International effort helps bring vision of a better life to cataract sufferers

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Samba Ba is so keen to have his cataract removed he has arrived at the Ipres hospital in Dakar a day early to make sure he is first in line for the operation.

The dignified 70-year-old has already had the surgery on one eye and has come prepared with his stick and a mat to sleep on.

He is there ahead of the Sightsavers International team from The Gambia, which has travelled overland for 13 hours in a car loaded with supplies to set up a temporary camp. Over the next three days, they aim to work with Senegalese eye surgeons to carry out around 200 operations.

In Senegal, 40,000 people are blind from cataracts, about 18,400 are becoming blind, but local surgeons manage to perform just 2,000 operations a year. In contrast, The Gambia, a tiny West African nation of just one million people, has eliminated its backlog of cataract operations by taking a bold approach and training nurses and medical assistants to perform the surgery.

"Training doctors is long and expensive and maintaining them is expensive," explains Jerreh Sanyang, head of The Gambia Sightsavers team.

It is an approach that The Gambia hopes Senegal will adopt. The temporary camp, the fifth they have set up in Senegal, is aimed not just at helping individual patients, but also at training local surgeons.

It is part of a Health for Peace Initiative in West Africa, a move by The Gambia, Guinea-Bissau, The Republic of Guinea and Senegal to promote security in the sub-region by co-operating on health. Each country is responsible for a specific health area. The Gambia, which cut blindness by 50 per cent in just 10 years from 1986 to 1996, chose to take the lead on eye health.

By early the following morning, nearly 80 other people, dressed in colourful robes, have joined Mr Ba to await their turn quietly in the shady circular courtyard of the modest hospital. There is no hubbub or chaos, just an air of simple efficiency. The elderly patients are led in groups of 10 to another courtyard, where they have a final pre-operation check at a picnic table before signing or marking consent forms with their fingerprint.

Inside the operating room the patients lie perfectly still as one of the surgeons takes a long, fine needle and injects local anaesthetic into the muscles around their eyes.

It can take just 10 minutes of cutting and sewing to remove the diseased lens, replace it with an artificial one and restore the patient's sight. In the UK, a similar operation would take around 30 minutes.

Five surgeons working simultaneously with just two assistants between them operate on 80 patients in a little over six hours. It is a slick conveyer belt.

Relaxing in their scrubs in the courtyard shortly after 4pm, the surgeons say they could have seen even more people and would have been happy to work into the night if there had been more patients to see.

Meanwhile, the patients are getting ready to spend the night under a corrugated iron shelter in the grounds of the hospital on mats.

The next morning in the grey early light, the patients emerge ready to have their bandages removed. The night appears to have been a bonding experience. All of the patients are retired, many are isolated, and they seem to have found the experience something like a slumber party.

Mamadou Kanoute, a retired carpenter, says: "The people were very nice. We ate well, slept well. I am going to go and see my friends and tell them to come and having this operation. I am pleased."

Nurses efficiently line the patients up in white plastic chairs, hand out records, antibiotic drops and painkillers in twists of paper. Then the medical staff move swiftly along the line, taking off the bandages. In less than 20 minutes, the process is complete and the mood of the patients has changed from quiet to joyful.

Souley Iley, 80, worries about providing for his seven children and is very excited to have his sight back. "I have never seen such things. I am looking around and seeing things very well, praise God. I am very happy and I am looking forward to seeing my wife for the first time in six years. Yesterday I couldn't see you. Today I can see you," he says.

Hamady Niang, a muezzin, says: "It was really dim. I couldn't even see my hands before. Now I am looking forward to going to the mosque on my own and reading the Koran."

Mamadou Joof, 65, says his sight is crucial so he can go back to earning money: "Now I will go back to work, harvesting peanuts. Now I will be able to return to the fields."

Ngoya Gueye says she will look for a new husband now she has her sight back. The 60-year-old was married twice, first at age 12 for 20 years. She was childless and her husband divorced her. She married again, but was divorced again when she remained childless. For religious reasons, she believes it is better to be married when she dies.

The operation seems to have dramatically changed Ngoya Gueye's personality. She walks taller, with more confidence and a sprightly air. She invites us back to the humble house where she lives with her niece and extended family and when her toddler great-nephew puts a bottle cap in his mouth, it is Ngoya who spots it first, not us.

"I couldn't do my shopping, I was too scared to go out by myself. If I wanted to go anywhere, my family had to take me so I could only get out about twice a week. Now I will be able to go out more," she explains, before crossing the village square by herself for the first time in three years to buy food. Her niece Rama Bousso, a nurse, tried to have the operation done privately but it cost more than a year's wages for the average person.

The Sightsavers team from The Gambia is performing the operations for free. The Senegalese government has targeted poor, retired people for the camp, and the only disappointment was that not more people turned up. Dr Saar, coordinator of the Senegalese National Programme of the fight against blindness, says the authorities will cast their net wider next time to help even more people.

Baaba Maal, a Senegalese singer visiting the camp, said: "The number of people seen in a few hours is incredible. I was surprised by the speed and accuracy. What is important is to share experiences. It is going to make a big difference to this country. It will increase productivity. I feel happy for them as a lot of them are very old and this will give them a new lease of life. It is like a miracle. The result is great and the lesson is that you can do things across countries by developing relationships."

www.sightsavers.org

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