A Journey to: Gibraltar by Michelle Brown
Gibraltar is a tiny British Overseas Territory located at the very Southern tip of Spain. The Rock of Gibraltar has long been associated with the Barbary Apes and despite its small size of 6 square kilometres, is home to approximately 27,000 Gibraltarians.
Due to the close proximity with Spain, the majority of locals are bilingual. Most will speak English and Spanish and at times, a mixture of the 2 which can be confusing to those within earshot. At a few miles from the northern tip of Africa, Gibraltar is home to a wide variety of cultures, with large Moroccan, Spanish, Jewish and Indian communities as well as British citizens. The presence of the Ministry of Defence base also gives rise to a large group of British Forces families.
Life on the rock can best be described as Britain abroad, with British policemen strolling along the streets in uniform and red pillar boxes and phone booths dotted around the town. The main language is English and the currency is pounds sterling although many businesses will also accept euros. You will also find a number of UK chain stores on the local high street such as Marks & Spencers, Next, Tommy Hilfiger, BHS, Topshop, Hollands & Barrets and even a familiar supermarket Morrisons. The schools conform to and follow the British Curriculum and the students sit the same exams as their British counterparts. The temperature however, is warmer than the UK as Gibraltar has a typically Mediterranean climate.
The local hospital has top of the range facilities considering the small population which it serves, which has surprised many visiting locums. This is necessary however, given that any complex cases would have to be referred to UK for investigation and/or treatment. The Orthoptic service is run by the Head Orthoptist Michelle Brown, a local who travelled to UK to study for her degree in Orthoptics and worked in London for a few years prior to returning home. The Ophthalmic Unit has a very similar set up to those in the UK and consists of a team of 2 Consultant Ophthalmologists, 2 Optometrists, 1 Ophthalmic Charge Nurse, 3 Ophthalmic Staff nurses, 2 Ophthalmic Nursing Assistants and the Head Orthoptist. The hospital is funded by the Gibraltar Health Authority which is modelled on the NHS. There is a voucher scheme in place similar to the NHS GOS scheme for subsistence towards the cost of glasses and the Health System also underwent (a locally adapted version of) Agenda for Change in 2010.
Orthoptic services include: Orthoptic paediatric & adult clinics, joint cycloplegic paediatric clinics (with Optometrist), Glaucoma Screening (with Optometrist), Visual Fields, Diabetic Screening and Vision Screening.
As Gibraltar is small, all primary school children are offered a vision screening appointment at the hospital where they are referred to the Hospital Ophthalmic services if required. The Head Orthoptist also obtained a qualification in Diabetic Screening Grading, enabling her to run a joint Diabetic Screening clinic with the Ophthalmic nurses. The nurses do the pre-dilation work up before the Head Orthoptist performs fundus photography and then grades the images obtained, informing the patient and arranging follow up as necessary. The glaucoma clinics are run with the Optometrist, with the Head Orthoptist doing VAs, Visual Fields, checking compliance with treatment, Anterior chamber assessment and IOP measurements prior to dilation and passing through to the Optometrist for Volk assessment and OCT. Any complex patients requiring investigation or treatment such as retinal detachment surgery are referred to Moorfields Eye Hospital and are flown out under sponsorship of the Gibraltar Government. The Department has an on-site theatre for minor procedures such as cataract surgery, intra-vitreal injections etc and uses the main hospital theatres for procedures requiring general anaesthesia such as squint surgery.
The Orthoptic Department was awarded accreditation by the BIOS as a University placement site in early 2014. The Head Orthoptist obtained the necessary qualifications to be a lead clinical tutor and is taking Orthoptic undergraduates from both Sheffield and Liverpool Universities. Also in the pipeline, is the development of a Colorimetry Service. This has been some years in the making, with the Head Orthoptist working closely with a local dyslexia support group. AHP Heads meet on a monthly basis to discuss areas of mutual interest and a multi-disciplinary approach to stroke services is currently being reviewed.
Orthoptics in Gibraltar is fun and with so many different clinics, it is never boring! Feel free to contact the Head Orthoptist for any further information at Michelle.Brown@gha.gi
