Anna Mobutsu, a 23-year-old farm labourer, cannot imagine taking a journey farther than a few hours' bus ride from her home in the South African town of Nelspruit. As an illiterate single parent with a seven-year-old son and an elderly mother to support on R5OO (£50) a month, Anna does not even have a television to introduce her to a world beyond her own. "But this afternoon I went to London."
Anna's 30-minute "visit" took place via a video link in a lecture room at Pretoria Academic Hospital. Anna alternately peered into a camera or watched a large screen on which Michelle Beaconsfield, a specialist at London's Moorfields Eye Hospital, discussed her medical condition with Professor Polla Roux, the head of the Pretoria hospital's ophthalmology department.
The teleconference project was the idea of lan Murdoch, a consultant ophthalmic surgeon at Moorfields and senior research fellow at the International Centre for Eye Health at the Institute of Ophthalmology. It has been funded by a lottery grant awarded to the British charity Fight for Sight. Five other Moorfields consultants are contributing their expertise and time to the project.
So far, Fight for Sight has introduced telemedicine to three South African cities - Pretoria, Bloemfontein and Pietermaritzburg. 'The potential benefits of this project are fantastic," says Professor Roux.,"Instant communication with experts in London helps us to provide the best cures for patients such as Anna. The telemedicine connection between the South African centres means we can exchange views and ad- vice across the country, ultimately running our own training centres. It also gives our doctors, medical students and nurses the opportunity to learn from the finest international specialists."
Dr Claire Walker, the director of Fight for Sight, calls this teaching the "ripple effect". Dr Walker was in South Africa when the project was set up late last year. "It's the dialogue between consultants that is so important. The South African consultant will say 'I thought it might be this condition', and the Moor- fields consultant will reply 'Yes, it might be that, but have you thought of this?' Subsequent patients will benefit because their doctor has learnt some- thing that they perhaps did not know before. We hope that those major hospitals will communicate their knowledge to local clinics so people won't have to travel so far for diagnosis and treatment," she says.
More immediately, Anna hopes the project will help to provide a cure for an eye condition that has plagued her for four years - a huge orbital tumour that protrudes below her right cheek, forcing her eye into a painful slit, compromising her sight, distorting her face and causing her to tilt her head away from strangers in a posture of embarrassment and fear.
"The problem with my eye has been going on since I was 19." says Anna. "When I first woke up and saw that a lump had swollen up like an egg on my face I just thought I'd slept badly. But the swelling got worse, so I went to a clinic where the nurses gave me eyedrops and ointment. When that didn't work I went to another doctor and then to hospital in town. None of it helped, and I stayed at home for two months waiting for my eye to recover."
Anna is just one of thousands of rural and disadvantaged South Africans who need ophthalmic expertise and medicine. Government funding is stretched to the limit, however, and despite the high level of eye problems (blindness is five times higher in South Africa than it is in the UK), public hospitals battle to provide enough doctors, blankets and beds, and private clinics are too expensive.
"South Africa can't afford the level of ophthalmic specialisation achieved by hospitals such as Moorfields, and only a handful of extremely wealthy South Africans can afford to travel over- seas for medical help," says Professor Roux. "The majority of patients at hospitals such as ours are very poor or unemployed - labourers, pensioners, schoolchildren and rural people. They can barely afford to pay for the ambulance or taxi to get here."
Anna's tumour was not malignant. She has had it surgically removed and her eyesight is expected to return to normal. For her, the Fight for Sight project has been life-changing. When she first arrived at the clinic, she confessed that the worst pain wasn't in her eye: "it's in my heart, the feeling that I'm ugly and no one wants to be with me. I never look in a mirror and the only times I go out are to work and to church. If I go to busy places, strangers stop and ask what's wrong with me. Even my son wants to know why I look so horrible.
"Ever since my eye swelled up, I've gone to church three times a week to pray for a cure," she says. "As soon as I'm better I'm going back to thank God. I always knew He would send a way to make me better - I just didn't know that it was going to be from London."