Seva Canada: A Solution in Sight

The team at Seva Nepal are brilliant! Kandel, Parami and Shravan work tirelessly to bring eye care to the very poor, those in remote areas, women and children. They are models of compassion in action.

Here’s a series of photos that Parami sent us from an eye camp that took place in Terathum, Nepal this autumn. It illustrates the tremendous burden (literally) that cataract blindness places on families and communities.

This woman is blind from mature bilateral cataracts and was carried to the Seva eye camp at Terathum by her teenaged grandson in this traditional Nepali basket.

Here she waits, sitting in the basket, with hundreds of other eye care patients

The burden of cataract blindness... a teenage boy carries his blind grandmother to have her eyes examined by the ophthalmologist.

The blind woman has her eyes examined by Dr. Iris Winter from Biratnagar Eye Hospital. During the first day of the camp, Dr. Winter examined 220 patients.

Receiving cataract surgery at the Seva-supported Terathum Eye Camp in Nepal

Her sight restored through a 15-minute cataract surgery costing about $50 (less than a haircut in North America), this Nepali woman can now walk on her own back to her village. Restoring someone's sight is the most cost-effective way to reduce poverty according to the WHO.

This woman was one of 5 patients who were carried on the backs of their relatives to the Seva-supported eye camp. Some patients walked two full days to seek care.

Here are the happy results of this camp: A total of 564 patients were examined in the three-day eye camp and 67 surgeries were performed, of which 54 were sight-restoring cataract surgeries (31 female & 23 male) and 13 (female 7 & 6 male) were other surgeries like pterigium, chalazion & entropion surgeries*. A total of eight bilateral blind patients underwent surgery.

Our deepest thanks to the team and to our wonderful Seva donors who made this possible. And thank you to Parami, Shravan and Kandel at Seva Nepal for sharing this heartwarming story with us.

To give the gift of sight, visit www.seva.ca.

Definitions:

What is pterigium?:  A pterygium is fleshy tissue that grows in a triangular shape over the cornea (the transparent part or front window of the eyeball). It may grow large enough to interfere with vision.

What is chalazion?: A chalazion  is a cyst in the eyelid that is caused by inflammation of a blocked meibomian gland, usually on the upper eyelid. Chalazions differ from styes in that they are more painful than styes, as well as bigger in size. A chalazion could take months to fully heal with treatment and could take years to heal without any.

What is entropion?: Entropion is a medical condition in which the eyelids fold inward. It is very uncomfortable, as the eyelashes rub against the cornea constantly. Entropion is usually caused by genetic factors and may be congenital. Trachoma infection may cause scarring of the inner eyelid, which may cause entropion. Treatment is a simple surgery in which excess skin of the outer lids is removed. Prognosis is excellent if surgery is performed before the cornea is damaged.

By Penny Lyons
Executive Director, Seva Canada

November 20^th

Thirty six elderly Tanzanians sit under the shade of a Poinciana tree in Ndatu village.  All are from the same village in the district of Arumeru, about an hour from Moshi.  They know each other well so the air is a filled with the sounds of laughter and conversation.

I have come to this village with a team from KCCO.  There are 4 of us:  Herieth Mganga, KCCO’s new gender and blindness coordinator, Fred the driver who doubles as the visual acuity tester in the field,  Dr. Amadou Bio from Benin,  who is training to be an ophthalmologist, and myself.

Fred at the Kilimanjaro Centre for Community Ophthalmology in Tanzania

All 36 of these people have agreed to participate in a study (there will be 150 participants in total from 4 different villages) to determine the effect that correcting presbyopia (or age related far-sightedness) has in their daily life.  Do reading glasses make an elderly Tanzanian’s life easier?  Most are illiterate but if they can now pick the stones from the rice, thread a needle and take thorns from their fingers will this significantly improve their quality of life?

A patient has her eyes examined in Tanzania

There is very little refractive error in Africa and most of these people have distance vision that someone 40 years their junior would envy.  The flip side of that great distance vision is that many of the 36 have difficulty seeing things that are close so “reading” glasses (even though most do not read) are provided to them free of charge.  While doing the vision testing, four cases of cataract were diagnosed and referred on to hospital for treatment and a few infections were treated.

Each person who received reading glasses will be visited in their homes in three months to determine what difference, if any, the reading glasses had on their daily life.

