Wednesday 30th August – Part 2
In the afternoon we visited a health centre, to meet a village health team. These are all volunteers, who are trained by the local government in a wide range of health issues, including eyecare. They then encourage people in their community to come to the centre if they have problems. They had pulled together a drama group of young people, who performed a series of sketches and songs which were aimed at educating people about eyecare. (They also showed us one about HIV/Aids). I was taken aback at the high quality of the performance, although it was a bit sobering to see the casual acceptance of domestic violence as a key cause of eye trauma. They included a section on traditional healers, with a satire on witch doctors – it was clear that many in the community fully understood the need not to use traditional herbs for eyecare, (they can exacerbate corneal damage) but we still saw evidence of it everywhere.

Wednesday 30th August – Part 1

Still at Jinja, we spent the morning visiting a school and a blind child (at home as school was on holiday other than for those doing revision for public exams). At Budondo school we met an itinerant teacher, who covers both visual and hearing impairment needs. This teacher was responsible for 24 schools in the district, as well as teaching science at Budondo. Not all the schools had children with special needs, but this was still a workload which was too much for one man on a bicycle. He was only able to visit each school about once a month. The teachers are not paid extra for this, although it did make them more likely to gain promotion – this teacher had become the Deputy Head of Budondo, which of course added to his workload! Apart from this, his main concern was the limited number of Braille books available.

We visited Susan, a 9 year old girl who had suffered cerebral malaria when she was about 3. This had left her totally blind. She also had trouble with her legs, but it seemed that this might have been because her mother had assumed that she shouldn’t walk, as she seemed to be improving her mobility since going to school. She looked about six. Her mother was homeless, and she moved around before the school had found her. She sang a number of gospel songs, and had a beautiful voice. It was hard to be optimistic about her future, as she lacked the supportive family which Dennis had.

Tuesday 29th August – Part 2

I saw my first case of trichiasis in Jinja. We met an old lady who had had a trichiasis operation some time ago, but her vision had been badly damaged before we had found her. She was now totally blind as she also had a cataract in the one eye which had retained some vision. A number of the blind people we met on this trip had more than one problem, which complicated the question of whether and how to operate.

In the afternoon we met Dennis, an 11 year old boy, blinded by measles followed by the use of traditional herbs at a young age, who had only been going to school for about a year. His parents had thought that blind children were incapable of this until the local village team discovered him and referred him to the project. He is now able to find his way around quite well – he is able to find the latrine, walk to school or to the local market. He washes his own clothes and has started his own patch where he is growing vegetables. Although still very shy, he had clearly made stunning progress in just a year. As an aside, I couldn’t help but compare what a young blind child is expected to do in Africa (wash his own clothes, grow food, walk several miles to school alone) with what a sighted child is expected to do in the UK, and wondered at the different levels of independence!!

Tuesday 29th August – Part 1

We set out first thing for Jinja. We fund a major Comprehensive Eye Services (CES) project called ‘Busoga CES’, and Jinja is one of the districts which is part of the overall programme. I confess to a childish excitement at the fact that we briefly visited the source of the White Nile, although it is now much less dramatic than when Speke discovered it, as the dam has changed the river from rapids to one which is wide and slow – it is hard to see where Lake Victoria ends and the Nile begins!

Our partner in Jinja is the local district government. We were escorted by a number of their key people including Moses Wakaisukaki and Lydia Namuwaya. They were clearly well on top of their roles, and both were well respected in the community. They took me to meet a number of beneficiaries who had received rehabilitation training of various kinds. This included functional literacy for those who had been able to read before going blind, and help from the National Agricultural Advisory Service, who provided piglets or goats and training as to how to care for them to those who had been farmers.

I was rather shocked that one of the biggest concerns several had was that their white canes were being stolen. Apparently the local witch doctors think that a white cane has ‘guided a blind man through the world’ and is therefore a symbol of good luck which can ‘show you the way’. They were stealing wooden ones, breaking them up, boiling them and then selling the remains as allegedly powerful spells. It is hoped that this problem will reduce as we now distribute metal canes. This was the first time in my travels that I have heard such a thing.

There was an increasing emphasis in the CBR schemes I saw in Jinja on income generation. Obviously we still cover mobility and orientation, personal living skills and subsistence agriculture, but at the Jinja Association of the Blind it was clear that people were clamouring for more help to be economically included not just socially included. I think we need to consider how we can do more for people in this area.

