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

Today’s Globe and Mail newspaper featured a front page story by Geoffrey York about Peter Ash and the work he is doing to raise awareness of the slaughter of people with albinism in Tanzania.

Peter, a BC businessman who has albinism, founded a charity called Under the Same Sun. He has worked tirelessly to get this grim story in the news and to press the Tanzanian authorities to do something about these horrific crimes. I remember him telling me that when he went to Tanzania to visit victims and meet politicians, people would call out to him the dreaded words “Dili dili” — a direct threat that he  might be killed for his body parts to make witchcraft “get rich” potions. He and his brother must travel with bodyguards when they go to Tanzania.

Peter Ash and Under the Same Sun have supported Seva Canada’s work with children in Tanzania by funding three  shipments of children’s eyeglass frames to Moshi. In fact, the next shipment is due to be sent by KLM Cargo and Worldwide Animal Travel this Thursday.

As the Globe article stated, people with albinism usually have poor vision. Where Seva works in eastern Africa, there are many children with albinism in the blind schools as well as adult patients with albinism who come to the eye clinics. Recently, Dutch photographer David de Wit took these images of children with albinism at the the blind schools.

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.

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!

Amanda Marr from our sister organization, Seva Foundation, writes about the great work being done by Seva Cambodia:

After a three-hour drive from Siem Reap province, Roshelle, the USAID (United States Agency for International Development) Child Blindness Project Manager, and I arrived yesterday in the  province of Battambang, where Seva Cambodia’s office is located.  I had the pleasure of meeting for the first time Dr. Bal Kumar KC (“Dr. KC”),  Seva Cambodia’s technical advisor and ophthalmologist, and Diro, the Child Blindness Coordinator, as well as seeing Ratana, Seva Cambodia’s Program Manager, again.  Today was a full day, starting early in the morning when Battambang Ophthalmic Care Center (BOCC) opened to tour the facility and meet the staff.

Eye Unit at Battambang Referral Hospital

We then toured the nearby Eye Unit at the government-run Battambang Referral Hospital. One ophthalmologist is stationed there, along with a refractionist who also does school screenings when he is not working at the Eye Unit.

Upon returning to BOCC, we met a 5-year-old girl who came for her first follow-up visit after having her second cataract removed during the recent eye camp in Banteay Manchey.  Her story was featured in the recent Seva Canada newsletter. (http://www.seva.ca/newsletter.htm)  Life for both her and her family has improved drastically: her mother can now work in the fields while her older sister takes care of her, and she is now much more engaged with her surroundings.

Then it was off to a remote district about an hour away, where a BOCC outreach worker had gathered the community at the nearby pagoda (temple) to be examined by Dr. KC.  Along the way, we picked up a woman with ptosis (drooping eyelid) whom Dr. KC had operated on.  Her son also has ptosis but is too young for the operation.  We drove to her father’s house, where 3 of her siblings had been operated on for the same condition.  They are doing well, and the other 2 siblings with ptosis plan to go to BOCC to get the operation in May.

Buddhist monk having his eyes examined by Seva

At the pagoda, Dr. KC identified patients with several different eye conditions, including a number of elderly people with cataracts and one woman with pterygium, a fleshy growth in the eye that can eventually lead to blindness.  We filled the van with these patients and drove back to BOCC, where they received surgery.

Within one hour, we witnessed 4 cataract surgeries, all of them elderly women, conducted by BOCC’s resident ophthalmologist, Dr. Heng Ton, who was trained by Seva in Nepal at partner institution Lumbini Eye Institute.

Screening schoolchildren in Cambodia www.seva.ca

Later in the afternoon, we drove to a school screening, where the eye unit refractionist was determining the strength of lenses needed by children with low vision who’d been identified by their teachers.   They will receive custom-made glasses within the next few weeks, allowing them to see the blackboard, read, and hopefully excel in school.

We are returning to Siem Reap tomorrow, when we will tour Angkor Hospital for Children, another one of Seva’s important partners in Cambodia, before I take off for Nepal.

This has been a wonderful opportunity to witness the great work being done by Seva Cambodia.

Amanda Marr
Seva Foundation Sight Project Manager

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.

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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