Category Archives: Cataract
Late last year, I had the opportunity to meet Valieth and Susana, two young sisters who had been identified through a community screening. They both had congenital cataracts. We arrived at their home and were greeted by the girl’s grandmother Fausta. As the she told us about their life and the challenges that she faced trying to take care of two young girls, she soon broke down in tears.
Fausta told me about the Bible verse that has helped her get through the hard times and give her the strength she needed and it is a verse that I have reflected on many times since my visit. James 1:12 Blessed is the man who remains steadfast under trial, for when he has stood the test he will receive the crown of life which God has promised to those who love him.
Although I knew that the surgery for the girls would not be some magical fix for the family’s hard life, I knew that it would ease the burdens they face and provide the girls with a brighter future, giving the girls an opportunity when they grow up to repay their grandmother for her love and kindness.
When I returned to meet them at the end of June, I was not disappointed. I was greeted by the Fausta and the girls, who skipped and danced around me. Smiles beamed from their faces and I could see instantly that the support that CBM had given for the surgery was life changing. They were delighted with the teddy bears that had been given to CBM by one of our supporters and continued to play as I talked to Fausta, and I knew that for Valieth and Susana that life had changed for the better.
I showed the family a printed version of their story with photos from last year, and they gathered around remembering the day that they had travelled to hospital and had their sight restored. I also shared with Fausta prayers from supporters in the UK for which she was truly touched. I felt humbled by the thanks that she gave to CBM and wished that our supporters could feel this joy first hand.
The girls have been back to the hospital for follow up, but will need to go again, it is likely that they will both need glasses and Valieth will potentially need more treatment on one of her eyes to ensure she has the best vision possible. But the future is looking brighter now, the girls are enrolled in school and are fulfilling Fausta’s dream of getting an education.
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’.
In March, I visited Ivory Coast in West Africa to monitor the progress of our project to scale up the prevention of blindness in the country. This is one of several CBM projects co-funded by Standard Chartered’s Seeing is Believing Programme.
The aim of our programme in Ivory Coast is to increase the number of people who receive cataract surgery to restore their sight. The catchment area of the project includes 7 hospitals, covering a population of around 5.4 million. In that area, an estimated 31,500 are blind due to cataract, according to Ivory Coast’s Eye Health Strategic Plan 2013-16. Cataracts can be easily treated with a simple surgical procedure – but for most Ivorians, sight saving treatment is out of reach because there aren’t enough suitable facilities or trained doctors.
In a poor country like Ivory Coast, where nearly 1 in 4 people lives on less than $1.25 a day, losing your sight is a terrifying prospect. At the COMB hospital in Dabou, I met Seydou, who was waiting to undergo cataract surgery. Seydou was forced to give up his job as a minibus taxi driver three months ago, when sight loss in one eye meant that he couldn’t judge the distance between his taxi and other cars. With little or no support available from the state, he had to rely on family and friends to support him, his wife and his seven children. For him, the surgery was life-changing – very soon he will be working again, regaining his independence and the chance to escape poverty.
Another patient I met at COMB hospital was Ndri Kouassi. In his 70s, the former draughtsman became completely blind due to cataract four years ago. It was a traumatic experience; he became completely dependent on family members. In hospital, before surgery, he seemed vulnerable and lost; his wife held his arm to guide him but he often stumbled. A few days later I met him at his home. With his sight restored, he was a changed man, laughing and confident. Now he could see his children and grandchildren, he explained, he was no longer in the wilderness.
CBM has been working with COMB hospital for many years and the hospital is playing a key role in our programme, hosting a training programme for eye-specialists in carrying out cataract surgery. Once they’ve completed their 6 month training programme, these doctors will work at one of four new cataract surgery facilities that CBM is setting up and equipping at regional hospitals. By the end of the four year programme, we expect to have trained 42 ophthalmologists and increased the number of cataract surgeries by 200%.
Currently many patients have to travel miles to get the surgery they need. I met one elderly lady who was staying with relatives so that she could get to hospital for surgery. I was struck by the dedication of her daughters, who had made the long, difficult journey with her so that their mother could have her sight restored. But for many people who have lost much of their sight, such a journey would be impossible. Equipping regional hospitals and training doctors to work in them is vital if eyecare services are to be accessible to those that need them most.
