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John Cooper and his ophthalmic assistant Anita, traveling to Grand Tru County, the hardest area, the hardest terrain to cross to screen patients. @ Sightsavers

John Cooper and his ophthalmic assistant Anita, traveling to Grand Tru County, the hardest area, the hardest terrain to cross to screen patients. @ Sightsavers

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Hard to reach

John Cooper is an ophthalmic nurse based in Harper, south east Liberia. This is a particularly challenging country to work in, as it is emerging from a decade and a half of civil war. This damaged or destroyed many of its institutions, left its infrastructure in tatters and forced many health workers to migrate. Another aftermath of the war is the poor state of the roads, which make it extremely difficult to travel to underserved communities in need of eye care services.

John talks about what his job involves, and some of the challenges he faces:

"I have been an ophthalmic nurse for six years. I got into medicine when my father had a stroke. When I visited, he wasn't being looked after properly. The staff were so busy and there weren't enough of them. After training, in 1986 the war came and I worked for a relief agency. Again there was a big staff shortage, but particularly for eye care. My father's first wife was blind and I have seen that blind people suffered particularly in the war, with nobody to help them. Sightsavers supported my ophthalmic nursing training in Ghana from 2001 - 2003.

Today as I look at the number of people who come daily to our clinic for treatment, and return after surgery with smiles on their faces, I am happy and proud to assist in making a difference in people's lives.
It takes me 25 minutes to walk to the JJ Dossen Hospital where I work. I get there at 9am, where I first clean my instruments and set up my equipment. I can describe in detail a typical day that I experienced recently:

The day began at a staff meeting, but I was called to see a one-day-old child born with no eyes. I spent some time counselling the mother of the child. While I was still with the child's mother, another call came from the emergency room, for me to go and remove a foreign body from a patient's eye.

"I have seen that blind people suffered particularly in the war, with nobody to help them"

Upon my return to the clinic, the patient load had terribly increased. There were just too many people waiting to be attended to. It took much time to stabilise the condition. There were glaucoma patients waiting to have their ocular pressure monitored, community members waiting for replacement spectacles, and relatives of cataract patients waiting to find out when the ophthalmologist will be visiting Harper to perform surgery. With very limited staff to work with, attending to a crowd of people with different issues can be hectic.

My daily and weekly activities are largely determined by the clinical needs of the patients. A week in every month is scheduled for community outreach in hard to reach areas. I travel to these areas on a motorbike. During outreach we do eye health education, follow-up on post operation cataract patients, and do vision testing. I also train the community directed distributors (CDDs - who distribute Mectizan® to prevent river blindness) in integrated primary eye care, so they can identify eye conditions.

"I love the joy shared with patients when sight is restored"

The hardest thing about my job is trying to cope with patients' frustration when services are delayed. Patients diagnosed with blinding cataract can wait for months for surgery. There is only one ophthalmologist in the region. But I love the joy shared with patients when sight is restored.

I am writing a book entitled the Challenges and Realities of Relief Work in the South East. This is intended to share my tears and joy in providing humanitarian services to the people in the South East Region of Liberia.

I hope one day to be trained as a cataract surgeon, to supplement the work of the ophthalmologist, or to be trained in community health to provide eye health education so that blindness can be prevented and controlled at the community level."