Monday 28 August – Part 3

In the afternoon the Uganda country office gave me a presentation about their work. The areas we work in have a high level of visual impairment. There is a significant amount of trachoma in many areas, and residual blindness amongst some of the older people from the days when oncho (river blindness) was rife. We have submitted a proposal to International Trachoma Initiative (ITI) for parts of Uganda to be included in the Pfizer azithromycin donation project, and are optimistic that we will be successful.

Education for visually impaired children seems to be further advanced in Uganda than in some of the other places I have visited. There is universal primary education, where everyone is now entitled to 7 years of education. However, there is still the usual issue of equipment, Braille books and adequate teachers to ensure that all visually impaired children can benefit. The numbers involved are significant when you take into account the fact that the average number of children per woman in Uganda is seven. I was worried about what happened to all these children after primary education – apparently the President is seeking to introduce universal secondary education next year.

One major challenge which our programme faces is that the number of districts is proliferating. We work closely with government at the district level, and each time a district is split, there is pressure for us to duplicate project management, which obviously increases costs.

Monday 28 August – Part 2

Around mid morning we set off for the Ministries, to meet the Minister of State for Disability and Elderly Affairs (Hon SK Madada) and the Minister for State for General Duties at the Ministry of Health (Dr Richard Nduhura).

The meeting with the Minister for Disability and Elderly Affairs was very constructive and went beyond the usual courtesy visit. It was agreed that Sightsavers should sign an MOU with the ministry to cover CBR activities.

In Uganda we work closely with the government in CBR, rather than relying on faith groups as we currently do in Ghana. We have MOUs with local government, but Ben Male was very keen to formalise an overall MOU with the ministry, and they clearly wanted this too. The ministry was sponsoring a ‘week of the elderly’ in October, and wanted Sightsavers to become more involved. They also invited us to sit on the national steering CBR committee.

The meeting at the Ministry of Health was more of a formality. We did however hear from Mulago hospital (the main national referral hospital) about their need for $1.5 million to build a new eye unit, and the need for a new ophthalmologist for the Hoima eye unit (built by Sightsavers). We clearly have a good relationship with the Ministry.

Monday 28 August – Part 1

I began the day by meeting the Uganda Country Office staff. Johnson Ngorok, the Deputy Regional Director for our East Africa Regional Office, was also with us. I held a surgery, talking through where we stand against our organisational objectives and some of the issues we currently face. These included the progress made so far towards Global Working and the imminent staff survey, in which all staff are being encouraged to share their views. This will be the first ever comprehensive survey of all Sightsavers employees.

I was asked a number of questions. They were particularly keen on the new Community Based Rehabilitation (CBR) policy, and were looking for more guidelines and training on how it should be implemented One area where there is definitely some confusion is in how forecasting and accounting work together. I was very pleased to see how Finance worked very closely with the programme people – they were clearly a single country team rather than ‘programme staff’ and ‘finance and admin’. I was also pleased that the concept of the staff survey was received positively, and hope we get a good response!

Today I arrived safely after an uneventful trip from Heathrow to Kampala via Entebbe and Nairobi. Somewhat to my surprise - given recent events - my baggage also arrived with me.

My trip to Uganda has three main purposes:

a) To meet the staff of the Uganda Country Office, to talk about how our organisation is performing and our key themes and activities, as well as to listen to their concerns and issues
b) To visit a range of projects and meet a number of partners to give me a better insight into issues in Uganda.
c) To meet a number of Ministers to build on the existing governmental links and to advocate for higher priority for eyecare and social inclusion for visually impaired people.

It’s going to be busy, but I’m looking forward to it!

July has been a relatively quiet month for me, although the irony has been that the heat and humidity of my small, un-airconditioned hotel room in Geneva (for a WHO meeting about the strategy of Vision 2020 for the next 5 years) was far in excess of anything I have experienced in Africa!

The Geneva meeting brought together many eyecare agencies and ophthalmological societies with WHO. One of the great things about this sector is that the NGOs collaborate with one another to try to ensure that we work more effectively against the common enemy of avoidable blindness, rather than competing to say ‘I did more cataract operations than you’. It is a refreshing change from the commercial environment I worked in before Sightsavers.

A number of important themes came out, particularly around our priorities for which diseases to concentrate on. Our fight against trachoma and river blindness is really bearing fruit, with the numbers of people suffering from these diseases (mainly in Africa) on the decrease. Obviously we need to continue our work to ensure this trend isn’t reversed, but it also means that other causes such as diabetic retinopathy and glaucoma are now much more significant from a percentage point of view. The whole eyecare community has been taken by surprise to see how diabetic retinopathy is increasing significantly even in developing countries – notably in Asia, as it had been perceived wisdom that diabetes was only a real problem for those living Western lifestyles.

