BY MOLLA MITIKU
Sisay Abebe, 64, is one of the residents in Logia, Afar region. He had been leading his life with the income he earned semi-farming activities. All of a sudden, situations change for he lost his vision altogether caused by cataract that has absolutely changed his life to gloom since.
“It is hard to live for such a long time without vision particularly for a lonely person like me,” Sisay told Addis Standard. For it was impossible for him to move from one place to another place and does any work, selling what he amassed during the old good days for his means of existence was the only option he had for the first few years following the accident and then he completely became dependent on other mercery individuals.
For Sisay, the past six years were the darkest period in his life as he couldn’t identify people or anything in those times. “Thanks to my lord, now I have regained my sight,” he shouted with happiness. Although he is one of the fortunate people who recovered their lost sights due to rarely conducted cataract surgery campaigns, billions worldwide and millions in Ethiopia have been suffering from avoidable blindness.
Owing to the cataract surgery conducted under the auspice of the Himalayan Cataract Project (HCP) Cureblindness hosted in Semera, Afar region, from October 22 to 27, 2023, Sisay retained his normal vision along with other 369 people who got the ophthalmic surgeries that sparked a ray of hope for the under privileged once in recovering their lost sight. Cataract surgery operatives who participated in this campaign argued that there are tens of thousands of people with similar problems in the region who haven’t yet get the chance.
Hiwot Degneh (MD), who successfully operated and restored Sisay’s sight, is one of the four health practitioners who participated in handling the cataract surgery campaign in Semera. “Observing people gain their lost vision back following a successful eye surgery left an ophthalmologist without enough words to express the satisfaction,” she told Addis Standard.
Hiwot participated in five similar eye surgery campaigns organized to help people suffering from avoidable cataracts. “In this campaign, we planned to operate on about 500 people, but we did 369 surgeries and managed to restore their sight”. She added. The number of people who are subjected to blindness is alarmingly increasing from time to time and currently about 900,000 people with sight problems only in the Amhara region where I am on duty”.
Blindness is one of many other severe health challenges worldwide, affecting more than 2.2 billion people. The interventions by governments and Non-Governmental Organizations (NGOs), though play significant roles, are unable to meet the huge demand particularly in developing countries like Ethiopia. In this regard, cataracts, the clouding of the lens of the eye that prevents clear vision, have remained the leading cause of avoidable blindness, visually impairing millions of people in Sub-Saharan Africa. In Ethiopia, recent surveys indicated that cataracts are the main cause of blindness and low vision, which contributed to 49.9% of blindness and 42.3% of low vision cases. Despite efforts exerted to minimize its impact, success is still far-reaching and the masses unable to access adequate eye care treatment.
HCP Cureblindness is one of the organizations that have been intervening in sight refurbishment worldwide. In collaboration with 65 global partners and over 100 volunteer network collaborators, it has been playing a significant role in reinstating vision, eradicating preventable and curable blindness.
K-T Overbey, the CEO of CHP Cure blindness, said that since being founded in 1995 by two visionary eye surgeons, Geoff Tabin (MD) and Sanduk Ruit (MD), HCP has been providing high-quality eye care, education, and world-class eye care infrastructure in over 25 countries around the globe.
“It has performed over 1.4 million sight-restoring surgeries, provided screenings and basic eye care to over 14.5 million people, performed 195,000 corneal transplants, prevented 50,000 cases of corneal blindness, and trained 19,500 eye care professionals,” she told Addis Standard.
She had paid a two-day visit to Ethiopia, where Addis Standard approached and talked to her about the significance of their intervention in curbing blindness. She emphasized that her meetings with authorities at the Ministry of Health to deepen partnership were commendable and fruitful. According to the CEO, the involvement has also focused on skilled manpower development and building eye care centers that can provide high-quality care for restoring sight in different parts of the country.
“We are committed to curing treatable blindness and setting a long-term, sustainable solution to such impacts by providing training for local ophthalmologists, public nurses, and other allied personnel,” Overbey said, adding that “we are providing equipment to make sure that once we’ve trained people, they have the opportunity to use their skills so that eye health can be delivered in the highest quality at an affordable price, making it accessible to people”.
HCP has envisioned to create a world where no one is needlessly blind, it hasn’t yet achieved this although it made tangible impact towards that goal, she underscored. This prominent eye care NGO focused on fighting avoidable blindness has provided surgeries to over 170,000 people. Besides, it providing training to local ophthalmologists and endowed equipment that accounts for half a million surgeries in Ethiopia.
