Executive Summary.
“Blindness and visual impairment have far reaching social, economic and developmental implications. They are the harbinger of poverty. In fact, they perpetuate it. Moreover, there is increasing evidence that women suffer a disproportionately higher burden of visual disability.”
… DrGro Harlem Brundtland, former director general WHO
“Tough as it is to be blind on land, consider for a second what it means to be blind in the creeks.
..DrMejuyah Okorodudu
World Health Organization (WHO) figures indicate that 285 million people are visually impaired worldwide, out of which 39 million people are blind and 246 million have low vision. The global cost of visual loss is presently nearly $3 trillion ($2,954 billion USD). A disproportionate high percentage of the global visually impaired, about 90%, is in the developing economies of the world3. The causes of blindness are also dissimilar between the two worlds. The industrialized west with their superb health infrastructures have hereditary and aging diseases, for which little can be done today, as major causes of blindness. This against, the mainly avoidable causes of blindness from, cataract, glaucoma, corneal diseases, childhood blindness, trachoma and onchocerciasis in the developing countries. The Nigerian national blindness and visual impairment survey (2005-2007)5 served as a timely wakeup call on the magnitude of the problem in the country. It revealed amongst other findings that, the prevalence of blindness in Nigeria for 40years and above is 4.2% and that 1,130,000 individuals in the above age bracket are currently blind in Nigeria.
The Niger Delta region of Nigeria is presently in conflict over control of resources from crude oil. This type of unstable and insecure environment, impacts negatively on development and services, especially services for the blind and physically/ mentally disabled citizens. Protraction of the crises further deepens the plight of blindness on poor indigenous communities. The Delta and Edo State Governments have numerous Health facilities in the Niger Delta area. These facilities are in most instances, viewed by the locals, with suspicious reservation, as belonging to government whose health workers in their white uniforms are rarely seen when needed. Secondly, the peculiar
environment of the Niger delta region of Nigeria, mainly riverine, has meant also that over time most healthcare workers are reluctant to be posted to the region on a permanent basis. As of today, there is no resident ophthalmologist in the Niger delta region (the creeks) of the two states. With this contrived lack of access to orthodox medical care, the near illiterate, poor, blind person in these remote locations is then at the mercy of the itinerant traditional herbalist/surgeon (coucher). The consequence of the local surgeons (couchers) intervention is without a doubt dubious and detrimental to the eye health of the patient. Alarmingly statistics from the Nigeria national blindness survey exposed the fact that approximately 50% of all recipients in the survey had their cataract surgery at the hands of the traditional surgeon
To mitigate this perceived deprivation, the Federal and State governments occasionally undertake medical and surgical expeditions to these remote regions. Because post- expedition care is not built into the strategy, patients who may develop complications after the expeditions are uncared for. These poorly managed cases contribute to the unfortunate growing numbers of poor outcomes which then negatively affect future uptake of services as patients lose confidence in the expedition services. Consequently, they turn to the ubiquitous local traditional eye care providers/ couchers whose financing is more flexible and consumer friendly. New concepts in medicare(best ophthalmological practices) advocate a proactive approach, with a bias for high quality rural outreaches and a built in inter-outreach component. Medical teams visiting local communities get a much better understanding of the communities, their health needs and so can offer community focused/friendly solutions.
The need, backlog of cataract blind, is huge but can be achieved one piece at a time. This project, THE FEB, by Africa Cataract and Eye Foundation [ACEF], is a Public- Private Sector Initiative for the elimination of blindness due to cataract, based on the Indian ARAVIND model of high quality, high volume cataract surgery – ECCE + IOL (extra capsular cataract extraction with intraocular lens implant). The main goal of the project is to establish a comprehensive eye care service for the approximately 1,000,000 citizens of the region. It will focus on the geographical area of the Niger Delta region characterized by rivers and their tributaries and creeks. The area to be covered is served by the Forcados, Escravos and Benin rivers which provide waterways to access communities in the seven (7) Local Government Areas (LGA`S) – Warri North, Warri South, Warri Southwest, Burutu, Bomadi and Patani in Delta State and Ovia South West in Edo state (estimated population of one million, sixty-four thousand, one hundred and thirteen, 1,064,113).
The project areas are oil producing areas with health infrastructures provided by the state governments, local government authorities and the oil exploratory companies. The network of health facilities will provide facilities initially for the screening and outreach work and as capacity is built, comprehensive continuous services. This collaboration will help oil companies, operating in the region, enhance their corporate social responsibilities, build trust with communities and meet the much desired objective of HEALTH FOR PEACE.
The project will build in cross subsidy from families, the health services – both public and private, to accommodate the estimated 70.2% of Nigerians who live on less than
$1.00 (US) per day7. It is the promise of this project that no one would be denied surgery because of personal inability to pay for services. Based on this a mutual trust is built between the communities and health providers.
The design of the project is in two phases. Phase 1 will be for the establishment of a high quality high volume surgical center with planned screening and ferrying in of patients by road and boat to the surgical centre. The second phase will be the establishment of vision centres closer to the communities where continuous inter-outreach services will be provided with the cataract surgical services still being provided at the high quality surgical centre.
The ultimate benefit of THE FEB PROJECT is that with a resident ophthalmologist/local eye care teams and easily accessed eye care service situated in the region, the overall cost of services will be reduced and patients will be more inclined to utilize the hospitals.
The first phase of five years (2012-2017) of this eye care programme will include the following activities:
- Advocacy with traditional rulers and through them to their communities, oil exploratory companies, local government authorities.—ONGOING
- Capacity building including the training of eye care teams at base hospitals, vision centres and community based health providers phased as per the plan of activities
- Construction of a eight (8) bed base hospital in Benin City (ACHIEVED)
- “SIGHT BY LAND” A fully equipped mobile eye theatre for rural outreach (ACHIEVED) and bus to transport patients from their villages to base hospital and back home after surgery (ACHIEVED).
- “SIGHT BY BOAT” Refitting of an eye boat ambulance for riverine outreach down the 3 rivers Forcados, Escravos and Benin and their tributaries and creeks (2012). (BOAT DONATED. AWAITING REFITTING).
In conclusion we must remember that blindness is a serious predicament to befall anyone. It goes hand in hand with poverty – as a cause and a consequence. Poverty and the attendant dire consequences will continue to be closely bound to the general health of the society. This project will establish a comprehensive eyecare service in
the region, reduce blindness, and help to alleviate poverty and build cohesion and
trust between families, communities, the general public, the private sector and the State Government. This is development in the real sense.
Gabriel MejuyahOkoroduduB Pharm; MBBS; DO (WACS)
Rural river eye doctor.