Monthly Archives: June 2015
By Professor Allen Foster, Professor of International Eye Health, Co-Director of the International Centre for Eye Health for London School of Hygiene and Tropical Medicine and former President of CBM International.
The World Health Organisation in 2010 estimated that there are 39 million blind people in the world, but in 80% of these cases the blindness can be prevented or treated. In the year 2000 the WHO together with a group of International Non-Government Organisations, including CBM, launched “VISION 2020 – the right to sight”, a 20 year initiative to eliminate avoidable blindness in the world. So what are the results?
There have been good successes, in fact in 2000 the projected number of blind people in the world for 2010 was well over 50 million, so the actual 2010 figure of 39 million has to be seen as an improvement. There have been good results to control diseases like river blindness (onchocerciasis), vitamin A deficiency (in children) and trachoma, all of which were major causes of blindness in poor countries. There have also been improvements in the delivery of eye care services generally around the world, but particularly in the middle income countries of Asia and Latin America. However the fact remains that about half of all blindness, around 20 million people, is due to cataract which is very treatable.
Cataract occurs when the clear lens in the eye opacifies, becoming like a frosted window. There are a variety of causes, but most cataract is associated with the aging process – the older we get the more likely we are to develop cataracts.
The good news is that the cataract can be removed and its function to focus light on the retina can be replaced by a small artificial lens placed inside the eye (intra-ocular lens) at the time of surgery. The operation is safe and has a very high success rate so that most people have excellent restoration of sight providing the eye has no other problems.
So if the operation is so good why are there 20 million people around the world blind with cataract? The main reason is poverty. Many low income countries do not have enough trained eye specialists. For example in the UK there are about 20 eye specialists for every million people while most African countries have only 1 to 3 eye specialists per million people; and those that are available, for family reasons, tend to work in larger cities which is often far away from poor people living in rural areas.
In order to make cataract surgery available to blind people CBM has been supporting the training of ophthalmologists, cataract surgeons, eye assistants and nurses throughout Africa for many years. A lot has already been achieved; for example in Tanzania there used to be 5 ophthalmologists when CBM started to support eye training and now there are 35 together with over 60 trained cataract surgeons and more than 300 eye nurses / assistants; however there is much more to be done if the goal of VISION 2020 to eliminate avoidable blindness by 2020 is achieved.
It is estimated that Africa needs another 2,000 eye specialists (to achieve 4 specialists per million population) by 2020, but at present less than 100 are being trained each year. Without the eye surgeons, people will not be able to receive cataract surgery and the problem of blindness from cataract will continue. CBM in partnership with other like-minded organisations and Ministries of Health in Africa is seeking to address this urgent health need to train eye health workers for low income countries particularly in Africa.
Professor Dr. Allen Foster, former CBM International President (2006-13) and Medical Consultant/Director (1985-2005), is Professor in International Eye Health and Co-Director of the International Centre for Eye Health at the London School of Hygiene and Tropical Medicine. From 1975-1985, Allen was a general medical officer in a mission hospital in Tanzania. In 1998 he received an O.B.E. (Order of the British Empire) ‘For services to Ophthalmology in the developing world’.
On 4th June I travelled to Nepal to join CBM’s team of local staff and emergency response specialists, who have been working since the devastating earthquake on April 25th to ensure that people with disabilities and injuries receive the help they need. Here is my first blog from Nepal, after a very moving day in Bhaktapur.
This ancient city lies nine miles east of Kathmandu. At its heart lie four connected courtyards containing some of Nepal’s most famous UNESCO World Heritage Sites, many of which were damaged or destroyed by the earthquake that shook Nepal on 25 April 2015. In the main Durbar Square, around the base of one of the damaged temples, is an exhibition of photos of some of those who lost their lives, either because they were unlucky enough to live in old or poorly constructed homes or caught by the falling masonry in the web of narrow streets that characterise the area. Many of the photos show the faces of elderly men and women, or very young children, both groups disproportionately affected by natural disasters, but there are also faces of many other people, caught indiscriminately by either the first quake, or the one that followed two weeks later on May 12.
In one picture, a teenage girl in school uniform smiles shyly at the camera. Just a few yards away, a group of girls and boys of around her age are donning hard hats and picking up shovels before dividing into teams and heading off in different directions. Their matching t-shirts declare them to be members of the local community who are volunteering in street clearing initiatives. This is one of the worst hit areas of the city and the lanes are still clogged with rubble, sometimes piled under the eaves of damaged houses, sometimes still filling the street so that you need to scramble over to get through. Despite other parts of Kathmandu being almost untouched, here there is not a road or side street which remains untouched. Everything is covered with a thin film of dust, and the few shopkeepers who have ventured to open up again, busy themselves continuously with dusters and rags.
I am with Pramita Shrestha, a social worker from KOSHISH, a CBM local partner that offers psychosocial counselling and trauma care in the Bhaktapur District. Pramita describes the additional support the psychologists and counsellors are providing, not only for those with mental health problems that they were already supporting, but also to an estimated 3,500 earthquake survivors who will need psychosocial support over the next few months. This is one of the less visible after-effects of a disaster of this scale but one which touches on the lives of so many survivors. Schools have just reopened again and we are passed by rows of neat white shirts and royal blue skirts, matching ribbons bouncing above – but numbers are down as many children are too anxious to leave their parents, too scared to enter the school building or, with the many aftershocks still being experienced, too sleep-deprived to function well. People have also started to return to work where they can, or to the social activities they used to enjoy and we see a few small groups of men on the verandas of undamaged houses playing cards or board games, while women sit in twos and threes knitting. But there are also those who sit in their doorways staring into space, and KOSHISH is reporting new cases every day of people of all ages struggling to come to terms with what has happened. Sadly for all those that come, as many remain unwilling to seek treatment for any kind of mental health condition which remains widely misunderstood and taboo in Nepal, as in many places.
