A vision for the future

Leah Oatway

• Last Updated: December 10. 2008 1:40PM UAE / December 10. 2008 9:40AM GMT

ARSI NEGELE, ETHIOPIA // Yeshiemebel Gebre, led by her daughter, walks slowly out of the clinic, white gauze protecting her eyes from the sun.

She is in a remote village 250km from the capital of Addis Ababa, after surgery to treat a potentially blinding condition called trichiasis.

At 50, she is one of about 50,000 Ethiopians in remote areas who are receiving free or heavily subsidised treatment to prevent blindness. The programme is run by the Ethiopian non-governmental organisation Grarbet Tehadiso Mahber (GTM), and funded by Noor Dubai, a humanitarian campaign to provide preventive eye care to one million people that was launched in September by Sheikh Mohammed bin Rashid, Vice President of the UAE and Ruler of Dubai.

Noor Dubai will provide US$500,000 (Dh1.8 million) to Orbis International, an international organisation devoted to eliminating avoidable blindness in developing countries, to extend GTM’s eye-care programme to three sub-districts of the Oromiya region to the south.

Half a million Ethiopians live in this region, the largest and most populated in the country, without access to eye treatment or the means to pay for it.

The twice-weekly clinic at Arsi Negele is operated by staff in the nearby town of Zeway, also known as Battu, at the Zeway Secondary Eye Care Centre. An ophthalmologist and two nurses work in a complex of white, wooden buildings that house two operating theatres, an in-patient ward and pharmacy. The hospital opened in Sept 2006 with financial and technical support from several NGOs; it serves 300,000 people in 47 villages.

Mrs Gebre’s painful condition was caused by several bouts of trachoma, an eye infection spread through flies and human contact that affects more than 10 million Ethiopians.

If contracted several times, the infection can develop into trichiasis, which pulls the eyelid inward. This causes the eyelashes to scratch the cornea and, if left untreated, can result in permanent loss of sight.

According to the latest Ethiopian government health survey, 1.3 million people have trachoma, which is easily transmitted by flies, fingers, clothing or a lack of clean water with which to wash. More common in women and children because of their close contact, it thrives in rural areas where people have limited access to clean water and basic health care.

In some communities, Orbis says, blindness from late-stage trachoma is so pervasive that people accept it as a fact of life. Ethiopia is ranked 170th out of 177 countries on the UN Development Programme’s Human Poverty Index.

At least 1.2m Ethiopians are blind and more than 2.8m have poor vision because of cataracts.

With the correct intervention, according to the Ethiopian government, 90 per cent of that blindness is either preventable or could be cured. Yet one-quarter of the country’s 79m people do not have access to primary health care.

There are just six optometrists and 83 ophthalmologists in Ethiopia, most in Addis Ababa. The journey to the capital is too far and too expensive for the 85 per cent of the population that lives in rural areas.

The government’s four-year plan for eye care, begun in 2006, estimates that outside of Addis Ababa there is one ophthalmologist per three million people.

Governmental, non-governmental and private organisations provide health care around the country but most have limited budgets and are poorly equipped and understaffed.

Orbis is working with local universities to teach ophthalmic nurses how to carry out trichiasis surgery and give antibiotic treatment.

Noor Dubai’s funding will help train 14 more nurses and 100 school teachers, who will provide eye-care and vision testing once a year.

Dr Redda Tekle Haimanot, a neurologist and the founder of GTM, acknowledges that finding skilled practitioners was a challenge.

“The demand for trained manpower is increasing,” he says. “It used to be possible to employ ophthalmic nurses for 2,000 birr [Dh746] per month, but now you cannot get one for twice that. They all go to large international NGOs or private clinics where they earn more than 5,000 birr.

“They don’t want to go to outreach programmes to earn less money and work from the early hours to 6pm. It’s hard to find the right people.”

Back at Mrs Gebre’s house 10km from Arsi Negale, two rooms made of mud and sticks shared by six of her nine children, she removes the gauze. Her eyes are red and watery, but the treatment has been successful. However her chances of catching trachoma again remain high because less than 20 metres from her front door, several goats and an ox are standing in a growing pile of animal faeces. Flies are everywhere.

The scene is recreated in towns and villages throughout the country, says Dr Worku Mekonen, medical director at the Zeway centre.

