Merlin Hetherington, Alex McMaster / University of St Andrews, Scotland
In late summer 2018, undergraduate students Merlin Hetherington and Alex McMaster set off on their incredible 10,000km self-supported journey by tandem bicycle across Africa, on an epic mission to train health care workers to use Arclight, an innovative eye examination device. Unfortunately, they have recently been forced to leave the saddle due to health concerns, but are valiantly continuing their mission using a combination of hand-drawn cart and ElliptiGO with Burley trailer. We first covered their trip back in November, but recently caught up with Merlin, who told us a bit more about the device and their adventure so far.
How did the idea for the trip come about? Why did the Arclight inspire you?
I started getting interested in eye care services for low income countries as I was working on my dissertation project. A lot of blindness is preventable or treatable. I realised that protecting sight was a worthwhile cause that would have a positive impact on someone’s life and family, so I wanted to get more involved. My dissertation project involved the Arclight device and some associated training tools. This device is set to be quite ground-breaking for eye-care in low income countries but needs to be introduced to health professionals working in these places.
At the same time my flatmate and I were interested in undertaking big trip. We had done some touring on a tandem in Europe and felt like we wanted bigger. The prospect of big wilderness; deserts, mountains and forests; the unpredictability of travel in what is largely a developing continent excited us.
What exactly is the Arclight device? How does it lend itself to use in a low-resource setting?
The Arclight is a combined ophthalmoscope and otoscope. Significantly it’s also solar-powered and much easier to use than traditional devices. It was designed by the University of St Andrews specifically as a tool for low-income countries and its very affordable. In the UK it retails for £48, but for low-income countries it can be acquired for just £10. Any profits from sales in the UK subsidise distributions to low income countries in Africa and South East Asia.
Ophthalmoscopes and otoscopes are typically designed for the needs of wealthy countries and tend to be expensive and require replacement parts. This means that very few practitioners in low-income countries have these essential tools.
The Arclight’s patented design means it is a much more compact device, making it easier to use and not require replacement bulbs or batteries. Studies have shown that it performs as well as traditional devices that are up to a hundred times more expensive. Dr Will Dean at the London School of Hygiene and Tropical Medicine described it as a “game changer” for the prevention of blindness in Africa.
If someone is familiar with direct ophthalmoscopy, it does not take long to show them how to use the device. Even newbies pick it up fairly quickly so we also carry with us small simulation tools also made by Arclight. These simple tools simulate 24 common disc and retinal pathologies. The teaching sessions end up being quite busy and interactive.
How have you identified healthcare teams or populations to target along the way?
We worked closely with Ronnie Graham who is an advisor for the International Agency for the Prevention of Blindness. Firstly, he was able to give us a much better idea on the eye care situation in each country and which groups to work with. We then started by contacting National Eye Care Coordinators in each Ministry of Health and allowed them to direct our training to where they felt there was most need.
We have trained a lot of medical students and optometry students. They will become the future of healthcare in their countries and will also be posted to the most remote and rural areas once they complete their training – with an Arclight in hand they have the agency to improve eye-care services.
How did you organise the logistics for such a significant trip? Will you have any in country support along the way?
The logistics have been mammoth and the whole project was nearly a year in the planning. As with any venture, things started with trying to secure the funding. Once that was in place we spent three months trying to line up distributions and contacts in each country. Luckily the university provided us with accommodation during this time and we had a lot of support from friends, family and university staff. We ended up taking a trip to Ethiopia to present at the conference for the College of Ophthalmology for Eastern Central and Southern Africa. This turned out to be extremely helpful for making contacts and when firming up plans with eye care representatives in the countries on our route. The finances, distributions, social media, risk assessments, insurance were all needed to be covered. Additionally we had the cycle itself to prepare for, specialist kit to get, route planning and a training schedule to stick to. I’m really glad we had the two of us were so focussed and the support of the University of St Andrews and the Scientific Exploration Society has been crucial.
What about considerations for your own health and wellbeing along the way?
Your own health and wellbeing should be the main concern in any expedition. Naturally, preparation and planning for this started before we left. We found the trip had many risks, from road traffic trauma and human threat to the extreme heat and exertion in a tropical environment – we had to consider many potential problems. It surprises a lot of people that in most of the countries we planned to go through there are no emergency response services, that an ambulance isn’t going to pick you up. Therefore we have a satellite device with us. This can alert a global response centre and coordinate a rescue and if we don’t make our daily check-in an alert will be raised.
We had situational awareness and self defence training through Personal Safety London. We also have tailor-made trauma protocols based on the kit we are carrying – chest decompression and improvised pelvic stabilisation. We have an acute trauma kit on a frame bag, quickly accessible on the bike. In addition we have an extensive first aid kit including antibiotics and a malaria self-test kit, packed away in one of the panniers.
Eight-months on a tandem is a long time to spend constantly with someone, even your best friend. For our own sanity and mental health and to have an enjoyable break we made plans for our parents and my girlfriend to come out for a visit halfway through.
Not everything can be planned for and one of the hardest decisions was recognising that continuing in saddle wasn’t a good idea. Hours of pressure on the perineum can cause numbness and tingling which can lead to long-term damage. When you’re so invested in something, it’s easy be in denial and ignore the need to change your plans. Thankfully, that is the difficult decision we have come to.
So what is next if you are not continuing on the tandem?
We took a few days to reflect but both agreed we still wanted to try and make it to Cape Town under our own steam and fulfil our Arclight objectives. We started trying to find alternative ways moving south towards Cape Town. The best solution we could find was to build a hand drawn cart and start walking. This has been an amazing twist for us and has seen us walking through some of the most isolated areas of the Masai Steppe. However it can’t be a long term solution as we still have thousands of miles still to go. It looks like we might be able to get help from Elliptigo and Burley to continue on wheels without the pressure of a saddle. They look like really interesting bikes that you ride standing up, without a saddle – a bit like a gym cross-trainer.
How can we follow your progress?
Instagram and Facebook are the best ways to follow us, we post short updates and photos fairly often. All these accounts can be found on our website where there is more information about our project and there is also have a live tracking map so you can see exactly where we are at any given moment!
How can we support you?
The value of all the Arclights we intend on distributing is £20,000 and we decided to be ambitious and try and raise that money through a crowdfunding page. So far we are about two thirds of the way there, so are looking for more support. The page has now closed, but people can donate to our cause through the University of St Andrews
However, our aim isn’t just to raise money and bring attention to the Arclight. We hope our project will inspire people, young and old, to be more adventurous and take on a challenge. We also hope to bring attention to issues that, in a globalised world, affect all of us and it is our collective responsibility to do something about. Therefore telling people about our trip, either on social media, at work or over the garden fence really helps us out, so please spread the word!
Further Information / www.arclight-tandemafrica.com