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Corneal ulcer: Save a life even in death

THIRTY nine years ago, Ope was born with all her sensory organs intact. Her birth took place in a Lagos General Hospital. A week after her delivery, she and her mother got a clean bill of health. Her organs were tested and certified okay before they were discharged.

But eight months later, Ope was struck with measles. It was a tragic incidence because Ope could only have taken the measles vaccine at the age of nine months. Her mother did all she could to save her from the clutches of the deadly child hood disease that could lead to death as well as corneal ulceration was only able to save her life.

Today, as pretty as Ope is, she cannot tell what she looks like all because the measles affected her cornea.  Ope is of the 69 per cent of Nigerian children blind from corneal disease. A survey of children with corneal scars showed that at least 42 per cent were caused by ulceration after measles.

Micheal 14, was not as lucky. A student of Okota Grammar School, Lagos, he never knew an episode of conjunctivitis popularly known as apollo could cost his sight. Today, Micheal can no longer attend classes. His parents are making plans to send him to school of the blind.

His ordeal started when he had conjunctivitis and instead of taking him to an eye clinic his parents decided to self -medicate. They applied various liquids such as breast milk, fuel, urine, battery water among others.  Unfortunately, rather than relief,  Micheal had corneal injury.

Experts say corneal injury that results in plant material getting into the eye can lead to fungal keratitis.  Today, Micheal’s case is increasing the number of blind people due to cornea injury in the country.

Unfortunately, although, cornea blindness could be reversed, non availability of corneas has made it  impossible in Nigeria.

Everyday, the Federal Road Safety Commission, FRSC, comes up with  alarming number of deaths through road traffic accidents, yet, those who require organs such as corneas  to live a better life still wait eternity simply because Nigerians do not believe in donating any part of their bodies.  Even when the victim is an organ donor, the family members will never allow his or such wish to be fulfilled in death.

According to the World Health Organisation(WHO) estimates, globally there are 45 million blind people, 135 million people who are visually impaired and one adult goes blind every second and one child becomes blind every minute.

Minister of Health, Prof. Onyebuchi Chukwu, says Nigeria has about 1,170,000 blind people, based on a blindness rate of 0.78 percent and cornea blindness is about 7.9 percent that is 92,430.

Unfortunately, non of these unfortunate Nigerians are benefitting from corneal grafting.

The National blindness and low vision survey carried out between 2005 -2007 revealed that there are over one million Nigerians who are blind, another three million visually impaired; and over 80 per cent of the causes of blindness in Nigeria were avoidable.

Out of this intimidating statistics, experts say to reconsider  the culture of not wanting to donate their corneas would save the 70 per cent of  corneal scarring in childhood blindness.

Some visually impaired

Many studies have  implicated vitamin A deficiency, trauma, trachoma, onchocerciasis, leprosy, suppurative corneal infections, herpes simplex virus infections, ophthalmia neonatorum and harmful traditional eye medicines in corneal blindness.

A reasonable proportion of such affected persons may regain their sight with corneal transplants. However, corneal transplant services are practically non-existent in Nigeria due to absent corneas.  Since the Federal Government of Nigeria acknowledged the need for an eye bank and promulgated the decree No. 23 titled Corneal Grafting Decree 1973, not much was done in this regard.

Consequently, thousands of Nigerians remain needlessly blind. There is thus a need to awaken public consciousness about eye donation/corneal transplants.

Further investigations from medical literature showed that Corneal blindness is usually caused by  infections such as bacterial infections common in contact lens wearers, especially in people using extended-wear lenses.  The virus that causes cold sores (the herpes simplex virus) may cause recurring attacks that are triggered by stress, an impaired immune system, or exposure to sunlight. Also, the virus that causes chicken pox and shingles (the varicella virus) can cause corneal ulcers.

Furthermore, improper use of contact lenses or steroid eye drops can lead to fungal infections, which in turn can cause corneal ulcers.  Parasitic (Acanthamoeba) infections which are microscopic, single-celled amoeba that can cause human infection.

They are the most common amoebae in fresh water and soil. When Acanthamoeba enters the eye it can cause severe infection, particularly for contact lens users.

