British charity brings sight to sore eyes
Joseph Openek’s slender frame betrays his anxiety as he approaches the white Landcruiser emblazoned with the Queen’s crest. He has the resigned air of someone who has placed his trust in strangers, a decision he has ducked for more than a decade.
Mr Openek’s right eye is clouded white with an opaque scarring and the lid on his left is turned inward, forcing the lashes – “like thorns” – against his cornea. His vision is fading fast, as are his chances of survival.
“If I don’t have this eye they will only give me bones, not meat,” he says gesturing to the walled village of mud and straw huts opposite.
Mr Openek, one of the 1.2 million Karamojong people of north-east Uganda, is wary of the help he is seeking. “He thinks the doctors will take out his eyeballs before putting them back,” says Daniel Okaali, head of UK charity Sightsavers’ trachoma elimination programme in northern Uganda. “It’s a common fear. He came because his neighbours told him the car had Queen Elizabeth’s name on it. “They trust the Queen and UK aid.” Mr Openek, persuaded his eyes will remain in their sockets, climbs into the 4x4 to join more than 40 others who will undergo surgery to save their sight.
They have trachoma, an ancient disease caused by the chlamydia bacterium.
It is spread by dirty fingers and flies, scarring the underside of the eyelids and forcing them to tighten and curl inwards. The result is trichiasis – a slow and torturous descent into blindness as the lashes scrape the eye, destroying it blink-by-blink over years.
Once common in Britain and much of the West, trachoma remains the leading infectious cause of blindness worldwide, affecting an estimated 1.9million people. But it is now tantalisingly close to global elimination.
Dr Caroline Harper, CEO of Sightsavers, says the disease has been eliminated in all but the most remote parts of the globe over the past decade.
“The number of people at risk is falling fast, but as we push the disease to more and more remote locations the harder the work becomes,” she says.
Napak in north east Uganda is a case in point. A vast region of bush and savannah bordering South Sudan, it suffered an epidemic of violence between the mid-nineties and 2010, leaving its health infrastructure in tatters as infectious diseases ran rife.
But trachoma, once endemic in the region, has been driven down from an incidence of 57 per cent in 2008 to just 7.6 per cent in 2014 – and with a final push it should be wiped out.
Next, the team picks up Anna Namoe, a mother of two who lost her husband and oldest son in the violence. She can see, but both eyelids are turned inwards and she keeps them all but closed to avoid blinking.
Women in Africa sometimes wear tweezers round their neck so that they can remove their lashes to stop the scraping. Mrs Namoe, who owns nothing more than the clothes she is wearing and a cowhide to sleep on, relies on her 14-year-old-son to pick them out with his fingernails.
“It helps but when they break half way, that is the one which hurts the most,” she says.
Two hours later, Mrs Namoe and Mr Openek are dropped at the field clinic where the operations will take place, joining dozens of others from across the region. Makeshift operating tables have been set up, on which up to 20 patients – or “40 eyes” – are processed a day. The operations are carried out under local anaesthetic by Sisto Lomongin and Henry Isabirye, two young Ugandan health workers.
Mr Lomongin – aided by a nurse with a plastic torch – clamps his patient’s inverted eyelid in place. With a clean blade he makes an incision along the length of the lid parallel to the lash. The lid is then rotated outwards, permanently lifting the lashes from the globe of the eye and allowing the patient to see clearly and without pain.
It’s a relatively simple and quick operation (about 15 minutes an eye) but one that requires a steady hand. For the patients it must be terrifying, but they make no sound.
The following day, Mr Okaali and his team are back on the road following up on the patients, all of whom were returned to their villages within a few hours of being operated on. When we get to Anna Namoe’s village she is not well. She had been left the previous evening – her eyes patched with surgical gauze – in the care of her sister, but she has been left alone to fend for herself and is shaking, weak from hunger and close to collapse.
“This is the real problem here,” says Mr Okaali, referring to the lack of care and risk of social abandonment in the area for people with complicated health issues.
Back in the village, the team raise Mrs Namoe’s blood sugar with fruit and biscuits, and slowly her strength returns. An hour or so later her bandages are removed and, although her eyelids remain swollen, she is able to blink without pain for perhaps the first time in a decade.
‘He came because his neighbours told him the car had Queen Elizabeth’s name on it. They trust the Queen’