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Jebel Touray is the Nyatero for the village of Madina Kaiaf © Jenny Matthews / Sightsavers

Jebel Touray is the Nyatero for the village of Madina Kaiaf © Jenny Matthews / Sightsavers

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Friends of the eye

The creation of a new eye care worker role in The Gambia is proving to be a real success story in stamping out the painful eye infection trachoma.

The Nyatero (literally ‘friend of the eye') is a community-based eye care worker responsible for the eye health of 250 people within their local area. Trained in primary eye care and given basic tools, they liaise between the health services and the community, carrying out eye screenings and basic eye care, and referring more complex cases.

The Gambia suffers from a severe shortage of health care workers, with only four doctors to every 100,000 people, among the lowest in Africa. Nyateros have helped bridge the gap between the community and available health services, carrying out some of the more basic eye care work, freeing up nurses to concentrate on the more complicated cases, and thus allowing the doctors to work on even more complex cases. The role was trialled in 2006 and has now been rolled out nationwide, with great success.

Chosen by their local community, Nyateros give up their own free time, often after working long days on their farms, to provide eye care for their fellow villagers. Alagie Touray, from Kafuta village, explains his motivation for being a Nyatero: "I love being useful for the community I live with and helping people to prevent eye diseases. It's like a way to carry out my prayers in daily life."

Surgery

For someone about to have eye surgery, Binta looks remarkably calm. Her son, Njujareh Fofana, the local Nyatero, has obviously prepared her well for eyelid surgery.

Binta, 55, had suffered from frequent trachoma infections in her life, and recently developed trichiasis. Her sight has been deteriorating rapidly, and she's had terrible pain every time she blinks. She says: "I keep taking the lashes out but they come back and it's no good." Binta has also suffered from terrible headaches, which means she has had to spend days lying down and has been unable to care for her grandson. At a village eye screening, coordinated by her son, her problem was diagnosed, and ophthalmic nurse Mustapha Jagne arranged to come back to perform surgery in Binta's house.

During surgery Binta remains relaxed and her only concern is that she'll wake her grandson sleeping in the next room. Njujareh says: "it's great that people can have surgery at home because many are too frightened to go to hospital. Also, few people have access to transport so it's very difficult to get to hospital." Mustapha finishes the surgery in just 30 minutes, and a happy and relieved Binta greets the small crowd of people who have gathered outside her house.

Antibiotics

It's a busy afternoon in Sabah Nigeu village. It's eye screening day, and many people have turned up to have their eyes checked. The one well for the village is nearly 50 metres deep, and the scarcity of water makes it difficult for people to keep up with face and handwashing, so many villagers are suffering from trachoma.

The past few weeks Nyatero Babu Ceesay has worked hard encouraging the villagers to come along to the screening. At 54, Babu has been a Nyatero for the past two years. He says: "Being a Nyatero is a constant part of my daily life." Every day he wakes up early in the morning and goes to the health post to see people before starting work in the fields. He returns to the post after lunch and again after work, as well as setting aside time once a week to visit people who can't get to the post. "It's a challenging and demanding role," he says, "but I like to give back to the community. I want to sensitise the people about eye care, especially with regard to our most important asset - the children."

Babu runs the screening session with ophthalmic nurse Mustapha Jagne. Villagers identified with trachoma are measured and given the correct dosage of azithromycin, while those with trichiasis will be booked in for eyelid surgery, which Mustapha will return to perform.

Face and handwashing and Environmental hygiene

Challa, a cluster of two villages, is testament to the importance of the Nyatero role, and the commitment of the community itself in making the SAFE strategy a success. The Nyateros educate the villagers about face and hand washing, and organise regular screenings and treatment for trachoma, while a village committee shows people how to maintain a clean environment, ensuring each household keeps their house and garden clean. The villages, which Sightsavers provided with sanitary kits, rakes and a wheelbarrow, also get together for monthly village clean-ups.

Village chief Alhagi Gai says: "trachoma used to be a huge problem and many elderly people were blinded by trichiasis. We first heard about the SAFE strategy ten years ago and since then people's health has improved hugely."