Sunday 12th August (Part 2)

We visited the Resource Centre, where they have a range of low vision devices and training aids before driving to the BNSB Sirajganj base eye hospital. Sirajganj is in the north west of Bangladesh, a 3 hour drive from Dhaka. This meant we drove through some of the most badly hit flooded areas, and for much of the time it was like driving along a dyke across a massive lake. People were living in makeshift shacks by the side of the road, alongside their livestock.

We went to open a paediatric out patients department wing of the base eye hospital. It was a spacious modern wing, with bright murals and furniture. We toured the area then the rest of the hospital, which was full of cataract patients. I met my first children who were part of the
Bangadesh Childhood Cataract Campaign – five children ranging from six months old to about five years. All had bilateral cataracts, and some had been operated on the previous day. Although I have been with Sightsavers for more than two years now, it still moves me to meet a totally blind child, knowing that tomorrow that child will see for the first time.

The hospital, together with a number of associated sub centres in two other districts, performed over 13,000 cataract surgeries in 2006. The doctors I spoke to believed they could do twice as many if they were able to mobilise the patients, and they had plans to open a number of Vision Centres to help achieve this (small centres in more remote areas where they can screen people).

It was clearly an efficient operation, and Prof Matin, the President, was keen to do more. He was very scathing about government hospitals – saying the staff had the ‘wrong attitude’.

Our return journey to Dhaka was rather protracted as part of one of the roads had collapsed due to the floodwaters, causing a serious traffic bottleneck.

Sunday 12th August (Part 1)

This morning we set off to visit CDD (Centre for Disability in Development), a community based rehabilitation (CBR), education and low vision partner. CDD provide all the special needs training for both education and CBR in Bangladesh, and are funded by Sightsavers to provide training in the visual impairment aspects of CBR for CBR workers. In addition to providing training, CDD provide many of the Braille books for schools, and offer a low vision service.

The quality was very high, although all the training was provided in Dhaka, which meant CBR workers and teachers had to travel from all over Bangladesh. The CBR course was three months long, which must lead to recruitment issues. They are hoping to open two new centres in other parts of the country soon. I was pleased to hear that several of the trainers at the centre, and a number of CBR workers, were blind.

There is no concept of an itinerant teacher (trained to identify and give special assistance to blind and low vision pupils) in Bangladesh – they train class teachers and resource teachers (who provide expertise for all pupils with special needs at a single school). There is a standardised Bangladeshi version of Braille, but children are taught English Braille first as apparently this is easier, before moving on to Bangla Braille. There is an increasing demand for Braille texts, which is putting a strain on CDD who rely on a single heavy duty Braille printer.

Saturday 11th August (Part 5)

We have recently started a pilot programme with a new organisation of blind people – BVIPS. This is a group of blind graduates who are starting up, as the only other organisation of (rather than for) the blind is apparently non active.

The office is clearly very active in advocacy, but there was one area which stood out for me – their work with NFOWD (see later) and the electoral commission in promoting the voting rights of visually impaired people. They had been successful in improving the process to allow visually impaired people to have a sighted guide of their own choice to vote with them (although they had to be of the same gender as Bangladesh segregates its voting stations). I wondered whether we have done any similar work elsewhere, and thought this sort of advocacy ought to be fundable from the Department for International Development etc. This will all have to be repeated for the next set of elections due in 2008.

This evening we held a dinner at a local restaurant for a range of partners, government officials, donors and other agencies. This was a great opportunity to meet a number of partners ahead of visits later in the week.

Saturday 11th August (Part 4)

Back at the office our attention turned to social inclusion and advocacy work. Our community based rehabilitation (CBR) in Bangladesh is as much an outreach, case finding project for cataracts as it is a CBR project. Over the last four years it has identified nearly 50,000 cataract patients compared to 7,000 persons needing rehabilitation services. CBR workers are also used to ensure follow up – a great example of real comprehensive eye-care services (CES) in action. (Sightsavers promotes a model of comprehensive eye-care services, whereby a community is served with ALL aspects of eye-care in their entirety)

I asked whether the restriction on only being able to support visual impairment rather than other disabilities proved to be a problem, but this did not seem to be the case. At the moment we had a cross referral system with other INGOs for other disabilities, although it was acknowledged that this wasn’t working as well as it might. We did not have any evidence concerning the proportion of blind people who had other disabilities, but CDD expressed the view that children with multiple disabilities would generally not survive infancy.

The office was keen to do more on education, which they regarded as the priority should more funds become available.

