritanians. Ideally we should reach a point where we impart what we want from a medical or military perspective and then it sticks around, that's sustainment," Carlton said.
Before MEDRETE 13-2, Carlton said Mauritania was doing the traditional procedure, which was the Extra Capsular Cataract Extraction (ECCE) which had decent results, but nowhere near the good results of the SICS.
"Surgery isn't easy and there's always a learning curb associated with it. When you're learning a technique it's difficult, but once you get it, you get it and you keep it -- that's where Dr. Diallo is now," Carlton said.
Diallo agrees that the new technique (SICS) is more successful than the older one (ECCE).
"This kind of mission is very important for Africa because cataracts are the first cause of blindness in Africa. In Africa we didn't have enough ophthalmologists to treat all the cataracts so
Americans came and they helped us. Dr. Carlton gave me the opportunity to come to Mauritania, and I am very happy. I think the mission has been very successful. SICS is very important for African ophthalmologists to practice to get better results compared to the old technique we use. Our patients are very happy and they get better vision. I hope this won't be the last I do," Diallo said.
Along with sustainment, Carlton said learning the new technique is beneficial to Africa because it is inexpensive. Mauritania is one of the countries where resources and surgical expertise to perform the surgery are lacking.
"The Ministry of Health doctors and the Ministry of Defense are very competent at what they do, but they lack resources. Typical cataract surgery in the states is very technology dependent and very expensive. You have to find something that has good results and costs a lot less. This procedure costs about $15 in terms of supplies whereas the surgery we do in the states is probably $600 just for supplies. This is a procedure that is inexpensive and repairs the patient's vision in 20 minutes or less with a low complication rate and very little follow-up requirements on our part. It's like a 'win, win, win, win, win' type situation," Carlton said.