It has been working with the Ministry of Health, as well as partner organizations, hospitals, teaching centers and clinics throughout the country to address the excess of treatable blindness. Even if it looks bizarre and far-fetched, curbing sight impairments will be possible through consolidated efforts, developing local capacity, building centers, and equipping them with the necessary medical equipment and infrastructure.
“We think about how we can make a difference in the lives of the people by helping them regain their sight and just sustaining that long-term impact by building a system that can continue to provide high-quality vision,” she said, adding that “we track very closely where we work, how we work, and what comes of that. I feel very confident that our resources are going to have the greatest impact that they can in Ethiopia”.
The organization has just planned a budget of just a little bit less than $20 million US dollars, and a little bit more than half of it is allocated to Africa. “Since vision care is a critical need for every single person, HCPs have been striving to avoid barriers related to the place where they live and the money that they have to access high-quality eye care”.
In its continuous effort to reach the underprivileged communities in the country, HCP marched to the Tigray region after the Cessation of Hostilities Agreement (CoHA) between the federal government of Ethiopia and the Tigray authorities, conducted its post-conflict eye care surgeries in Quiha in its first outreach.
Zelalem Habtamu (MD), Country Director of HCP Cureblindnes, told Addis Standard that in the six-day outreach post-conflict cataract surgery in Quiha, Tigray, 1,300 patients underwent eye operations, and another similar campaign is planned for spring 2024.
The ophthalmologists whom Addis Standard approached confirmed that no national survey was conducted recently but the findings of the national survey conducted a decade ago revealed an estimated 1.6 million sight-umpired people. Zelalem said the organization has performed over 718,215 sight-restoring surgeries and provided eye screenings and basic treatments to more than 5.6 million people since 2008 in Ethiopia. HCP has also been providing support for the eye bank of Ethiopia, specialized ophthalmic training for 50% of sub-specialists, and increased local capacity in the country.
It has also continued investing in “programs and infrastructure, allocating over 12 million US dollars” to date to build self-sustaining eye health systems and a special eye hospital that is under construction in Bahir Dar that leads to a robust eye care system.
One may feel how hard it might be to learn to move from one place to another and to participate in various community activities without vision, but HCP’s major positive impact on sight restoration for hundreds of thousands of people in Ethiopia is so recommendable.
Ashley Ellis, HCP Cureblindness Senior Communcations Manager, says there are a lot of factors that distinguished the intervention of HCP worldwide than another does. “It different from others due to the commitment to building sustainable systems. Its model is rooted in local providers, patients and institutions, combining direct surgical care, multi-tiered training opportunities, and structural improvements to elevate eye care in the country,” she underlined.
Hiwot also commended the interventions made by HCP and other international and local organizations to improve access to eye care services in Ethiopia. She said that opening new centers and holding campaigns for cataract surgery, are so praiseworthy that more others need to join hands. Creating a conducive atmosphere for underprivileged people to access eye health care services not only helped raise the number of beneficiaries of cataract surgeries but also significantly reduced the need to attend hospitals.
HCP has also been funding government hospitals with ophthalmology simulation suites to meet new trainee requirements, enhance training, and improve patient care. “There’s an enormous backlog of blindness, and we are doing everything we can to address it directly through outreaches or other direct patient care, but we believe that is better accomplished by building up a system of high-quality care by Ethiopians for Ethiopians to cut down the backlog and get ahead of it,” Zelalem told Addis Standard.
The eye care hospital, which is currently under construction in Bahir Dar, is a typical example of this end, and it will serve both as an eye care and training center. He added that it is designed to provide a new level of quality eye care not only for the people of the region but also for the entire country and even beyond.
“Building local capability, ensuring technology transfer, equipping hospitals and eye centers with medical equipment, and enhancing the supply of medicine are some of the many other things that the organization aimed for,” Zelalem said, noting that “supporting the government and local partners with infrastructure, equipment, technology, and other supplies empowers them to treat patients in the required quality.
Despite the high demand in the country, HCP is trying its best to extend equitable access to people in the country. Since it intervened in the Ethiopian health care system for the last 14 years, it has procured, imported, and distributed medical equipment worth more than 4 million US dollars and trained thousands of people who can support and provide health care to the required qualities in society.
The organizations under his leadership have reached nearly half a million people who need eye care and health services. According to the director, HCP has two modalities: rendering health care services through its capabilities and providing funding and financial support so that local ophthalmologists can go for outreach in remote areas and help those patients who can’t afford to come to big cities for the services. It also mobilizes doctors and other health care professionals to go out to the site and provide care at the community level.
Over the past 14 years, the sight-saving organization has operated on more than 159,000 people for cataract surgeries and 118,000 people for post-traumatic stress disorder (PTSD) surgery; that is more than 170,000 people throughout the outreach approach”.