Heriath Mganga, KCCO’s new gender and blindness coordinator, working with women in rural Tanzania

At this point you might be asking yourself if this study is important, or even relevant, to the elimination of preventable and treatable blindness.  It is because it illustrates the cornerstone of all of Seva and our partner’s work; together we create programs that are based on evidence.  Evidence tells us a problem exists, it tells us the extent of the problem and it tells us what should be done to correct that problem.

With evidence, we can spend our donor’s dollars effectively and get the maximum benefit – whether we are studying presbyopia, childhood blindness, the incidence of cataract in a population or the barriers people face when trying to access treatment.

Dr. Martin Spencer, a Canadian ophthalmologist from Vancouver Island, has been selected as a 2009 Global Hero by Verge Magazine.  To read the feature by Verge Magazine about Dr. Spencer and his work, click here.

A long-time Seva board member, Dr. Spencer has transformed the way cataract surgery is done in the developing world.

Dr. Martin Spencer has volunteered overseas with Seva regularly for many years and has both preformed surgery and trained eye care specialists in India, Nepal, Tibet, Malawi, Guatemala and Cambodia. He was one of the first doctors in the world to travel to India, Nepal and Tibet to set up eye camps in remote areas. As a volunteer, he receives no funds and pays for the trips himself. He has voluntarily operated on thousands of cataract patients, transforming their lives by restoring their sight.

Dr. Spencer’s contributions go much further than providing cataract surgery to the blind. He also pioneered a modern cataract surgical technique that can be used in rough situations, such as remote mobile eye camps.

His expert program advice to Seva Canada led to the creation of a manufacturing unit in India called Aurolab, which today provides millions of intraocular lens implants annually for cataract patients, as well as surgical sutures and other sight saving products. The creation of Aurolab brought the cost of intraocular lenses down from $250 per lens to around $5, making it affordable in poorer countries and transforming the way cataract surgery is done in the developing world.

Dr. Spencer has designed several instruments for cataract surgery as well as two intraocular lenses. He has published and lectured extensively on topics related to cataract surgery, particularly in developing countries.

Marty is the recipient of many previous awards including the Lewis Perinbam Award in International Development (1997), the American Academy of Ophthalmology Achievement Award (1999) and the Achievement Award of the International Agency for the Prevention of Blindness (2004). Dr. Spencer got his medical degree in Chicago and his residency in Ophthalmology at the University of Western Ontario.  He is currently works in the Nanaimo area of Vancouver Island specializing in cataract and intraocular lens surgery.

Congratulations, Marty!

By Penny Lyons, Executive Director, Seva Canada
November 16, 2009

Madagascar, where do I even start? Stunningly beautiful, heartbreakingly poor, rich in culture, language and traditions and complex in its politics.

I travelled here from Tanzania with Dr. Paul Courtright, co-director of the Kilimanjaro Centre for Community Ophthalmology (KCCO) based in Moshi, Tanzania. KCCO has been working with Madagascar eye care programs since 2007 – at first helping create national eye care programs and now also funding training, outreach programs and a pediatric program.

Our task here is to follow up and expand on the work that KCCO has done, as well as evaluate the programs that have been funded by Seva donors. The Canadian International Development Agency (CIDA) has funded outreach in the Vakinankaratra region, as has the May and Stanley Smith Charitable Trust.

Each of these two organizations have helped fund the creation and implementation of community outreach programs in this populous region in the highlands of Madagascar centered around the city of Antsirabe, just 3 hours drive south of the capital city of Antananarivo. In addition, Alcon Canada generously donated an enormous amount of ophthalmological supplies, including intraocular lenses.

Seva programs that I have visited previously have all been well established. National blindness plans were in place, outreach was active and well organized, a comprehensive training program was in place and all programs were working toward both financial sustainability and ensuring services were available to the most vulnerable – particularly children and women.

It has been both enlightening and rewarding to witness the birth of a new program here in Madagascar and to fully comprehend the partnerships at all levels of government, healthcare and community that have to be created in order for eye care programs to succeed. In fact, given the complexities, it is a wonder it happens at all. But here in Madagascar, as in our other programs, there are individuals, hospitals and local governments that have dedicated themselves to making it happen and are committed not only to creating eye care programs but are also committed to creating excellent ones.

Today I visited an outreach program in Mendoto, a small centre about 150km west of Antsirabe. When the team from Fitsaboana Hospital in Antsirabe arrived at about 8am, there were over 300 people in the courtyard of the local hospital. We assumed they were patients waiting to be seen at ALL the hospital departments, but as we started to set up we realized they were all there to have their eyes screened and treated.

