International Coalition for Trachoma Control

Trachoma tributes shine a light on outstanding contributions to the global elimination of trachoma

In 2012, Emily Gower, Associate Professor, epidemiologist and trachoma expert approached Jim Johnson, Associate Professor at the Center for Experimental and Applied Learning at Wake Forest University with a challenge: to improve the quality of surgeons and surgeries to treat trichiasis. Immediately intrigued, Johnson began closely working with Gower to identify the challenges involved in improving surgical outcomes and increasing the number of well trained surgeons to treat trichiasis. As a result of this partnership, Johnson and his team began developing an innovative new surgical simulator that is revolutionizing the way surgeons are trained for trichiasis surgery.

Trichiasis is a condition caused by repeated and untreated trachoma infections. It is an extremely painful and blinding condition that currently affects about 3.2 million people (according to 2016 data) but it can be treated with a low-cost and relatively straightforward surgery. Although a record-breaking 260,000 surgeries were performed in 2016, the quantity and quality of surgeries will need to be increased in order to achieve the global elimination of trachoma by 2020.

Gower and Johnson's program, aptly named HEAD START, or the Human Eyelid Analogue Device for Surgical Training and Skill Reinforcement in Trachoma, aims to improve training for surgeons working to clear the backlog of people urgently needing surgery. The surgical simulators allow surgeons to practice eye operation skills, including cutting and suturing, in a practical setting. With life-like features, the simulators are bridging the gap between medical theory and live surgery. 

HEAD START is a huge improvement for training surgeons and maintaining best practice. Before HEAD START many surgeons practiced surgery techniques on fruit, such as oranges, with many progressing straight from orange rinds to live patients. While experienced surgeons rarely had an opportunity to assess their skills or refresh their training in a practical classroom setting.

The surgical simulators feature removable cartridges with disposable eyelids that enable surgeons to practice their techniques, replacing only the eyelid before each learning session, increasing the efficiency of production and cost-effectiveness for programs. 

Jim Johnson's in-depth knowledge of applied learning has led to the program being designed in a highly inclusive and engaging way. Johnson's vision was to simulate surgeries in an environment that is permissive for failure so that surgeons can learn from their mistakes. For Johnson, failure is one of the best motivations for learning. Using this concept, Gower and Johnson frequently consulted with experienced surgeons and surgeons in training. They developed numerous prototypes and tested them in a variety of contexts, analysing how training surgeons experienced the new surgery simulation.

Gower's knowledge and expertise in trachoma elimination and experience in the NGO sector meant she was able to bring in a number of member NGOs from the International Coalition for Trachoma Control (ICTC), including CBM, Light for the World and Orbis International, to help develop the most reliable replica of the human eyelid, accurately capturing the texture and feel of making an incision and placing sutures in a very close approximation of the human eyelid.  

In collaboration with the Center for Experimental and Applied Learning at Wake Forest University, these organizations tested the prototypes and the protocol for training with the device. They conducted multiple field studies, supported by a variety of organizations including Seeing is Believing Innovation Fund, Helen Keller International and The Fred Hollows Foundation. 

HEAD START has become a widely-adopted training approach to ensure high quality surgery training. All major new funding initiatives that support national trachoma programmes now use this ICTC-recommended approach both for training new surgical technicians and monitoring and retraining experienced surgeons. Gower and Johnson's partnership with ICTC and national program staff has been hugely significant. ICTC members have closely supported the development of multiple prototypes and have created technical positions and preferred practices for its use, paving the way for it to be used in all national programs.

The strong multi stakeholder partnership started by Jim Johnson and Emily Gower, demonstrates what can be achieved when people with different expertise collaborate in a consultative, inclusive and engaging way. Today, World Sight Day, the International Coalition for Trachoma Control pays tribute to Emily Gower and Jim Johnson for their step changing contribution to trichiasis surgery training and the pursuit to eliminate trachoma related blindness.

Emily Gower currently serves as Associate Professor at the University of North Carolina.

Jim Johnson currently serves as Associate Professor of General Surgery Administration and Director of Industry Relationships and Professional Education at the Center for Experiental and Applied Learning at Wake Forest University.

HEAD START partners include the International Coalition for Trachoma Control, CBM, Helen Keller International, Human Analogue Applications, International Association for Prevention of Blindness, Light for the World, MMDP/USAID, Orbis International, Standard Chartered Bank (funding for Seeing is Believing), The Carter Center, The Fred Hollows Foundation, The Queen Elizabeth Diamond Jubilee Trust, UK Department for International Development, University of North Carolina, Wake Forest University School of Medicine, World Health Organization GET2020 Alliance