We therefore agreed that we must put more resources into these diseases, even though they are more difficult to treat in the field.

Another key theme was that refractive error (simple short or long sight) actually affected a huge number of people. Lack of access to glasses means that many people in developing countries are effectively blind just for want of spectacles. WHO should soon be releasing some research showing just how many people are in this position, but early indications are that the numbers are shocking.

At Sightsavers we intend to scale up our work in this area. We do not send second hand glasses overseas – this really doesn’t make sense as it costs less to import new ones in bulk from places like India and China, and these are usually much better. By the time you have cleaned and sorted old spectacles, the cost is uneconomic in comparison. We are looking at how we can get appropriate glasses to people, particularly children of 11 – 15, being the age when refractive error usually develops in earnest and starts to have an impact. Of course this is when it can then hamper their education and which can have lifelong implications.

In July we have also welcomed two new trustees to Sightsavers – David Sands Smith, who has many years of experience working for DFID overseas, and John Lafferty, an extremely impressive Glaswegian judge, who has been completely blind since his twenties.

Next month I shall be travelling to Uganda, where I will be visiting schools and eye hospitals and getting an understanding of the challenges we face there.

Last week was Sightsavers Annual Meeting, where the Country Representatives from our overseas offices all congregate in a Brighton hotel to share experiences and learn from each other. It is always a tremendous experience for me as I get the chance to talk to the people who actually deliver our work overseas and who understand the real problems and challenges we face on the ground. Our Country Reps are employed locally (we aren’t an organisation that employs armies of ex pats!) and they have a deep understanding of the issues their countries face.

We started the meeting with a piece from me setting the scene and letting people know how we are doing so far in 2006. I had good news to tell, as our income so far this year is up compared to the same time last year. We still need much more though as we only really scratch the surface of the need that is out there. We were all very pleased about the resolution passed by the WHO recently to priorities the prevention of blindness. It gives us a great platform which we can use to persuade governments to put more money into their eyecare budgets (or in some cases to put in anything at all!)

We covered a range of issues from the need to ensure our own people were getting the training they needed to be effective to rather more mundane things like how to manage accounting and IT across an organisation working in so many different countries. We also discussed how we could increase our fundraising activities, in particular how we might expand our fundraising base beyond the UK and Ireland and how we could get more money from donors such as DFID (the UK Department for International Development).

We then spent quite a bit of time looking at how we could make sure that the programmes we develop will last for the long term. The best measure of our success in a country would be if we could leave it and put our money into a more needy place, safe in the knowledge that we had left behind eyecare services which would be able to continue without us. It is of course very difficult and there are no easy answers...

Finally we started the process of pulling together our next Strategic Plan – quite a big challenge when we have so many organisations to consult to make sure we are going in the right direction.

We sometimes worry about whether holding meetings like this is a good use of funds, but any fears I had were definitely allayed by the experience. Email and phones are wonderful inventions, but at the end of the day the benefits of people all meeting together to compare notes and make sure they learn from each others experiences and not just their own are incalculable.

For me, though, the highlight of the week was a dinner at my flat in Brighton which I gave for our Regional Directors. The four of them (from India, South East Asia and two from Africa) together with our Director of Overseas Programmes were treated (subjected?) to my cooking. It was a beautiful warm evening, and a marvellous opportunity for me to get a real understanding of what our work is all about.

My trip to Ghana - Day 5

The day began with a meeting with Dr Agatha Aboe from International Trachoma Initiative (ITI), Philip Downs from The Carter Centre and Dr Maria Hagan, the Head of Eye Care Unit, Ghana Health Service at the WARO offices.

ITI work in the Northern and Upper West regions, where trachoma is known to be prevalent. As there is no full survey of Ghana it is not known whether trachoma exists elsewhere, but they were pleased to hear that we are considering a survey of Upper East region which would at least give a clearer idea of the situation.

The aim is to declare Ghana free of trachoma by 2010. There is currently a backlog of about 9,000 trichiasis operations, but the distribution of azithromycin (an antibiotic) has reduced the incidence of new cases.

