Seva Canada: A Solution in Sight

Tanzanian boy with low vision using a magnifier at school. Photo courtesy of David de Wit

Next week, Seva will ship 122 special low vision devices such as magnifiers to Tanzania.

The equipment, worth $4,000, was generously donated to Seva by the Children’s Low Vision Project of British Columbia. We are very grateful to Lynn Langille, the Program Coordinator at the Children’s Low Vision project, and her colleagues.

The low vision devices are being sent to Seva’s partner in eastern Africa, the Kilimanjaro Centre for Community Ophthalmology, and will be distributed by KCCO to various eye care programs and blind schools in Tanzania and Malawi.

Normal vision is known as “20/20″. This simply means that the eye being tested is able to see an object at 20 feet as well as any eye with very good vision. If you have 20/60 vision, this means you can see at 20 feet what a person with good vision can see at 60 feet. If you have vision that is between 20/60 and 20/190, it is called being partially sighted or having low vision.

Children with uncorrected vision conditions or eye health problems face many barriers in life, especially in developing countries. Vision doesn’t just happen. A child’s brain learns how to use eyes to see, just like it learns how to use legs to walk or a mouth to talk. The longer a vision problem goes undiagnosed and untreated, the more a child’s brain learns to accommodate the vision problem.

Seva Canada’s vision is a world in which no one is needlessly blind or visually impaired and where those with unavoidable vision loss can achieve their full potential.

Thank you also to Air France – KLM Cargo and to Worldwide Animal Travel of Vancouver for once again shipping vital eye care materials to Tanzania.

African boy with low vision trying to read. Photo courtesy of David de Wit

The Marine Drive Ladies’ Invitational Golf Tournament held in June raised $15,900 for Seva’s eye care programs for in Tanzania and Malawi. The funds will be used to bring sight to African children and women.

Specifically, $4000 will be used to help support the development of a comprehensive eye care program for the children of Malawi and based in the Queen Elizabeth Central Hospital in the capital city of Blantyre.

Africa has one of the highest rates of childhood blindness in the world and most of that blindness is due to cataract.  The children most at risk are those below five years old. Up to 60% die within one year of becoming blind and those who survive can expect to spend on average 40 years without sight. Over 90% of blind children receive no schooling and the great majority will be unable to realize their full potential. Thus, blindness in children accounts for nearly one third of the economic cost of blindness, although it represents less that 4% of the overall magnitude of blindness. The human cost in terms of suffering is immeasurable.

Objectives of this pediatric program include:

• increasing by 50% the number of children referred to the hospital who are blind or severely visually impaired;
• increasing by 50% the number of surgeries for congenital and developmental cataracts each year for the next three years;
• ensuring that 100% of children who need glasses after surgery get them;
• ensuring that over 80% of children receive intraocular lens implants during cataract surgery; and
• ensuring that 100% of children get the follow up they need.

The remaining $11,900 from the golf tournament will be used to support the ‘Sentinel’ system in the Kilimanjaro and Arusha regions of Tanzania. This system was created as a means to reach more women and girls and provide them with the eye care services they require.

Two-thirds of all blind people are women, primarily because they are treated less than half as often as men. This disparity is even more pronounced between girls and boys. Seva Canada has taken explicit leadership in the gender and blindness global initiative. All Seva-led projects work towards achieving gender equity by focusing on overcoming traditional barriers to women’s and girls’ access.

This project focuses on increasing the use of eye care services by women living in the Kilimanjaro and Arusha Regions. This community intervention involves women, identified within their communities as leaders, acting as “sentinels”. Thirty-two women have been trained in counselling, community mobilization, awareness creation and data collection. The sentinels identify women with visual disability in their community and offer appropriate counselling and referral to the nearest eye care services.  This model has been very effective and has increased the uptake of eye care services by women and girls by as much as 100% in many areas.

