It is the little things that make the big things. Seeing change in Madagascar
If you have heard of Madagascar, you likely know the cartoon version better than the reality. King Julian is quite the character, bringing the uniqueness of the lemur to life. Last week I had the good fortune of meeting a lemur in the flesh in Madagascar and they have as much personality as Julian. Unique to Madagascar, they are a unique species.
Last year, CBM Ireland embarked on a quite unique project to prevent infant and childhood blindness in Madagascar, using a new piece of technology, called the ARCLIGHT. It was developed in the University of St Andrews in Scotland and allows community health workers in some of the most challenging places in the world to screen children from when they are born for preventable eye-health issues.
In places like Madagascar, the vast majority of young children get no form of eye screening or testing resulting in issues such as cataracts, congenital glaucoma, and even retinoblastoma (a form of eye cancer) being undiagnosed until it is too late to save their sight, or even their eyes. It is a sad reality that is avoidable.
Practically speaking, there are few clinics or hospitals with the necessary equipment that are accessible to people living in rural areas with poor roads and no public transport. Parents, because of cultural norms, can be sceptical of modern health systems, and for many, even if a child was diagnosed with a problem, they wouldn’t have the means to pay for the necessary treatment. The health system is there, but it has limited resources. The tax base is narrow and the tax-take is low.
Travelling to Madagascar in my role as CEO of CBM Ireland, an organisation that works to end the cycle of poverty and disability, I was there to look at one project in particular. For the last year, with funding from Electric Aid, ESB and EirGrid Staff's Development Fund, we have been working with the Ministry of Health and our local partner in Madagascar SALFA (the Malagasy Lutheran Health Department), a truly incredible organisation on a project to prevent childhood blindness.
SALFA has grown over the decades to include ten hospitals and over 40 rural clinics. CBM supports them in their work. Last year, we commenced what we consider to be an innovative – and game-changing – eye health project in the Vakinankaratra region of Madagascar.
With a population of over 2 million people (Madagascar has 30m altogether) Vakinankaratra has 300,000 children under five, who should have their eyes screened but do not. This has been possible. Why not? It is complicated.
There are not enough outreach health workers.
They usually have to travel by foot, pedal bike or motorcycle – the former being slow and the latter hard to maintain on mountain roads.
The equipment that is needed is expensive and fragile. It isn’t built for daily 70km motorcycle rides on dirt roads.
Even if it was robust, it isn’t financially feasible to provide each health worker with a €5,000 piece of equipment in Madascar.
Plus, the electricity supply is intermittent – so the ophthalmoscope may be without power when it is needed.
And transport and travel is much harder here. We came here to Antsirabe from the capital Antananarivo on one of the main highways. It took us 6 hours to travel 170km. This was one of the good roads.
But with the ARCLIGHT, this is changing. The Arclights are a low-cost, low-technology, hard-wearing piece of equipment that mean health workers will have what they need to do eye screening on infants and children up to the age of five who would otherwise have not had the chance to have their eyes screened for preventable blindness issues. Arclights retail at about 100 euro, but for a charity like CBM the cost is much less as it operates as a social enterprise, thanks to the pioneering work of the University of St Andrews in Scotland. What it can do is life changing.
The Arclight is a great piece of technology because it makes possible, in places like rural Madagascar, where the type of eye treatment we are used to in Ireland is just not available, that children will have their eyesight saved.
You think of Specsavers, where you receive an eye-test for 20 or 30 euro, you are examined with top-notch equipment that costs thousands. Yet in rural areas of Madagascar this examination is not happening. It isn’t feasible or affordable, but with the ARCLIGHT basic screening for referrals can happen.
In the last 6 months, the project in Madagascar screened over 20,000 children. 70 were identified as having issues: some very serious and were sight and life threatening. At one clinic, we were told by the community health worker who identified her, the story of the child Sombiniaina who is not yet one year old, and was diagnosed with retinoblastoma. She had just finished her last session of chemotherapy the day before we arrived. The whole community was thrilled.
We talked to the mother of Fanjii, not far from that clinic, who just last week had surgery on an infected eyelid that had become very dangerous. Fanjii was back home and recovering. We talked to another mother in Belasau Health Centre whose baby had a pterygium that had spread across the cornea and was now in recovery.
These were the good news stories that we were able to witness. But there are still many children in areas that the project has not yet reached waiting to be screened. No doubt there will be more cases like these that will be found. And there will be some that will not be got to in time as well. If a child loses her sight early it is often not recoverable because the brain loses the ability to process light. This is a real tragedy. Even more so when it is avoidable.
Travalling to Madagascar with two of our Charity trustees, Eoin McManus and Mark Finan – a solicitor and a barrister – I was reminded by how impactful the work of an international NGO can be. Having worked in overseas aid for over twenty years, I find I may be coming a little cynical and jaded because things do not seem to change. But Eoin and Mark, who give their time to the charity voluntarily (while holding me to account) were also giving up valuable work time to be there and to see first hand what our charitable donations were achieving.
They reminded me that not all change has to be systemic or systematic. A child like Sombiniaina cannot wait for systems to change, for development to occur, for democracy to yield its fruits. Cancer cares nothing for circumstances. It has no pity. Change for Sombiniaina is having that cancer killed and her sight restored. Change at a community level is a nurse who has an Arclight and is able to refer children to the right hospital when it is needed. Change for the SALFA surgeon is having the equipment repaired to be able to carry out a cataract operation. Being part of those changes, even remotely from Ireland, is what Mark and Eoin reminded me is important. The smile of Fanjii will hopefully stay with me when I get frustrated at the challenges that seem insurmountable and remember that it is the little things that add up to the big things.
Every little counts, so they say.
Dualta Roughneen is the CEO of CBM Ireland. This article appeared in: https://www.irishcatholic.com/seeing-change-in-madagascar-it-is-the-little-things-that-make-the-big-things/