Dolma Tchiki, Seva Tibet Office

Dolma Tchiki works for Seva Canada, in their Tibet Office, managing eye care projects across the Tibet Autonomous Region.

The Tibetan region is different from the rest of china, in terms of climate, culture and religion, categorised as 'high plateau'- with very distinct weather patterns. I

t is Very cold, with a lot of snow on the mountains and elsewhere, with moderate summers. All Tibetans practice Buddhism, so there are many monasteries. The main population is divided into two groups: farmers & nomads.

Tibet is considered to have the highest prevalence of cataract in China. A regional eye care assessment was carried out by Seva in 2002, showing that blindness 1.39%, while 50.7% of this was due to cataract.

In the Tibet Autonomous Region, Seva provides around 70% of eye care services.

Seva has 15 years' eye care experience in Tibet, and the eye care assessment helped tremendously with VISION 2020 regional planning by various govt agencies and other NGOs. Since the assessment in 2002, Seva has also been able to do very solid planning for its eye health services. Seva Tibet works with 8 govt hospitals, and this is different from many eye care organisations who work only with private clinics. The experience has been very positive, and I was pleasantly surprised to find that we have received a lot of support, particularly from the regional government. I am very optimistic about the future of eye health care in the Tibet Region, especially since two years ago when the Chinese MoH increased budgetary support for cataract patients in Tibet. This money will help us to develop hospital infrastructure, and also to reduce cost of this essentia

l surgery to the patients themselves.

Seva developed a suitable, comprehensive eye care model for Tibet:

• annual eye camps in the Regions
• helping govt hospitals to build capacity
• [previously to Seva's intervention foreign volunteers were needed to provide eye care services because there were no local doctors with necessary training and competence] now, local doctors have gained confidence with the technique, and all cataract surgeries are now done by Tibetan practitioners.

Building local capacity is one of Seva's priorities. We train surgeons and other personnel. Although fully qualified ophthalmologists, many Tibetan staff did not have the skills even to perform cataract surgery. We initially sent doctors to China for clinical training, and later to Lumbini Eye Centre in Nepal for surgical training. Lubmini is dealing with a much higher volume of patients than anywhere in China, so it presents an excellent opportunity for ophthalmologists to get experience in a variety of surgical techniques.

Having returned to Tibet after 4 years' studying economics in the USA, I was overwhelmed by Seva's dedication to elimination of blindness, and decided to change my own direction from economics to health programming. In my role here, I document 'human interest' stories, which can be used to illustrate to donors the tremendous benefit of their contributions, however small.

An example of a case which touched my heart was when little girl of 7 years was brought to the clinic. She was very pretty girl, but I noticed that she was not very animated - she just sat on her mother's lap, very still and rigid. I asked the mother about her daughter, and she said that her girl had been blind for two years. Before that, she had been very active, with a bright personality, but had become increasingly withdrawn ever since. When I tried to engage the girl in conversation, she was very shy and nervous of being touched, or interacting in any way with a stranger. Ten minutes before she went into the operating theatre, I realised that she would not let go of her mother. It was so sad to see this beautiful girl, who should have been running around a schoolyard with her peers, but instead was as withdrawn and reserved as an eighty-year-old woman...

I visited her the next day, and was taking photos of the little girl and other patients. She was fascinated by the camera, and by everything around her - running around the room and examining everything she found. It was like looking at a different child! This transformation was almost instant - in just one day her personality, and her life chances, had utterly changed. This simple piece of surgery had opened up her world.

Seva Canada is very grateful to be part of VISION 2020. It allows us to exchange information and experiences with other eye health organisations, some of which can benefit our own work, while we can help others by sharing what Seva has learned in 15 years working in Tibet. I was lucky enough to attend a workshop on the subject of Gender and Blindness held by Seva's partner agency in Tanzania KCCO, where I presented some of my experiences here, and to learn from other programme professionals. It has been a real 'eye opener' for me! Watching other programmes from other countries teaches me tremendously - there are many more ways to reach female patients, than we have used in Tibet. Here, in terms of hospital-based care the take-up is dominated by men and boys, while in our eye camps more female than male patients attend for treatment. This disparity is largely due to difficulties in travel and transport. In a huge country, there are only 3m people, so density is very low, and it is difficult for women in particular to cover those sorts of distances alone.

Sightsavers' Eye Health Hero: Dr Hillary Rono

Dr Hillary Rono, an ophthalmologist and zonal eye surgeon for North Rift Region in Kenya has been named by Sightsavers as an Eye Health Hero for 9GA.

