An effective collaboration in Mali

In November our Chief Executive, Caroline Harper, visited parts of Francophone Africa: the French-speaking countries of Togo, Benin and Mali. She shares her experiences meeting partners and beneficiaries, and advocating with governments on issues affecting our work.

Travelling to Mali

Wednesday 21 November

Today was entirely taken up with travelling from Togo to Mali. We are seen as the leading eye care agency here.

I had to catch an Air d’Ivoire flight to Abidjan in Cote d’Ivoire, changing to another flight first to Dakar in Senegal then finally to Bamako in Mali. I arrived just half an hour late and my luggage arrived within a few minutes of me sweeping through immigration without incident. Eat your heart out BA and Heathrow!

A mighty wind

Thursday 22 November

The Harmettan wind is just beginning here in Mali, so the air was full of dust. However, it is the cold season (only 32 degrees) and actually quite pleasant. I began at the Sightsavers office, where Elie Kamate (our Country Representative) introduced me to the country programmes. He is particularly pleased that the Koulikoro project (funded by the European Commission, and a major consortium led by Sightsavers including Helen Keller International, Islamic Relief and Water Aid) is going well, with the Memorandum of Understanding now signed and everything started.

A major concern

Elie told me that CDTI (Community Lead Distribution of Ivermectin (the generic name for Mectizan®)) was born in Mali. It has been going very well for many years but there is now major concern that the new Neglected Tropical Diseases (NTD) programme has caused damage. The NTD programme here was funded by USAID and devised by ITI (International Trachoma Initiative) and all the volunteers have now been offered money. Once USAID funding ends in five years, it will potentially be left to Sightsavers and others to go on paying the volunteers, who previously worked for nothing.

Finally, Elie told me about the next eye care project he wants to do – in the Mopti region, where the trachoma (link) rate is thought to be extremely high, and where we would potentially be able to partner with World Vision who are already doing sanitation work there. This could help with the FE (Facial cleanliness, Environmental hygiene) parts of the SAFE strategy.

After some really nice lunch (Francophone Africa certainly has great food!), we visited the National Eye-care Coordinator.

The ‘Miracle Operation’

The biggest initiative running in Mali is ‘Operation Milagro’, where Cuban ophthalmologists are coming over for six months of the year to run free cataract clinics, aimed at clearing the backlog of around 68,000 cataracts. This was through an agreement between Fidel Castro, the President of Mali and President Chavez (of Venezuela).

They say they are set to do 17,000 this year, with targets of 28,000, 32,000 and 35,000 for the next three years (the backlog is still growing). This will of course be a marvellous achievement, but surprise surprise the government hospitals (which charge for surgery) are seeing a sharp fall in the number of patients.

I asked whether he had thought about the issue of sustaining the capability (including training) for when the Cubans had gone. I sensed that he had not, but was simply focussing on clearing the backlog. I know that 2011 sounds a way off, but we need to get the government to think about the implications and plan ahead.

The importance of sustainability

The Cubans are supposed to help with training, but they haven’t done so as yet. Before they came Mali was doing 9000 surgeries a year, which isn’t far short of the incidence rate. Whether they will still be able to achieve this after the Cubans leave and the backlog is gone (although achieving this will require a great deal of outreach work in later years), depends on careful planning now, and making sure there is a smooth transition.

We spoke about IOTA (Institut d’Ophthalmologie Tropicale d l’Afrique) - the training centre for ophthalmologists and ophthalmic nurses. They are currently training six ophthalmologists – only one of whom is Malian. However, they charge 27 million CFA for training, whilst the equivalent centres in Senegal and Cote d’Ivoire only charge four million.

I asked the National Eyecare Coordinator what he thought of the Neglected Tropical Diseases programme. He was pushing for the funding to be made available for more than just drug distribution (eg for the SAFE trachoma strategy). This simply won’t happen, but it ought to be possible to design a programme which respects the fact that most of these diseases require other interventions in addition to drugs.

The need for rehabilitation

Friday 23 November

This morning we drove to Tienfala, where we have been working with WaterAid on the trachoma SAFE strategy. We jointly funded a well which WaterAid built, and they are now creating latrines for everyone in the village, including versions which blind and other disabled people can use more easily. We drove through Bamako, and I was shocked by the number of blind people begging on the streets. This was much higher than anywhere else I have been. There is a clear need for more rehabilitation work, including economic rehabilitation.

At Tienfala we met a number of blind people, the mayor and a government representative, and they told us that until river blindness was controlled the village was essentially deserted. No government reps were willing to be posted here because of this disease.

River blindness is now fully controlled, and the village is populated again. Since the project began, diarrhoea cases have fallen from 11% of the population to 6%. We haven’t collected the statistics to demonstrate the impact on active trachoma, something Elie agreed that we should do. The mayor was of course keen for Sightsavers to do more, and to build more wells both within the village and in other villages, some of which still have none.

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