“It is a breeding ground for eye disease because the presence of a dirty, dusty environment, with animals living together with people, favours the multiplicity of flies which transmit bacteria,” he says. “The lack of an adequate amount of water – this family share a water station with an entire village because they cannot afford their only supply – along with poor sanitation affects the rate of eye disease, because a lack of water means they do not wash enough, so their face is dirty.”

About 37 per cent of people living in Zeway’s catchment area suffer from trachoma, although in some areas the rate can be as high as 76 per cent.

The only way to achieve a dramatic reduction in infection rates would be through mass distribution of an antibiotic called Zithromax (azithromycin) at least once a year, for several years, along with widespread clean water and sanitation programmes.

It is estimated that more than 80 per cent of the target population in affected communities should receive antibiotics to address the need nationwide. A single dose can cure trachoma.

Using Noor Dubai’s money, Orbis and GTM plan to distribute the drug to at least 310,000 people next year and teach 90,000 people how to prevent the disease. Thousands of other people are also to be examined, provided with spectacles and treated for cataracts and trichiasis.

Back at the outreach programme site in Arsi Negele, Obsitu Geleho, 60, clutches her yellow registration card as she jostles for space with fellow patients. The widowed grandmother left her home at sunrise, walking for four hours in the hopes the outreach team could help relieve her trichiasis.

Like Mrs Gebre, she suffered in silence for several years, unaware of the consequences of delaying treatment and afraid of the cost.

Nearby, Gemedo Gelgelu Tunebo, a 19-year-old natural science student with cataract clouding in his right eye, smiles as he explains that he has not seen from it since infancy.

“When I sleep for a long time, my eye hurts. I wanted to finish my education before coming but the discomfort became too great,” he says.

The condition, corneal opacity, was caused by an untreated infection. Without a
corneal transplant Mr Tunebo will see with his right eye, but while Ethiopia is now home to only the second eye bank in Africa, established by Orbis, a lack of awareness regarding the importance of tissue donation means transplants remain a challenge.

Four hours south of Addis Ababa, past fields of ruined crops damaged by unexpected rains in the rural town of Butajira, another secondary eye-care centre run by the same organisation is providing vocational training and rehabilitation to two men who did not access eye care in time to save their sight.

Inside a shaded room at Burajira Secondary Eye Care Centre, Mohammed Shure, 15, and Jamal Awol, 45, sit cross-legged on floor mats, weaving large traditional straw baskets.

Both men are blind.

Mohammed lost his sight when he was two years old after catching measles. Mr Awol, who has 11 children and two wives to support, became blind six years ago from a condition called uveitis, an inflammation of the inner part of the eye which can be caused by a number of conditions, including arthritis, and is treatable if caught early.

Both had given up the hope of working until they were admitted on the programme three weeks ago.

They will spend the next two months at the centre with 18 other blind and physically disabled men in a vocational training course, receiving free training, food and accommodation.

When those men finish their two-month stint, 20 women in similar predicaments will be enrolled.

Mr Awol, a former farmer, has been forced to rent his land to provide a small income for his family. All but one of his children have dropped out of school because, although education is free, he could not afford the cost of uniforms, exercise books and other materials.

“When I lost my sight everything became gloomy but my children have encouraged me,” he says. “They say God gave us this situation, there is nothing we can do but get on with it.”

Outside the centre’s two examination rooms, Dr Fitsum Bekele, the medical director, talks to a crowd of villagers awaiting eye examinations about trachoma and ways to prevent it.

Around the corner, Sophia Kibret, a 29-year-old language teacher from another nearby village, is being fitted with new spectacles made at the centre’s optical workshop.

The frames are shipped from France by another NGO and lenses are prepared at Butajira’s workshop, before being sent out to the outreach programmes and the Zeway eye centre for distribution.

“If this is the situation 250km from Addis Ababa,” Dr Haimanot says later, “imagine what it is like further out in the other woredas [sub-districts].”

The long-term aim of both centres is to become self-sufficient.

“We are becoming conscious that we cannot always depend on donors and so we are going to use the funds generated from those who can afford to pay to treat the poor, so that in 10 years we will be independent,” he says. “I think I should have started this work young, when I was 26. Those years spent doing general practice and teaching at university for 20 years, I think were wasted years.
“In Butajira, if I develop one shallow well I give service for two or three thousand people. It’s not comparable.”

loatway@thenational.ae