From Fred Ezeh, Abuja
National President of Nigerian Optometric Association (NOA), Dr. Anderson Chimeziri, has appealed to the Federal Government to integrate eye care into Primary Health Care (PHC) services so more people can have access to the services.
In this interview, he highlighted the importance of such a decision in order to tackle the issues of eye problem from the root, thereby, offering protection to the eyes of younger Nigerians.
He also highlighted some of the factors that are responsible for children coming down with eye challenges at the early age.
Few weeks ago, the world commemorated World Sight day. What’s the significance of the day?
It was a remarkable event for us at home and abroad. It was a day set aside to raise awareness on the importance of eye sight/care. The day is usually marked on the second Thursdays in October. This year, the day fell on 12th October. It was a day for professionals in eye care services and other stakeholders in health care services to create awareness on the importance of good and quality eye care services.
What campaigns were done by the professionals?
Like I said earlier, it was a great awareness for us. We, the professionals that involve in eye care services notably, optometrists and others in the policy making side of the services, used the opportunity to educate and enlighten the people on what is required of them to keep their eyes healthy, and by extension maintain quality sight, thus preventing what could result in total collapse of their eye functions which could result in blindness.
Things like what
Do you know that 80 per cent of the causes of blindness are avoidable? Yes, they are if only adequate information and knowledge is made available to the people especially those in the rural communities where there is limited information and health care professionals including optometrists. However, in doing this, there’s need to emphasize on behavioral changes, which includes dieting, exercise, harmful traditional practices, self-medication and other related practices. The world sight day was designed to provide such an opportunity for the people to know about these things.
Do you think Nigerians have enough knowledge about their eye health?
I won’t confidently say that Nigerians have been fully sensitized. You must know that Nigeria has a large population, over 200 million, and 80 per cent of the population lives in the rural communities where there is little or no presence of government. Unfortunately, professional eye care services are mostly domiciled in the urban areas. But many people, especially in the rural communities, have little or no information about eye challenges, hence many of them adopt harmful practices that often result in severe damage to the eye or even blindness. It’s a fact that if you visit some local government areas, you will discover that there’s no eye care services there or qualified professionals to offer such services.
Do you have continuous advocacy and sensitization programmes to sustain the momentum?
Yes, and I must tell you that sensitization is an ongoing plan. This is because children are being born everyday, and younger people develop into adulthood. People’s level of knowledge, exposure and reasoning change with time, so, our sensitization plan is a continuous engagement. Besides, health is a dynamic science; hence practices and knowledge change over time with empirical evidence to prove. There’s a continuous discovery in the world of science. For instance, chloroquine was used to treat malaria for a very long time, but that has been replaced with Artemether/lumefantrine combination, which has proven to be more effective in the fight against malaria.
Why are children coming down with eye problems at an early age?
The first reason is the increase in knowledge, modernization and civilization. Children begin to expose their eyes very early in life these days, and that begins from crèche, nursery, primary and other levels. Each of these levels get the eyes of these children exposed beyond what they could take at their level of development. These exposures have necessitated increased visual demand. In addition to that, advancement in science and technology has made us understand that lots of things can be corrected at an early stage in the life of a child which otherwise can lead to amblyopia. Amblyopia (also called lazy eye) is a type of poor vision that usually happens in just one eye. It’s less common in both eyes. It develops when there’s a breakdown in how the brain and the eye work together, and the brain can’t recognize the sight from one eye.
Science has proven that if these challenges are detected early in a child’s life, possible cases of blindness can be avoided. The medical glasses commonly being used have no effect on the children; rather it enables them to use the eyes effectively. Some of the things we believed in the past were simply based on superstitions and ignorance. But science has proved us wrong and provided the right information. So, early interventions save these challenges. These are some of the reasons why less children are in the school of the blind as could be noticed by all. Similarly, more research has provided guidance for the early treatment of eye challenges.
Is eye challenge hereditary?
Some eye challenges, particularly glaucoma, are hereditary. It’s important that we realize that there is infant glaucoma, which is often caused by inherited traits from the parents. We also have eye cases that are congenital, meaning that there was error that occurred during conceptions of the child. Such children are born with what is called congenital cataracts. These are mostly due to unavailable or insufficient enzymes that often help to digest lactose (milk). When a newborn child who lacks is being fed with milk, the milk won’t be digesting well. The milk will be deposited in the lens of the eye, and that often results in cataracts. If this kind of case is discovered at an early stage, the mother of the child or the caregiver is advised to immediately quit feeding the child with milk to protect the child from developing cataract.
There are also acquired cases like vitamin A deficiency. If a child is not properly fed and given appropriate vitamins during pregnancy, the eyes might not be properly developed. There’s also an environmental factor too. Here’s a good example of the environmental factor. There’s a factory close to where I work. Activities from this factory have polluted the main source of water for people in that community. As a result, all the children in that community are having brown eyes and very dark teeth as a result of the polluted water that they drink. But that was recently addressed when the government began to source potable water for the community from a more safe and clean source. So, parents need to know these basic things and take actions to protect their children from it. There’s also the case of allergy that a child could inherit from the parents. This is more pronounced on parents that consume tobacco. You noticed that some children scratch their eyes from the day they were born.
More people are having access to digital devices and engagements. What are the dangers to the eyes?
