"Getting cataracts is as inevitable as getting grey hair. All of us will get it if we live long enough, the key is to catch it early."
Dr Musukwe (Paediatric eye surgeon Blantyre hospital Malawi)
Before I went to Malawi you could fit everything I knew about cataracts and eye conditions on the back of a postage stamp. One of my Uncles had a cataract removed at a clinic in London about 10 yrs ago. I remember looking at his eyes thinking something's not right, his pupils looked cloudy, and he didn't look me in the eye anymore when we spoke. I didn't know it at the time, but these were the signs of a condition that makes millions of people go blind all over the world every year.
Eye conditions like cataracts, glaucoma, and trachoma are the main causes of unnecessary blindness in developing countries. In the UK trachoma is virtually nonexistent, and Cataracts in children is dealt with as soon as a child shows any signs of problems with their vision.
In Malawi it's estimated that about 10,000 children are blind because of cataracts. This is a rough estimate, as most of them live in very remote villages without electricity, or road access. So reaching them to get a true idea of numbers is very difficult. Even when we got to the villages, we're told many families hide their children with visual impairments out of shame. So the numbers could be higher.
I spent three weeks in the South West of Malawi, making a film for Channel 4's Unreported World series about children and adults who become blind unnecessarily because of cataracts. Joyce Trozzo my P/D (producer director) and myself covered hundreds of kilometres to meet people living in the villages of Dolo, Mkumaniza, Chapananga, Ngabu. The roads were some of the worst I've seen, they could only be accessed in a 4x4 or by motorbike. I used both and found the journeys on these dusty and rocky dirt tracks in temperatures nearing 40 degrees exhausting.
We concentrated on four main characters, Rex Bwana-usi a specialist eye nurse. He'd set up outreach clinics in these villages to find as many people with cataracts, Trachoma, and other treatable eye conditions as possible. We found out about the many mind boggling challenges he has to deal with just to get to these patients. Reaching his patients is only half the battle because Rex then has to try and get them to hospital for treatment. He has to do all of this even though his department doesn't have an ambulance! To me his job seemed like an impossible mission. We spent a lot of time with Rex exploring why he did this job, which kept him away from his family for long periods of time, and pushed him to the limit emotionally and physically.
Emeresi Jasi, (Jess) didn't know how old she was, there are no records of birth for most villagers. So most of her history had died with her parents many years ago. What I did know was that she was a proud grandmother. Jess could barely see the shape of your hand if you held it a few centimetres from one of her eyes, and was completely blind in the other. The first time I met Jess she almost collapsed in front of me, exhausted after walking 10km bare footed guided by her granddaughter, who also had to carry her baby on her back. We met them at one of Rex's outreach clinics. She told me how she was once the most important figure in her extended family, harvesting most of the family's food from her little plot of land. She cooked, cleaned, and like so many grandmothers in Malawi she was supposed to pass on these essential skills to her daughters and granddaughters. Now she was blind and couldn't do any of that anymore. She'd become a burden to her family. Jess said to me she desperately wanted to see again, and provide for her family. But without help she told me, she would just die a slow and lonely death.
Rose Paolo was 14, her mum and stepfather told us she'd been blind since she was 5, doctors think longer. Rose had missed nine years of schooling, as there are no schools close to her with resources to teach children that have visual impairments, or any sort of disability. She was extremely shy, cataracts had damaged the sight in both her eyes. She had a tiny amount of vision in the corner of her left eye. Rose was totally dependent on her family, it was a race against time to save her eyesight. Her family had no means of getting to hospital, even if she did have eye surgery there was no guarantee of success, because of the length of time she'd been blind. The biggest worry for Rose's mother was what would happen to Rose once she was no longer there if she stayed blind. Village life in Malawi is extremely difficult for everybody. Death from starvation, disease or dehydration is a daily reality. An operation to remove the cataract in both of Rose's eyes was not just about saving her eyesight it was also about saving her life.
Kelvin is 4 years old he'd been blind since birth. Rex told us Kevin was very close to the cut off point where having surgery might not work. As babies we start to learn to use our eyes, around six weeks after we're born. This is a crucial time, it's when the brain begins to create visual pathways with the eyes, as we start making sense of everything we see. Using these pathways we learn to recognise familiar faces, and relate expressions on people's faces with emotions, like happiness, anger, sadness. Our eyes also help us to understand, as well as see, objects, and their uses. If you've never seen all the things we see in day to day life, like trees, cars or people's faces,then sadly as the the years pass, it becomes more and more likely that your brain will never be able to fully comprehend these things and normal vision becomes impossible to obtain, regardless of surgery. When Rex met Kelvin he said it was essential that he had surgery as soon as possible. Rex held him in his arms and told us "I can't allow my little Kelvin to be blind, 70 years of blindness is no life for a child" especially if you live in a developing country.
To find out what happens to Rex, Jess, and Rose, make sure you watch
This Episode of Unreported World on C4 on the 16th October.