Anthony Loizides
In March and April 2025, as a final year medical student at Warwick Medical School, I spent four weeks in the Ophthalmology Department at Mawenzi Regional Referral Hospital in Moshi, Tanzania. Based mainly in the outpatient eye clinics, I observed and took part in the care of patients presenting with both acute eye emergencies and longer term follow up conditions. It was a very different picture of ophthalmic care to anything I had seen at home, and it left me thinking hard about what good outcomes really depend on.
A different kind of clinic
The emergency eye clinic ran unlike anything I had encountered on a UK placement. Patients queued outside the department before it had even opened, and once the doors opened, consultations moved quickly, with each patient seen and managed within a matter of minutes. There was no visual acuity testing beforehand, no imaging, and no electronic records; the slit lamp was, in practice, the only tool available, and every decision was made from what could be seen through it in a five-minute window.
What struck me most was not that this system worked, but how well it worked for what it was designed to catch. The doctors were confident and quick at spotting the major, sight threatening problems. What inevitably got missed, simply because there was no time for it, was the subtler end of the spectrum; earlier disease that a slower clinic might have picked up sooner. It felt like a clear example of a system triaging for what matters most when it cannot do everything.
What came through the door
The emergency workload was mostly infections, red eyes, trauma and foreign bodies. Conjunctivitis was an extremely common diagnosis, usually made quickly and treated with topical antibiotics. Watching this pattern repeat itself made me think about how much of my own training at home leans on the assumption that there is time; time to take a fuller history, time to consider other possibilities, time to review a patient again in a few days if something does not add up. At Mawenzi, that time simply was not there, and quick, practical decision making was the standard of care.
Cataract surgery, done differently
I also had the chance to observe cataract surgery, which was one of the clearest examples of medicine adapted to its setting that I saw during the elective. In the UK, cataract surgery is almost always done using phacoemulsification, where an ultrasound probe breaks up the cataract through a tiny, stitch free incision. At Mawenzi, while phacoemulsification is used when equipment and visiting specialists allow, the department’s doctors were highly skilled in Manual Small Incision Cataract Surgery, known as MSICS. This technique achieves comparably good results without relying on reliable electricity or expensive ultrasound machinery. Watching it in practice changed how I thought about it; this was not a lesser version of proper cataract surgery, but a technique deliberately suited to the setting it served.
The Patients behind the numbers
Perhaps the thing that stayed with me most was not clinical at all. Many of the patients I saw had advanced eye disease, often far more progressed than I would expect to see in a UK clinic. Many came from more remote, tribal communities in the region, for whom reaching a hospital, let alone a specialist eye clinic, was neither quick nor easy. For many, arriving at the hospital at all meant the problem had already become serious enough to disrupt daily life. It changed how I think about late presentation; not as a failure to seek care sooner, but as a reflection of real distance, geographic, financial and logistical, between people and the services that could help them.
Reflection
This elective showed me how effective ophthalmic care can be delivered even when the resources look nothing like a UK department and gave me real respect for clinicians who achieve strong outcomes by adapting skillfully to their environment rather than simply doing less with less. It also sharpened my interest in the barriers to eye care that exist long before a patient ever reaches a clinic; who gets to see a doctor, when, and why. As I continue building a career in ophthalmology, I hope to carry that perspective with me, not just the clinical skills the specialty demands, but an awareness of how much a patient’s outcome can depend on everything that happens, or does not happen, before they ever sit down at the slit lamp.