Thank you again to Diane Hardouin, Chair of the tournament and to Committee Members Esther Adamson, Dianne Cook, Sue Biddle, Naz Remtulla, Louise Forsythe, Lynn Neilsen, Carolyn Butt, Margaret Gillis and Michele Holwill. Kudos to David Hardouin and his hardworking group of guys; Tim Tait and his great team of professionals; Wade Hawksworth and his links crew; Haymond Ng and the clubhouse staff; and Ron Pauls and the office personnel. Special thanks to Kara Koszman, and a huge thank-you to Michele Greatrex for her undying support and optimism. Thank you to all the players, donors and sponsors.

In February, I wrote about a little girl in Madagascar with such severe and unusual myopia (nearsightedness) that there was no help available to her in her own country.

This morning we received these photos of 8-year-old Andoniaina (Ando for short) wearing her new glasses specially made for her in Canada.

Ando wearing her new glasses

Ando lives on a small island in the Mozambique Channel, off the southwest coast of Madagascar. To seek help, she and her father travelled one hour by speedboat to Tulear on the mainland, then drove 1,000 kilometres to the capital of Antananarivo to get her eyes examined. They were eventually referred to a hospital in Antsirabe, 170 km south of the capital for a second opinion. That’s where Dr. Henry Nkumbe, Seva’s partner in Madagascar, saw the little girl and asked Seva Canada for help.

Seva then called on longterm supporter and optometrist, Dr. Larry Louie, for his expertise. Together Dr. Louie and his colleague Wayne Trieu of I-Lab Optical in Edmonton created a very special pair of glasses. The glasses were then hand-delivered to Madagascar in time for Christmas by a representative of Sherritt International Corporation, a Canadian resources company.

“Something like this is not usually done and isn’t readily available. That’s what made it challenging,” said Dr. Louie. The typical eyeglass prescription is 2.00 to -3.00 points, but Ando has a prescription of -27.00 points for her right eye and -23.50 points for her left eye. This means that, without glasses, Ando can’t see much beyond the tip of her nose. Ando was essentially blind and would not have been able to see the faces of her family.

Andoniaina and her family

To keep the glasses from becoming too thick and thus brushing against her eyelashes, Dr. Louie and optician Wayne Trieu used special myodisc lenses with two bi-concave lenses on the front and back of each lens. Another challenge was getting a frame that was strong and durable and that would last a long time.

Andoniaina’s story and the way in which Canadians in three provinces came together to help her was featured in the Edmonton Journal and on Global news.

Andoniaina at school with her new glasses

On behalf of Andoniaina, her family and our partner in Madagascar, Seva Canada would like to thank everyone who helped change this young girl’s life by giving her the gift of sight.

Andoniainia in her classroom off the coast of Madagascar

Seva’s partner in eastern Africa is the Kilimanjaro Centre for Community Ophthalmology, popularly known as KCCO. Located in Moshi, Tanzania, within sight of Kilimanjaro, KCCO provides eye care services, ophthalmology training and resources to 9 eastern African countries – Tanzania, Madagascar, Rwanda, Uganda, Kenya, Malawi, Ethiopia and Zambia.

This short video gives an overview of KCCO’s work bringing sight and preventing blindness in eastern Africa.

[youtube=http://www.youtube.com/watch?v=SMYOYSXlpLw]

Today I’m heading out to Vancouver airport to visit our great friends at Worldwide Animal Travel who, together with KLM Cargo, very kindly ship children’s glasses to Africa for Seva. Three boxes containing 1,066 of lovely children’s eyeglass frames were donated to Seva Canada by OGI Canada Inc. and soon they’ll be winging their way to Kilimanjaro. Big thanks to Dick Murao at KLM Cargo for his compassion.

I think this is the fourth shipment of children’s frames I’ve sent in the last 2 years. Although adult glasses are easily procured in eastern Africa, children’s frames, especially the infant ones with hooks for behind the ears, are as precious as gold dust. Seva Canada and our partner in Africa, the Kilimanjaro Centre for Community Ophthalmology, is extremely grateful to OGI Canada Inc. for this very generous donation. Thanks Guy, Jamie and Sue for all your kindness!

