Seva Canada: A Solution in Sight

Huge thanks to Zaf and all the folks at Delta Optical‘s four locations.

For the month of June they are donating $30 to Seva Canada for every pair of glasses sold.

For 40 years, Delta Optical has been providing exemplary customer service and has built lasting relationships with their customers. The small optical chain provides service in Square One, Fairview Mall, Hillcrest Mall and Oakville, Ontario.

Here’s their wonderful poster:

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.

I was pleasantly surprised to be greeted at the Kathmandu airport by Parami Dhakhwa, Seva Nepal Program Coordinator, who whisked me away to the Seva office to meet Shravan Kumar Chaudhari, Finance Manager.  Due to some logistical constraints, Shravan had arranged for me to travel south by Lumbini Eye Institute (LEI) vehicle from Kathmandu in order to meet up with Ram Prasad Kandel, Seva’s Program Manager.

Kandel has proved to be a consummate host, and I am greeted warmly wherever we go.  En route to meeting Kandel, I briefly toured Bharatpur Eye Hospital the evening I arrived in Chitwan District.  The next day proved to be rather interesting.  Due to a bandh (strike) because of student elections, the LEI vehicle could not take me to Butwal.  Instead, I took a rather crowded public bus (I was lucky to have a seat!) to Butwal.

From there, Kandel and I went to Tansen, where the Palpa Lions Lacoul Eye Hospital was conducting a three-day surgical and screening camp.  With the exception of a minimal registration fee, all services were provided free of cost to the blind and visually impaired patients who filled the rooms and lined the hallways.

I met Dr. Salma KC, the eye hospital’s resident ophthalmologist, in the operating room, where she was performing one of many cataract surgeries that she would do that day.  Dr. Salma will be going to Vancouver soon for a pediatric ophthalmology fellowship.  Her specialized skills are much needed in a country of 29 million, where there are currently only three pediatric opthalmologists.

Dr Salma, one of 3 pediatric ophthalmologists in Nepal

The following day, we took a rather bumpy and hair-raising ride northwest to Gulmi District to observe a school screening.  All students with anything less than normal vision will be fitted and provided with eyeglasses.  Refractive error is especially prevalent in Asian countries such as Nepal, and by identifying children in schools, the Primary Eye Care Centre (PECC) in Gulmi is reaching children who may not otherwise come to the center for glasses.  They are also detecting eye conditions that can be prevented or treated before the affected children go blind. At the same time, this outreach will result in increased awareness among the community about the eye care services available. The children will go home and tell their families about the eye screening at school and the whole community will benefit.

The Primary Eye Care Centre itself is very well run under the capable and inspired leadership of Chairman Bharat Bahadur Chand, who proved to be an incredibly generous host: he invited us to his home for dinner and provided me with a very comfortable room to sleep for the night.  We also managed to squeeze in a quick trip to the Hindu temple of Yagyashala at the top of Resunga Peak.

On our return ride to Bhairawa, home of Lumbini Eye Institute (LEI), I got to hear one of Seva’s radio messages advertising free cataract surgery for children at LEI.  Although I do not understand Nepali, my ears perked up with I heard mention of Seva.  We also stopped by Butwal Lions Eye Care Hospital, which is quite an impressive facility with much space to expand.

I look forward to seeing the services at LEI today and tomorrow.  I have already met Sanjeeb Adhikari, Seva’s Child Blindness Coordinator, and hope to meet Dr. Karthikeyan, one of LEI’s two resident pediatric opthalmologists, soon.

I am both inspired and humbled by the dedicated staff and partners I have met.  Seva really is carrying out its mission of serving those most in need with high quality, affordable, and accessible eye care and truly embodies compassion in action.

Amanda Marr

Seva Foundation’s Sight Program Director is Dr. Chundak Tenzing, a Tibetan ophthalmologist from Nepal, who lives and breathes Seva’s mission of restoring sight and preventing blindness. Anyone who has ever met Chundak cannot help but be impressed by his caring nature and his deep compassion.

