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

March 13, 2010
Penny Lyons, Executive Director, Seva Canada

This afternoon marked the end of the Gender Inequity in Eye Care conference hosted by KCCO. It was a remarkable experience.

Each participant was passionate about equity in accessing eye care recognizing that the strategies developed by this group can have implications far beyond the obvious of getting women and children in for eye care services. The knowledge, research and experience shared by each country, institution, and program can be easily replicated into many, if not most, other health interventions and can have a significant impact on  other of the United Nation’s Millennium Development Goals such as poverty reduction, education and maternal and child health.  Today, plans were made for the future.  Next steps such as advocacy, public policy, research, human resource investment and public awareness were discussed and each individual present made a commitment to take specific action.

There was no championing of individual program or NGO interests.  No arguing about where funding would be directed and who would be represented in a public relations campaign.  Instead it was about as disparate a group of individuals as one could imagine working toward a common goal and a greater good.

It’s amazing really the connections that were made:  a Tibetan woman chatting with a Muslim woman from Kenya about common experiences as young, female professionals; a Nepali program manager offering advice to an ophthalmologist from Malawi about creating a community ophthalmology program; participants from 25 years old to 65 years old dancing in a circle at a local Reggae club and just enjoying the music and each other’s company.

At Seva we always say that “it’s all done with people”.    This is one of those times.

Moshi, Tanzania March 10, 2010
Penny Lyons, Seva Canada’s Executive Director

It is wonderful to be back in Tanzania. KCCO is humming with activity as guests arrive from all corners of the globe. The reason for all this activity is KCCO, together with the British Columbia Centre for Epidemiologic and International Ophthalmology and Seva Canada are hosting a gender and health meeting March 11-13 “Reducing Gender Inequity in Eye Care – Translating our Knowledge into Action”. Funding for this meeting was provided by a grant from the Canadian Institute for Health Research.  Participants include representatives from The International Agency for the Prevention of Blindness, the Tanzanian office of CIDA, the International Development Research Council, Seva partners from Tibet, Nepal, Egypt, India and Seva Foundation as well as participants from across Africa.

The goals of the meeting are to: share findings and effective techniques to reduce gender bias; share that knowledge at the national and international level; determine how to use these strategies, developed through eye care, in other health systems such as maternal and child health care; and to create new collaborations across regions and countries.

One of the key participants in this meeting is Herieth Mganga, KCCO’s gender and blindness coordinator. I had the opportunity to go into the field with Herieth yesterday. Our purpose was to interview Sentinels – women in the communities who are trained to find people who are suffering from debilitating eye conditions, like cataract, and ensure they receive the treatment they require.

We interviewed four Sentinels in the Hai District on the slopes of Mt. Kilimanjaro. These four women, Nkiraeshiwakwa, Hilda, Aziza and Raheima, have little formal education but have been trained by KCCO to detect eye conditions and to provide information and support to those needing services. They are an amazing group of women: dedicated, compassionate and determined. In the two years since the Sentinel program was implemented, the number of women, children and men accessing services has increased dramatically. They are treated with respect and admiration and now provide feedback to KCCO on how the program might be improved to reach more people in need.

While in the field we also met with some of the patients, found by the Sentinels and treated through KCCO. The patients, men and women alike, were grateful for the eye care provided and were glowing with praise and pride for the women in their community who had made it possible for them to see again.

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.

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.

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’s my last day in Tanzania. Mollie and I had a terrific weekend safari to Ngorongoro and Lake Manyara where we saw thousands of wonderful critters, including the sweetest baby elephant. He was so young, he was having trouble using his trunk and he was very awkward on his feet.

Last night it poured and today the cars are slipping all over in the mud. It seems that there are two options — dust or mud. (Like in Kingston, Ontario where they say there are two seasons: construction and winter). Fred, KCCO’s driver, says that we are at the start of the “short rains”, not because of some sort of farmer’s almanac prediction, but because of the fact that Dr. Paul Courtright and Dr. Susan Lewallen will soon be teaching the Nuffield Course on management, something they do every year at this time.

The mountainsides of Kilimanjaro and Meru are lush and green, but en route to Manyara we passed through miles and miles of very parched land. The Maasai with their herds of cattle must find life in the dry season very hard. Most of the rivers and watering holes were bone dry. I kept wishing we could give them a bit of our Vancouver rain.

I wish I had time today to join the field teams one more time. But I’ll stay in the office and gather photos and write reports. On my return to Canada, I’ll put together a film with video footage and stills, to show the work here and post it on YouTube so that you can get a sense of what I’ve been talking about.

Thanks for reading the blog. Please visit Seva Canada’s website at www.seva.ca.

Assante sana (thank you very much in Swahili),

Heather

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
(more…)

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