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.