Sunday 18th February

The foundation visited a village today and were able to view a trichiasis operation and talk to members of the community. We had lunch after, and they said they had found this both fascinating and shocking. Dr Hussein, their medical advisor couldn’t get over the fact that surgery was performed next to a hut. The foundation left early that evening, but not before telling us that they were extremely impressed with everything they had seen.

Saturday 17th February

This morning Sightsavers personnel attended the Ministers meeting to ratify the resolution needed to secure ongoing management of the Centre, while the foundation visited the hospital privately. This gave them the opportunity to talk to the Director of the Centre, consultants, nurses, students and patients, and generally to look at whatever they wanted without us shepherding them. They said they really appreciated this, and I believe it dramatically increased the levels of trust between us.

Early that evening we all visited State House, where the President was having a reception. This time the President did reveal himself, and there was an opportunity for the foundation (and for us) to meet with him, albeit briefly.

Friday 16th February Part 2

The Inauguration began at around 5:30, and was attended by the Vice President, and representatives of all the Health for Peace countries, as well as some ambassadors (eg the American ambassador but not the British High Commissioner). There were many speeches, including from Simon Bush, (West Africa Regional Director) from me and from the foundation, then the Vice President and the foundation jointly cut the ribbon and declared the centre open. Everyone trooped through the various buildings, and I was very pleased to see that all the final touches were in place. It looked absolutely stupendous, everyone was very impressed.

After some African dancing (which I was bullied to take part in!), the foundation retired, and we went on to a Gala Dinner – which started at 11pm.

Friday 16th February Part 1

We began the day with a courtesy visit to the Minister of Health, and met his permanent secretary. The MoH didn’t appear at a single meeting or function the whole of the time I was there, causing some offence to others (eg the Minister of Health from Sierra Leone) who had made the effort to come. It was also very peculiar as he was barely mentioned. The Minister for Education stood in for him, but there was no apology made. The President is currently on a rather bizarre campaign saying that he can cure AIDS and asthma via a new herbal concoction, so perhaps the MOH was involved in this.

The Sheikh Zayed Foundation arrived around lunchtime, having travelled via Ethiopia and Nigeria. A long and exhausting trip from Abu Dhabi.

15th February part 2

We went on to a secondary eye unit in another village, where they performed cataract operations. I was very pleased to see that they all had mosquito nets – something that isn’t universal in the places I have visited. I met the patients, and discovered that none of them had been cataract blind for more than a few months. Talking to the doctors here, it became clear that The Gambia has now cleared its backlog, and is treating incidence only. A great achievement. Recent surveys have shown that the prevalence of blindness here has reduced from 0.7% to 0.4%.

However, they see an increasing number of people coming over from Senegal, and even more from Guinea Bissau, and it is clear that the problems there (particularly in Guinea Bissau) are much more severe. It is therefore excellent that we will be starting programmes there this year, and that the Sheikh Zayed Regional Eye Care Centre (SZREC) covers all these countries.

We then visited a primary centre, to talk to a Community Eye-care Nurse, and then on to a school to meet a teacher who was also one of the ‘Friends of the Eye’, who move among the community raising awareness of eye-care and encouraging people to get treatment.

Overall it was a great visit, particularly since the Office were fully occupied managing the myriad of guests arriving (or trying to arrive) for the Inauguration.

15th February part 1

Today I had the tremendous experience of witnessing my first

trichiasis surgery. Momodou (project officer) took Hannah and me out to one of the villages, where an ophthalmic nurse performed the operation on a very nervous, but very brave elderly man. His wife had had the operation the previous week, and despite having suffered the complication of a granuloma (inflammation around the stitches which is easy to remove), had persuaded her husband to have the treatment.

The operation looks very much like battlefield surgery, although it is clearly done professionally and with proper attention to maintaining a sterile environment. It is also quite bloody to watch the nurse pull back the eyelid and slice through the inner lid, then cut deeply to release the adhesions. Not something to watch after lunch, but I found it absolutely riveting.

Tuesday 13th February part 2

We left Jerreh at the site, with his mobile glued to his ear, dealing with a vast myriad of administrative nightmares, and Dr Hannah Faal (West Africa Regional Eye Care Consultant) took me to the Royal Victoria Hospital, which had been the home of eye care in The Gambia for many years (she herself worked there). The comparison was very stark – two rooms and a veranda, plus a theatre.

We went back to the office and I held a surgery with the staff. Issues raised included the perennial of forecasting, which was perceived as very time consuming and rigid. It was felt that it was actually less rather than more flexible than the old budgeting system. It is clear that a re-launch and explanation of the forecasting approach, together with some tools to help people use it, is desperately needed, as this complaint comes up time and time again on my trips.

I was also asked about my views on user fees, and on why Sightsavers always rented offices overseas rather than building their own.

Tuesday 13th February part 1

I arrived late in the afternoon, and successfully transferred to the hotel, together with luggage. I believe I was one of the few who was able to fly direct from one airport to Banjul without any stopovers, connections, delays, or cancellations (Air Senegal chose these days to go on strike). Talking to Jerreh (Dr Jerreh Sanyang Country Representative) over the course of this trip really brought it home to me how difficult it is to travel in West Africa.

