Low Vision in Nigeria: Independence Day for the Blind and Visually Impaired

The purpose of my research project is to inform the blind and visually impaired community, in the US and abroad, about services and devices available to help them maintain or establish their independence and to inform members of the sighted, professional, and academic communities of the technological advances and low vision devices available to ensure that the blind and visually impaired are success in any arena they choose.

Background: Nigeria

Nigeria was once colonized by Britain so the British are viewed negatively. Americans, on the other hand, are not viewed negatively or positively for that matter. Overall, Nigerians are accepting of foreigners, but the expected suspicions about strangers are still present. Nigeria has a male dominated society. The woman plays the subservient role in society. Also, the parents have high expectations of their children and expect them to obey until the children get married.

The family structure is much like a Hispanic culture where an extended family is common. Nigeria is located in Western Africa, bordering the Gulf of Guinea between Benin and Cameroon. Prevalent Religions – 50% Muslim, 40% Christian, 10% indigenous beliefs Prevalent Ethnic Groups – Hausa, Fulani, Yoruba, Igbo, and Ijaw Prevalent Languages – English (official) or Pidgin English, Hausa, Yoruba, Igbo, and Fulani About 45% of the Nigerian population is below the poverty line.

Most Nigerian families are patriarchal and rights of inheritance are traced through the male members of the family. Extended families, in which parents, children, their spouses, grandchildren and other relatives live under one roof, are common in rural areas. Family relationships are guided by a strict system of seniority. The freedom to use first names is given only to seniors and superiors. It is an insult to call an elder sibling by his or her first name. Although the extended family system is changing, a tradition of mutual caring and responsibility is very strong in Nigerian family life.

Relationships in which a man has more than one wife are accepted by most ethnic groups in Nigeria. This practice is changing because of westernization and the spread of Christianity. In urban areas, more and more people select their own partners and marriages across ethnic groups are becoming more common. Divorce is also increasingly common in urban areas. Children are very important to Nigerian families. Parents believe that children will provide support for them in their old age.

In most families, women carry out all the household tasks, sometimes with the help of relatives or servants. The typical Nigerian husband does not have household duties. There are great differences between the lifestyles of the rich and the poor, and between rural and urban families. In rural areas the traditional practice of caring for the elderly by their children, grandchildren, spouses, siblings or even ex-spouses is strong, but in the urban areas, under conditions of hardship, this tradition is beginning to change.

The Yoruba people are one of the two largest ethnic groups of Nigeria, being concentrated in the southwestern part of that country. Much smaller, scattered groups live in Benin and northern Togo. The Yoruba numbered more than 24 million in the late 20th century. people of SW Nigeria and Benin, numbering about 20 million. The Yoruba are unusual in Africa in their tendency to form urban communities.

Today many of the large cities in Nigeria are in Yorubaland. The old Yoruba kingdom of Oyo was traditionally one of the largest states of W Africa. It dominated both Benin and Dahomey, but after 1700 its power slowly waned. At the beginning of the 19th cent., Fulani invasions, slave raids from Dahomey, and the growing contact with Europeans divided the Yoruba into a number of small states.

In the second half of the 19th cent. the Yoruba gradually fell under British control, and they were under direct British administration from 1893 until 1960. Yoruba religion includes a variety of gods. Vestiges of Yoruba culture are also found in Brazil and Cuba, where Yoruba were imported as slaves.

Traditional healers (sometimes called “surgeons”) in Nigeria often focus on maintaining a balance between the invisible world of the deities, ancestral spirits of good or evil, and other beings inhabiting the “other” world. Spirit causation remains a significant part of the traditional medical system, and the presence of disease or illness may be seen as a warning sign that there is an imbalance with either the natural or the spirit world.

