Up close and personal in Uganda

I’ve always been rather squeamish, particularly about anything to do with eyes and have always hated hospitals. So working for an eye health NGO was maybe not the most obvious career choice. And to do it twice verges on the really quite strange.

But having decided to go back to Sightsavers, there would come the time when I actually needed to look at the business end of what the organisation actually does. After all, there’s only so many capacity building workshops you can attend without starting to behave rather oddly.

So there I was in deepest rural Uganda in a local clinic where there was a trachoma camp run by Sightsavers partners. It’s had been a while since I had been out in an African village but it all came rushing back. The stillness of midday under the glaring sun, with all activity slowed to a crawl. The patience of the people in the clinic , most of whom were clearly in pain but sitting quietly and making no complaint. Feeling terribly self conscious about being the rich westerner in a very poor place while the locals seemingly accept your (unexplained) presence without curiosity.

I was there to see trichiasis surgeries. I don’t know of any diseases which are innocuous but trachoma is truly horrible. It’s a an infection spread by flies which causes intense irritation of the eyes and turns the eyelashes inwards so they scratch the cornea. Untreated, this is a slow and agonizing way to go blind. Trachoma is a disease of poverty. You didn’t need to be told that the district we were in was an endemic area, the poverty stared you in the face.

The surgeries took place in a very basic facility. Outside the small room where the operations took place, a maternity clinic was in progress and the operations took place to a background of babies crying. No one else made much noise at all, least of all the patients who endured in complete silence. I was slightly taken aback to learn that there wasn’t a doctor in sight, the surgeries were being performed by students from a training centre for ophthalmic clinical officers (OCOs), paramedics essentially. Supervised by an experienced OCO. Uganda in common with much of Africa has very few qualified ophthalmologists and those that do exist mostly work in the capital in private practice.

Despite this, the surgeries were conducted swiftly and skilfully. The result is to correct the ingrowing eyelashes and antibiotics then treat the infection. The relief for the patients must have been profound.

I had very mixed feelings from this experience. One was something akin to pride, or at least affirmation. In our business, we all tend to make big claims about the causes we work for. After all it is our job to sell the work to donors. We have to simplify the complicated reality of our issues, turning messy real life into soundbites. There’s always the temptation to play up the role of our own agencies in situations where there are many actors. I don’t think any of us ever deliberately tells untruths but there is always the worry that we can misrepresent what is actually going on.

So it’s reassuring frankly when you see the reality on the ground support the marketing message. The fight against trachoma isn’t actually that complicated, here’s a horrible disease that we can genuinely eradicate in the next few years. We are making real inroads and thus transforming the lives of very large numbers of poor people at very low cost (the surgery I witnessed cost about £8, the T shirts I bought at the airport for my daughters cost more).

And while many organisations are working together to do this, my own charity is truly playing an instrumental leadership role. That is inspiring, actually, even for a hardened old cynic like me.

But, and there’s always a but. About half of the people at the clinic didn’t have trachoma but had other eye complaints, mostly which could be treated very simply. But the camp didn’t have the necessary drugs because the project budget only covered trachoma drugs. Many people have been turning up at camps like this with cataract blindness, which can be reversed with a simply, cheap (£30 or so) operation. There isn’t the money to do that either. So it was affirming to see the people who were being helped but deeply distressing to see those being turned away.

Well that’s the point of people like me, I guess. Or if there is any point to what we do, it must be this. There’s lots of unmet need here. We just need to get off our arses and raise more money. A lot more money. And quickly.

Oh, you didn’t think I was going to end without saying this; you can help too. Go here and you can make a difference to this issue now. And we won’t even make you post a stupid picture of yourself without makeup.


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