Overcoming cultural barriers to eye health
The Muslim tradition of Purdah – practised in the Bukiyawa community in Katsina State, Nigeria – has created specific challenges for project teams trying to identify people with trachoma trichiasis (TT) as part of The Queen Elizabeth Diamond Jubilee Trust’s Trachoma Initiative.
In this community, as in many others, men are not allowed to enter houses where there are married women present. To tackle this and still be able to reach the women in the communities, the partners implementing the project on the ground identified and trained 26 female community health workers. This allowed them to enter the homes where married women are living to raise awareness of TT and explain the options available to help the people suffering from the disease.
The women chosen were already volunteering as Village Community Mobilisers (VCMs) and involved in other health programmes in the community, including tackling polio and lymphatic filariasis through Mass Drug Administration (MDA) – the process by which entire communities are treated with curative treatments.
Due to their background, the volunteers had an existing process for visiting hard-to-reach communities using maps to develop work plans, and they were experienced at educating community members on how to access health services. The Trust’s pilot scheme integrated TT work into the volunteers’ other health promotion activities.
Over a period of two weeks, a total of 38 people suspected as having trachomatous trichiasis were sent for screening at a special surgery day and, of those, 13 were confirmed to have the condition, 10 of whom were female. Surgery was provided for all but one of them, a 12-year-old girl who, due to her age, was referred to a local hospital for surgery under general anaesthetic at a later date.
There are still some issues to overcome as several women who were identified did not attend the screening however it’s clear that combining the skills, experience and time of the volunteers has been an effective way of finding suspected TT cases for surgery referral.