Chundak is also a poet. He sent the following message and poem for Seva Canada’s blog:

I am sharing with you
Voices from the field
Where the blind
Receive sight restoration
And walk unassisted
To live a life
With  dignity

When a heart opens its petals
Like a blooming flower
And hands deliver
A gift of sight

The expression of gratitude
Rolls down a cheek
Like dewdrops
Glistening in the sunshine

To wonder and say
What a journey
It is to be giving
And receiving
Happiness
In its purest form
With no strings attached

grateful Seva patients young and old

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

Last summer, a Seva Canada donor funded three eye camps in remote hill districts of Nepal. The first of the three camps took place in Khandbari in December 2008. To view a series of images from Seva of the eye camp, click on this link:

Seva-sponsored eye camp in Khandbari, Nepal in December 2008

In the next couple of days, our donors who are travelling in Nepal will get to see an eye camp in Gulmi. Watch this space for some of their images and impressions.

Providing eye care in Africa is full of challenges. Poverty, the shortage of eye specialists and transportation are all major obstacles.

Cataracts are the leading cause of treatable blindness in the world. Most people have no idea what is wrong with their eyes or that there is a solution. A 15-minute cataract surgery to remove the clouded lens costs about $50 Cdn and can restore sight. But because cataracts develop gradually and are painless,  most people in Africa won’t spend the money to travel to hospital to seek help.

Even once people know that they can have an operation to restore their sight, there may be a lot of fear and misconception. Hospitals are often viewed as places where you go to die, not to get cured. Moreover, many people have no conception of what cataract surgery is all about. Two of the common beliefs are that doctors will replace your eye with a goat’s eye OR that during surgery they’ll completely remove your eye, work on it on a table, and then put it back in again.

Both pretty scary thoughts…

Shamimu, a 5-year-old in Tanzania was going blind from cataracts. After counseling from the Kilimanjaro Centre for Community Ophthalmology, she and her family agreed to go for surgery. However, Shamimu was very nervous about the operation because all of her friends told her that she would get goats’ eyes. Here’s a picture of Shamimu struggling to read and write prior to her successful bilateral eye surgery.

We have three huge boxes in our office that contain the components of an ERG destined for Nepal. This ERG is not the kind that most of us are familiar with — an ergometer, which has been described as a cruel torture device to torment rowers. Our ERG machine is for eyes, not rowers.

The electroretinogram (ERG) is used mainly by ophthalmologists for the diagnosis of various retinal diseases. Electroretinography measures the electrical responses of various cell types in the retina, including the photoreceptors (rods and cones). An ERG is also useful in determining if retinal surgery or other types of ocular surgery such as cataract extraction might be beneficial.

The one in the Seva Canada office is heading to Nepal next week, being carried by our wonderful donors who have offered to act as Sherpas for this valuable piece of eye-care equipment — all 77 kg of it!

Huge thanks to the Rotary Club of San Francisco #2 who donated it to Seva and shipped it to Canada so it could make its long journey to the Himalayas.

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 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)

It’s always thrilling to look through the dozens of photographs and stories that emerge from eye camps.

Surgical eye camps in remote areas of Tibet are magical events. Literally hundreds of blind people, young and old, are led by their relatives to the camp to receive sight-restoring cataract surgery. Many have been blind for many years and need help from a full-time caregiver — often a child who can then not attend school.

Tibetans call the ophthalmologists “the eye openers”. The surgery takes about 15 minutes and costs about $50 and it changes people’s lives forever. Each year Seva Canada (www.seva.ca) and our sister organization, Seva Foundation, conduct up to 25 eye camps in Tibet.

Here’s a great group shot from an eye camp in the autumn of 2008. It makes us all smile.

A sea of happy faces of Tibetans who have had their sight restored at a Seva eye camp

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.

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

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