There are estimated to be about one million blind people in Nigeria, as well as 3 million who are visually impaired. There are estimated to be about one million blind people in Nigeria, as well as 3 million who are visually impaired. An additional global problem is that of low vision, which affects a huge number of people in the developing world. Although not categorically blind, people with extreme loss of vision suffer from severe visual impairment which can have a serious impact upon their their lives.

Definitions

Kids who are blind or visually impaired aren’t too different from kids who aren’t blind. They can do most things that other kids can do. Kids who are blind or visually impaired like to hang out with friends and do fun things, and they can go to college, have families, and perform many different types of jobs.

The big difference is that these children need to “see” the world in a different way. Blindness and other vision related problems are one of many health issues that plague the African continent. The African government is in the process of implementing many government sponsored programs that seek to eradicate this problem. Vision 2020: The Right to Sight is one such program, and was launched in Nigeria.

Vision 2020: the Right to Sight is a global initiative to eliminate avoidable blindness by the year 2020. Vision 2020 will address five major causes of blindness in francophone Africa: cataract, trachoma, glaucoma, onchocerciasis and childhood blinding disorders, particularly those leading to corneal scarring. “Sub-Saharan Africa together with China and India account for an estimated 60% of the world’s blind.

However, figures alone can neither depict the economic plight of blind people and those with serious visual impairment, nor express the untold suffering and humiliation they experience,” Dr Samba warned. As major reasons for such an increase, he mentioned rapid population growth and aging, appalling living conditions, the severe shortage of adequately trained ophthalmologists, and the limited supply of essential eye drugs and modern technologies to prevent and treat blindness.

In sub-Saharan Africa, 3 million children under age five suffer blindness caused by lack of vitamin A. Vitamin A is produced by the body when it has sufficient quantities of a precursor known as “beta-carotene.” When it doesn’t, the body can not produce sufficient vitamin A, and blindness can result. The World Health Organization (WHO) says that women with vitamin A deficiency face a significantly higher risk of death during pregnancy. And children are more subject to falling victim to other diseases if they don’t have enough of this critical vitamin.

Reducing the incidence of blindness not only increases the quality of people’s lives; it also benefits their countries’ economies. The World Bank estimates that for every dollar invested in capsule supplements, more than $100 is returned in the form of increased productivity associated with healthier workers and lower public health costs.

Before I go any further with this research paper it is imperative that I define a few terms, and note, every term defined in this paragraph will be discussed in further detail in the body of this research paper. First of all, I want to emphasize the difference between blindness and low vision. Blindness means that a person has no useful vision, while low vision on the other hand, means that your useful vision does not meet your needs and cannot be corrected by glasses, contact lenses or surgery.

If you are affected by low vision there are several devices available to you that make everyday life more approachable. These devices are called low vision aides or devices. A low vision device is an apparatus that improves vision, and they are broken into two categories: optical low vision aides and non optical low vision devices. Optical low vision devices use lenses or a combination of lenses to provide magnification (they should not be confused with standard eye glasses).

There are five main types of optical low vision aides. They include:

1. Magnifying spectacles
2. Hand magnifiers
3. Stand magnifiers
4. Telescopes
5. Closed Circuit Television

Non optical low vision devices include:

1. Large print materials
2. Check writing guides
3. Large playing cards
4. Enlarged telephone dials
5. High contrast watch faces
6. Devices that talk
7. Machines that scan print and read aloud

Blindness and other vision related problems affect African Americans more frequently than whites. Hispanics, however, have higher rates of visual impairments. Although there are millions of vision related diseases, for the purpose of time and space I plan to focus on the three that have the greatest prevalence in the African/African American community: these include Glaucoma, Cataracts, and Diabetic Retinopathy.

Glaucoma is often referred to as the silent thief of vision. Glaucoma is a collection of eye problems that elevate pressure within the eye, damaging the optic nerve, and seriously affecting vision. In advanced cases Glaucoma can lead to total blindness. A cataract is an opacity or haziness that develops in the eye’s lens. Finally, diabetic retinopathy is a broad based term that refers to the visual problems associated with diabetes. Now that we’ve gotten all of the formalities out of the way let me provide a bit of history about blindness and visual impairments.