Dr. Rono currently serves a population of over 1.5 million, treating a range of eye health conditions, the most prevalent being trachoma and cataract and childhood blindness. The North Rift Region, where Dr. Rono is based covers 3 counties in Kenya, made up of Tranizoia, West Pokot and Turkana.

After completing his Master of Medicine Degree in Ophthalmology, Dr Rono to be posted to the North Rift Region, which is considered a hardship zone in Kenya. He has served as the Zonal Eye Surgeon since 2006. The region covers, amongst other districts, Turkana which has so far registered the highest prevalence of trachoma in the country. The prevalence of active trachoma (TF) in Turkana County is 42.3% while that of potentially blinding Trachoma (TT) in adults >40 years is 9%. This is way above the WHO threshold of 10% and 1% respectively and therefore is a major public health problem in this region. At the time of posting, the Cataract Surgical Rate in this region was 100 cataracts per million population. This has significantly increased to 820 cataract surgeries per million population , within a period of 5 years. Patients seen and treated rose from 7,000 per year to over 19,500 annually over the same period. This he attributes to team effort and the kind support received from partners, among them Sightsavers, The Fred Hollows Foundation, Operation Eyesight Universal (OEU) and the Spanish Doctors among others.

Dr. Rono has excellent managerial skills, coordinating outreach programmes to remote areas in Kenya . He has overseen the renovations of various eye units in the region, with support from different partners. The construction of Kitale Eye unit was supported by Operation Eye Sight Universal. Kapenguria Satelite unit was constructed and equipped with support from the Seeing is Believing Initiative, Standard Chartered Bank , while the Lodwar Eye Unit was constructed and equipped with support from the Spanish Eye Doctors. The Kitale Eye Unit , where Dr. Rono is based is the second-busiest eye unit in the county and often conducts surgeries on patients who have been booked for that day. His typical day begins at about 7.00 a.m with a phone call from or to the eye units within his zone to review the previous days work. He plans for the day with his team and proceeds to review patients who have undergone surgeries in the wards. If he is going to the field for an outreach or a mobile clinic, his day would begin even earlier, with travel over long distances to begin his work. Dr Rono also serves patients from neighbouring countries such as Uganda and Sudan.

Dr. Rono has done much valuable work on trachoma programmes, participating in all trachoma surveys in Kenya, and coordinating trachoma prevalence surveys in the Turkana County, Upper Eastern Zone (Isiolo, Moyale and Marsabit Districts), Transmara District and East Pokot. He carried out research and wrote a thesis on the use of height as proxy to weight in dosing azythromycine among Kenyan children and developed a height stick which is now used for dosing in Mass Distribution of Antibiotics campaigns. He co-authored an article in the British Journal of Ophthalmology entitled, "What is the appropriate age of participants for a survey to estimate the prevalence of trachomatous trichiasis (TT)". He has worked with programme and eye care staff in Kenya in reviewing data capture tools and subsequent development of the electronic eye health information system now used by eye care workers across Kenya. He is an excellent team leader, with enormous dedication to eye care work in his country.

Sightsavers Kenya is proud to celebrate Dr. Rono as its 9GA Eye Health Hero.

------------------------------------------------------------

All IAPB member organisations are encouraged to sponsor their eye health hero to attend the 9GA. At the 9GA, heroes will have the opportunity to meet the world’s leading thinkers in prevention of blindness, to survey the systems at L V Prasad Eye Institute, and even participate in one of the ceremonies or gala events. Help us highlight the many small everyday miracles that make VISION 2020’s goals possible: nominate your hero now!

Please write to Alessandro Di Capua at adicapua@iapb.org to nominate your hero, or for more information on the programme.

Pakistan's Dr. Rubina Gillani named Eye Health Hero(ine)!

World-leading Australian NGO, The Fred Hollows Foundation (FHF) has nominated its tireless Country Manager for Pakistan as an IAPB 9th General Assembly Eye Health Hero(ine)

Eye Health Heroes is an initiative by the International Agency for the Prevention of Blindness. All IAPB member organisations (including virtually every major international NGO working in eye health, professional bodies for ophthalmology and optometry, and disabled persons' organisations worldwide) are encouraged to nominate and sponsor an eye health hero to attend the IAPB 9th General Assembly (9GA) in Hyderabad, India, September 2012. At 9GA, these 'heroes' will have the opportunity to meet the world’s leading thinkers in blindness prevention, to survey systems at the award-winning LV Prasad Eye Institute, and participate in the Assembly's many ceremonies or gala events.