We discussed whether there were any ways in which we could cooperate. There’s no scope for co-distribution of azithromycin and mectizan, partly because the Ghana Health Service only allows antibiotics to be distributed by health workers, not volunteers. Also partly because - according to Dr Hagan – there’s no knowledge as to whether the two drugs might interact, so they’re never given together. However, it was thought that training of ophthalmic nurses in particular could be integrated.

Philip Downs was focused on latrine construction, i.e the Facial Cleanliness & Environment part of the trachoma strategy, although the initial driver for the Carter Centre’s work on this had been to reduce incidence of Guinea Worm. There was concern that the emphasis has been placed more on the provision of water and less on sanitation.

My Trip to Ghana - Day 4 (part 2)

We went on to visit an outreach clinic being run by the ‘John Wilson Optical Centre’, which in turn is run by the EP (Episcopalian Presbyterian) Church. The optometrist and ophthalmic nurse were both very keen, but there is clearly a major problem with this project. It was originally conceived some years ago to raise funds for the rehabilitation project that EP church also ran. The assumption was that it could sell glasses for a profit which could fund the rehabilitation work. The problem is that the area in which it operates is very poor, and the people cannot pay enough for the glasses for the centre to break even - let alone make a profit.

We went on to visit the eyecare centre at the hospital, where we sponsor an eye clinic. The hospital was also seeking a lot more support from us (as was everyone), although I had to smile at the request from the ophthalmic nurses that they should be sent on courses in the UK. I asked whether there were no equivalent courses in Ghana or neighbouring countries. ‘But we would like to visit the UK’ they said. Am I just being suspicious in thinking these are young people who are hoping to find work in the NHS? Ghana is littered with posters from banks advertising how to send money from abroad, and the pictures on them are mainly of nurses. Needless to say we didn’t agree to this request. I gather that the problem of the brain drain hasn’t affected ophthalmology particularly badly in Ghana, not least because the ophthalmic nursing qualification that we sponsor isn’t recognised in the UK.

Whilst at the hospital we called briefly on Dr Awade, the Director of the Onchocerciasis Research Centre which happens to be based there. Dr Awade is doing research on new drugs for oncho (river blindness), which have a much longer half life in the body than mectizan and will hence be more effective – possibly meaning that it will no longer be necessary to provide drugs every year for at least twenty years.

From here we travelled back to Accra for a welcome early night.

My Trip to Ghana - Day 4 (part 1)

We travelled to Hohoe. Here we support an integrated education project, but the timing of my visit coincided with schools being closed other than for those taking public exams. So we visited a local orphanage where two of the children are blind and are supported by Sightsavers.



This was perhaps the most emotionally wrenching experience of the trip. The orphanage, run by Pastor Issa Anaabi and his wife, wins medals for its choir and they sang a range of gospel songs for us, including a rendition of ‘By the rivers of Babylon’ (infinitely superior to the Boney M version (for those old enough to remember!)). We spoke to the two children, Grace (17) and Michael (10). Grace had a beautiful voice and was clearly very bright. In answer to my question ‘what do you want to do when you leave school’ she replied ‘I want to be a journalist’. I asked if she could sing ‘Amazing Grace’, given her name. Of course I had forgotten the words until she got to them ‘I was blind but now I see’. I don’t know how I kept back the tears.

Michael was a much less optimistic story. He was blinded by his mother taking traditional herbs during pregnancy in an effort to abort him. She abandoned him when he was born blind, leaving him with his father and a new step mother. They were so ashamed of him they shut him in a room for several years, until someone mentioned the orphanage, so they took him there and abandoned him. He was clearly an emotionally damaged child (unsurprisingly), although he could write his name in Braille and knew his alphabet. He would clearly be loved and protected at the orphanage, but I found it hard to be overly optimistic about his long term future.

Finally, we visited Ivy, 10 yrs old, at her home. She has progressively deteriorating sight, and is expected to become totally blind so is now moving to Braille. The project workers and her mother said that she had a low IQ, yet when they showed me her exercise books, her maths was actually very good (although her English was poor). I was concerned that this was an example of a child who can’t see and hence finds it difficult to learn at school; the result being that they’re ever afterwards wrongly labelled ‘unintelligent’.

My trip to Ghana - Day 3

Today, we travelled to visit another rehabilitation project at Krachi, which is clearly very well run. The issues were similar to those at Bolgatanga, but they have also managed to get some financing from the local District Assembly to help support the project. They are planning to use a boat - from the Assembly - to access the many islands on Lake Volta, which have never enjoyed any rehabilitation services.