One, we support the healthcare facilities so that they can render services on a day-to-day basis. In addition, we support them in going to remote areas so that they can do those services as an outreach because those patients can’t afford to come to large cities to get services. So, instead, we employ more and more people to build healthcare services.
“The cataract surgeon campaigns are so tremendously expanded that we have the highest cooperation in geographical coverage,” the director emphasized. There is also a plan to do a more aggressive assessment of the treatment satisfaction of patients and strengthen partnerships with the government and other NGOs to avoid duplication and share expertise in 2024.
Barricades to sight restoration
Despite all the teamed-up efforts to cure sight losses, at this point, the eye health care system in the country has sustained a significant impact. These impediments against efforts exerted to restore sight impairments by the ministry and the NGOs persisted in a wider range, particularly among people living in poverty.
According to Overbey, working separately takes anyone nowhere, and it remains one of the obstructing challenges. She believed that restoring lost sight is such an important and big issue that a single organization will never solve it. Working in a challenging environment or in conflicting areas is also another blockade that retards performance.
Hiwot, on her behalf, argued for the unbalanced demand-supply symmetry. Despite efforts exerted by the government and NGOs like HCP through opening new centers in different parts of the country and holding campaigns at different times in different places, the services still mismatch the need for eye care treatment.
According to the ophthalmologist, a shortage of specialists, a small number of treatment centers, a scarcity of medicine, and a lack of awareness among society about cataracts and other causes of blindness have aggravated the crisis.
Zelalem also has the same opinion as Overbey and Hiwot. Considering the aforementioned challenges, he emphasized the inadequacy of foreign currency, which persistently obstructed the eye health care system as medical equipment and drugs were not accessible in the local market but rather bought and imported from abroad.
“It is so hard at this time to buy and import the required equipment and medicine from abroad due to the unavailability of foreign currency in the country,” Zelalem told Addis Standard.
The demand is very high, but many people have not yet reached it due to the insecurity situation in Ethiopia. It is really difficult to do the proper eye care treatments when moving to different parts of the country. He said that even though eye health care needs high resources, both skilled manpower and medical facilities and drugs, they are afforded in limited amounts.
Zelalem also emphasized that, despite the support from the Ministry of Finance and Customs Authority for importing 100% of the medical equipment from abroad, there are lots of things that need to be improved. As his organization needed to freely distribute around 20,000 eyeglasses to beneficiaries who had eye surgery and had the prescription to wear them, they haven’t received them yet, though the glasses were imported and reached customs authority for a high tax request.
In Ethiopia, eyeglasses are considered leisure commodities, though not that many people, including children, need eyeglasses to improve their vision and perform their routines. “We bought those eyeglasses for 27,000 US dollars to distribute to 20,000 people, but we are demanded to pay 105,000 US dollars in tax, which is more than four times the price of the eyeglasses, and this is a significant challenge to the health that must be changed,” Zelalem underlined.
Ethiopia is one of the most populous countries in Africa, with more than 120 million people. It’s expected that “nearly 6 million people are either blind or visually impaired” and need services. However, service is insufficient for the sight-impaired population in the country. Most of the available eye care facilities are concentrated in urban settings and large cities, which persisted as another challenge in the sector.
The Way Forward
The government has devoted itself to realizing access to basic health care in any village by establishing health centers, clinics, and health posts over the past three decades. Nevertheless, there are only a few centers in the country where such complicated eye surgeries are executed.
That is why organizations like HCP, in collaboration with the government, have been prioritizing working in remote and peripheral areas through campaigns. Hence, many experts in the field advised multifaceted approaches while striving to treat avoidable blindness. “In this regard, working together is always the best approach,” Overbey argued, noting that “government institutions and international and local NGOs must join hands and consolidate their resources and efforts to have an affirmative result on sight restoration”.
Working meticulously on raising awareness about the root causes and ways of preventing oneself from sight impairment is a vital strategy that could help several people, mainly children at school, from being susceptible to vision loss. According to Zelalem, improving the taxation system in the country and avoiding labeling basic materials like eyeglasses as luxury commodities could be crucial in striving against blindness.
It is also enormously helpful if the government gives special attention to making available foreign currencies, particularly for health care, which is dependent on imported equipment and medicine. However, Hiwot, who has been participating in the cataract surgery campaigns, believes that there is still a long way to go to eliminate avoidable blindness not only in Ethiopia but around the world.
Even though there is an endeavor to reach all sight-impaired people and restore their sight through surgery and other related treatments, there is still a long way to go due to the embodied obstacles that the eye care health system has encountered. In fact, to be optimistic, although it is a far-fetched task, there is a possibility to succeed in the long term with high commitment and collaboration.