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Reaching the community. Avoglah has found going door-to-door is the most effective way to distribute Mectizan©. © Sightsavers

Reaching the community. Avoglah has found going door-to-door is the most effective way to distribute Mectizan©. © Sightsavers

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Eliminating the problem

Avoglah Melegan lives in the village of Tove Agbessia in the Klouto District of Togo. This West African country has a huge network of rivers and lakes, which means that of the population of six million, four million are at risk from the threat of river blindness.

It's people like Avoglah (pictured above) who play a pivotal role in the fight against this blinding disease. A midwife by trade Avoglah has volunteered to distribute the drug Mectizan® to her community for the last three years. River blindness (or onchocerciasis) is caused by a parasitical worm and spread by the bite of the simulium black fly. The fly breeds in the high-oxygen water of fast-flowing rivers, so people who live or work near them are most vulnerable. As well as leading to blindness, infection can cause severe itching and skin discolouration ('leopard skin'). An annual dose of Mectizan® taken for over 10 years will break the reproductive cycle of the fly and protect people against the disease.

Tackling community reluctance
In previous years, Avoglah would gather the community together for a mass distribution in the centre of the village. She found, however, that many people didn't want to take Mectizan® because it can cause painful itching. This happens because the Mectizan® is killing the worms in the body and, even though it is uncomfortable, this is a good sign that the medication is working.

Avoglah now gives out the treatment on a door-to-door basis so she can spend more time with each family to explain the benefits and side effects to them personally, and give them more reassurance. This takes nearly a month longer than group distribution, but she hopes she can return to old method when more people are comfortable taking Mectizan®.

Difficult to reach everyone
In the village of Seveno Kope, the village chief Denis Avoudoupou adopts the same system of door-to-door distribution. Each year, he visits every person in his community - around 150 people in total. But their farms and houses are widely spread and there is a lot of dense vegetation, snakes and poor paths between them so it's difficult to reach everyone.

Another major issue is that Seveno Kope is on the Togolese border with Ghana, and the nearest Ghanaian village is less than a mile away and does not have a Mectizan® programme. As a result, people who know about the distribution come across the border to get the medication and immediately return to Ghana. There is also a lot of migration and it is often not clear whether migrants from Ghana have been treated. This is worrying for Denis, as he is uncertain whether they can eliminate river blindness in his village when people so close by are not being treated.

A positive outcome
Abra Kpognom lives in Seveno Kope. Her vision started to go blurry a couple of years ago, but she wasn't sure why. She was encouraged to take Mectizan® by Denis and she agreed despite previously refusing. Abra experienced itching and discomfort after taking the medication, but was delighted that her vision returned to normal shortly afterwards. She says "Now I can see so well that I can even thread a needle at night!" Taking Mectizan® has helped Abra to earn an income. She sells food in the local school, and to do this you need a health card proving that you are healthy enough to work with children.

Sightsavers has been working in Togo since 2001 to control river blindness and, last year, we supported the treatment of 2,352,643 people. As Mectizan® must be taken over a long period of time in order to ensure that the disease is effectively controlled, it is essential that this programme.