Abu Dhabi, UAESunday 25 August 2019

Blindness in the developing world is a female issue, but it doesn't need to be

Dr Zareen Khair talks about how she has made it her mission to change that in Bangladesh

Women in Bangladesh are more likely to suffer from eye problems than men, and yet they receive less care. Courtesy Fred Hollows Foundation
Women in Bangladesh are more likely to suffer from eye problems than men, and yet they receive less care. Courtesy Fred Hollows Foundation

Blindness shouldn’t discriminate, but it does. Currently, 55 per cent of people who are blind are women, and many of them live in ­developing countries. But that does not need to be the case, according to research conducted by the Fred Hollows Foundation. Four out of five people who are blind, shouldn’t be, it says, and that is something the foundation is fighting to change.

Restoring sight

During a visit to Dubai last month to mark International Women’s Day, Dr Zareen Khair, the Bangladesh country manager of the Fred Hollows Foundation, tells The National she has made it her mission to “restore sight to her fellow Bangladeshi women”. She also wants to help restore the sight of some of the most marginalised people in the world: Rohingya refugees.

Dr Zareen Khair is country manager of the Fred Hollows Foundation in Bangladesh. Courtesy Fred Hollows Foundation
Dr Zareen Khair is country manager of the Fred Hollows Foundation in Bangladesh. Courtesy Fred Hollows Foundation

Dr Khair is an extremely humble woman. She has been working for the foundation since 2008, having amassed 30 years of experience in global health already. Her interest in saving sight, she tells us, began when she read about the distribution of surgeries and noticed women were receiving 45 per cent of the treatments, and men 55 per cent, despite women being 1.3 times more likely to be blind than men. “I asked myself, ‘Why are women getting seen less often for surgery, when this problem affects more women than men?’”

Women and girls across the world have different needs, preferences and constraints

Dr Zareen Khair, Bangladesh country manager for the Fred Hollows Foundation

That is when she decided to focus on women specifically, with “grassroots” projects around Bangladesh. Dr Khair’s initiatives now include training post-natal workers, and going into factories to help restore workers’ sight. These projects work from the ground up and have the potential to reach hundreds of thousands of people.

“We know vision impairment and blindness have far-reaching implications, not only for the women affected, but also for their families,” Dr Khair explains. “To achieve the sustainable development goals, such as gender equality, and decent work and economic growth, as well as targets for Vision 2020, we must eliminate all forms of inequity in access to eye care for women and girls.

Our strategy recognises women and girls across the world have different needs, preferences and constraints.”

'Avoidable' blindness

Vision 2020 is a global initiative that aims to eliminate avoidable blindness by next year. The key word is “avoidable”. Dr Khair says there is no biological reason that women are more prone to blindness – aside from women’s longer life expectancy, which leaves them prone to eye diseases later in life. The Fred Hollows Foundation’s Restoring Women’s Sight study confirms this: “Studies show that the incidence of cataract blindness could be reduced by up to 12.5 per cent if women had the same cataract surgical coverage as men in low and middle-income countries in Asia and sub-Saharan Africa.”

Dr Khair’s initiatives now include training post-natal workers, and going into factories to help restore workers’ sight. Courtesy Fred Hollows Foundation
Dr Khair’s initiatives now include training post-natal workers, and going into factories to help restore workers’ sight. Courtesy Fred Hollows Foundation

A 10-minute operation can reverse the effects of cataracts and people can see clearly again, Dr Khair says. It’s a “minimally invasive” and cheap surgery, and yet Bangladesh has some of the highest rates of untreated cataracts in the world. One of the biggest reasons for this, and the prevalence of female blindness in the developing world, Dr Khair explains, is a lack of access to care. “Women tend to stay at home and care for their families, so they aren’t going to get routine medical care,” she says. “We soon learnt that to care for women, we had to advocate to the men. Husbands, fathers, fathers-in-law, were reluctant to let them seek care alone.”

Not a priority

Dr Khair says medical care is simply not prioritised for women. The foundation reports that treatment tends to be seen as more important for men, because women are rarely the breadwinners and “often lack a stable source of income and have limited decision-making power”. “People give more importance to the eye care of sons,” Dr Khair explains. “If they have money it goes on the boys ... but if women can see, they are empowered and they, too, can work.”

Women's medical care is seen as less of a priority, as they are not the breadwinners, Dr Khair explains. Courtesy Fred Hollows Foundation
Women's medical care is seen as less of a priority, as they are not the breadwinners, Dr Khair explains. Courtesy Fred Hollows Foundation

This is why Dr Khair’s initiatives are so important. By training maternal and post-natal nurses to carry out basic medical care, such as eye tests, and making sure they are able to identify and diagnose issues, women can receive the appropriate medical care in a timely manner. Meanwhile, women make up 80 per cent of workers in the textiles and garment factories in Bangladesh, and under Dr Khair’s initiatives they are being treated in their places of work, rather than waiting to visit a hospital.

Education is key

The foundation’s report on the matter lays out its strategy: “It goes beyond equality and recognises that women and girls have different needs, preferences and constraints. We are therefore placing women and girls firmly at the centre of our programming, service delivery, partnerships and global advocacy work. We are working closely with the local communities in each country to understand the pathways women follow in accessing eye care.”

It is crucial to educate people that going blind is not an inevitability. “Women simply accept blindness,” Dr Khair adds. “It’s like going grey – needing glasses and then going blind is accepted as part of growing old, and we need to educate people to know that doesn’t need to be the case.”

Besides the obvious human impact, there’s also a real financial benefit to providing decent eye care, says Alison Hill, the global head of communications for the Fred Hollows Foundation. “For every $1 [Dh4] invested in eye care in the developing world there is a $4 economic return, because it is one of the cheapest and most cost-­effective health interventions you can do,” she tells The National. “Investing in eye health makes sense.”

When you think about it like that, it’s very hard to understand why this is still a discussion.

Case studies

Testimonials have made all the difference to Dr Zareen Khair’s initiatives in Bangladesh. Teaching women about eye care has been one of Dr Khair’s priorities since she started her projects, and medical assistant Musfeka Najnin, 22, is a great example of why educating women can have such a positive impact on their health.

“A lot of children, women and old people go blind in our country,” Najnin explains. “So I thought if I became a doctor, I could give them medical help and save them from blindness. When I do the training, I tell the stories so they are aware of why health is so important. They listen to me really carefully and ask questions, and I try to answer as much as I can.”

I am happy I started this job, because I love working with mothers and children

Zinnat Ara, maternal health worker in Jessore

Najnin says that without this education “there would be more blindness in this area as they wouldn’t have known what to do.” The Fred Hollows Foundation says Najnin is one of 25,000 women who has received training, and already 12,000 schoolchildren have been checked for problems with their sight.

Zinnat Ara is a maternal health worker who treats people in Jessore. She has been working for 10 years and visits 20 houses a day, which can add up to 90 to 100 people. It’s people like Ara that the foundation wants to work with most. “I am happy I started this job, because I love working with mothers and children,” she explains.

The foundation adds: “We equipped many local clinics to carry out eye treatments, enabling these poorer villagers to receive affordable care in their home towns … now all the local clinics are full of patients, referred by the maternal workers, to have their sight restored.”

Updated: April 4, 2019 05:23 PM

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