At 14 years old, Paul Ajayi is experiencing the world through two eyes for the first time since he was three, thanks to a remarkable free surgery. While one eye is still on its way to recovery, he gets perfect vision through the other, liberating him from the confines of the School for the Blind where he had been enrolled.
Paul Ajayi is not alone in receiving life-altering treatment from the skilled surgeons at the Restore Foundation for Child Sight (RFCS). Over 5,000 children residing in slums and underserved communities in Lagos have been granted access to free eye screenings, consultations, medications, eye drops, glasses, and surgeries according to the foundation.
It described the impact of these interventions on children with visual impairments as profound. With improved vision, the children’s school performance, which previously suffered due to poor sight, has significantly improved, enabling them to clearly see the board from the back seats of their classrooms.
A major crisis globally and locally
Globally, 1.4 million children, accounting for 4 percent of the estimated 36 million blind individuals worldwide, face the challenges of visual impairment. Shockingly, 70 to 90 percent of these children reside in low-resource developing countries across Asia and Africa, highlighting the urgent need for comprehensive eye care in these regions. Furthermore, an additional 17.5 million children are at risk of developing poor vision.
Refractive errors, such as nearsightedness, farsightedness, crossed eyes, and lazy eyes, afflict approximately 20 percent of children, according to the Boston Children’s Hospital. This accounts for 12 million visually impaired children worldwide. Non-refractive errors, including glaucoma, cataracts, and retinoblastoma—a rare cancer of the retina—are also prevalent among children.
In Nigeria, the prevalence of blindness among children up to the age of 15 stands at 0.6 percent. Several children in the country are also unable to afford eye care due to poverty, their parents’ financial constraints, limited access to eye healthcare facilities, or their parents’ low literacy levels.
Intervening through outreaches
RFCS said it has been diligently targeting these vulnerable children through a series of outreach programs, reaching approximately 5,400 children living in disadvantaged communities over the past year. Since its inception in April 2022, the foundation has conducted five outreaches in Nigeria’s commercial capital city of Lagos, covering communities such as Makoko, Agboyi in Ketu, Ebute Metta East and West, and most recently, Isawo in the Owutu community of Ikorodu.
Each outreach typically spans four days, beginning on a Wednesday and concluding on a Saturday. The first three days are dedicated to screening children in community schools, while the fourth day focuses on reaching out to children in the wider community who are not enrolled in formal education.
Dr. Dhikrah Akinremi, the operational manager, explains the extensive range of services provided during these outreaches: “We conduct vision testing and eye examinations, offering immediate treatment on-site. We come equipped with the necessary tools and medications, providing drugs to children with medical eye problems. We also fit frames for those with defective focus, whether long or short-sightedness, and produce the required glasses for them. Additionally, we perform sight-restoring surgeries, such as alignment correction for children with squints and cataract removal.”
Paul Ajayi’s journey to restored sight began when he was discovered during one of these outreaches. He had been battling vision problems since the age of three, with cataracts impairing his sight. Despite his parents’ limited financial means, they attempted to seek treatment, but Paul’s vision continued to deteriorate. Eventually, he fell, causing further damage to one eye and rendering him officially blind. It was only when his father enrolled him in a school for the blind that RFCS came across his case. Referrals and surgeries on both eyes later, Paul is now relearning how to navigate the world as a sighted young boy.
Odds stacked against the initiative
The pursuit of improved eye care in underserved communities, especially in the areas targeted by the initiative, comes with its fair share of challenges. Accessing remote communities, especially those located in riverine areas, proves to be a significant hurdle. The difficulties are compounded by inadequate transportation infrastructure, including bad roads that hinder the foundation’s ability to reach these communities promptly.
Even when help is readily available for children with visual challenges, the ultimate decision regarding eye check-ups or treatment lies with the parents. Dr. Halima Alimi, founder of RFCS, recounts instances where parents rejected the recommended care despite the foundation’s assurance that the services would be provided free of charge. She cites examples such as a father refusing eye surgery for his daughter with a severe squint in Makoko, and a mother instructing her daughter in Ikorodu not to wear glasses, despite the immediate improvement in her vision after trying them.
Financing the project poses another significant obstacle, as the endeavour requires substantial capital investment. Dr. Alimi, a consultant ophthalmologist, highlights the need for support from various stakeholders, including frame sellers, lens manufacturers, and eye drop producers.
To date, the foundation said it has distributed over 1,200 eye drops, 455 pairs of eyeglasses, and performed about 35 free surgeries to restore vision for beneficiaries. However, these numbers merely scratch the surface, underscoring the pressing need for sustained efforts in this field.
Prioritising children’s eye health
Young children often struggle to articulate vision-related challenges they may be facing, and visual impairments are frequently detected only after a decline in academic performance is observed. Two Nigerian consultant ophthalmologists, Sunday Okonkwo and Elizabeth Nkanga, argue in a 2020 article published in the International Journal of Health Sciences and Research for regular systemic eye screenings in schools and timely intervention to prevent or minimise the burden of eye diseases among school children.
They emphasise the preventability or treatability of 80 percent of the leading causes of blindness in developing countries, including refractive errors, congenital cataracts, trachoma, and xerophthalmia. Blindness and visual impairment can have detrimental effects on a child’s education, development, and quality of life, ultimately leading to substantial economic losses for a nation.
While several organisations and government agencies focus on eye health initiatives for adults in various communities, dedicated emphasis on children’s vision sparingly exists. Dr. Alimi calls for more organisations to join the cause, stressing the need for concerted efforts throughout Lagos and across the country.
She said she firmly believes that legislation is crucial in elevating eye care in Nigeria, and in advocating for the enactment of eye health protection bills for children at federal and state levels. Such legislation, she said, would foster a shared understanding among parents, teachers, and medical professionals about the importance of regular eye check-ups for children and provide a clear framework for early detection and intervention.
She noted that Paul Ajayi’s story serves as a poignant reminder of the transformative impact that access to quality eye care can have on the lives of underserved children. As organisations like RFCS continue their noble mission, she expressed optimism that more children in need will find their vision restored and their future brightened.
This story has been supported by Nigeria Health Watch through the Solutions Journalism Network, a nonprofit organisation dedicated to rigorous and compelling reporting about responses to social problems, solutionsjournalism.org