Emily Gower
Associate Professor, Department of Epidemiology, University of North Carolina at Chapel Hill

Most surgical trainees practiced on a glove or orange. HEAD START provides a high-fidelity, low-cost way to gain and refine skills in all of the necessary steps of surgery prior to exposing the trainee to a patient.

Dr. Emily Gower is a global expert in Trachomatous Trichiasis (TT) surgery outcomes who has spent nearly 2 decades working in Africa, focusing on preventing blindness in areas with limited resources. She developed a low-cost surgical simulator (HEAD START) that is now the standard for training new trichiasis surgeons around the world and is recommended for use by the World Health Organization. 


Trichiasis, the leading infectious cause of blindness globally, is corrected by a surgical procedure typically performed by eye nurses with very basic medical training. Prior to Gower’s innovation, most nurses had no opportunity to practice the surgical procedure prior to performing surgery on live patients, and surgical outcomes were poor in many settings, with up to 50% of patients needing repeat surgery. Gower developed HEAD START to fill the gap between didactic and hands-on training by providing trainees with a safe environment in which to learn the procedure steps and practice with utilizing surgical instruments.


HEAD START is the only surgical simulator available for trichiasis surgery – prior to its development there was no standardized approach for trichiasis surgery trainees to practice surgical skills. It can be used anywhere, making it ideal for trichiasis surgery training, which often takes place in very remote settings. It is also scalable, as it is used in nearly all trachoma-endemic countries with active surgical programs.

Gower’s innovation has dramatically changed clinical practice by addressing the challenge of poor surgical quality. There has been an increased focus on surgical training and outcomes globally, and most country programs have reported dramatically lower recurrence rates (10-20%).