An effective collaboration page 2
Drug distribution
Saturday 24 November
We visited the village of Manabougou, where we met two community volunteers who distribute Mectizan®, albendazole and azithromycin. This is all part of the Neglected Tropical Diseases programme. They showed me how complicated it is. They have one stick for Mectizan®, one stick for azithromycin and a cord to measure for schisto. Azithromycin comes in powder form for children and has to be mixed with water in different amounts depending on height – this is because the tablets are too large for the children to swallow. Albendazole is at least easy – it is a single tablet however tall you are. Historically we used to break the Mectizan® tablets in half because they were too big, now they are very small. I wondered whether something similar could be done with the azithromycin, as it was much less convenient to give liquid than tablets (and the liquid tastes disgusting).
I do think more thought needs to be given to how to simplify the NTD programme and make it easier to administer.
Primary eye care training
They had received a day’s training in primary eye care (link), and felt they were able now to recognise trachoma and cataract – if they did they sent people to the local health centre. Trachoma was constantly mentioned as the big problem – there was more fear of this than of cataract.
We have been doing some rehabilitation work here too, with one rehabilitation worker covering six villages.
Unable to help
I met two blind (or more likely low vision) children – both from the same family. A boy of four and a girl of seven, they had been identified at an eye camp and certified as irreversibly blind by the ophthalmologist there. Their father was keen that they should both go to school. Tragically the village is too far from our Inclusive Education pilot programme in Bamako, so it seemed unlikely that we could help them. I found this very upsetting – here was a father who wanted his blind daughter to get an education – how often do we find we have to work hard to persuade fathers of blind daughters that they should be educated? And yet we could not help him.
Elie undertook to get their eyesight checked again, just to be sure there was nothing we could do to improve their vision. This made me even more determined that we should do more in education in our next plan period.
Supporting patients through surgery
Monday 26 November
We went on to a village in the Kati district where trichiasis (link) (the condition where eyelashes turn in on the eyes following repeated infections of trachoma) operations were being performed. We watched an operation on a woman in her thirties. She was very frightened and kept wanting to go back to the fields where her family was harvesting. She tried to pull off the metal plate which holds back the eyelid, so I held her hand. I hope that helped rather than made the whole experience even worse for her!
I have to say that watching trichiasis surgery requires quite a strong stomach as it is quite bloody. But it works, and we plan to do up to 80,000 of these over the next five years to deal with all the trichiasis in Koulikoro region.
The nurses had already operated on ten people that day, and planned to do another ten more than afternoon – there was a queue of mainly women waiting outside.
Tuesday 27 November
We began the day by visiting IOTA, which is the only institute of its kind in Francophone Africa. It does training (for students from all Francophone countries), research and eye care treatment, and has been operating for fifty years. At the moment they have 17 different nationalities in training, and have trained over 570 students in ophthalmology and ophthalmic nursing. They are keen to open a school of optometry, and were looking for our financial support for this.
I asked why the IOTA fees were so much higher than those in Senegal or Cote d’Ivoire. Apparently the course here includes a significant practical element missing from the others – students will have performed 300 cataract operations by the time they leave. However, it was recognised that the fees are too high, and that as a result there is spare capacity. They believe they could train 15 ophthalmologists, rather than five now, and 40 nurses rather than 13. They plan to have a workshop in January to explore how to reduce fees (set by government at the moment) and expand services. Sightsavers will be invited.
Unintended consequences?
I asked whether they were concerned about the impact of Project Milagro on their training. If one of the major advantages of their programme is that students can operate on 300 patients during their training, I thought there could be a problem as people went to Milagro rather than government hospitals as Milagro is free and government hospitals charge, reducing the number of patients available.
This was something they had only just begun to think about, and at the moment they thought there wouldn’t be a problem. Given our experience in other places, where any free eye camp immediately reduces the number of paying patients in nearby facilities, I think they may be being a bit complacent. I was glad though that they were thinking about the issue!
IOTA believed that Milagro should have been either collocated with them, or based in remote areas. They were still in negotiations with the Ministry on this matter.
What do you think?