The curse of river blindness: The river Sewa in Sierra Leone can make a man rich or take away his sight. Though a pill can now prevent it, the river people still put their blindness down to witchcraft

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WE COULD hear the river long before we suddenly came upon it, a soft, steady roar beneath the calls and clicks of hidden birds and insects in the dank, humid forest. The track through the shadows suddenly opened out on to the river bank and there it was: huge, silvery, majestic. The sudden brightness and motion made us stop for a moment and blink. I stared a little longer. There is something god-like about a river flowing through forest, inexorable, gentle and terrifying, and this river, the Sewa, in central Sierra Leone, is particularly lethal.

Up to their waists in its warm swirling water stood a line of six bare-backed men gripping huge sieves of gravel. They plunged the sieves into the water, heaved them out, twisted and shook them, paused and peered into them, scooping out handfuls of mud and pebbles. Then their mates on the bank would throw another shovelful of earth into the sieve to be washed and spun.

The earth had been mined earlier in the day from the terraces above the river and brought laboriously down to the bank in sacks. These men are diamond miners,enslaved by the river, working long, back- breaking hours in search of the tiny glassy flash in the gravel which buys them freedom. Even though they are only paid a fraction of what the stone is worth to the diamond merchants in Europe, it is still enough to make them rich for a year or so.

But diamonds are not the river's only gift. The river also brings the little black fly. And the little black fly carries the worms that cause river blindness, the disease that attacks thousands of people every year in Africa alone. In Africa it is almost better to be dead than blind. The blind are totally dependent. They cannot plant crops or cook or fetch water and wood. They sit at home all day, a drain on their families resources, until they die. Yet the the people who live along the banks of the Sewa have come to accept its fateful cycle. Is their river a god or a demon, they wonder. It draws them to it - and then it kills them.

THE VILLAGE of Mokaba, about a mile from the river, is a collection of mud huts in a clearing in the forest. The only signs of contact with the modern world are a few corrugated iron roofs; the rest are thatched with grass. As we drove in children ran out barefoot to stare at the car and bare-breasted women waved from the shadow of their verandahs. We were met by Mr Mejor, one of the local hospital workers, wearing a T- shirt that read 'What a Wonderful World'. Not many people in Moka-

ba could see it. Half the village - about 100 people - have gone blind.

Mr Mejor lives in the village but is employed by the eye department of the local hospital in Bo, the nearest town. We had arrived on the day of a medical inspection and Mr Mejor had assembled everybody in the open hut in the middle of the village that serves as a meeting point. One by one they lined up to be examined by Edward Sandy, a community nurse from the eye hospital, who peered into their eyes with an ophthalmoscope then checked their legs for streaky patches of pale skin or lumps under the skin, both tell-tale signs that the disease has entered

the body.

River blindness is caused by the black simulium fly which, when it bites, deposits microscopic worms under the skin which then accumulate in tissue, significantly inside the eyeball. The worms emit a poison which irritates the eye; in response the eye develops protective cataracts, and eventually these cause blindness.

After examining the first few villagers, Mr Sandy pulled away. 'This will take all day,' he said. 'They all have worms . . . And see this man,' he pointed to one of the men who had come forward, 'he is blind, completely blind. There's nothing to be done for him.'

The man, 55-year-old Abdullahi Kamanda, said that he had lived near the river all his life, farmed a little, fished the river and searched for diamonds. Like scores of others he now sits all day in the shadow of his hut, his pale milky eyes staring blankly. He waits to be fed or to be led to the latrine by a child. The rest of the family is working in the fields or by the river.

Mokaba is at least surviving. The neighbouring village of Walihun is already being reclaimed by the forest. The deserted houses without their roofs have melted in the rains and look like sandcastles after the sea has washed over them. Only one extended family of nine adults and two children remain in Walihun. The father, Mustapha Gatewar, is already blind and sits all day in a hammock in front of his mud hut. His family tend a few beds of sweet potatoes and cassava. The people here did not believe their blindness was caused by the river. They believed their whole village was cursed. So they fled, only to join another village further down the river.

These are just two among thousands of tiny villages whose inhabitants are suffering from the disease that breeds in fast flowing rivers in tropical climates. The World Health Organisation estimates that 270,000 people have been made blind by the disease and 17.5 million people suffer from it worldwide, most of them in Africa, south of the Sahara - especially Cameroon, Nigeria, Uganda and Zaire. But it also occurs

in isolated areas of Yemen and

Latin America.

Here in Sierra Leone, the W H O tried a frontal assault on the disease by spraying the rivers in which the black fly lays its eggs. This was very expensive and had to be carried out repeatedly or the fly, and the disease, returned. War and subsequent civil disorganisation put a stop to the spraying programme a couple of years ago. But in 1988 a new drug had been developed which seemed to offer an alternative. Ivermectin was originally developed as a veterinary drug but was found to be a safe prophylactic against worms in humans. One little white tablet gives protection for a year and purges the microfilia - the worms - from the body. The US manufacturers of the drug, Merck, Sharp and Dohme, have given the tablets free to Sight Savers, a British-based charity for the blind. Distribution is a problem, however, and has to be consistent and properly supervised.

Ivermectin is popular, not necessarily because people believe that it will stop them going blind, but because it kills off all the other worms which debilitate the people here and thus has a general rejuvenating effect. One man told me with a giggle that he had taken three tablets already and his wife was very pleased with him these days.

