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From flash floods to lion attacks: all in a day’s work in Zambia

Julia Strong, July 2017

The Swedish Postcode Foundation is supporting Sightsavers’ trachoma elimination project in Zambia over two years, with a grant of 3 million SEK (£262,000).

Sightsavers’ Julia Strong travelled to Zambia with Moa Stenholm from the Foundation to see how the project is helping to save sight and change lives. Here, Julia shares her stories from the trip.

 

Moa Stenholm, Glenda Mulenga and Julia Strong with Sightsavers’ Zambia staff outside the country office in Lusaka.
Moa Stenholm, Glenda Mulenga and Julia Strong with Sightsavers’ Zambia staff outside the country office in Lusaka.

Monday

Moa and I are up early to meet Sightsavers’ Zambia Country Director Glenda Mulenga and our driver, Collins, before setting off on what will be a journey of nearly 700km over two days across the breadth of the country. We are travelling to the remote Mwase health centre, in the eastern Lundazi district, to see what we later learn will be one of the district’s final ever trichaisis surgical camps – Zambia is now close to eliminating the disease.

As we drive across  lush green countryside, it becomes clear how sparsely populated the country is, with just 15 million people spread across more than 750,000 sq km – that’s three times the size of the UK. We pass acres of maize fields (the staple crop for 60 per cent of the population) and, to our surprise, many miles of blooming sunflower fields.

The Great Eastern Road is hot and long, with little traffic, and occasionally we pass groups of women selling sweet potatoes and ground nuts by the edge of the road. We arrive in Chipata town, where we’re staying overnight, just in time to catch sunset over the hills.

Glenda and Moa standing on a bridge of the Lwangwa river in Zambia. Behind them is the muddy, swollen river with green trees either side.
Glenda and Moa by the Lwangwa river. It was so swollen after rainy season that villagers had to abandon their flooded homes.

Tuesday

We set off early to complete the final 100km of our journey to Mwase village, stopping off in Lundazi town to pick up District Medical Officer Dr Zulu. Mwase can only be reached by 30km of bumpy dirt track, and Dr Zulu tells us that during rainy season the road can become completely impassable, cutting off village communities and preventing people from accessing vital healthcare.

We pass a couple of buildings bearing the sign ‘health post’: these are the initial points of contact for people who want to see a health worker. If they can’t be treated here, they are referred to one of the district’s 49 health centres, such as Mwase, for more comprehensive care.

We reach the health centre by 9am and are met by a crowd of about 40 people, who are waiting for sight tests and to be screened for eye conditions such as trachoma and trichiasis (advanced trachoma). Ophthalmic clinical officer Tedson Thomas Mandera explains that 12 people have already been diagnosed with trichiasis and will have surgery that day.

As Tedson and his team prepare for the operations, we meet some of the patients about to go in for surgery. Christina Zulu, a young mother from Mutambla village, has been diagnosed with trichiasis and cataracts in both eyes. She tells us she’s been struggling to do the housework, but she doesn’t complain, explaining her only problem is that her two-year-old son cries too much.

We stay in the room as she has her surgery, which today will just be on one eye. The surgeon numbs her eyelid with an anaesthetic injection and makes an incision along her lid, before repositioning her lashes and putting in stitches. These are made of silk, so Christina will return to the health centre next week to have them removed.

Shortly after the operation we speak to Christina in the ward, where she will stay overnight. She tells us she feels OK and is glad she had the surgery, and would encourage others to do the same.

With 12 trichiasis operations performed it has been a long day for the surgeons, and we pack up to leave about 3pm.

Christina Zulu sits on a hospital bed with a bandage over her left eye, while holding her two-year-old son.
Christina Zulu with her two-year-old son.

Wednesday

Having spent the night in Chipata town, we set off early to travel back to Mwase to meet the patients that had trichiasis surgery yesterday, as well as others who were operated on last year.

We notice some common themes as we talk to the group – everyone had experienced pricking in their eyes from their lashes, as well as watering eyes and blurry vision. Several admit they had been afraid to seek medical help earlier because they were afraid having surgery would make them go blind.

One of the patients, Frakson Hara, had surgery in 2016, but explains that when he heard Sightsavers would be visiting he wanted meet us to tell us how the surgery has changed to his life.

He had trichiasis for three years and used to pluck out his eyelashes to ease the pain, but when they grew back the pain was even worse. As his eyes wept, his sight became so blurry that he needed a string to guide him from his home to the latrine outside his compound. The worst moment, he tells us, is when he finally had to give up one of his favourite pastimes – reading.

