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Our Chief Executive, Caroline Harper, visited Francophone Africa: the French-speaking countries of Togo, Benin and Mali. She shares her experiences meeting partners and beneficiaries, and advocating with government ministers on issues affecting our work.

Day one: arriving in Togo

Thursday15 November

I arrived safely in Lome in Togo, via Paris.

There have just been elections, which passed off peacefully and the existing party regained power. The sanctions which had been in operation for many years, and which have crippled the country, have now been lifted

We only support river blindness work in Togo and Benin. We did this originally to protect the work we do in Ghana and Nigeria (the black fly doesn’t respect borders!). As a result we aren’t currently supporting eye care or social inclusion work, in contrast to our preferred Comprehensive Eye Service model. One of the reasons for my visit was to investigate whether this made sense into the future.

The need for a more comprehensive service

Friday 16 November

The day began with a courtesy call on the Minister of Health. As might be expected, the Minister expressed his gratitude for all our work on river blindness, and asked us to extend this work into eye care more generally.

We moved on to meet the Cabinet Director of the Ministry of Health, whose mother was blind from onchocerciasis (river blindness), who agreed that introducing a more comprehensive eye care system should be a priority there.

We then went on to a meeting with various eye care specialists and the Onchocerciasis Coordinator and his deputy. This disease is not integrated into eye care in Togo (even though it appears in the national eye care plan of 2002/3), so this meeting was designed as much to bring together the various key people here as it was to brief me.

Impressive results

The oncho team presented first. The results were impressive. Sightsavers is the only international non-government organisation supporting oncho control here, and together we are reaching 85% of the population in areas where it is endemic. Almost all the villages recently tested have reduced their river blindness prevalence from 80% to 5% or less.

The discussion moved on to eye care more generally. The current cataract surgical rate is about 420 operations per year, which whilst poor is up from less than 300 at the time of the national plan. This improvement was put down to work from the Swiss Red Cross. There are five public sector ophthalmologists in Togo, and this is supplemented by volunteers from China and Spain. The view was that these volunteers did more harm than good, as they left the few local ophthalmologists to handle the follow-up and infections were common. There are 40 ophthalmic nurses and one optometrist. Apparently optometry isn’t recognised in most Francophone countries.

There is no national budget for eye care (or at least there is a budget line but no money allocated to it). The plan has therefore essentially not been implemented.

A dramatic contrast

The eye care situation was in all a pretty depressing picture, and a dramatic contrast to the successful river blindness programme.

We went on to visit the ophthalmology department at the CHU Tokoin teaching hospital. This was also rather depressing – there were a couple of slit lamps and an auto-refractor, but the visual field analyser was irreparably broken. There was an operating theatre which was dedicated to the ophthalmology department, but I didn’t see an outpatients department.

Limited resources

Generally the impression I got was of staff who were pretty dedicated but working with very limited resources. When something broke they were reduced to trying to order it over the internet, and patients had to buy their own IOLs (intraocular lenses to be used in cataract surgery to replace the eye’s existing cloudy lens) and bring them with them to the hospital. Some of these problems were due to the sanctions, which have only just been lifted. The net result though is the woefully low number of cataract operations performed at the government hospital, and a cost per cataract to all patients of £53. The average monthly wage of a Togolese person is £17, so there are not many takers.

A warm welcome

Saturday 17 November

We drove north into the Plateaux region, to meet with the Regional Director of Health and the local District Director.

The main thrust of the day was meeting the community in two villages, and witnessing an example drug distribution. This was quite an experience. The first village in particular turned out in the hundreds to greet us with drums and dancing. I was expected to give a speech to the crowd (in French – which was a trial as I haven’t used French other than to order food on skiing holidays when I was 16).

The CDDs (community drug distributors) here were very enthusiastic, and the whole community seemed to treat the process as their own. The CDDs were distributing both Mectizan® to protect from river blindness, and albendazole to treat lymphatic filariasis (better known as elephantiasis). The river blindness and LF programmes have been combined here for around six years (at no additional cost to Sightsavers!), and the time is approaching when the albendazole can be stopped.

The second village was smaller but equally enthusiastic, with painted signs saying ‘Vive Sightsavers International’. The village chief was the first to take his Mectizan® in a nice ceremonial gesture that seemed probably unnecessary, as the community was so comfortable with the programme.

Given that Togo has struggled so under the sanctions, and that the eye care programme there is so inadequate, it was interesting and a credit both to Sightsavers staff and the government partners that their CDD network was working so well both for river blindness and for LF.

My future recommendations are to expand our programme in Togo, rather than restrict our activities to river blindness only. We have established relations with key partners here, and are well respected and well placed to make a real impact for a relatively small amount of money.