Working on the frontline to save sight during COVID-19

Dr Ute Dibb is an eye surgeon at CBM’s partner hospital, Norton Eye Unit, in Zimbabwe. She has previously worked with CBM partners in Nepal, Rwanda and Malawi. In this interview, she talks about the current challenges people in Zimbabwe are facing in accessing eye health services and the impact COVID-19 is having on a country already facing blindness and economic crises.

Why did you choose to be an eye surgeon?

I chose eye care because it’s a discipline where you can achieve a lot with very little cost, time and equipment. You can really change someone’s life in a short amount of time, which I find extremely rewarding.

Why is Zimbabwe facing a blindness crisis?

The levels of untreated blindness in Zimbabwe are quite high. Global estimates usually say that it’s about 1% of any population that is blind, but the surveys that have been done in Zimbabwe show that it’s more like 3% – that’s really, really high. Most of these cases are preventable. So 75% of all cases of blindness are preventable and half of them will be due to un-operated cataract.

Most government hospitals have little or no drugs at all, no consumables, often no running water, power cuts – it’s a highly dysfunctional system. Then we’ve got an economic crisis on top of this. A civil servant can’t even afford to have their parent’s cataract operation operated at a government hospital these days. Patients are not coming because they can’t afford to come.

How has Covid-19 impacted Norton Eye Unit?

A normal day in Norton, pre-Covid, would mean that there would be long queues waiting to be seen, patients sitting just about everywhere because we have very little space. Our outpatient department is 45 square meters and if you have 10,000 patients a year going through those doors, it’s going to be crowded, all the time, everywhere.

When Covid-19 struck, for quite some months Norton was the only eye unit in the country, of 15 million people, doing cataract surgeries. We’ve got very little space, we have very, very big numbers of patients coming. The challenge for us has been how to manage those numbers.

We’ve had to adapt how we work, which means treating fewer patients. We see just about 30 or 40 patients in a day. We operate no more than 20, to be able to space everyone out and to keep patients safe, to keep ourselves safe. And with everyone else being shut, it then translated into massive queues at our gate every morning. I take my hat off to my eye nurse Sister Mususa who went out there every morning, trying to screen the patients, because obviously we had to now select – there was no way we were going to see everyone, we could not. So we had to select and really only focus on the completely blind patients, people who had come from very, very far. But it was heart-breaking to continuously tell people “I’m very sorry, you can still see in one eye, come back next year” and “I’m very sorry, I know you can’t see well, but you still see too well to be seen right now, to be operated right now, please come back next year”. Obviously, “please come back next year” is not really helpful now that we’ve realised 2021 is just a sequel of 2020.

Can you explain the link between poverty and disability?

It’s always a challenge to lose your sight, no matter where you are in the world. However, I think what is specifically difficult in Zimbabwe is the fact that we’ve got an unemployment rate of 90%, so most people don’t have jobs and, if you turn blind, you end up competing with many other people to earn some money, somehow. You immediately find yourself at the end of basically every queue. If it’s a younger person, education is a challenge. There are some schools for the blind, but there are nowhere near enough.

It’s this typical cycle of poverty and disability. So people turn blind because they’re poor, because they can’t afford the treatment, and then they stay poor because they’re blind and can’t earn any money. And to get out of this poverty-disability cycle is really, really challenging, in a county like Zimbabwe.

How will the Light up Lives appeal help?

What I hope that Light up Lives will achieve is more eye care services closer to the home of the patients. So we need more eye units, staffed and equipped, closer to the patients so that they can be treated, that surgeries can be done without the patient having to travel far distances.

It will also help if we have more basic eye care training for community nurses, who are in the villages, who do the primary health services for the patients. The more knowledge there is, the more awareness of eye problems, the better it will be for the patients in the end.

For us in Norton, it would hugely help to somehow reduce the burden of this avoidable blindness. There is such a high demand for eye care in Zimbabwe, we do need a lot more places where people can get help.

Sight-restoring cataract surgeries, it’s one of the most cost effective healthcare interventions… by a long way. It only takes around 10 minutes. It’s doesn’t cost very much. And in 10 minutes to go from disability to independence, it doesn’t get much better than that. I know I’m biased, of course, but I think it’s a huge cause to support. And now that the UK government has promised to double any donations that can be made, it’s a great time to do so!

Through our Light up Lives appeal – and thanks to match funding from the UK government – we aim to improve access to sight-saving eye health services in Zimbabwe. With your support we hope to launch a major 3-year project that will significantly reduce the number of people living needlessly with blindness or visual impairment in Zimbabwe’s Midlands Province. If we raise enough funds, we hope to:

• Enable over 44,000 women, men and children with eye health problems to access good quality treatment and support;
• Deliver over 4000 sight-restoring cataract surgeries and more than 1500 other eye surgeries;
• Provide 1500 people with prescription glasses.

Giving people’s sight back will enable improved health outcomes, decreased dependency, improved livelihoods, inclusion in other community development programmes and, therefore, reduced poverty and vulnerability.

Donate now to support our Light up Lives appeal and help give sight to people living in the world’s poorest communities.