We come across a single house collapsed among a row of otherwise intact buildings. Further along, two stories of a house withno side wall stand open to the air, as if a huge serrated knife has sliced vertically through the building. As we approach, we see two figures rolling brick pieces down a corrugated iron sheet propped against the wall. On every street we come to, similar activity is beginning to take place. People on rooftops, shovelling debris. People pushing wheelbarrows of dust out of alleyways or carrying piles of bricks to the truck that cannot make its way down the blocked streets where life has started to go on once again. Around the next corner, we come across a slogan daubed on a partially collapsed wall, “We will rise again”. Later someone walks past with this printed on a t-shirt.
The photos in Durbar Square are one of the ways that the city is mourning its loss and it will take decades before the country is close to full recovery. But this slogan has started to appear across the city and perfectly reflects the resilience of a nation that is already working hard to pick itself up and move forward. KOSHISH was there in the days immediately following the earthquake, providing psychological first aid as vital as the bandages being so much more visibly applied, and it will continue to support for the long term the efforts of the Bhaktapur community to “rise again”.
I arrived in Nepal on May 12th, some hours after the massive aftershock that caused more casualties and a number of additional damages to properties and infrastructure.
I could see in the faces of people how their lives were shaken again, and how they didn’t see where and how to ensure the safety of themselves and their families. My first night in Kathmandu was broken by a number of aftershocks that woke me up and made me run outside in search of safety.
Though earthquakes are not new to me, every time it makes me realise how frightening they are, bringing a feeling of helplessness.
Three weeks later, life has become quasi-normal in Kathmandu, with its traffic jams, crowds in the street, shops and restaurants all open. If you don’t travel to affected areas you won’t see that two major earthquakes hit the city only few weeks back. Though people are still talking a lot about them and every day small aftershocks remind all of us that it has happened.
Working with partners – ensuring inclusion
It’s been three weeks of working with partners to provide support to the most affected people, to raise awareness about persons with disabilities and older people and to make sure that all of them are included and have equal access to relief, despite the challenges posed by isolated and remote villages and the upcoming rainy season.
Our partners are doing a great job to save lives and contribute to the effort made to assist people in need through trauma care and rehabilitation, organising medical outreach camps, providing psychosocial support – trying to help people to regain independence and normality in their lives. However, we still hear stories from persons with disabilities and older people not being able to access distribution points and being left behind – unintentionally – by relief stakeholders. It is a hard job to reach out to the most at-risk, as often they are not informed, cannot reach the front of the queue and their voices are not heard.
What would you do?
What would you do to find food if you are an 80 year-old man living more than a three-hour walk far from the main road and next city? You will walk downhill, hoping to access a relief package, and then find out that you have to carry a 30 kg bag back uphill …and that you can’t do it. You will seek support, but all other people are also too busy trying to survive to help you.
What would you do if you are a blind person trying to find out where distributions are happening and how to access them, only to discover that you have to compete to be front of the queue as there are not enough supplies for all? Obviously you’ll be at a disadvantage, and most likely you’ll lose out.
What would you do if you are a deaf person, having been transferred by helicopter to Kathmandu for trauma care and have no clue of what is happening to you as no one can communicate with you?
These are only few stories, but many more like this are reported every day…
It is great that donors and organisations are moving towards inclusive policies and frameworks, but exclusion happens on the field. What would you do if you were that relief worker and have limited aid to distribute? Field workers must be supported to turn inclusive policies into inclusive humanitarian action.
Advocating for inclusion
CBM works with our partner the National Federation of Disabled in Nepal (NFDN), supporting them to identify persons with disability and older people and assess their needs to then mobilise humanitarian stakeholders to respond to them. It is very encouraging as many of these organisations are willing to make the extra effort, but lack knowledge or information to ensure inclusion.
Bhojraj Ghimire, CIL Kathmandu (checked shirt) takes part in the workshop on disability inclusion organised by CBM and the International Federation of Red Cross and Red Crescent Societies (IFRC) in Kathmandu
Early last week I gave a two-hour orientation on disability inclusion to Red Cross staff, and the head of the delegation said:
“The Red Cross movement was created to help the most difficult to reach and the ones who couldn’t care for themselves, and yet in our response we reach only the easy one. We need to make the extra effort to access all those who are living in remote areas, who are facing barriers to access relief and whose rights we should protect.”
Well, this kind of statement and willingness to walk the extra miles is very encouraging as it will support the relief worker to pay attention and develop the mechanisms to help the older man to carry home his 30 Kg of goods, the blind person to find the distribution point and be in front of the queue or the deaf person to access a sign language interpreter to understand what is happening to him and get news from his family.
I will travel back to Europe soon but I’m confident that our partners will continue to raise their voices and to make them heard by all. Change is coming!