Into Africa, Seeing And Believing. 
Patricia
Hallahan’s quest to eliminate blindness in east africa. by frank shouldice. We’re juggling with numbers here. Every five seconds someone in the world loses his/her sight; a child goes blind every minute. That amounts to seven million cases a year. Add that to 45 million people already blind and another 135 million with limited vision. Patricia Hallahan, regional director with Sight Savers International, confesses she’s not very good at figures but calculates that four in five cases of blindness could be prevented or cured. Clearly her experience in East Africa puts some numbers at her fingertips.
“Knowing it’s reparable or avoidable is what makes me feel so energetic,” she says forcibly. “Because we’re not doing half enough about it!” You can tell that working with those in the dark has changed the Dubliner’s appreciation of light.
Born the eighth child in a family of nine, Patricia Hallahan’s Phibsboro upbringing on the city’s northside was normal but busy. After working for a year in the bank, she took up nursing, then qualified in midwifery and extended herself further by taking up Social Sciences at UCD where she gained an interest in overseas development. When she saw a Concern notice seeking
volunteers in Bangladesh in 1982 Hallahan didn’t hesitate.
“I was going to get that bug out of my system and come back to my ‘real’ life here – and here I am 21 years later!” she laughs, as though surprised at the thought. “It was all hands on deck for everybody,” she reflects, recalling when floods hit in 1988. “There are times you think about in your life when things just clicked. I think back to that time when we had a small team with limited resources.
“Bangladesh certainly had a huge influence on me. It was a very good experience. A very difficult environment but I learned a lot. What strikes me about the people I meet in such difficult circumstances is the power people have to overcome diversity. It’s that human ability to thrive or overcome circumstances that are sometimes unimaginably difficult. At an individual level the indomitability of the human spirit is amazing.”
In between lifting flood victims to safety she met Peter Benson, a welder and teacher from England who was working in Bangladesh with the Volunteer Service Overseas. They got married and after a spell working abroad returned to Trócaire’s head office in Dublin. Six years later Hallahan was offered a posting to East Africa. Whatever impulse existed before, boarding the plane this time was less straightforward. The couple had two young children – Róisín and Tadhg – and the Africa job was long-term.
“It’s the challenge, I suppose,” says Hallahan. “I mean there’s so much work to be done at home but for me it’s just about being close to where things are happening. It was also an opportunity for the children to experience a different life, exposure to different societies and cultures.”
Bags packed, the family adventure resumed, bound as a foursome for Nairobi. Two years later she was approached by Sight Savers International to take over as regional director for its East, Central and Southern Africa operation. On temporary leave from Trócaire, the answer was again, yes.
Her remit includes Kenya, Uganda, Tanzania, Malawi, Zimbabwe, Zambia and South Africa, treating 945,000 patients from a general population of 65 million. Sight Savers – originally set up in 1950 by blind patron John Wilson as the British Empire Society for the Blind – deals exclusively with sight-related issues. The vast majority of the world’s 45 million sightless are in the developing world, with nine million in India alone. It is estimated that the global figure will rise to over 70 million within two decades, which is why the World Health Organization is coordinating Vision 2020, a multi-agency program aimed at eliminating avoidable blindness by the year 2020.
To most people ‘avoidable blindness’ is a strange concept, but untreated cataracts are the biggest single problem in the developing world. A simple 20-minute procedure to insert an Intra-Ocular Lens (IOL) can restore lost vision. Local anaesthetic is sufficient for adults, and the lens is far preferable to wearing glasses, which are expensive, breakable and difficult to replace. Each IOL procedure costs about $30 and last year Sight Savers performed 176,086 cataract operations worldwide.
“I find this type of work very satisfying,” says Hallahan. “I came from a general nursing background, and this is a very focused area where it’s easier to measure impact. The way I see it, these are human rights issues and I’ve had the experience of taking the bandages off patients – it’s really exciting when, for instance, a woman sees her grandchildren for the first time.”
Sight Savers is also heavily involved in distributing Mectizan, a drug which can prevent onchocerciasis (river blindness). The disease is caused by a bite from black (or simulium) fly, a species which inhabits areas around fast-flowing rivers. The bite plants thousands of tiny parasites which cause intense itching and travel through the human body towards the eye, eventually causing irreversible blindness. In the delta towns and villages of West Africa widespread blindness is not uncommon – in fact the former Northern Gold Coast was known locally as ‘Country of the Blind.’