The number one intervention for children with low vision is refraction and the prescription of the appropriate glasses. When I was in Tanzania in September 2008 attending a workshop on childhood cataract, I heard many sad and frustrating stories about the lack of kids’ glasses. A young girl was washing in the river and her glasses fell off and were lost. By the time she was seen by an eye specialist two years later and given a new pair of glasses, she had lost much of her vision, never to be recovered.

One ophthalmologist from Gondar in Ethiopia told me, “There are so many children with uncorrected refractive error. I work 700 miles from the capital, Addis Ababa, and even if parents can afford them and want to buy children’s glasses, it is impossible to get them. They may not even find children’s frames in the capital.”

Without glasses, children cannot reach their potential and many risk blindness from ambylopia. Providing children with the glasses they need is an urgent issue. Thank you OGI!

Carrying on the photography theme, we want to spread the word about the work of Dr. Larry Louie.

Dr. Louie is an international award-winning photographer and Edmonton optometrist who, like Marco Antonio Cruz, is using his powerful images to raise awareness of the issue of global blindness.

The 20 Dioptor Lens: A local doctor doing an examination. Copyright Larry Louie

In September 2008, Larry and his wife Joanna Wong, travelled to Tanzania to see the work being done by Seva Canada’s partner, the Kilimanjaro Centre for Community Ophthalmology headed by Drs. Paul Courtright and Susan Lewallen.

To view a slideshow of Larry’s eye care images from Tanzania, click http://www.socialdocumentary.net//LarryLouie or visit Larry’s website at http://www.larrylouie.com/

Seva Canada is helping Dr. Henry Nkumbe and his colleagues in Madagascar with a children’s eye-care program.

Alcon, the manufacturer of eye-care products, very kindly donated medical supplies. Dr. Nkumbe sent photos of the staff of the hospital’s medical director opening the boxes. It was like Christmas.

Our thanks to Alcon for helping children and adults in Madagascar see.

At Christmas I took my daughter and nieces to see the film Madagascar 2. After watching it, I couldn’t help but think of the kids in Madagascar who can’t see Madagascar and by that I mean not the film but the country. The reason they can’t see their own country (or anything else for that matter) is because they are blind.

One of those children is 8-year-old Andoniaina. She suffers from extreme myopia (nearsightedness) and is unable to see beyond her nose. For those of you who understand these things, her eyesight is OD: -27.0 DS, OS: -23.50 DS.

There were no lenses available in all of Madagascar to help her so Seva Canada got a request to lend a hand. Dr. Larry Louie, an optometrist and Seva donor in Edmonton, sprang into action and he and his colleague made a very special pair of glasses. Representatives from Sherritt Mining, who have a nickel mine in Madagascar, carried the glasses there in time for Christmas.

So Andoniaina has glasses now and can, for the first time in ages, see Madagascar. Amazing.

At Seva Canada we’re often asked if we’ll take used eyeglasses and send them to the developing world. The fact is that it costs a lot to collect, sort, ship and distribute used eyeglasses and, in all of the countries where we work, you can buy inexpensive adult frames.

But the story is different for children’s eyeglasses in Africa. There’s a huge need for a steady supply of infant and children’s frames. Thanks to KLM Cargo and the nice folks at Worldwide Animal Travel, plus some very generous donors, we’ve been able to send multiple shipments of kid’s frames to Tanzania.

Last month I took another 4 huge boxes containing over 1,400 children’s glasses to YVR for shipment to Kilimanjaro. Pascal at Worldwide Animal Travel was happy to help. Seva’s boxes were easier to deal with than their next item for shipment — a real live polar bear being shipped from Edmonton to Luxembourg Zoo. How do you ship a polar bear? In a very large cage with a groom to travel alongside it.

Heather at Seva Canada (www.seva.ca)

The week-long workshop of Childhood Blindness has just finished and the partipants from Cambodia, Nepal, Uganda, Kenya, Ethiopia and Tanzania have determined ways to work together on research and activities to improve children’s eye care in their countries. It’s been incredibly inspiring for me to attend and I feel that I have a much better knowledge of the issues around childhood cataract and low vision.