They estimate their backlog of patients for cataract surgery at about 200 and a waiting time of about a year for rehabilitation. They are cooperating with the District Assembly in pulling together a register of disabled people, including the nature and cause of their disabilities. Leafing through this, the overwhelmingly dominant cause of irreversible blindness is glaucoma, which is something we need to try and get a grip on in the future.

The main problem here is with a lack of vehicles – we offered to replace one of their two motor bikes which had irretrievably broken down. It was also mentioned was that some of the clients had a problem with microfinance as they had become accustomed to handouts and didn’t understand that they actually had to repay the loans.

We crossed Lake Volta (the biggest man-made lake in the world) via plantoon to reach Nkwanta, where we’re staying overnight. There were beautiful views over the lake at sunset, but these were marred somewhat by thoughts of the number of people on the register of disabled who had been blinded by ‘spitting snakes’!

My Trip to Ghana - Day 2

We had a range of meetings today at the three Upper East projects in Bongo, Bawku West and Bolgatanga. I had the opportunity to meet Project Managers, Field Officers, volunteers, beneficiaries, community representatives and committee members as well as traditional rulers and representatives of the Ghana Association of the Blind.

The issues arising at the meetings were all very similar: there is a significant backlog of (a) those needing cataract surgery and (b) those waiting for rehab. One common request was for us to provide for education of blind children and for children of the blind. All the beneficiaries and the GAB (Ghana Association of the Blind) were very keen that rehabilitation and integrated education projects should go hand in hand.

Looking at the map of Ghana at our country office later, I realised that we really only scratch the surface when it comes to rehabilitation work; we cover the Upper East region and some of Volta but nowhere else. Of course, even within these regions we only cover some districts, and this begs the perennial question: do we put more of our money into existing projects which are already set up and so can reach more people more quickly, or spread more thinly in more regions? It’s a tricky question.

Beyond this, there’s also a clear need for more (and more accurate) baseline data. Here, as everywhere in Ghana, they simply use 1% as a likely figure for the prevalence of blindness, despite it being an area where river blindness is endemic. In one village near the Burkina Faso border we met three blind people in three adjoining houses; either a massive coincidence or blindness is at a far higher rate than is assumed.

Finally, we had dinner with the Bishop of the Archdiocese and Father Jacob (the Project Coordinator). They mentioned that they were twinned with the parishes of Portsmouth and Chichester – perhaps there’s room for some kind of community fundraising? I suspect that this sort of twinning happens quite a bit in West Africa, so coordination should be possible with a range of partners.

My Trip to Ghana - Day 1
I’m going to be posting a diary of my trip to Ghana in instalments… a little late, maybe, but it should give you an idea of what I did as it happened!

I had several objectives for the trip: to meet our staff over there; visit some of the projects we’re involved in and meet partners; get a better insight into particular Ghanaian issues; and finally to meet Ministers and other decision makers to advocate for more funds to be put into eyecare.

Travelling through Ghana
After arriving in Accra from Heathrow, the first task was to drive to Boltanga. Accra is on the coast, and Boltanga is almost on the border with Burkina Faso, so this drive essentially covered the whole of Ghana from south to north. Initially we had planned to fly, but internal flights were cancelled. Although this meant we used almost a whole day for travelling, it gave me a real insight into what the country was like – the difference between the capital, towns, shanty areas and rural mud huts was stark.

Rehabilitation projects
On arrival we had a brief meeting with the partner running the rehabilitation projects in Upper East (the Anglican Church) and others. The meeting was led by Father Jacob Ayeebo, the Project Coordinator for all three projects.

This programme provides good service to ‘service users’ (as the beneficiaries are called), but there is a concern that the partner is wholly dependent on Sightsavers. In order to encourage sustainability we want to encourage them to find funds from elsewhere as well. For this reason we have offered them help in fundraising, both from local companies and the local District Assembly.

The rehab services they provide include showing how people who are blind can find their way around using a white cane or how to do everyday tasks such as cooking, how you tell the difference between different denominations of money or skills to find wo

Hi, and welcome to my new blog. This is something a little different for me, but hopefully by writing it I'll give you some idea of the range and variety of my work... and at the same time show how Sightsavers is changing the lives of millions of people around the world.

Mostly, I'll be writing it 'on the go', however, sometimes I have to travel in areas which have limited internet access - this is actually true of many of the countries in which we work - so some of my posts will have to be retrospective. In this way, I'm going to kick things off by going back over and writing about a recent trip I took to Ghana, which will be coming in instalments over the next few days.