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Kids learning Braille at the Akpakpa Centre for Blind and Low Vision Persons © Sightsavers

Kids learning Braille at the Akpakpa Centre for Blind and Low Vision Persons © Sightsavers

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Caroline Harper visits Benin

In November 2007 Soghtsavers', Caroline Harper, visited 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. She began in Togo and moved on to Benin...

Arriving in Benin

Sunday 18 November

Today we drove across the border into Benin, and on to the main town of Catanou where we had dinner with the National Onchocerciasis (river blindness) Coordinator. As in Togo, there were no real links between different eye care people.

Monday 19 November

We began by visiting the Director of Health, along with the National Oncho Coordinator. They shared with us the National Eye-care Plan, written in 2005. It had yet to be implemented - the vast majority of cataracts in Benin are performed either by CBM (another charity) at their mission hospital, or by visiting volunteers from Tunisia. A similar problem was being experienced with the latter as with the volunteer ophthalmologists in Togo - no follow up meant that the government hospitals were left to pick up the pieces with infections etc. The cataract surgical rate in Benin was 470 in 2005, and there are currently around 26 ophthalmologists.

Another depressing picture

The biggest problem seems to be the cost of the operations - at £130 each this was horrendous - worse even than Togo - and well beyond the pocket of the vast majority of the population. CBM charge £60 and the Tunisian volunteers offer free surgery. So why would anyone go to a government hospital?

The comparison between the depressing picture in eye care and the tremendous success of the river blindness programme was as stark here as in Togo. However, as we saw when we visited the government hospital the problem was primarily the cost charged, rather than the availability of equipment or staff.

We had a presentation from the onchocerciasis team, showing that all villages tested in Benin are now showing river blindness prevalence below 5%.

Everyone was understandably very keen for Sightsavers to begin supporting eye care here.

Rehabilitation, training and education

In the afternoon we visited the Akpakpa Centre for Blind and Low Vision Persons. This centre had been built using Rotary money, and its ongoing costs were provided for by the Ministry for Social Welfare. They had also provided a school bus, so the children could be picked up from home - there were no boarders here. CBM contributed a lot of equipment but no cash. The Centre had a very enthusiastic leader, and it provided both rehabilitation and training for visually impaired adults, and a primary level school for visually impaired children. The children then went on to a nearby secondary school, which was integrated, meaning visually impaired and sighted children learn alongside each other.

One real concern was that adults and children were all treated as totally blind, even if they actually had low vision. There were no low vision aids available, and one teacher said it was particularly annoying when people with residual vision insisted on trying to read, as ‘they will only go blind anyway, and then be one or two years behind in learning Braille'.

What a waste

The centre had received a Braille embosser, two computers and a scanner from the Force Foundation in the Netherlands. These had never been used, as the school could not afford to pay the person who had been trained to use them, or indeed to train up anyone else. I have learned in my previous travels that this is not uncommon, and it is really important when donating equipment to make sure that the partner has the wherewithal to use it and maintain it. They had no other assistive technology. One of the teachers had a Perkins Brailler, and he used this to create Braille books which were then copied for the children.

There was such a lot Sightsavers could do for this establishment, which clearly had a passionate leader and was reasonably well supported by the Ministry for Social Welfare.

This evening we had dinner with the Director of Communicable Diseases and the National Oncho Coordinator, who told us many stories of voodoo and witchcraft (Benin is the original home of voodoo)...

Very few patients

Tuesday 20 November

We visited the main teaching hospital in Catanou, and it was clear that sanctions make a real difference. In comparison to Togo this was quite a well equipped ophthalmology department, with plenty of staff. All the equipment was working, and had been provided by the Ministry. The big issue was there were very few patients - the number of cataract surgeries done had been dropping year on year, and they only expect to do 30 this year. This was entirely due to the cost of the surgery, at £130 sterling. The price was set by the Ministry, and hadn't changed in several years, despite the fact that when it was originally set they were using general anaesthesia and patients were staying overnight. It was clear to me that until this problem was resolved, nothing would change, and the number of cataract operations performed would continue to dwindle.

There were quite a few students currently being trained - not just from Benin but from other Francophone countries. The lack of surgeries meant that the students got very little practical experience. The ophthalmologist who showed us round was very keen to get a wet lab to enable the students to practice.

I felt that if they could solve the problem of cost and increase the patient numbers, this could be a good facility.