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March 2017

Sightsavers International

Richard Lloyd-Hart

  Officially The Royal Commonwealth Society for the Blind - is a charity working to aid people who live in poverty around the world and who suffer from cataracts, trachoma and river blindness. It also works in other fields connected to blindness, but perhaps these are the three where it is most prominent.

The charity was founded in 1950 by John Wilson. He was the son of a Methodist minister, and was blinded in a laboratory accident at school, aged 12, but this did not prevent him from winning a scholarship to Oxford University. Only eight years after the charity was founded Royal status was conferred by the Queen, and its founder was knighted in 1975. The charity operates in 27 underdeveloped countries from Haiti via Uganda to India.

The hardships suffered by the blind need no description. The Government's Department for International Development recently reviewed 42 aid agencies believed by the Department to be "leaders in their field….who can….achieve real results in terms of poverty reduction and provide good value for money". Only nine achieved a high performance rating; Sightsavers was one of them. The American non-profit evaluator Givewell, which focuses primarily on the cost-effectiveness of the organisations which it evaluates, included Sightsavers in 2016 as one of the top seven charities recommended by it. Internet records going back to 2008 indicate that this is the first time Sightsavers has featured in Givewell's list. The charity spends 94.5p of every pound raised on its work; 5p on getting in more funds; and only 0.5p on administration.

Cataracts are the cause of about 50% of the world's blindness, and the usefulness of money spent on cataract operations was shown by the World Health Organisation in their bulletin of 6th September 2011, which says "Clearly cataract surgery is practised under very different circumstances in different parts of the world, and although its cost varies enormously it is one of the most cost-effective of all health interventions. The operation requires no follow-up and, once performed, confers a lifelong benefit free of further cost to the charity".

Trachoma, the commonest cause of blindness due to infection, is caused by bacteria which bring about a roughening of the inner surface of the eyelids. This leads to a breakdown of the cornea. The eyelids turn inwards along with the eyelashes which scrape against the eyeball, causing great pain, especially when blinking, and eventual blindness.

It is spread by eye, nose and throat secretions passing from those infected either directly or e.g. via towels or clothing. Where effective hygiene is in place the disease has been eliminated; also in every developed country except Australia. Health education is the key to elimination. Some 1,300,000 people have permanent blindness due to trachoma. It is common in more than 50 countries worldwide. It is being attacked by (i) surgery (ii) antibiotics (iii) facial cleanliness and (iv) environmental improvements. In communities short of water (iii) is not easy, and the provision of water is by organisations for whom the elimination of trachoma may not be their highest priority. Nevertheless in recent years Ghana, Mexico, Saudi Arabia, Iran, Oman and (most recently, in 2016) Morocco have all eliminated it. It is commonest in Ethiopia, Malawi and Nigeria.

River blindness, an infection second only to trachoma in causing blindness, is spread by the so-called black fly, which bites humans, thereby spreading its tiny larvae from an infected person to a healthy one. The larvae mature under the skin into adult worms which mate there, producing more larvae of which some migrate to the surface of the skin to be picked up by another black fly and some to the surface of the cornea. Their passage through the cornea can in time render it completely opaque and its owner blind.

The most effective remedy is a drug called Invermectin. It is provided free by the manufacturer, Merck & Co. It needs no refrigeration and has a wide safety margin, so it can be given at very low cost by minimally trained community health workers. Someone taking it every six months will stay free of the larvae, and, while Invermectin does not kill the adult worms, it will, if administered to a neighbourhood for long enough - 15 to 17 years is the practice - cause them to die out and with them the disease.

About 37,000,000 people are infected and about 300,000 permanently blinded. Since my previous article Mexico (in 2015) and Guatemala (in 2016) have reported the disease eliminated, following Colombia (in 2013) and Ecuador (in 2014). The main base of the disease is however in Africa, particularly Nigeria.

Money donated to Sightsavers is therefore helping to free from trachoma and river blindness not just people alive now, but their descendants for ever.

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