History

According to an article published by EHO, the earliest medical records known to us, derived from the ancient river cultures of Mesopotamia, and they show that even 5000 years ago eye care was a specialty in its own right. In fact, a papyrus was found naming 20 eye diseases, and Herodotus, a Greek historian, visited Egypt in the fifth century BC and met doctors who specialized in opthomology, because of the high incidence of blindness. From the beginning of time blindness and other vision related issues have left the people affected by them shunned by the community and sometimes their own families.

In the fourth century AD the earliest recorded asylum specifically for the care of the blind was created in Caesarea. In the early days the most that sightless people could hope for as far as employment, would be to become a successful begger. But, like Martin Luther King, Jr. the people born sightless or diminished vision had a dream to be all that they could be and set the dream in motion with the opening of several schools for the blind.

The first school was opened in 1791 in Liverpool; the second was opened in 1799 in London, the third 1805 in Vienna, and the fourth, mentioned in this article, in 1806 in Berlin. These schools sought to improve the lot of the sightless, and to prevent the sighted from becoming sightless. As mentioned in the definitions section of this research paper there are three major eye conditions that greatly affect African/African Americans, once again they are: Glaucoma, Diabetic Retinopathy, and Cataract.

In the following paragraphs I will discuss each disease in detail (who.int).

Cataract

According to WHO, cataract is responsible for up to 60% of the blind in the sub-region, or some 1.2 million people, with an estimated 300 000 new cases of blinding cataracts each year. “The cataract surgery rate (CSR) in the sub-region is still among the lowest in the world – only between 200 and 400 per 1 million of the general population compared to 3500-5000 in the developed countries,” said Dr Alain Auzemery, Director of IOTA Cataracts are among the most misunderstood diseases of the eye.

A Cataract is an opacity or haziness that develops in the lens of the eye. There are three types of Cataract:

1. Nuclear Sclerotic Cataract
2. Cortical Cataract
3. Posterior Sub capsular Cataract

Individuals who have a nuclear cataract generally have trouble seeing at a distance, while people who have a cortical cataract suffer from a chemical imbalance that causes water to be drawn into the outer cortex. People with this type of Cataract often complain of double vision, and finally, with a posterior cataract changes can occur rapidly and tend to be much more advanced in one eye. His type of Cataract forms an opaque growth on the back surface of the eye.

People with this form of Cataract may incur problems with focusing and distortion, and affects reading vision because of its central location in the eye. Now that we have discussed the three major vision disease affecting African Americans let us now turn our attention to devices that can help alleviate the stresses of visual impairments.

Glaucoma

Glaucoma affects about 2.2 million Americans age 40 and over, and another 2 million don’t even realize they have it. Glaucoma is most often called the silent thief of vision, and is the leading cause of blindness in African/African American over age 40 (healthgap.gov).

There are two forms of Glaucoma: acute closed angle glaucoma and open angle glaucoma. In acute angle glaucoma the pressure in the eye progresses rapidly and causes acute pain. This form of glaucoma hits suddenly and requires immediate surgery. It should be noted that this form of glaucoma is rare.

Open angled glaucoma is more common and can go undetected for years. While undetected the pressure in the eye continues to build and can cause irreversible vision loss, because the pressure damages the optic nerve fibers. Peripheral vision is most often affected by glaucoma. Advanced cases can lead to total blindness. The following list indicates the high risk factors for developing glaucoma:

1. Being over 55
2. Having a family history of glaucoma
3. Being very nearsighted
4. Having diabetes
5. Being African American/ African descent
6. Being Native American Cassel, Chapter

If you fall into any of the previous six categories, make it a point to visit and discuss this information with your ophthalmologist. The next disease I would like to address is Diabetic Retinopathy.