Saturday 11th August (Part 3)

We went from the school to one of the slum areas where the people served by this project live, and walked through. The smell is probably the aspect which will stay with me – the sweet smell of rotting rubbish, which languished in huge mountains all around, the foetid stench of sewage and the acrid smell of woodsmoke all mingled. It was very muddy underfoot and the dark bamboo homes were crammed tightly together and had been damaged by the floods. People paid 500 takas (£5) a month rent for a tiny one room shack to the private owner of the land, who could sweep them away at any time if a better development opportunity arose. These people lived hand to mouth – most were unemployed. Many of the children were near naked with skin problems and as there were no latrines (although there were fresh water standpipes) it was likely that diarrhoea would be a major issue, particularly as they walked through floodwaters to reach the slum area. I have to say that the poverty I witnessed here was more depressing than anything I have seen in rural areas.

Saturday 11th August (Part 2)

I did not know whether to be proud or appalled that Sightsavers funds 50% of all cataract operations in Bangladesh, and 100% of all low vision services. The Cataract Surgical Rate (CSR) needed to deal with the current backlog and incidence rate is between 2,400 and 3,000 per million people per year, compared to around 1,000 being achieved at the moment

Attention turned to the Bangladesh Childhood Cataract Campaign, where it was very pleasing to see that we are well on target for this year. I was quite surprised at the age profile of the children treated – only 25% were under 5, and more than 25% were between eleven and fifteen. Apparently some sight is restored even for this older group, which I had not appreciated.

At this stage we took a break from the office to visit an outreach camp for the Dhaka Urban eyecare project. This was held in a school near a number of the slum areas. Patients came to the school for examination, and if they were found to have cataract they were checked for hypertension, diabetes and any problems with tear ducts then those who could demonstrate they were poor were transported directly to the hospital for the operation, free of charge.

In the half day before our visit they had identified twenty patients, including a 30 year old woman with bilateral cataracts whom I met. She had had problems for a couple of years and was tremendously excited at the prospect of recovering her sight.

Saturday 11th August (Part 1)

This morning began with a briefing at the Country Office

Blindness in Bangladesh is overwhelmingly caused by cataract – the recent national blindness survey showed 80%.This seems to be a much higher proportion than anywhere else I have visited. There is a considerable amount of refractive error (people who require glasses) and low vision – this often overlaps with cataract. Diabetic retinopathy (blindness caused by diabetes) and glaucoma are clearly problems which will become significant in the future, but at the moment cataract dominates.

As always seems to be the case, the ophthalmologists are concentrated in the urban areas whilst 80% of the need is mainly in rural areas. Around half the ophthalmologists are in government hospitals and half in NGO hospitals (a small no in private hospitals), but 86% if cataracts are performed in NGO hospitals and only 10% in government ones. This rather shocking statistic is caused by a number of factors, including lack of training, lacking of mid level eyecare personnel and lack of equipment. Wherever we went during the trip, people were dismissive of the possibility of the government hospitals ever functioning properly. Nonetheless, it is my view that we should not be deterred from our long term goal of developing the government sector, not just the NGO sector.

It is particularly concerning to hear that the government has set aside £300k to spend on eyecare, yet it cannot seem to do this because of lack of management. This is despite having a Vision 2020 committee led by the Director General of Health, a separate directorate for eyecare and a National Eyecare Plan. Clearly a priority needs to be providing support to enable them to spend this budget properly (and keeping up the pressure them to do so).

Friday 10 August

This was essentially a rest day (Friday and Saturday are the weekend in Bangladesh), with the opportunity to read the briefing notes provided by the Country Office. I was very pleased to have the chance to meet some of Nazma’s family who generously entertained me that afternoon.

Thursday 9 August

Nazma (Nazma Kabir is Regional Director for South Asia and the Caribbean) and I flew on Emirates from Gatwick Airport. (On airmails donated by Emirates, a company who provide corporate support to Sightsavers.) The journey was uneventful and we arrived after a short connection at Dubai with all luggage intact just one hour late.

Visiting Bangladesh

9 – 17 August 2007

This was a particularly difficult time to visit Bangladesh, as it was in the grip of the worst floods for a decade. Although I had seen newspaper pictures in the UK, this doesn’t really compare with seeing the problem directly. Our partners work had been disrupted, particularly in the north of the country, and my programme had to be significantly curtailed due to travel problems. This was a pity, but on the other hand I think it is important that I visit places during difficult conditions, not just when things are at their best, so I can appreciate the challenges under which our people work.

The key objectives of the trip were:

• To meet the staff of the Bangladesh Country office, discuss current and future programme plans and to brief them on the status of the Strategic Review.
  

• To meet a number of key partners, both long standing and new, and perform a couple of inaugurations of new centres.
  


• To meet government officials and advocate for Vision 2020 and social inclusion for blind people
  


• To meet a range of beneficiaries.