Dr Gillani is a medical doctor and public health specialist. Her role as Country Manager, which she started in 1998, means there is a lot of managerial work to do but Dr Gillani still sees herself as a 'field worker'.

Dr Gillani spends half of her time in the office and the other half travelling extensively throughout Pakistan. Often she needs to travel up to twelve hours to get to a remote community. During this time she does most of her observing; of women and children and of the poverty apparent throughout the country. "Reaching the population of Pakistan is not easy," says Dr Gillani."It is also very hard to change attitudes. The Foundation has come out with a multi-pronged approach. We have trained the doctors, held eye clinics, used accredited facilities and introduced quality into the recipients' perspective... That has been challenging."

Dr Gillani is crucial to The Fred Hollows Foundation's programme in Pakistan. Without her determination, strength, knowledge and ability to 'get the job done', the success of FHF's work so far would not have been possible. "Besides doing my job working towards reducing cataract blindness rates, I feel that in a country like Pakistan where it is very different and conservative, I am also working towards the cause of women," says Dr Gillani.

------------------------------------------------------------

Register for 9GA here.
Please write to Alessandro Di Capua at adicapua@iapb.org to nominate your hero, or for more information on the programme.

Ethiopia's Dr Alemayehu Sisay is Eye Health Hero!

Ethiopia's Dr Alemayehu Sisay MD is IAPB's first Eye Health Hero.

Eye Health Hero is a novel initiative by the International Agency for the Prevention of Blindness (IAPB) where all member organisations (including virtually every major international NGO working in eye health, professional bodies for ophthalmology and optometry, and disabled persons' organisations worldwide) are encouraged to nominate and sponsor an eye health hero to attend the IAPB 9th General Assembly (9GA) in Hyderabad, India, September 2012. At 9GA, these 'heroes' will have the opportunity to meet the world’s leading thinkers in blindness prevention, to survey systems at the award-winning LV Prasad Eye Institute, and participate in the Assembly's many ceremonies or gala events.

ORBIS, the international sight-saving organisation has nominated Programme Manager and Ophthalmologist, Dr Alemayehu Sisay MD, as ORBIS's Eye Health Hero.

Working in southern regions of Ethiopia to tackle trachoma, Dr Sisay's work is tireless and incessant. Dr Sisay is a hands-on Programme Manager, travelling to rural areas and remote health points. As an ophthalmologist himself he assesses projects, makes recommendations and assists with the continued professional development of the eye care professionals working to eliminate trachoma.

Such is his passion for the cause and his overriding sense of duty, Dr Sisay stops people in the street if he sees they or their children have symptoms of trachoma. He examines them and directs them to the nearest source of help, all whilst on his way to meetings or programme assessments.

Image: Zithromax antibiotics distribution. Copyright ORBIS, Raul Vasquez

Ensuring that trachoma is eliminated in the southern region of Ethiopia is our goal and using the WHO SAFE strategy we are making great inroads.

Dr Sisay has also been doing cataract surgery in remote rural health facilities, which was the first of its kind. This approach had made cataract surgical services accessible and affordable to poor and needy rural communities. This approach has evolved into SECUs' being established in rural projects. Moreover, he has been training nurses on basic refraction to perform school screening, and provision of spherical lenses for school children.

Image: Ethiopia - Trachoma in Gamo Gofa. Copyright Raul Vasquez 2002

ORBIS is proud to celebrate Dr Sisay, in Ethiopia and across the world, and all those doing fantastic work to eliminate avoidable blindness in developing countries, at the IAPB 9th General Assembly in India, 2012.

---------------------------------------------------------

Register for 9GA here.
Please write to Alessandro Di Capua at adicapua@iapb.org to nominate your organisation's hero, or for more information on the programme.

Moving Towards VISION 2020 in Niger State - Dr. Isah Jibril

Dr Jibril was in London last week to present the findings of his project, and to mark his successful completion of the MSc in Community Eye Health at the International Centre for Eye Health at London School of Hygiene and Tropical Medicine. He kindly

contributed the following to our blog:

As Coordinator of the Eye Care Programme in Niger State, Nigeria, I have a big remit to carry forward the VISION 2020 objectives of my State.

