Friends Fight Blindness in Africa

(Thanks to Alfred Wasike of Friends Theological College for this report and for the pictures!)

More than 500 clients or patients have converged on Kaptama Hospital, along the slopes of Mt Elgon for the much needed general medical & eye camp. A team of Friends from George Fox University School of Nursing, Wabash Friends Church (USA), Friends Sabatia Eye Hospital have been here since Monday, June 5th. This is one of the biggest medical camps ever organised by the Kaptama Hospital Board and the Africa Ministries Office (AMO), John Muhanji, AMO Director says.

The team leaders include Dr. Amos Kibisu (Kakamega County Hospital), Elizabeth Roark (Assistant Professor of Nursing at George Fox University), and Dr. Eric Dale (Wabash Friends Meeting). Friends Theological College (FTC) Kaimosi Students are helping in the Medical Camp as part of our Hospital Ministry. Dr. Robert J. Wafula, the Principal of the prestigious hub of top quality Quaker-backed education in Africa is among the people who came for an eye check.

According to the World Health Organisation (WHO), blindness prevalence rates vary widely but the evidence suggests that approximately 1% of Africans are blind. The major cause is cataracts; trachoma and glaucoma are also important causes of blindness. The bulk of blindness is preventable or curable. Efforts should focus on eye problems which are universally present and for which there are cost effective remedies, such as cataract and refractive problems and on those problems which occur focally and can be prevented by primary healthcare measures, such as trachoma, onchocerciasis, and vitamin A deficiency. Major development of staffing levels, infrastructure, and community programmes will be necessary to achieve Vision 2020 goals.

Africa, especially the sub-Saharan Africa is home to approximately 7.1 of the world’s 38 million blind (WHO/PBL/97.61 Rev 2). The shortage of staff to provide eye care in Africa is legendary. According to the British Journal of Ophthalmology, the barriers that prevent people from presenting for cataract surgery or trichiasis surgery in Africa include:

• Cost: This includes not only the cost of the actual operation, but less obvious costs such as transportation to the hospital, loss of work, and living expenses while in hospital as well. Additional costs will exist for a caregiver or guardian who is usually required to accompany a patient.
• Accessibility of services: Since most Africans are rural and the eye care services are in the cities, a journey, often a major one, is necessary to reach the service. However, while high quality cataract surgery generally requires a fixed facility, trichiasis surgery can be done in rural villages.
• Knowledge of services: Lack of awareness that cataract or trichiasis can be cured by surgery prevents many from seeking treatment. Lack of understanding of what will be entailed (time, money, pain) is another a barrier.
• Trust in outcome: Patients often fear the outcome of surgery, with justification. While there has been no assessment of outcome of routine cataract surgery in Africa, some outcomes are less than desirable. A few bad outcomes can discourage a whole community.
• Cultural and social barriers: Cataract occurs more frequently in females, yet a population-based study in KwaZulu Natal, South Africa, demonstrated that females underwent cataract surgery at only three-fifths the rate of males. This may be due to less education, social support, and control of time and money among females compared with males.

VISION 2020 AND AFRICA

The Vision 2020 initiative refers to goals and priorities (described in the WHO/PBL/97.61 global initiative for the elimination of avoidable blindness) that are being adopted by many individuals, non-government development organisations, the WHO, government agencies, and ministries of health that work in the field of prevention of blindness. Its aim is to decrease the current projection of 75 million blind by the year 2020 to 25 million. The major causes of blindness in poor countries can be divided into three groups: (1) those which occur universally and for which there are successful cost-effective treatments, including cataract and refractive errors; (2) those which occur among specific populations and which can be prevented by inexpensive medicines, including vitamin A deficiency, trachoma, and onchocerciasis; and (3) major blinding diseases that are less well defined and for which cost-effective screening and treatment for poor people do not currently exist, including diabetic retinopathy and glaucoma. For Africa, it is important to put high priority on the first two of these groups. In order to do so there will have to be tremendous developments in staffing, infrastructure, and organisational capacity.

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