Eventually, Frakson was diagnosed by community health workers and was referred for surgery, supported by Sightsavers. He can’t emphasise how much it has helped him: he tells us he can now look after himself properly (today he is smartly dressed in his suit). Most importantly, he can read again.

Frakson with cataract and TT surgeon Mr Limwanya.
Frakson with cataract and TT surgeon Mr Limwanya.
Mwase Basic Primary School

We spend the first part of the afternoon visiting a primary school in Mwase to see the hygiene promotion work that the project is supporting. For Sightsavers, improving water, sanitation and hygiene facilities is important as it is closely linked to the spread of neglected tropical diseases, including trachoma.

We meet head teacher Mwale Saviour, who explains he has established a school hygiene committee and appointed two teachers to promote good hygiene in classes. Each day at registration the children’s faces, nails and hair are checked, and the school’s weekly assembly features hygiene messages to teach the children the importance of keeping clean.

Children at Mwase Basic Primary School stand next to large water buckets as they learn how to wash their hands to prevent the spread of trachoma.
Children at Mwase Basic Primary School learn how to wash their hands to prevent the spread of trachoma.
Lundazi District Hospital eye department

After leaving Mwase, we head back to Lundazi to visit the district hospital eye department where trichiasis surgery is carried out. At the moment the department has just one small room to treat patients from a community of 332,000 people. Yet with funding from the Swedish Postcode Foundation, a new wing has been built that will adjoin the existing room and double the size of the department.

Trachoma mapping has shown that the prevalence of trichiasis in Lundazi district is now so low that there is no need to continue surgical outreach camps. As a result, the hospital will treat any remaining trichiasis patients, and the extended space will enable the ophthalmic staff to set up a dedicated bed for minor eye operations, including trichiasis surgery.

We wrap up our time at the hospital speaking to cataract and trichiasis surgeon Mr Limwanya. To explain the challenges of delivering eye care in rural areas, he recounts the tale of ophthalmic nurse Mr Mandera, who was travelling alone on his motorbike to a remote health centre to deliver medicine. Suddenly, he came face to face with a lion. As it charged at him, he fainted and his motorbike fell on him. Fortunately, the lion backed off and local villagers rushed to help him. He came round, got straight back on his bike and returned to work. Now that’s dedication.

Cataract and TT surgeon Mr Limwanya works at his desk in the office at the hospital.
Cataract and trichiasis surgeon Mr Limwanya.

Thursday

As our trip draws to a close, we travel back to Lusaka to Sightsavers’ offices, where we meet Ministry of Health Provincial Medical Officer Dr Mwale, who is also the principal researcher on the trachoma programme in the country, representing the Ministry of Health. As the principal investigator for the Tropical Data Mapping Project in Zambia, he talks us through the results of the recent mapping activity across 44 districts.

He explains that the mapping, led by the Ministry of Health and supported by Sightsavers, with funding from The Queen Elizabeth Diamond Jubilee Trust, showed that Sightsavers’ project is achieving its goal to reduce the trichiasis surgical backlog. Trichiasis is therefore no longer present at high levels in the four districts where Sightsavers has been supporting surgery through camps funded by the Swedish Postcode Foundation. The total national trichiasis surgical backlog is now estimated to be 4,495 people – much lower than previously thought.

The mapping also showed that levels of the infectious form of disease, trachoma follicular, are higher in two of the project districts – Kasama and Mungwi – than previously thought. We can now redirect Sightsavers’ support to drug distribution in these districts as Zambia moves a step closer to eliminating trachoma as a public health problem.

By Julia Strong, Sightsavers Trust Manager

Zambia: the facts

A group of villagers gathered outside their homes in Mwase village, Zambia.

Two-thirds of Zambia’s population of 16.2 million live in poverty. Life expectancy is among the lowest in the world, at just 57 years old, and health outcomes are poor.

An older man in Zambia has his eyes examined by a doctor, who holds one of his eyes open and shines a light into it.

It's estimated that 2.3 per cent of people in Zambia are blind, and a further 8.7 per cent have visual impairments. Eye infections are the seventh main cause of hospital visits.

A schoolboy from Mwase villagein Zambia washes his hands with water from a large green tank.

Sightsavers aims to help eliminate trachoma in Zambia by 2020. The Swedish Postcode Foundation has funded implementation of the SAFE strategy in five districts.

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