Yes, the world is increasingly being infused into digital devices and spaces. There are dangers associated with that, but it’s correctable if early attention is provided. It’s important that we note that soft blue rays that are produced by digital devices are more dangerous to the eye than the natural sun rays that we often run away from. As much as we often advise children not to play during the peak of the day because of high concentration of dangerous ultraviolet radiation, the radiation that comes from digital devices like television, laptop, desktops, smart phones, tablets and other digital devices, constitutes more potential hazards to the eye. And these blue rays can result in nervous toxicity. They can destroy the nerves and make the child have digital strain or what we described as computer vision syndrome. However, there are several innovations that have been developed to block the rays from reaching the eyes. These are some of the things that can be provided for the use of children to protect their eyes from harmful rays that come from digital devices.
What’s your assessment of government responses to the issues of eye care?
As far as I am concerned, this administration of President Ahmed Bola Tinubu has started well in terms of the health care system. During the World Sight Day that was commemorated a few weeks ago, several issues and suggestions were presented to the stakeholders on how best to improve on eye care services. In addition to that, three operational documents were also launched to provide a guide to eye care services in Nigeria. However, most of the programmes shouldn’t end at the launching stage, which often comes with ceremonies. There should be more concentration on the implementation stage. That’s what matters the most. We also need a concerted effort across the various levels of government to ensure that more opportunities for improved eye care services are provided.
Do you support the call for inclusion of eye care services at Primary Health Care (PHC) centres?
Yes, and that should be done as fast as possible. For us at Nigerian Optometric Association (NOA), we recommend that eye care services should be an integral part of PHC services especially at local government levels. In addition to that, Chairmen of Local Governments should be mandated to take ownership and support eye care services in their areas of jurisdiction. There’s a need to stop the issue of eye challenge from the root and that can only happen if the local government authorities are involved and mandated to participate in eye care services. That will go a long way. It’s important that the services of optometrists are engaged at the local government levels to provide the eye care services.
Do you have an idea of the number of people that come down with eye problems, particularly blindness annually?
The figure was initially pegged at one million a few years ago. But the figure has risen to 1.3 million as indicated by the recent figure. You could see that the growth rate is not bad at all, and this was because of increase in knowledge, modernization and civilization. There is also an increase in case finding. More people are presenting in the clinic than before.
Also, health-seeking behaviours of Nigerians are increasing and that’s because of increased campaign by the media and other stakeholders. Unfortunately, as the prevalence of blindness is dropping across the country, the prevalence of visual impairment is on the increase. What this means is that more people are not going blind as was the case in the past, but more people are becoming visually impaired. The prevalence of visual impairment has become higher, according to available data.
With increased digital penetration and its dangers to the eyes, do you have enough manpower to respond to the surge that may be experienced soon?
There’s serious improvement in manpower production. Initially, the distribution and allocation of optometrists was lopsided but that is gradually being addressed. We are producing more manpower now than it was some years ago. We now have training in Bayero University, Kano; University of Ilorin; Afe Babalola University; Bingham University, Karu, Nasarawa State; University of Abuja, and more to come. That has made it evenly spread across the country to enable more manpower production.
What about the necessary financial resources?
This is where we have serious challenges, and we need the government to quickly come to our aid. For example, an Ultraviolet block lens is unaffordable for an average Nigerian. A very good one is about N30, 000 to N40, 000, and that’s because of the import duty. But if the taxes are waived, it could come at a more affordable rate, so it can be easily distributed to children at an affordable rate. Also, some ophthalmic equipment is very costly. For example, an average OCT equipment costs over N60 million. How many rural private eye care doctors can afford it? I suggest that the government should create what is called National Health Bank where loans can be accessed at a very affordable interest rate for such interventions.
What about remunerations?
That’s another very important item of discussion. Undoubtedly, remuneration is a source of motivation and encouragement for doctors. One thing that enables results is a motivated staff. People give their best when they are motivated, financially and otherwise. For instance, if the government pays doctors peanuts, it will be expected that they would put in limited time and service, and dedicate ample time to their own private facility. This will enable the doctors to work well in rural areas where there is less concentration of health care workers.
There’s a “Japa” wave in the health sector. Is it affecting your profession too?
Yes, we are having a fair share of the brain drain challenge and we are feeling the negative impact. At least, 20 optometrists or more leave the country for professional practice in the United Kingdom (UK), and other countries of the world weekly according to my record. That’s a serious manpower crisis facing us. Many of these doctors choose the location because the UK government needs their services in the rural areas, and as a result, they are well paid to encourage them to work in the rural communities. None of these doctors work in London or other major cities in the UK but in rural communities. The UK has also made it easier for them to come over and practice there. All they need is to pass the interview. Several other hurdles that hitherto frustrates their exit have been removed by the UK government. These doctors are paid up to 350 pounds each day they work. No senior professional optometrist can earn up to that in Nigeria. These doctors work in a conducive environment that encourages dedication and productivity. That’s the situation.
How many registered optometrists do you have in your database?
We have over 7,000 registered optometrists (eye doctors) in our database. But I can confirm to you that we have less than 2000 of them that are currently practicing in Nigeria. Optometrists are leaving the country just like other professionals in the health sector and all knows the reason for their leaving. I can mention the names of the doctors that left this country in the last few weeks, and their states. Lagos state government employed 15 optometrists last year but only four resumed, the rest left the country for professional practice abroad. Undoubtedly, many colleagues are frustrated working in this country. From poor working conditions, to poor remunerations. Insecurity has worsened the matter, making it difficult for colleagues to consider working in rural communities and other unsafe places. That has made it difficult for these rural communities to have access to good eye care services. We appealed to the government to find urgent solutions to the growing problems of eye care, starting with the integration of eye care into PHC services so that issues of eye challenge can be tackled at the root.