One Mectizan tablet a year is enough to kill the parasite. “Small input, big output,” explains the Nairobi-based director. In an epidemic crying out for optimism, one of the most startling developments is the ongoing contribution made by Merck & Co., a U.S. pharmaceutical company.
Merck produces Mectizan and in 1987 the company undertook to donate it free of charge for as long as necessary. Last year alone Sight Savers distributed 8.8 million Mectizan tablets across ten African countries.
“Sometimes in development we tend to see things as all good or all bad,” feels the Dubliner. “River blindness is a huge problem, and for us to get the drug free makes a huge difference. Merck deserve credit for this.”
Other procedures carried out by mobile units – such as treating trachoma – are more difficult, and despite the miracle-working aura of restoring sight, not all blindness is treatable. “There’s a lot of fear about working with the eye and there’s a lot of superstition about health care in general,” she feels. “There’s also a lot of discrimination against people with disabilities – and sight disabilities in particular.
“We work in a region where HIV and malaria are the top two priorities. Blindness is probably about fifth or sixth on the list. I thought the eye was a small thing, but when you go into it there’s so much to learn,” adds Hallahan. “Especially the fact that 80 percent of blindness is preventable.”
Raymond V. Gilmartin,
Chairman of Merck, on the issue of corporate responsibility as it relates to the developing world.
Our donation program with Mect-izan, now almost 15 years old, is reaching more than 25 million people a year in more than 30 countries and is helping to eliminate river blindness as a public health problem in those areas.
Remarkably, it takes just one pill once a year to provide this benefit. But getting one pill once a year to 25 million people – often in the remotest of villages – has been no easy task. It took years of work with international and local organizations, non-governmental development organizations, and government ministries to create an effective delivery system for this medicine.
Our experience with Mectizan has taught us that global health problems are bigger than any company’s or country’s ability to solve on their own. It taught us that even the simplest pharmaceutical intervention faces tremendous challenges in delivery. And it taught us that broad-based collaborations are necessary to address the most pressing global health care needs.
Toward that end, we are working to improve access to vaccines around the world through efforts such as the Global Alliance for Vaccines and Immunization – a partnership among the WHO, the World Bank, foundations, the health care industry, the Bill and Melinda Gates Foundation and others. Our commitment includes a $100 million donation of our hepatitis B vaccine. We are also providing a million doses of our measles, mumps and rubella vaccine to Honduras to support the Pan American Health Organization’s objective to eradicate measles in the Western Hemisphere.
While collaboration is an essential part of all of these efforts, it is even more essential with HIV, where the challenge goes far beyond the need to get one tablet once a year to everyone who needs it.
Merck’s research laboratories have produced two significant medicines in the global fight against HIV/AIDS – Crixivan and Stocrin – and these medicines have made a great deal of difference for people with access to them. Beyond these medicines, work continues in our laboratories on an experimental HIV vaccine. If we’re successful – and it’s far too early to tell – we hope it will become part of the long-term solution.
But with 40 million HIV-infected people around the world – two thirds of them in sub-Saharan Africa – traditional methods of delivering and paying for medicines are not and will not be enough. The global tragedy of HIV makes the need for constructive partnerships more imperative than ever.
In the spirit of partnership, Merck has been working as part of the Accelerating Access Initiative – the cooperative effort between UNAIDS, the World Health Organization, UNICEF and others – not just to provide lower prices but to work on health care interventions for the prevention, treatment and care of HIV/AIDS-related illnesses, including mother-to-child transmission of HIV.
Finally, we have aggressively lowered prices for our HIV/AIDS medicines in the developing world, and have announced that we will not profit from the sale of these medicines in developing countries. The early signs are encouraging that our action will help spur greater access – and spur governments and other purchasers to invest more funding in health care infrastructure to ensure more effective care and treatment.
We share the sense of urgency felt by people who are battling the scourge of HIV around the world. And progress is being made – in the delivery of more affordable medicines, in devising effective prevention and education programs, and in the search for a safe and effective vaccine.
While that search goes on, our company and others continue to do what we must: building partnerships that offer the best hope for progress. HIV is an indiscriminate killer, but we are not powerless to halt its global spread. By working together, pooling knowledge and resources, we can find effective solutions to this critical challenge – and make a world of difference for millions of people living with HIV today.
Remarks by Raymond V. Gilmartin, Committee for Economic Development Corporate Citizenship Award. The Waldorf-Astoria, May 16, 2001.
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