Niger is the largest of Nigeria's 36 states, with a population of 4.5 million people spread across 12 million acres - 40% of which is water, and getting around the State can be a challenge! Around 80% of people in Niger State make their living through agriculture or fishing. It is not an affluent population, and blindness or vision impairment can have a big impact on a family.

According to the Nigerian Blindness Survey which took place between 2005-07, around 25,000 people in Niger State are bilaterally blind, 13,500 from cataract alone. Around 1,200 more people go blind from cataract every year - a daunting prospect for our Eye Care service.

In addition, 21 of the 25 local government areas receive annual ivermectin treatments to address the persistence of onchocerciasis or 'river blindness' in Niger State. This was the focus of my project for the MSc - examining coverage and outcomes from the ivermectin distribution programme.

Looking at the situation holistically, if nothing is done in the next five years, Niger State is likely to have around 17,000 people blind from cataract alone. For us to be able to plan according to VISION 2020 guidelines will be essential to addressing this situation. I believe that with a well-drafted plan in place, we will be able to make a real difference.

Before embarking on this training, as a clinician I could devote only 30% of my time to prevention of blindness in the community. Since taking the CEH course, I spend up to 80% of my time on community ophthalmology - a much better way to benefit more people.

One of the most important challenges we faced before was achieving the inauguration of a state Committee for Prevention of Blindness. When I returned from the course in September 2010, I swung into action with advocacy visits to policy-makers at State level, and at last the Committee was formed in November last year. The effect has been felt already, with government support for positive policy changes for eye care.

Another challenge now is to convince eye health NGOs to work with us in Niger State. At present, apart from UNICEF which is involved in ivermectin distribution, no NGO supports eye care programmes in my State. I hope that the development of an effective State action plan for eye care will attract NGO support. I hope eye health NGOs will take note of this message - Niger state could be a great opportunity for them to help make a big difference!

When I return home, an urgent priority will be to contact several eye health NGOs, both in Nigeria and here in the UK, to partner with the Niger State Eye Care Programme, and help us to achieve our VISION 2020 goals.

I am grateful to Almighty God, and also to my Mentor Dr. Abdullah Usman Imam at Niger State MoH, whose support and guidance have helped me lay the foundations of my career. Dr. Imam took the MSc in 2003, and the State Govt generously supported my training so that I may follow in his footsteps.

Thanks to VISION2020, Lions Club of Perugia, Italy and Lions of Limbe, Malawi are to help blind children in Phalombe, Malawi

These days one receives so many scam and malware-ridden emails, imagine a stranger writing out of the blue, offering to give you USD 10,000 if you get back to them. Most of us, me included, would disregard such an email or trash it - as I almost did years ago. Thank God, I did not delete one particular email and this is why as I am blogging, now that USD 10,000 has been transferred to the Lions Club of Limbe in Malawi to help the blind and visually impaired!

You see, Lion Marco Terzetti of Perugia Lions club in Italy had by chance came across my blog site in December 2008, and was fascinated by my articles on VISION 2020 - the global initiative to fight avoidable blindness and what was being done in Malawi, especially with regard to blind and visually impaired children. At that time I was blogging frequently about the project I was launching in Southern Malawi to help blind children and the challenges we were facing in Malawi. In all honesty, I wasn’t blogging to ask for money from anyone. So when Marco emailed back with a few words saying “email me back to collect a cheque for your project in Malawi”, I said to myself here we go, another Nigerian email claiming that thousands of dollars have been left in a bank in Abuja and that I should help and get a 50% share ( and I do get a lot of these emails lately :)

Putting my trust in God, I replied to Marco asking how this was going to be possible; after all, what was his interest as he didn’t know me?

The rest is history (email me to know followed after that), but I am proud to announce that through my blog site, the Lions Club of Limbe Malawi have benefited from Lions of Perugia, Italy with a grant of USD10,000 to support a project for blind and visually impaired children in in Phalombe, Malawi.


I came up with the idea that the project should take place in Phalombe. Lions Clubs are very strong supporters of VISION 2020 and the first phase of their projects concentrated on infrastructure development –which for Malawi resulted in Lions clubs building 4 Lions eye hospitals and donating them to the Government. I work at the biggest Lions SightFirst eye hospital in Malawi, which is located at Queen Elizabeth in Blantyre. The second phase of the Lions Project concentrated on supporting surgeries to reverse blindness from Trachoma and countries like Ethiopia have massively benefited from the Lions Fund.