Yesterday’s lectures were conducted by a pediatric ophthalmologist from Glasgow, Dr. Tim Lavy, who is working and teaching in Dar es Salam on the coast. It turns out that he’s friends with two of Ted’s (my husband) classmates from Edinburgh. He kept stressing that cataract surgery in adults is very different than in children. His words about cataract surgery in adults were so inspiring that I’ll quote them here: “Cataract surgery in adults is just wonderful. It’s the best operation in the world. ”

This afternoon, Mollie and I are going to the local “blind” school, where about 70% of the kids are not actually blind, but have low vision. I know it will be very hard to witness. As I sit and type this, I can hear children crying from the ward across the courtyard. This week they have been doing 30 oculoplastic surgeries, many of them quite complicated and no doubt very painful. The wards are quite full and all week long there’s been this background sound of crying. Also, outside the surgical ward, there have been anxious patients, some of them Maasai with their striking clothing and dangling silver earrings, waiting for their loved one.

Tomrrow, Mollie and I leave for our two-day safari to Ngorongoro Crater and Lake Manyara.

I’ve just come back from a full day with Patrick’s trachoma research and education team. I don’t think I’ve ever been quite so dusty. Nine of us crammed into the KCCO jeep and headed out to Masai villages to examine children’s eyes and take swabs from all the kids aged 1-9 in two village areas.

It was a fantastic and fascinating day. We split into two teams and walked from house to house through dry corn fields and along narrow dusty paths. I had the best job. Not only did I get to sterilize the ophthalmic nurse’s hands, but I was the one who got to give the kids pipi (sweets) after they had their eyes checked and swabbed. Since this involved flipping the eyelids to check for trachoma, some kids weren’t too happy about it.

Most of the kids had English names and there was even a Brenda! (like my sister) One little chap was called Manager, and, as Odilia, the ophthalmic nurse, put it, “If Manager cries, they’ll all cry.” …. And they did. But all parents were happy to have the team come and check the children.

Because these places were seriously off the beaten track, we needed both a guide to help us bounce down the very rocky roads and also the help of village elders to guide us from house to house. It’s a very poor area – unlike what I’ve seen around Moshi or up Mount Kilimanjaro. The Masai like to live close to their cattle and the flies help spread trachoma. But I’m pleased to say that today, after dozens of swabs, we didn’t find a single case in that area, so I assume that the education about face washing, hygiene and latrines is working.

Tomorrow (Wednesday) I’ll rejoin the Childhood Blindness Workshop. Monday’s session from 9-5 was brilliant. There are program people and ophthalmologists here from Cambodia, Nepal, Uganda, Kenya, Ethiopia and of course Tanzania.

It’s now Monday morning and the international workshop on Childhood Blindness is just about to start. Over the weekend, people from Nepal, Cambodia and Uganda have been arriving, but the Ethiopian person is missing.

Since the KCCO office was closed on Saturday and Sunday (though Drs Courtright and Lewallen seemed to work the whole time anyway!), Mollie and I rented a car and hired a driver and went up to see the waterfalls at Kilimanjaro. The contrast between the dry plains and the lush mountainside is amazing. Our local guide immediately impressed me when, within one minute of setting off to the waterfall, he reached up to an overhanging branch and gently plucked a 1 ½ – inch chameleon from the leaves. Remarkably, he did this twice more during the day, finding a large horned female and a bright green male.

Yesterday (Sunday) Mollie and I explored Moshi and in the evening we were invited to join a special dinner in honour of a visiting team of ophthalmologists who are occuloplasty experts from the US. They are here at the Kilimanjaro Christian Medical Centre (also home to KCCO) to teach the doctors about plastic surgery of the eye and this week will perform surgery on a series of patients and pass on their skills.

Tomorrow, Mollie and I will not attend the workshop, but will take the opportunity to join Patrick and the team to go to the field and see the trachoma work. We will be traveling to a Masai area where trachoma is endemic.

More soon. Heather

Two-thirds of the world’s blind are women, yet they are the least likely to receive treatment. KCCO, our partner in East Africa, is the world leader on this issue and today I got to see their work first hand. Mollie, a Canadian donor, and I went with Margaret Kessy, KCCO’s Gender and Blindness Coordinator, to meet a group of village women called “Sentinels”.