Firstly we visited the hospital to check that everything was ready for the inauguration. My first thoughts were how great the hospital looked. It is very well designed in comparison to many I have seen. There did however seem to be a plethora of remaining tasks – the contractors were repainting the entire inside of the various buildings, and were also attending to a few cracks (not structural!!). There was furniture and equipment to unpack, and some paving to be laid. The landscaping looked good, although sadly we had been forced to burn off some of the elephant grass at the edge of the site as the President’s security had been concerned about snipers. Apparently this also reduced the risk of future fires so wasn’t all bad.

My Trip to The Gambia

The objectives of the visit were as follows:

• To visit and inaugurate the new Sheikh Zayed Regional Eyecare Centre.
• To meet and build relationships with the Sheikh Zayed Foundation, with a view to encouraging a long term funding relationship.
• To visit some of the programme work in the Gambia (a limited amount though due to the administrative challenges with which the Country Office were grappling).To support the ongoing advocacy initiatives, particularly around the Health for Peace Initiative (HFPI).
• To meet the Country Office staff of The Gambia – who will also be supporting Senegal and Guinea Bissau programmes from this year onwards.

Originally it was intended that I would visit Senegal, to see the impact of the HFPI work there, and to meet those involved with our planned project in Louga (funded by Anglo American). However, the President of The Gambia’s office announced that the Inauguration should move from 18th to 16th at very short notice, and this made a visit to Senegal impossible. It also threw a significant spanner into the best laid plans of the Country Office and many visitors!

Note on Health for Peace Initiative
This is an initiative between a number of West African countries (initially Senegal, The Gambia, Guinea Conakry and Guinea Bissau, recently extended to include Sierra Leone and Liberia), where they have agreed to cooperate on health matters to help preserve peace in the sub region. Each country is spearheading one or two aspects of health (eg HIV/Aids, immunisation, malaria), and The Gambia has chosen eye-care.

Overall Impressions

This was an absolutely fascinating trip, and something of an emotional rollercoaster. I will never forget it. Here are a few of the thoughts I am currently left with:

• The dedication of many of our overseas staff is not to be underestimated. Staff in Sierra Leone stayed with us through the war and worked in unspeakable conditions, and Verda is now having to cope with very difficult situations and extremely harsh conditions. They all have my deep gratitude and utmost respect.
• Working in post conflict environments is extremely hard, and we need to think very carefully about whether it is the best use of our resources. When a society is so badly broken down eye-care is absolutely not top of anyone’s list, and it is really difficult to make progress. On the other hand, the people in such a situation are in great need, and the visually impaired are particularly vulnerable. A difficult call.
• River blindness is a persistent disease, and if we become complacent because the apparent burden globally has reduced then it will simply come back with a vengeance.
• The Neglected Tropical Diseases initiative is gathering momentum, and we need to think carefully about how to deal with it.
• Sierra Leone is a programme which is definitely up and coming, with a particularly strong Oncho (river blindness) Coordinator leading great progress in this area. Let us hope our application to Irish Aid is successful so we can build the eye unit in Kenema. (It was!)
• HR development is the key problem in both countries. This is a problem all over Africa, but the added complication of post conflict conditions makes it a really huge stumbling block.

Wednesday 15th November Part 2

Our last visit was to the Christian Association of the Blind (CAB). There are five different associations in Liberia, which causes problems – two are officially recognised by the African Union of the Blind. CAB generally seemed pretty on the ball, and it was clear that Dr Kota, the Director, would be an excellent advocate and a good community based rehabilitation partner. The only wrinkle is that CAB are building their own School for the Blind in Monrovia with money from the World Bank. I asked why they didn’t just support the existing school, and it was clear that there was a situation rather like that with Sierra Leone Association for the Blind (SLAB) in Sierra Leone, where they would prefer to manage schools themselves, even if they say they support the Ministry of Education.

After a quick clean up at the hotel, we left for the airport and I had an uneventful trip home via Senegal and Brussels.

Wednesday 15th November Part 1

Verda (Sightsavers Country Representative for Liberia) and I went out to Malama to visit a river blindness endemic community, and see how Mectizan® distribution was working in the field. The distribution is managed from a health clinic sponsored by World Vision.

The last distribution had been a bit haphazard as no census had been conducted first, but this is something that will be remedied next time. There is a very large catchment area, and problems finding enough volunteers in each village to distribute the drugs, (CDDs). There were a range of issues – low literacy rates and resentment that CDDs weren’t paid being two key ones. We found a few anomalies in the registers, in particular there were cases where children under five were being treated. The view was that height was taken as the overriding factor rather than age, as claims of age were often incorrect. The CDDs we met were very unhappy about not being paid, particularly as they said that the community didn’t believe this to be true.

Verda and I went to a local village and called an impromptu meeting to try to address this. We explained the situation, and I stressed that there was no money to spare to pay CDDs either from the government or from Sightsavers, but that many communities chose to show gratitude to CDDs either in kind or by exempting them from other community labour. The clan chief in the village was not very supportive (‘if they volunteer they should just get on with it’), and it became clear that unless local community leaders are really bought in and understand that the programme is supposed to be community led rather than government led, this problem will persist.