18 - 24 October 2001
Issue No.556
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Al-Ahram Weekly Online 18 - 24 October 2001 Issue No.556 |
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For your eyes only
With hard data critically lacking on the prevalence of afflictions that cause sight loss, looking for answers to Egypt's eye care problems is like groping in the dark, writes Dena Rashed
The sight of children, flies seemingly glued to their faces, is a common one to scenes of poverty. Those who look close enough can see the black kohl mothers with little resources put in their children's eyes to protect them from eye diseases. It is hardly enough. Most of these children will grow up suffering from afflictions that, untreated, could result in blindness.
Poverty, the lack of awareness and limited access to reliable health care deprive many of their sight. Can the medical establishment meet the challenge?
photo: Randa Shaath
It is a hot and dusty day in Al-Sahil, a low-income district north of Cairo, and 13- year -old Mustafa is sitting with his mother looking rather bothered. "I hate operations and I hate seeing doctors," he says, although he admits that he has had two accidents before, "and since then I can't see clearly." Mustafa is aware that the situation could be serious, but still, he maintains that seeing a doctor is a show of weakness. His mother, seated beside him, says that she too suffers from some eye problems, but she does not plan on seeing the doctor. "It was too crowded to get an application, but it is okay, as long as I have got one for my son," she said.
Mustafa and his mother are among some 200 people crowding to see the doctors from Al-Noor Foundation, a non- governmental charity organisation run by Al-Maghrabi Optics. Al-Noor visits rural and urban low-income districts across Egypt offering free eye examinations and medication, setting up appointments for surgical operations when needed.
Talal El-Far, secretary-general of the Research Institute of Ophthalmology in Giza, says that lack of information among people is an enormous stumbling block. "Illiteracy still hinders many people from being aware of the diseases they have or they might get," says El-Far.
But this is not how Gamal Ezzel-Arab, medical director at Al-Noor Foundation sees it. "It's not about people's awareness -- it's not even about the cost of an operation," he argues. "Rather, it is the quality of service available to most people that hinders them from frequently visiting eye doctors."
Ezzel-Arab says that in many cases, operations do not give good results. When a flawed operation is not followed up properly, as is the case in many public and private facilities, patients feel that they would have been better off not having done anything in the first place. This mentality spreads. "Many of the eye diseases that cause blindness are preventable, and bringing people to understand these reasons is not a difficult task. It just needs to be a priority," says Ezzel-Arab.
The lack of concrete and accurate statistics concerning the number of people suffering from eye diseases remains one of the major obstacles facing those seeking to address the prevalence of blindness in Egypt. "The only statistics and surveys available to us date back to the 1970s, and even those are not that accurate," Ezzel-Arab explains. "It is impossible to know what disease to tackle first if we don't even know which one is more prevalent than the others."
Trachoma (trachomatous trichiasis) and cataract are believed to be the major causes of blindness and visual disability, especially in developing countries. Areas with poor sanitation and overcrowding are believed to have a higher incidence of trachoma, as it is transmitted by direct contact. In an effort to estimate the magnitude of these and other conditions, a far- reaching survey has been organised by Al-Noor Foundation in collaboration with the Ministry of Health (MOH), the Canadian International Development Agency (CIDA), the British Colonial Centre for Epidemiological and International Ophthalmology, and Pfizer Inc.
The first of these surveys was conducted in Menoufiya governorate, in northern Egypt. The sample size included 6,000 persons, with adults over 50 and children between the ages of two and six, out of a population of roughly 2.8 million residents. "Many doctors thought that trachoma was a disease of the past, but the survey we conducted has proved otherwise," says Ezzel-Arab. "The prevalence of active trachoma in children was as high as 30.7 per cent of children, with 5.8 per cent suffering intense trachoma, which often leads to blindness in adulthood."
As for the adults, trachoma was recognised in 8.4 per cent of adults 50 years of age and over. Ezzel-Arab notes that 40.7 per cent of these adults have already had surgery, and 44.6 per cent of those who had surgical correction have had the disease recur, requiring additional surgery.
The results of the survey indicate that trachoma, accounting for about 10 per cent of all cases of blindness, is the third leading cause of blindness in Egypt. The leading cause is cataract, followed by corneal blindness (see related article). In Menoufiya alone, there are at least 8,200 people who have become blind and some 22,900 people who are visually impaired due to trachoma.
Ezzel-Arab says that the survey will extend to three other governorates in Upper and Lower Egypt "in order to reach a reliable estimation of the prevalence of blindness and eye diseases." This week the same survey is being conducted in the Upper Egyptian governorate of Minya. In addition to gaining much-needed statistical data, the campaign has the added benefit of promoting good eye care and "drawing the attention of medical officials in Egypt to the importance of this issue," asserted Ezzel-Arab.
Abdul-Hannan Choudhury, medical officer of the control and prevention of blindness section at the World Health Organisation (WHO), emphasised this point. "Egypt needs to put this issue at the top of its health agenda, because if we don't deal with the problem now it will ultimately double in the future," he told Al-Ahram Weekly.
But not everyone is comfortable with the participation of the private sector in this effort. Taha Labib, head of the Ophthalmology Research Institute, is not impressed with the results of the surveys conducted by Al-Noor. Although he acknowledges the difficulties posed by inadequate data on this subject, he questions the motives of the private sector, saying that Al-Noor's findings cannot be used as a foundation for future research.
"I object to the fact that patients who need surgery are to be hospitalised in the hospitals of Al-Maghrabi [a private, profit- making organisation]. They should be treated in the governmental hospitals," Labib insisted. "I believe a great part of this project serves as an advertisement for a private organisation."
Is Al-Maghrabi giving with the right and taking with the left, as they say? For many, the question is irrelevant, as governmental hospitals are seen as simply incapable of bearing the burden. El-Far of the Research Institute highlights a lack of communication among governmental hospitals as a key problem. "It is not about the number of doctors or the number of hospitals, but about the calamitous organisation of Egypt's medical services," says El-Far, who added that many of the problems facing patients can be eliminated by instituting a smoother, more intelligent system.
Even though medical intervention in government hospitals is subsidised, WHO's Choudhury argues that treatment is often too expensive for the average Egyptian. "Operations are still costly, ranging from LE1,000 to LE2,000 for a cataract operation. It should be much less, since the lens itself does not exceed US$10."
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