Other causes of corneal ulcers include: Abrasions or burns to the cornea caused by injury to the eye. Scratches, scrapes and cuts from fingernails, paper cuts, makeup brushes and tree branches can become infected by bacteria and lead to corneal ulcers. Burns caused by caustic chemicals found in the workplace and at home can cause corneal ulcers. If the eyelid does not function properly, the cornea can dry out amongst others.

However, to encourage Nigerians to donate their eyes after death, the Society for the Blind and Ophthalmological Society of  Nigeria, OSN came up with the Eye bank of Nigeria to ensure that Nigerians with cornea problems could be given another chance to live a normal life.

Sadly, since the birth of the  Eye Bank from the money donated for cornea grafting in 2004, not a single cornea has been harvested locally until August 2010 when 47- year- old Late Kola Shodipo died. Late Shodipo had prior to his death, in 2008  pledged his eyes.

In the views of the Medical Director of the Eye Bank of Nigeria, Dr. Mosumade Faderin, the biggest challenge the country is faced with is that the public first of all doesn’t believe they should donate any part of their body after death. This is as pertinent as it is not possible to restore sight to a ‘blind’ person.

Faderin said: “All cornea transplants in Nigeria have been done with corneas gotten from other countries, mostly from India and China. “Since the bank came into existence in 2004, not a single cornea has been harvested locally until very recently,”

According to Faderin, for the cornea to be useful for a transplant, it must be removed within 12 hours after death with the consent of either the deceased, given before death, or the family members.   Since the inception, the organisation had been able to transplant a total of 32 corneas despite the fact that Nigerians are weary of donating their eyes due to various misconceptions surrounding donation of organs in this part of the world.

Faderin regretted that ‘for anyone needing a cornea for graft, a processing fee of between $1950 and $2250 are being charged, and majority of those needing this intervention are young people and very few of them can afford to pay this.

According to Mr. Olaseinde Akinsete, Chairman of the Board of Eye Bank, although corneal transplant is lawful in Nigeria under Decree No.23, titled Cornea Grafting Decree 1973, not many corneal grafting operations have been carried out in the country.

“Under the Decree, any person can, either by writing or orally in the presence of two or more witnesses authorise the excision of his or her eyes after death. The law stipulates that the person lawfully in custody of the body after death may unless he has reason to believe that the request was subsequently withdrawn, authorise removal of eyes. Notwithstanding the promulgation of the above-mentioned decree, not many corneal grafting operations were carried out in Nigeria.”

Chukwu had told Nigerians during the World Sight Day in Abuja that the country has subscribed fully to the WHO initiative to combat avoidable blindness known as vision 2020: The Right to Sight. He said that this initiative was established by WHO and International Agency for the Prevention of Blindness (IAPB) to eliminate avoidable blindness by the year 2020.

In as much as the Minister has reaffirmed the Federal Ministry of Health intention to promote human resource development to train and motivate eye care teams to deliver comprehensive eye care at the primary and secondary levels of service delivery, observers are of the view that for blindness as a result of cornea ulceration, attitude change and an effective legislation would enhance eye donation rates for corneal transplantation in Nigeria.

They also recommended that guidance and counseling and legislation should be adopted to change peoples’ negative attitude to eye donation and encourage voluntary donations.

Also, there is no gain saying that late Shodipo made his intention of donating his eyes in 2008 because of his love for people and applauded his humanitarian work. The first locally harvested corneas from a Nigerian donor who had pledged/donated his eyes after he saw and heard the experiences of two cornea graft recipients prior to his passing on has to be commended.

Health watchers are of the belief,  that the gesture of Late Kola Shodipo and his family should be a starting point for a change in the scenario so that Nigerians can donate their tissues.

The taboos and misconceptions can be corrected so that people can benefit from the dead. They can offer something to the living. It is not only in the eye, even in the other specialties of medicine, so that Nigerians would not have to travel far away India and America in search of solution to their kidney transplant.

In the words of the Medical Director Eye Bank of Nigeria, Dr. Mosumade Faderin, If Nigerians are ready to donate their eyes after they passed on, we might be able to help millions of blind people in Nigeria.


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