Ivory Coast is one of the poorest countries in the world – the UN’s places it at 168 of 186 countries in its Human Development Index. CBM’s four year project is co-funded by Standard Chartered Bank’s Seeing is Believing Programme.
For years, CBM has needed hard evidence on the economic impact of restoring vision, and now we have it.
A recently completed study in Kenya, Bangladesh and the Philippines showed that following a sight-restoring cataract operation, the average economic gain per family per year is £250. Not much by UK standards, but an awful lot of money for a Bangladeshi family.
It costs CBM about £20 to do one cataract surgery, so the return on investment is 1,500%!
In 2010, CBM and its local partners restored eyesight to 644,000 cataract blind people who would otherwise have remained blind, due to poverty. So a bit of maths shows that the global economic impact of CBM’s cataract surgical work comes in at about £160 million. Not bad at all!
Now, we have to get the message across to governments that restoring vision benefits their economies!
I couldn’t quite believe what I was hearing! It was such a great moment for Sambani, and he was so honest.
I met Sambani two days before, indeed depressed and sad. Dr Ute Wiehler has operated his first eye, and I did his second cataract operation two days later. All went well, even better than anticipated! I now saw him playing skittles with Coke bottle tops in the eye hospital courtyard with another boy who was staying in the hospital with his mother.
Sambani is from Kalonga Village in Lilongwe District. He lives with his parents and four siblings. He had been blind for two years, and had stopped going to school last year.
He had been doing well at school, and told me “I was an intelligent boy!” He was in standard 4 but his low vision “made me to be a useless boy” he said. I couldn’t believe what he was saying.
Sambani told me and nurse Rose, that he is now going to continue his education because he is “still young”. He wants to be a driver or a teacher.
It will be great to take Sambani back home today, so he can be with his whole family again, and then start school again next week when school opens for the new year. We will try and meet him again in a few months to see how he is doing.
Pieter, the South African missionary living near Monkey Bay phoned me yesterday. There are many people he has met in the villages who would like to, or need to, come to Nkhoma for their eyes. Lumbani will be heading down on Sunday with the ambulance to help collect them.
We will try and meet with Mary who lives nearby, and see how she is doing, 4 months after her surgery!
Mary is young and had been at school until just over a year ago. Now she is totally blind. The brittle undiagnosed Diabetes had metabolically robbed her of her sight in a matter of months. Her sugar was so high when she came to Nkhoma, we had to spend 2 weeks controlling it even before it was safe to think of operating.
Tikale had a traumatic cataract in his right eye. He was trying to get through some bushes to cross a road, when one snapped back and caught him strongly in the eye. Within a week his vision clouded over, and by the time a month later when he made it to the hospital he was blind in that eye.
Next week we have another Salima session. An extra ambulance of patients from the Lakeshore every day, referred by one of our close partners Malawi Council for the Handicapped, MACOHA. So a busy week ahead screening and helping two hundred or so people from Salima District, around a two hour drive from Nkhoma.
Mr Kambewa, the fantastic Clinical Officer and Cataract Surgeon here at Nkhoma, does a large amount of the work in theatre. Operating patients cataracts with high quality and high volume!
One of the jobs that falls on me however is operating all glaucoma patients (the surgery is a bit longer… around 30 minutes instead of 8 minutes for cataract surgery, and a bit more tricky with all the small stitches); and also all the patients who need cataract surgery, but have only ‘one eye’, in that the other is blind from a cause that we cannot treat.
In Nkhoma, I am planning carefully for the next two months as we run up to the end of the year. We will stop working for Christmas, but will be aiming to help as many people as we can for the next two months, and hope to work flat out.
I had a busy day on Tuesday getting all the initial surgical supplies together for the modern phaco cataract surgery machine. I and the staff are very excited about the prospect of introducing this to Nkhoma! Imagine… the country’s first ever permanent modern phaco cataract surgery unit.
On Wednesday I met a wonderful group of CBM supporters from Canada, and we showed them the work here.
It was Strinnar Duncan’s wedding day yesterday. 9am Church, followed by photos around Nkhoma, then a big lunch (chicken and goat); and then lots and lots of dancing (Pelikani-pelikani; the tradition of different groups of guests dancing at different times, throwing money in the air as you go).