Ironically, the VISION 2020 office is in London at the International Centre for Eye Health where I am based when I am in London. This is not the only reason I am a strong advocate of VISION 2020!

I am happy for now that through this VISION 2020 initiative and the partnership with Lions club, the poor blind and severely visually impaired children in Phalombe, Malawi will be helped. Meanwhile I continue exploring other avenues to promote VISION 2020 in Malawi.

Sorry I forgot! I am a Lion member myself even though I am not in the picture with the Lions of Limbe. Y can see me among the children in my red polo t-shirt. The Phalombe project is for 2010-2011.


Want to help?

Any ideas?

What do you say?

Khumbo Kalua

"Her Sight is Worth It"

World Sight Day is around the corner and here at Seva Canada we have a host of local and national events aimed at raising awareness of blindness among girls and women. Our national video contest, Her Sight Is Worth It (http://www.seva.ca/contest.htm), has been featured in Canadian Teacher magazine and the BC Teacher's Federation newsletter. The idea is simple: create a 3-minute video on the topic of gender and blindness. Winners will be featured in the World Community Film Festival in 8 locations across Canada starting in January 2010.

On World Sight Day itself, Seva Canada is having a party. Two hundred people will be attending Seva's Eye Opener Benefit in Vancouver, featuring a 9-piece R&B dance band, a silent auction, door prizes and our special guest, Dr. Paul Courtright, the world expert on gender and blindness. Dr. Courtright arrives this evening in Vancouver and will be in Canada until October 11, where he'll be meeting with government representatives in Ottawa and Vancouver and doing media interviews about his work in Africa with the Kilimanjaro Centre for Community Ophthalmology and the barriers that women and girls face in accessing eye care.

Seva Canada is using World Sight Day as a launching pad for a year-long campaign to raise awareness about the 30 million women and girls who are blind. That is a staggering number... almost the population of Canada. It's been said before that people don't go blind by the millions, but one personal tragedy at a time. Here's a story we just got from the amazing team at Seva Tibet about one of those 30 million tragedies...

Chime Dolkar, blind from bilateral cataracts, has spent the last two years barely surviving by begging on the streets of Nakchu, nomadic town at an elevation of 4500 meters in northern Tibet. Since the age of 4, her little daughter Tashi has led her blind mother by the right hand through the streets, trying to get enough food to keep them both from starving. At night, they would crawl into a small and nearly worn-out tent stationed near a bridge in the upper town.

There were times Tashi, now 6, begged by herself, telling her mother to rest in the tent. Several weeks ago, Tashi was begging on the street where the Civil Affairs office was located when an official, who was aware Chime’s blindness, told the little girl that a Seva medical team from Lhasa would be doing free surgeries for the blind and would be arriving in one week. He encouraged Tashi to talk her mother for treatment.

Tashi ran back to the tent with the great news. Chime reacted rather indifferently from hearing it and responded, “Surgery? Why would I want that? I am destined to become blind. It’s better for me to comply with my fate.” Poor Tashi didn’t really understand that much about destiny, fate and all that complicated hypothesis, and disagreed with her mom by saying, “Nothing is fixed. If you keep trying to change things for the better, what you call ‘fate’ will be different. Why don’t you try the surgery? It’s free. Please give it try, mom, please!”

Chime agreed, counting off the days until the Seva-funded medical team’s arrival. As each day passed, their excitement escalated. When the medical team arrived they diagnosed Chime with bilateral cataracts and on the first day of the camp Chime’s had cataract surgery on her left eye. Later, on the third day, she had surgery on her right eye.

Nothing in her 48 years of life had so transformed Chime’s life as listening to her daughter’s advice and regaining her sight through surgeries. Until then, Chime said that her life was “totally meaningless and a failure”.

The sight-restoration surgery has given Chime new hope and confidence. She is anxious to re-plan both her and Tashi’s life. No longer forced to beg, Chime is planning on asking the local government for a job at the Nakchu train station. Smiling, she says, “I will be very happy if I can work at the railway station…I can work as a garbage cleaner or security guard.” She gazes at Tashi and continues, “Tashi should be going to first grade of elementary school. Wow, life is not that bad after all!”

Her sight IS worth it.

Heather Wardle

Development Director

Seva Canada Society

100-2000 West 12th Ave.

Vancouver, B.C. V6J 2G2

Tel: 604-713-6622

Fax: 604-733-4292

www.seva.ca

You can give the Gift of Sight now. Click here to donate.