The team quickly organized the room we were given. A visual acuity chart and registration desk was set up; there were 2 examination areas for the ophthalmologists; the counselors, who provide information to those requiring more care like cataract surgery or low-vision services, had a small table; and a makeshift pharmacy was created. Patients were divided into two lines, one for children and one for adults, and each ophthalmologist took one line. Periodically someone was sent to scout the lines to make sure those who required the most complex care or who were very elderly were brought to the front of the line.

It was hot, both outside and inside the makeshift clinic. No one complained and no one took a break. Bottles of water were brought to the team, but they barely stopped to take a drink. Everyone knew how many patients were waiting and how far they might have travelled to get there. They could drink later.

In the first two hours, 4 children were diagnosed with congenital or developmental cataract in both eyes and appointments for surgery were made.  Many more children were seen but who could not be helped – children blind because of damage to their corneas – many of whose sight could have been restored if they lived in a developed country. Children with birth defects or severe low vision were referred to the counselors so their families could learn where to find help. Twenty-four adults were scheduled for cataract surgery and, once again, there were many more who simply could not be helped.

The ophthalmologists were unbelievably kind and gentle with all who came and, even after very long waits in the brutal sun, not one patient complained. The last patient was seen at 6:30 pm. All were grateful to be treated and I was grateful to be there.

Our gratitude to the Canadian International Development Agency, the May and Stanley Smith Charitable Trust and Alcon Canada for their generous support in bringing eye care to the people of Madagascar.

By Penny Lyons

Kilimanjaro view near Moshi

I arrived in Moshi, Tanzania on November 6th.  The jacaranda trees are showering lavender coloured blossoms, Mt. Kilimanjaro shines brightly in the early morning sun and the hot season is just beginning.

Part of my job as Executive Director of Seva Canada is to evaluate Seva’s programs overseas. So, at least once a year, I visit one of our partners.  On this trip I am visiting the Kilimanjaro Centre for Community Ophthalmology (KCCO) located in Moshi, Tanzania.  KCCO is a mentoring and training facility for community ophthalmology programs and is the only institution of its kind in all of Africa.

I have been attending, and help teach, a course on ‘bridging strategies’.  Bridging strategies are all the activities used to connect people and communities with the hospitals that serve them.  KCCO’s challenge is how to reach the unreached – to find patients and help them get the eye care services they need and deserve.  The students in this course are ophthalmologists, community program managers, hospital directors and ophthalmic nurses from Uganda, Rwanda, Ethiopia, Tanzania, Madagascar as well as two of Seva’s partners from the Kham Eye Centre in Tibet.  The students are learning how to create community outreach programs or to improve existing ones.

Today the students and I visited a Direct Referral Site (DRS) which is a screening program where a team, composed of an organizer, doctor, nurse refractionist and counselor, visit selected sites on a regular schedule, diagnosing, counseling and treating patients. Patients who need surgery are transported back to the hospital for surgery.  This DRS is in the Same district, about 2 hours drive south from Moshi.  The KCCO team will be in Same, based in a government hospital, for 3 days.  At the end of the three days the team will transport those patients needing further care, like cataract surgery, back to Moshi.  Once the patients have been treated they will be transported back to the hospital in Same.

I watched the students learn the process of the DRS.  Notebooks and pens in hand they asked questions of the ophthalmologist, counselor, refractionist and the outreach coordinator.  They evaluated KCCO’s outreach programs against their own.  They made suggestions and compared notes with each other.  They critiqued.

Outreach care to eye patients in Tanzania

Patients, young and old, sat on benches lining the walls and watched the students while waiting their turn to see the doctor.  None of the patients seemed frightened or concerned.  KCCO has been doing outreach in this district for a number of years and their reputation for good-quality care and compassion precedes them.

It was fun to watch the students interact with the patients, outreach team and the other students.  Over the past few days, while participating in the course, they have become comfortable with each other and the easy familiarity crosses cultural and language barriers.  Our two Tibetan partners, an ophthalmologist who is the Director of the Kham Eye Centre and Kham’s community programs director, offer a unique perspective to the African participants that all can benefit from.  I think many of the students will continue to keep in touch and support each other as they develop and refine their own outreach programs.

Seva Canada's Executive Director, Penny Lyons, at work in Tanzania

This support and sharing across borders and across eye care programs is one of the most important activities that Seva supports and is one that will help ensure that effective programs, that reach the unreachable, are developed in all of our program areas.  Africans helping Africans with a little Tibetan know how thrown in for good measure.