These “Sentinels” are women who have committed to help find people with eye problems and encourage them to visit the Direct Referral Sites and get help. Margaret is working with 50 Sentinels in 14 different villages and is conducting a research project on the issue of gender and blindness. Today we met with 7 amazing women in a lovely village in the hills, surrounded by lush coffee and banana plantations.

Margaret was speaking with them about her research on the barriers to care faced by women and children and their role in helping people get treatment. She presented them with the materials they need to talk to patients about eye care, to collect information about their cases and to determine why they might refuse treatment. There are a lot of fears around eye surgery. Many people believe that if they get cataract surgery they will be given goats’ eyes, so you can imagine that there’s a bit of an uphill struggle to get people to hospital. According to Margaret, people may come to hospital if they have injured their eyes and are in pain, but with the painless white clouding of cataracts, they will not seek help — indeed, they likely don’t know that anything can be done to save their sight.

Today’s discussion, conducted in a mud-floored, windowless building in the heart of the village, was lively and full of warmth and commitment. All of the women clearly loved Margaret and felt comfortable asking questions and sharing ideas. Mollie and I were very impressed by their dedication to reach out to those who were very poor and who otherwise would not get eye care.

KCCO is a busy place. Next week there is a Childhood Blindness Workshop with people coming from Nepal, Cambodia, Ethiopia, Uganda and, of course, Tanzania. I’ll sit in on most of it, heading out part way through the week to see the trachoma work.

What a magical place this is. Kind, dedicated people doing great work and sharing their knowledge. I’m having a blast!

Heather

Yesterday was my first full day in Tanzania. At 9:30 a.m., I set off with a team from Kilimajaro Centre for Community Ophthalmology to conduct what is known as a DRS, or Direct Referral Site, like a screening centre for eye patients.

After an hour bouncing around in a jeep over rough, dusty roads, we reached Rongo District in the lush hills. By the time the team from KCCO arrived at the local hospital to conduct the screening, there were scores of patients, young and old, lined up waiting to have their eye problems addressed.

Over the course of the day, 120 patients were seen and a further 50 at the sub-DRS about 18 km away. Each patient had his or her visual acuity checked using an eye chart hung in the hospital courtyard, then the patient was seen by the Assistant Medical Officer and nurse. It was very moving to see the care and kindness shown to each patient – the reassuring hand on their shoulders, the soft words and the dedication to help them get better.

Those patients who needed cataract surgery were referred to a counselor, who helped explain the process and allay their fears. At the end of the day, 10 patients with mature cataracts were brought back to KCCO for cataract surgery. They will have their operations today and will be driven back to their homes once all the follow-up is complete.

Here’s a film (made later and added in) showing KCCO and the work at the Direct Referral Site:

[youtube=http://www.youtube.com/watch?v=SMYOYSXlpLw]

Today, I’m travelling with Margaret, KCCO’s Gender and Blindness Coordinator to visit more projects in the field. Got to dash!

Heather
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Seva Canada is an international eye-care nonprofit based in Vancouver, Canada that has been preventing blindness and restoring sight in the developing world for over 27 years.

Seva works with local partners in 7 countries — Nepal, Tibet, India, Tanzania, Guatemala, Cambodia and Egypt — to train local eye care specialists and create sustainable eye-care programs to serve communities for generations to come. A 15-minute cataract surgery costing $50 Cdn will restore someone’s sight and change that person’s life forever. It’s a quick fix in a world of complex problems and is one of the most cost-effective health interventions.

We hope this blog will be a place where our overseas partners and travelling Seva Canada folks can share their stories of Seva’s sight programs.

I’m Heather Wardle and I have the great privilege to work for Seva Canada. I’m off to Tanzania on September 24th where I’ll be attending a major conference on Childhood Blindness and seeing the programs at our amazing partner, the Kilimanjaro Centre for Community Ophthalmology. Here’s a few photos of their work.

Eye patients registering at a Direct Referral Site

This little baby had bilateral cataract surgery

Here's KCCO's Resource Centre where I'll be typing my updates

Heather