Supervising Trichiasis Surgeons: It’s All About Support

By Will Fowler  - June 21, 2017
Mr. Abdou, left, supervises a trichiasis surgeon during a mobile surgery campaign in Cameroon’s North region in June 2017. (Photo: William Nsai/HKI)

Several weeks had passed since Abdou Njanga, a senior ophthalmic technician in Cameroon, had seen his patient.

“When she saw me from far away, she started dancing, and continued all the way until she reached us,” he said. “And she fell into my arms. That made me profoundly happy.”

Mr. Abdou had performed trichiasis surgery on the 35-year-old woman, saving her remaining vision and ending her pain. Her reaction would make any surgeon proud, but for Mr. Abdou, it was doubly gratifying. Mr. Abdou had recently greatly increased his commitment to trichiasis patients, training to become a supportive supervisor to fellow surgeons.

The new role will allow him to help other trichiasis surgeons achieve the best possible outcomes for patients.

Traditionally, surgeon supervisors have often played a “policeman” role, assessing surgeons’ performance from a fault-finding perspective. While that approach may have helped weed out poorly performing surgeons, it did little to improve surgeons’ skills and motivation and promote quality outcomes for patients.

Taking its cue from global recommendations and preferred practices calling for a more supportive approach to trichiasis surgery supervision, the MMDP Project worked with national ministries of health to implement a new model, one that focuses on helping surgeons continually improve and succeed. 

“I see my role of supportive supervisor as being a mentor, able to pass what I have learned to the surgeons working in the field, and share my experience,” said ophthalmologist Dr. André Bertrand Kengmogne after his supportive supervision training in Cameroon.

Dr. Kengmogne wears a loupe, used to magnify the surgical site during trichiasis surgery. (Photo: Sabrina La Torre/HKI)

The training workshops last five days. Participants learn what to look for during supportive supervision, including everything from the way the operating table is positioned, to the length of the surgical incision, to infection control practices. They learn the value of using supervision checklists and systematic approaches to surgeon support.

They also learn “soft skills” not normally covered in their previous technical training – like active listening and clear verbal communication, and how to work with adult learners.

“Thanks to MMDP Project support, I realized that although I had basic knowledge of the surgical technique, there were many things I did not know regarding the surgical procedure and the key criteria to ensure quality,” said Mr. Abdou.

Dr. Kengmogne particularly appreciated learning how to ensure best practices in the field.

“This was something different and new for me, since I am used to working in hospital settings,” he said. “But I realized that we can adapt best practices to the field setting, and that with proper training and support the surgeons can operate at the community level while respecting quality surgical standards, for example regarding infection control and sterilization.”

Dr. Kengmogne said it’s up to him now to “keep a vigilant eye” during trichiasis surgeries, spotting any improper practices and making sure they are corrected.

“This was stressful at first, but now it is exciting to work with the teams on ensuring quality,” he said. “I feel useful for the surgeons. I can help and support them to improve their practice.”

To date, 38 supportive supervisors in three countries have been trained under the MMDP Project.

Ultimately, their work is about helping patients.

“You have to know that trichiasis patients are sad and in pain most of the time,” Mr. Abdou said. “I want to bring back joy to them.”

Will Fowler is a communications intern with the MMDP Project. He based this story on interviews conducted by Sabrina La Torre, the project’s Capacity Strengthening and Technical Support Specialist. Funded by USAID and managed by Helen Keller International, the MMDP Project helps countries provide treatment and care for people suffering from the debilitating effects of trachoma and lymphatic filariasis.