The History of Save The Nation's Sight Clinic
Dr. Thomas Baah's Story
As a child, Dr. Baah attended a village school. During his first three years of schooling, he sat under a tree for his education because there was no school building in the village of Tumu. He walked barefoot to school until he passed the Common Entrance Examinations at the age of fourteen.
When he was in class six and about twelve years old, Dr. Baah's sister died of measles. His mother brought his sister from their village in Tumu where they lived with an aunt to the nearest doctor in Jirapa and in Bolgatanga, along bumpy roads. Dr. Baah says that he still remembers the day that his sister died. "She would look up at me wanting to smile, but she was too ill to do anything." His mother obtained some tablets from Catholic nuns. At home, she crushed and mixed them with water for her to drink. Not long afterwards, his sister died. This was Dr. Baah's first experience with the death of a close relative. He says that he was devastated by the tragedy, and decided then to become a doctor. However, he said that becoming a doctor seemed like a joke at the time, a "wishful and fanciful childhood dream."
When he was in Upper Sixth Form in GSTS, Takoradi, Dr. Baah fell ill during the first term and had to be taken back to his village near Tumu in the Upper West Region of Ghana. He wasn't able to attend school during that year. However, he returned to school to write the Advanced Level examinations and passed with good grades in 1981. He then applied to medical school but failed to attend an interview for admission into medical school through no fault of his own. Communication was difficult. A traveller arrived in Tumu with an old newspaper from Kumasi. Someone who knew Dr. Baah saw his name among the list of students invited for a medical school interview. This friend came to show Dr. Baah the paper, but the interview date had passed. Dr. Baah decided to go to the medical school several weeks after the interview to find out if he could still be considered for admission. Professor Eldryd H.O. Parry, who was the Dean at the medical school, admitted Dr. Baah into the medical school after a short interview. Against many overwhelming odds, Dr. Baah was able to achieve his dream of becoming a doctor.
While preparing to write their final year medical school examinations twenty years ago, some of Dr. Baah's colleagues were already set to leave the country. Two thirds of his classmates left for better job opportunities in England, the U.S., and other countries. However, Dr. Baah has dedicated his life to working to serve those who are least privileged in society, in line with the ideals that motivated him to pursue a career in medicine. In 1991, Dr. Baah became the first Ghanaian doctor to accept a posting at Our Lady of Grace Hospital in Breman Asikuma in the Central Region.
In 1994, Dr. Baah left Our Lady of Grace Hospital to pursue a career in ophthalmology. His early childhood experiences of living with a blind uncle motivated this career choice. As a child, Dr. Baah's uncle would call him and ask for help to visit the toilet or to attend the meetings of village elders. Dr. Baah says that "memories of him painfully remind me of the thousands in Ghana who are needlessly blind from treatable cataracts." Dr. Baah completed his ophthalmology training in West Africa and then in 1996/1997 he pursued a Master's Program in Community Eye Health at the esteemed International Centre for Eye Health in London.
In 1998, Dr. Baah accepted the challenge to start a new eye clinic at Our Lady of Grace Catholic Hospital in Breman Asikuma. The objective was to make specialist eye care services available, accessible, and affordable to the rural inhabitants of the Central Region. In addition to providing care to paying patients, Dr. Baah coordinated outreach programs on public holidays and on weekends with his own resources. He later partnered with Unite For Sight to significantly increase the number of outreach patients receiving free care. Dr. Baah worked with Unite For Sight since 2006 to provide eye care to patients unable to afford care at Our Lady of Grace Hospital. In Summer 2008, Dr. Baah decided to pursue a rural village outreach program in which he and his team visited two regions of Ghana during June and August 2008: Tumu (his hometown) in June, and Keta in August. Dr. Baah explained that "my experiences in Tumu and in Keta showed that given the necessary support one can do more for rural patients than in a fixed clinic. In Keta and in Tumu, I did more operations in the two months than I would have done in one year in Breman Asikuma...To help these victims of blinding cataract, new strategies are required to take cataract surgery to their doorsteps. The solution is Save The Nation's Sight Clinic." Dr. Baah remained in his position at Our Lady of Grace Hospital until late 2008 when he decided to establish Save The Nation's Sight Clinic in order to reach increasing number of patients living in poverty throughout Ghana. Dr. Baah's new clinic is a well equipped eye clinic located in Accra that focuses on taking cataract surgery to the doorsteps of patients in deprived communities throughout all regions of Ghana. Dr. Baah refers to himself as a "mobile foot soldier on the forefront of the battle against preventable blindness".
