Rb-NET in action – Kenya

By Dr Kahaki Kimani, Kenyatta National Hospital, Kenya:

“Despite the strides we have made as a country in the management of children with retinoblastoma there are still major gaps, which include:

  1. Late presentation: Despite many efforts at creating public awareness on retinoblastoma, many people including health workers still miss the significance of a white pupil or squint in a child.
  2. Shortage of chemotherapy drugs: We still have episodes of critical drugs going out of stock and delaying treatment and impacting negatively.
  3. Industrial action: In the past three years we have had two protracted strikes in the public hospitals. We have seen a steep rise in the number of patients presenting with extra-ocular retinoblastoma, some already with metastasis.

We are fortunate to have L V Prasad Eye Institute (LVPEI) as our partner in the Rb-NET run by the VISION 2020 LINKS Programme. The benefit of this partnership is that they still see late presentation retinoblastoma children (which is no longer the case in the UK, where babies and children are identified and treated early) and together we can discuss and review our cases. 

In December 2018 Dr Swathi Kaliki (retinoblastoma specialist) and Dilip Mishra (ocular pathologist) from LVPEI visited our hospital. During their visit we had interactive lectures and practical sessions. We had a whole day in theatre where we reviewed and treated patients with challenging cases of globe salvage. Dr Kaliki gave valuable suggestions on new ways of approach, especially regarding chemoreduction and Transpupillary Thermotherapy (TTT), which we have been implementing since, with improved results. Dr Kaliki also gave valuable input into our Retinoblastoma Best Practice Guidelines, which we were in the process of revising. Dr Dilip gave a practical session to the pathologists on how to report histology slides of eyes with retinoblastoma. This was very useful since we do not have an ocular pathologist and rely on general pathologists.

Through this collaboration we have access to Dr Kaliki and can consult her whenever we have any difficulties. We have also managed to get a three-month clinical fellowship at LVPEI for one of our ophthalmologists from Moi Teaching & Referral Hospital in Eldoret. For a long time we have been hoping to improve the level of care for children with retinoblastoma; we are happy to be moving forward.”

Dr Kimani is a key part of the future plans for the development of effective treatment for Rb in Kenya and for the future of Rb-NET and sharing learning with other countries in Africa (many of which are less advanced in tackling Rb than Kenya). Her expertise in developing the retinoblastoma service in Kenya and her determination to continue to grow it and to establish two other centres in the country (Mombasa and Eldoret) to reduce the need for all children to travel to Nairobi, is an example of a country-wide approach that other countries in Africa can learn from.