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A Vision For The Future Of Health Care
Wednesday June 9 2010
The mark of any community is how it treats its most vulnerable. Communities all over Uganda are working together to eradicate river blindness; a debilitating and destructive disease affecting the country's poorest and most vulnerable.
In Mbale District, Uganda, a young girl waits to have her height measured. A stick in hand, she points to pictures she has traced in the dry earth. Every so often, she solicits compliments for the trail of doodles that stem from her feet but nobody seems to be paying attention. Beside her, are school friends, neighbours, and family, including Mustafa Mugwano, who is resting docile on a bench. It's a hot and stuffy afternoon, but all are gathered here today to see Cleus, the village health worker, who is measuring people so he can give them the right dose of a drug called Mectizan.
Mectizan treats Onchocerciasis, commonly known as River Blindness. The disease causes intense itching, skin disfigurement, vision damage, and in some, irreversible blindness. Parasitic worms burrow under the skin and multiply throughout the body. The worms spread from person to person by little black flies which breed, in their thousands, near fast flowing waters.
Bunawazi is a remote farming village in the Mbale district of East Uganda. Here, the nearby rivers are the only source of water, the sustenence of life, but also of disease. The rivers teem with black flies that cause River Blindness and the Bunawazi community fish, wash, bathe and play in the rivers contaminated water, every day.
In this environment up to 300 bites daily are common says Dr. Frank Richards, a public health specialist from The Carter Centre, who help distribute Mectizan. 'This is the kind of biting rate that will easily sustain river blindness'.
River Blindness is the world's second largest cause of preventable blindness. Uganda is one of 18 endemic countries in Africa, where 99% of cases occur. Here in Bunawazi, the majority if the community are infected, including Mustafa who is partially blind.
'There is no misery like it' says Cleus, who has witnessed the suffering of many in his community. 'You cannot work, you cannot sleep, he who cannot work or sleep becomes poor'. The disease ravages not only the individual, but the family and wider community. Young children without severe symptoms are often taken out of school to look after ill family members, or to work themselves as the main breadwinner. In the long term, the chains of their community's poor health hang over their own future and slow down development.
Today, Mugwano is only partially blind and he is able to work, but his legs look as though someone has taken a sander to them. They are permanently disfigured from his battle with river blindness, the unbearable itching made him violently scratch his legs with rocks and sticks until they cut open. Like many, Mugwano lived like this for years, scratching in the absence of a medical authority to diagnose River Blindness. Traditional healers assumed he was bewitched, which led to stigmatization in the community, estrangement from his family and eventual displacement from his home. Mugwano was exiled from Bunawazi. For 10 years he lived in oppressive freedom, surviving in the wild forests nearby, with nothing but his own personal hell to keep him company. 'I hated myself, nobody wanted to be near me'. Mugwano looks to this time in his life with tides of worry; 'But, I am lucky', he says stoically. Some sufferers become psychologically traumatized and never recover. Some become tired of suffering and take their own lives.
Mugwano's symptoms have improved since his return to Bunawazi, and so have public perceptions of River Blindness. The community are more knowledgeable about the disease and less fearful because health workers like Cleus have been trained to educate them as well as treat them.
Mectozan relieves itching, improves vision and prevents blindness by stopping the worms inside the body from breeding. To date, it has been the most effective drug used to prevent continued infection. However, getting the drug to as many people as possible remains a difficult task. One of the greatest challenges within the African health sector is a critical shortage of human resources. According to health development organisation AMREF, the average doctor-to-patient ratio across Africa is 1 in 20,000. In remote areas where local medical infrastructure is less adequate than average, the ratio is closer to 1 in 50,000.
Through the Carter Centre assisted River Blindness Programme, more than 20,000 people have been trained to serve as community health workers. Volunteers like Cleus don't get paid, however they're primary incentive is the well-being of their communities. This makes the program a cost-effective and sustainable way of treating the disease.
The Ugandan government have made a bold commitment to eradicate River Blindness by 2015. Working in partnership with NGOs and service providers such as The Carter Centre, the Ugandan River Blindness Programme presents a fine model for community-led health care and perhaps, a template for combating other endemic diseases such as HIV/Aids.
In an article written to G8 leaders, Dr Michael Salley, Director General of AMREF, suggests that community health workers are the answer to most of Africa's health care problems. 'Disease doesn't exist in isolation' he says 'it thrives on an already weakened health-care system. Addressing the system includes getting communities to participate in identifying their needs and addressing the social, cultural and economic factors that make them vulnerable in the first place.'
Last year, former Minister for Health, Emmanuel Otaala reported that Uganda had significantly reduced the prevalence of River Blindness from 60% to 20%. With 5 years to go, Uganda is on its way to eradicating River Blindness; which is due in no small part to its large infrastructure of community health workers. If anybody needs proof that people-driven initiatives work, this is it. Certainly, community mobilization on a global scale will play a big part in whether the Millennium Development Goals are also met by 2015.
Beyond the simple satisfaction of meeting basic needs, is the satisfaction of simple pleasures. Mugwano likes to farm his land. It's impossible to ignore the joy he receives from gaining his sight and life back. His smile is infectious yet contented; eyes misty yet bright. 'Life has been given to a lifeless soul,' he says.
This feature was written between 6 March and 30 April 2010 as part of the Guardian International Development Journalism Competition
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