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February 2018

Sightsavers International

Richard Lloyd-Hart

Sightsavers International - 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, himself blind. Only eight years after its foundation Royal status was conferred by the Queen, and its founder was knighted in 1975. The charity operates in 30 underdeveloped countries, from Sierra Leone via Uganda to India.

The hardships suffered by the blind need no description. As to the charity's effectiveness in dealing with them: the Government's Department for International Development recently entered into Programme Partnership Arrangements with a number of aid agencies, including Sightsavers. 2016 was the final year of these partnerships, and following a review the Department has given Sightsavers an A+ rating for its work in the five years of its partnership. The American non-profit evaluator Givewell, which focuses primarily on the cost-effectiveness of the organisations which it evaluates, confirmed in 2017 its inclusion in 2016 of Sightsavers as one of the top charities recommended by it (nine in 2017; in 2016, only seven). In 2016 the charity was also given the first prize in the charity sector in the Top 50 Customer Service awards.

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 described cataract surgery as one of the most cost-effective of all health interventions; the operation requiring no follow-up and, once performed, conferring a life-long 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. Where effective hygiene is in place, the disease has been eliminated, and in every developed country, Australia excepted. Health education is the key to elimination. Some 1,200,000 people have permanent blindness due to trachoma. It is common in 41 countries worldwide.

It is being attacked by surgery, by antibiotics, by facial cleanliness and by environmental improvements. In communities short of water facial cleanliness 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 2017 Laos and Cambodia joined the six countries which I listed last year as having eliminated the disease. It remains however widespread 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 the tiny larvae that cause the disease 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 in time can render the entire cornea 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.  Four of the last five years have seen some country report the elimination of the disease. However the disease is still rife in much of Africa, particularly Nigeria.

I am particularly drawn to Sightsavers, since money donated to it is helping to free from trachoma and river blindness not just people alive now, but their descendants in perpetuity.

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