Save The Nation's Sight Clinic: History and Social Entrepreneurship Model
Dr. Baah developed a proposal to establish a new clinic in October 2008, and Save The Nation's Sight Clinic was inaugurated in January 2009. The clinic is based in Accra and provides some care to patients in the Accra region. For much of the year, Dr. Baah identifies regions in Ghana that lack ophthalmologists but do have district ophthalmic nurses. He links up with Regional Directors of Health Services, District Directors of Health Services, Medical Superintendents of Government or Mission Hospitals, District Chief Executives, traditional and opinion leaders in communities, and with local NGOs and other stakeholders in the provision of health services. Patients with operable cataracts are identified, and operations are undertaken in nearby hospitals. The district ophthalmic nurses continue to provide postoperative care for the patients after Dr. Baah's team departs the region.
Dr. Baah's logistics and coordination efforts prior to each outreach are immense and noteworthy. He develops an extensive outreach team consisting of local ophthalmic nurses, community members, cooks, drivers, and other personnel. He must personally visit each location to coordinate all of the details, to receive permission to operate there, and to coordinate with the local district to utilize their hospital facilities to provide cataract surgery, pterygium surgery, and other surgical operations. Since Dr. Baah's teams are constantly providing care to new regions and working with different health personnel throughout the country, the logistics are quite complex and time consuming. Dr. Baah's commitment and dedication to reach new regions is laudable.
When the program begins in the designated region, the team is usually based near the district hospital. Each day, the outreach team is split into approximately 6 separate outreach teams who go to separate villages/towns in order to reach the patients who are hardest to reach. In each village/town, the team usually sees 25-100 patients per day, and the individual village teams therefore collectively see a range of 150-600 depending on the totals seen by each of the 6 village teams.
Most importantly, Dr. Baah has developed a sustainable eye care system that is not reliant on outside sources. He is an example of an extraordinary social entrepreneur. Approximately 1/3 of the patients seen in the villages have Ghanaian health insurance, and their eye surgeries are therefore fully covered by the local health insurance scheme. While the new health insurance scheme is promising, many patients do not have health insurance, and the government's health insurance reimbursements take many months to process which puts a strain on the health clinics awaiting reimbursement. For patients without health insurance, it would take more than 6 months for them to be approved for the government's insurance, and it would not be appropriate for the patients to be told to wait until they receive insurance before they can receive eye care. Therefore, Unite For Sight funds the surgical expenses for those patients so that they can receive immediate care.
In addition to the surgical expenses that are funded by the health insurance scheme or by Unite For Sight, each outreach day incurs significant expenses that Dr. Baah's sustainable system is able to internally cover.
Save The Nation's Sight daily self-funded outreach expenses include:
Hiring of vehicles
Fuel for the outreach vehicles
Supplies for screening patients (medication, spectacles, stationary, etc)
Surgical consumables
Payment for use of facility (district hospitals)
Accomodation for outreach team's staff(rental of guest houses)
Meals for participants
Stipends for local outreach team
Miscellaneous items
Dr. Baah purchases medication from local sources, and patients receiving medication are required by the clinic to pay the costs for the medication. Likewise, Dr. Baah purchases eyeglasses for patients, and those receiving eyeglasses are also required to pay for the glasses. Glasses transported to Ghana by volunteers are added to Dr. Baah's eyeglass inventory and helps to expand the resources available to his clinic and to the patients. Proceeds from the sale of the medication and glasses are able to fund the daily expenses of Save The Nation's Sight. Dr. Baah emphasizes that while the patients receiving sponsored surgery are blind and unable to work and earn an income, those receiving glasses and medication are not disabled, have sources of income, and are able to afford the expense for the medication and eyeglasses. Having grown up in extreme poverty, Dr. Baah notes the importance of engaging communities in sustainable health care provision that does not rely on charity. He explains that those purchasing reading glasses contribute to keeping the outreach program running so that the clinic is able to continue finding and helping those who are needlessly blind.