BEFORE the examination in Mokaba, Mr Mejor had already conducted a house to house survey of the village and presented Edward Sandy with a school exercise book of names. Sitting at the table, Sandy ticked off each person collecting a tablet and a mug of water from a bucket by the table to swallow it with.

The blind were given a note by Mr Sandy which they could take to the eye hospital in Bo. Twice a week, Dr Dennis Williams, a former major in the Sierre Leone Army and now in charge of the eye hospital, performs eye surgery on about 25 people. He has a brusque, military air and told me he likes to run the hospital as a family on first name terms, but I noticed everyone calls him 'sir'.

Cataract removal is now one of the most common operations here, and in most cases the entire lens has to be removed. In Europe it would be replaced by an implanted artificial lens, but that is too expensive for Africa. Each cataract removal operation costs about pounds 16 and Dr Williams has to guess what each patient can afford. About half pay nothing. The hospital is supported by Sight Savers, which pays Dr Williams an international salary. The government pay for a doctor is about pounds 50 a month.

The first part of the operation is the worst; the insertion of a syringe of anaesthetic straight into the eye socket. I couldn't believe how deep it went. Sometimes a patient's toes, sticking out from the end of the green operation gown, would curl in pain but no one even whimpered a complaint. Each operation began with a prayer and Williams hummed hymn tunes as he peered through his loupes, slicing and gouging and picking and stitching. 'Is that to help keep the patients calm?' I asked. 'Not particularly,' he said, 'but they would worry if I stopped humming.'

What did stop was the electricity. Suddenly the powerful lamps went out and the air conditioning died. Everyone froze and waited, Dr Williams's scalpel poised over an unseeing eye. Then it came on again and everyone breathed out. 'We have not got our own generator yet,' said Dr Williams. 'Sometimes it goes off for hours and we have to stop everything. But at least we have our own theatre now. In the old days before Sight Savers built this one, we had to share an operating theatre and eye operations were of very low priority and we could be kicked out at a moment's notice.'

The next day we went on a ward round and watched the nurses unwrap the bandages of yesterday's patients. People who had not seen for years could suddenly see light and a blurred image. Faces lit up, there were smiles and gasps of astonishment. 'It's what makes it all worthwhile,' said Dr Williams.

After four days in the ward they are issued with a pair of spectacles to replace their lost lenses. Then they walk back to their villages, some as far as 40 miles away.

Much of the hospital building at Bo is rotting through neglect and corruption, but the eye hospital is like a small oasis of cleanliness, efficiency and purpose. Dr Williams is optimistic. 'My hope is that we can extend the Sight Savers operation to cover the whole of Sierra Leone and in about 10 years Ivermectin will protect so many people that the River Blindness chain will be broken or at least be very, very weak.'

But though Edward Sandy and his staff at the eye hospital in Bo have an area of thousands of square miles and about two million people to care for, the size and difficulty of their terrain is not the chief obstacle. The real struggle is against traditional beliefs. Each patient in Mokaba had an exercise book with his medical details in it. Most had 'TM' written in the notes: 'traditional medicine', and Dr Williams raged against their stupidity and ignorance. I had asked one man in Mokaba what had made him blind. 'It is the will of God,' he replied. Edward Sandy told me later that this formula is for outsiders. 'They think it is caused by witchcraft' he said. 'If they go blind

they think an enemy has used witchcraft on them.'

RIVER blindness is good business for witch doctors. They charge high fees to divine who has used witchcraft to curse someone with blindness and to provide an antidote to the curse. There are many alternative traditional medicines to cure blindness and when nothing works on the milky film over the eye, the witch doctors resort to more and more corrosive substances. At the eye hospital the doctors have found that urine, salt, petrol, faeces, battery acid and ground glass have all been rubbed into the eyes of blind people as potential remedies. Being African does not give the hospital staff any special advantage in teaching people the true cause of their blindness. Why should the villagers believe that the bite of one fly rather than any other, can make you blind? Why should people who have never seen a microscope believe that the worms can enter the eyeball and produce poison that causes blindness? And why should they leave the river which gives them food and holds out riches beyond their wildest dreams, which would allow them

to escape to the town and have a

car and a new wife and a house of

concrete?

'If a man is mining for diamonds or gold in the river he will risk everything' said Edward Sandy. 'Even if you are only a fisherman and if your father was a fisherman and your grandfather, nothing will persuade you to move.'

Diamond mining like this is a lottery, and it can become a feverish addiction. Neglecting their families and their fields, these men dig and shovel and sieve for weeks in the hope of hitting the jackpot, though sometimes they get nothing. And do they get rich when they find a diamond? They get paid a tiny proportion of its value by their 'boss man', a man from town who supplies picks, shovels and sieves and pays the local chief for the rights to dig in the forest. The boss man sells the diamond on to a Lebanese shop owner, a licensed dealer, who will probably smuggle it to Antwerp and get the bulk of the profit. About five per cent of Sierra Leone's diamond exports are declared at customs.

'The diggers get chicken-change for what they find,' said Edward Sandy, 'They spend it immediately and in a year they are back here standing in the river.'

I asked one of the diggers if he felt exploited. 'What I get for the diamond is my destiny,' he said. 'If another man sells it for more that is his destiny. It does not trouble me.' And what about river blindness? He shrugged his shoulders - it was simply destiny.

This deeply rooted traditionalism is the main barrier to breaking the cycle of river blindness. I asked Dr Williams: 'What do they say when you have cured their blindness and you tell them about the little black fly injecting the worms into the bloodstream?' The doctor sighed and answered 'They say: 'Who sent the fly to bite me?' ' -

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