Sambani is from Kalonga Village in Lilongwe District.  He lives with his parents and four siblings.  He had been blind for two years, and had stopped going to school last year.  He had been doing well at school, and told me “I was an intelligent boy!”  He was in standard 4 but his low vision “made me to be a useless boy” he said.  I couldn’t believe what he was saying.

Sambani in the Clinic

He lives with his father and mother and four siblings, and they were looking after him.

Sambani after his second cataract operation

Sambani told me and nurse Rose, that he is now going to continue his education because he is “still young”.  He wants to be a driver or a teacher.

Sambani

It will be great to take Sambani back home today, so he can be with his whole family again, and then start school again next week when school opens for the new year.  We will try and meet him again in a few months to see how he is doing.

Pieter, the South African missionary living near Monkey Bay phoned me yesterday.  There are many people he has met in the villages who would like to, or need to, come to Nkhoma for their eyes.  Lumbani will be heading down on Sunday with the ambulance to help collect them. We will try and meet with Mary who lives nearby, and see how she is doing, 4 months after her surgery!

Around 80% of blindness is avoidable (as in treatable or preventable); and 90% of blind people live in low income countries.

We are winning the war on blindness!

Looking into the dawn of a new decade towards 2020

But a lot of momentum has to keep building to increase efforts even further in the next 10 years to keep going until the job is done..

Thursday 14th is World Sight Day!  An international day of awareness to focus attention on the global issue of avoidable blindness and visual impairment.

80% of global blindness is avoidable.

4% of the World’s population are blind or severely visually impaired.  That’s four times the population of the UK!  It’s truly staggering, but we are also celebrating.  Yes there is a lot of need indeed, but we are winning the war on blindness.

It is incredible to think that CBM have with 102 years’ of disability and development experience and expertise performed over 10 million cataract operations.  And together with the WHO and the International Agency for the Prevention of Blindness, the burden of avoidable blindness is being tackled.  We need to carry on this work, and increase even more as we count down to 2020.

Mrs Samuel in her village before coming to hospital

Mrs Samuel back at home, a month after cataract surgery

But, it’s numbers.  Numbers that I can’t really get my head around.  What really counts to me, the staff at Nkhoma, and most importantly the patient… is that the 10 minutes, or even 6 minutes it takes for that cataract operation (and £20 donated by a kind supporter of CBM) will change that individuals life.  Forever.

New sight, New Life

Or as we say in Nkhoma…

Kuona kwa tsopano

Moyo wa tsopano

In line, waiting for surgery

Mrs Kadzichi back at home in the village

Jacaranda trees are in full bloom, and signify the start of the hot spell of October, before the amazing flame trees blaze across the countryside in November to announce the start of the heavy rains and spectacular electric thunderstorms in December.  The regular rains will only begin around Christmas time, but the next few months are among the most incredible in rural Africa.  I’ll get some shots of this remarkable change over the next few weeks to show.

We went into a village the other side of Lilongwe on Monday to see a couple of patients that had been to Nkhoma, and others that could come for help.  The picture Katrin took was amazing and it really stunned me.

The view is incredible.  A vast vista of space with fields and patches of trees, and real African beauty.  There is even two slices of fields in the distance that have already been raked in preparation for planting maize.  The house is however a simple mud hut, and the grass mat the only piece of furniture for the family.  The gentleman on the right is Mr John Round.  He had his cataracts operated by the Nkhoma team last month, and was very happy.

Mr John Round's stunning view

What stuck me is poverty.  It’s been nearly 3 years that I have been living in Malawi, and my house is on the edge of Nkhoma Mission village  with lots of mud huts around the valley.  We have had the chance to travel and see the Lake of course, as well as Zomba and the great metropolis of Blantyre.  But this comfort of my house with electricity only cutting out two to three nights a week, the tarred road to Lilongwe and the restaurants and fairly super markets there; and many of the comforts I see here hide the economic reality of the majority of the country; of people like Mr John Round.

We sometimes ask whether it is possible to ask people here to pay a little towards their cataract operations, or other treatment.  And the answer most of the time is simple.

There is a great definition of humanitarianism.  It is an attempt to honour the dignity of a person, who does not have a choice.

With CBM’s continued support of the work of the team at Nkhoma, this attempt can continue!  And the goal of eradicating avoidable blindness in Central Malawi can be achieved.

It’s a bold idea, and one that I and the team here don’t often get the chance to sit down and really consider.  We usually just get on with the work at hand!  But the photo of John Round and his family;  the great view, great happiness and also great poverty was a contrast that brought much of the realities of work and life here into sharp focus.

Glaucoma is the second main cause of global blindness, after cataract.  It is a condition that slowly affects the optic nerve at the back of the eye, and is often associated with high pressure in the eye.  Untreated, the high pressure destroys vision causing tunnel vision, and perhaps eventual blindness.  People here in Africa tend to be affected by a more aggressive form of the potentially blinding condition than say for example in USA or Europe.  Sadly though, because it is so slow to progress, people often become blind before they seek help here.  At Nkhoma last year I looked at all the glaucoma operations we did, and two-thirds of patients who we operated on were already blind in the other eye.  We are trying to start a screening program to detect glaucoma in the early stages, when we can treat it and stop the loss of vision.

All the same, what I basically do is to treat the high pressure, and thereby stop the loss of vision.  Here we do this with an operation called a trabeculectomy, which adds a little drainage outlet at the top of the eye to continuously relive the pressure.  It’s a lot more tricky than cataract surgery, but we get good results.  Another tricky thing is that I need to keep a close watch on the eye after the operation, for weeks and months.  We ask people who have this operation to stay at Nkhoma for a full two weeks after surgery, and then when they go home, we ask them to come back after a month, then after another couple of months.  But Nkhoma is far from some peoples’ villages; and less than half actually do come back.

Mr Edward Richard did come back.  In fact he kept coming back every month for the past 6 months since I did both of his trabeculectomy operations at Nkhoma in September and October 2009.  Mr Richard is a businnesman, and importer and shopkeeper in Lilongwe.  At 35 he is married with 3 children.

Mr Edward Richard

When I saw Mr Richard last year, he said the vision in his Left eye had been deteriorating over the past 3 years.  In fact he was nearly blind in this eye.  His right eye also showed signs of glaucoma.  Without any warning or pain, glaucoma had been robbing him of his vision.

Both operations went well, and when I saw him last week, World Glaucoma Week, the pressure in his eyes were well down, and his vision was stable, and in fact actually improved a little (which is unusual).

We had carefully explained to Mr Richard, as we do to all people who need a glaucoma operation, that the surgery will not give them back their vision, like cataract surgery; but will prevent their vision from getting worse.

I had 4 patients for glaucoma operation on the list for World Glaucoma Day.  Nkhoma Ophthalmic Nurse (and Nkhoma Eye Hospital employee of the month for February !) Vincent Saka counselled them, answered their questions, and put their minds at rest, that although we may not be able to restore what sight they may have lost; we could offer an operation to prevent blindness.  They all accepted and the operations went well.  I will be heading into the hospital this morning to see them all, as they are staying in for a couple of weeks.

Glaucoma patients at Nkhoma on World Glaucoma Day

Finding people with the early stages of glaucoma, and then treating them before they lose their sight is a huge challenge in rural Africa.

We are training medical staff in primary health centres in surrounding districts & villages as far as 100 miles away, to perform vision screening on people over the age of 40.  We hope to be able to reach many more people with glaucoma, before, for them it is too late.

Happy World Glaucoma Day from all at Nkhoma!