A Village Struggles for Eye Health

Hanyane : A Village Struggles for Eye Health Hanyane - A Village Struggles for Eye Health This book deals with primary eye care in the context of community health and development and provides a practical guide to the diagnosis and management of common eye problems. It is written for health workers involved in providing primary and secondary eye care and will also be of relevance to all those striving to improve the health of people in rural communities. It has many illustrations which enable the story of Hanyane to be retold to community groups as an example of what can be achieved. The book has been produced by the International Centre for Eye Health, London, and is based on the varied experience of the three authors during their years in Africa. ERIKA SUTTER is an ophthalmologist from Switzerland who was in charge of eye services and training of ophthalmic nurses at Elim hospital in South Africa for over twenty years. Nine years were spent establishing the Elim Care Group Project on which the story and discussion about Hanyane is based. She now lectures on community eye health at the Swiss Tropical Institute, Basle, and the International Centre for Eye Health, London. ALLEN FOSTER works for Christoffel Blindenmission as Medical Consultant for Africa and is also a senior lecturer in preventive ophthalmology at the Institute of Ophthalmology in London. He spent nine years as Medical Superintendent at Mvumi Hospital in Tanzania where he developed a training programme for eye workers from East and West Africa. VICTORIA FRANCIS is an artist and health education trainer. Her work in Southern Africa included training medical students in communication skills and developing a health education programme for community health workers in Triangle, Zimbabwe. She is now based in London where she produces materials and runs workshops in visual communication for health education. © International Centre for Eye Health - Text and Illustrations. Illustrations by Victoria Francis First Published 1989. Reprinted 1990, 1998, 2002 Any parts of this book, including the illustrations, may be copied, reproduced, or adapted by individual persons as part of their own work or training without permission from the author or publisher, provided the parts reproduced are not distributed for profit. For any reproduction by profit-making bodies or for commercial ends, permission must first be obtained from the publisher. Any person who does any unauthorised act in relation to this publication may be liable to criminal prosecution and civil claims for damages. INTERNATIONAL CENTRE FOR EYE HEALTH CBM International 1 Hanyane : A Village Struggles for Eye Health Table of Contents Foreword 3 Acknowledgments 4 Introduction 4 PART 1: Community eye care 5 SECTION A: The roots of poor health 7 SECTION B: Action towards eye health 65 SECTION C: Village development leads to health 114 PART 2: Common eye problems for village health workers 167 SECTION A: How to examine an eye patient 169 SECTION B: Making a diagnosis 173 SECTION C: How to work in your eye clinic 185 SECTION D: Health teaching to prevent blindness 188 PART 3: Lecture notes on common eye diseases for ophthalmic assistants 191 SECTION A: Examination of the eye 194 SECTION B: Basic sciences 196 SECTION C: Diagnosis of common eye diseases 206 SECTION D: Management of common eye diseases 239 2 Hanyane : A Village Struggles for Eye Health Foreword The authors of this book address three important factors in eye health and its promotion. • The belief (in line with Alma Ata) that all sections of health services should be responsible for developing and supporting health care within the community. • That eye health is an essential part of primary health care. • The need for health messages to be presented in a way that will be read, understood and absorbed. This is achieved in this book in the context of Joyce and Lerisa's story in the village of Hanyane - illustrated by lively drawings. Eye health, in common with other health care, cannot be isolated from other activities in the community. As in all branches of medicine, knowledge of eye disease and treating acute conditions is not enough in providing eye care. It also requires an understanding of how people function and the ability to work with the local community and its existing power structure in a sensitive way. The authors bring their long experience of working in developing countries to show how health care workers need to get out of their 'box' and join with other sectors in working within and for the community (see the illustration). The competition for resources is such that disabled children are less likely to survive than other children. For instance, more than half of children blinded by measles die within the first year. Resources are important to eye health - adequate water, sufficient and appropriate food for children, and early identification and treatment of illness by those close to home - are all necessary to the promotion of eye health. The authors in their story, which makes up Part 1 of this book, go through many of the problems in a community when new ideas and resources for looking after people with eye problems are brought into a village. Joyce, Lerisa and the better-off women in the story are allowed to make many of the common mistakes, and we can all learn from the way they overcome their difficulties. The authors emphasize simple and practical things that can be done to encourage all members of the community - from chief to the very poorest member - to work together to improve eye health and to increase resources for further improvement in health. The great advantage and value of this book is that through experience and practice good methods are encouraged and understood, unlike many books on community health where theory is put before practice. This is complemented in parts 2 and 3 of the book with systematic lecture notes on eye diseases, their diagnosis and management relevant to general health workers and more specialised ophthalmic assistants. Professor David Morley Institute of Child Health, London 3 Hanyane : A Village Struggles for Eye Health Acknowledgements This book is a record of what African people have taught us about eye care and appropriate teaching methods. Our foremost thanks go therefore to those with whom we have worked and from whom we have learnt so much. They are too numerous to be mentioned individually, but include the staff and women of the Elim Care Group Project, the nurses and medical assistants from Mvumi hospital, Tanzania, and the health workers and communities of Triangle, Zimbabwe. The book is a product of the International Centre for Eye Health, and throughout we have been encouraged and supported by Professor Gordon Johnson. Special thanks go to Janet Langbein, who typed and also edited many versions of the script. We are also grateful to those who read drafts of the text and helped to pre-test the drawings. Finally we thank Christoffel Blindenmission and the Royal Commonwealth Society for the Blind for the financial support which enables teaching materials to be developed at the International Centre for Eye Health. The authors and publishers are grateful to C.H. Wood and AMREF for permission to adapt table 6.1 and to use the diagram 'Steps in community diagnosis', originally published in Community Health (African Medical Research Foundation, Nairobi, 1981). Introduction This book is to help people involved in health care, particularly eye nurses, ophthalmic assistants and community health workers. It is divided into three parts. Part 1 is based on the true story of how a group of villagers were encouraged to improve their own eye health. The problems they faced, the mistakes and the successes they made are discussed. There are 30 chapters, each one consisting of an illustrated narrative, and a set of questions and discussion notes. This section can be used in three different ways. First, individual health workers may read and study the principles involved. Second, teachers of health workers may use the narrative, drawings and questions in a classroom situation. And third, the story and illustrations may be used by health workers to stimulate discussion and activities within community groups. Part 2 is written for health workers at the village level who, as well as preventing and treating general diseases, are required to know about common eye problems. This part explains how to examine an eye patient and to diagnose and manage the common eye disorders. There is also a section on the important health messages which can prevent eye disease and blindness. Part 3 is a set of lecture notes for ophthalmic assistants and nurses. The lecture notes outline the basic sciences relevant to eye disorders, how to examine an eye patient and the diagnosis and management of the important eye diseases. Together the three parts form a basis for teaching health workers at the primary and secondary levels about eye care. The book emphasises the two aspects of eye health and prevention of blindness. First, understanding how to work with communities in order to reduce eye disease and blindness. And second, knowing about eye disorders and their diagnosis and management. This book is dedicated to those who started the Care Groups - Selina, Andrew and the women of Chabane, Mtsetweni and Nkuzana - and to all those who later joined them. 4 Hanyane Part 1: Community eye care PART 1: Community eye care Contents Introduction to Part One SECTION A: The roots of poor health 1 Will Musa see again? - Roots of blindness 2 Vho-Mudau's

Load more