TO WHOM IT MAY CONCERN

Monday 21st Dec 2008

I and writing on behalf of Right to Sight in support of Chris Eksteen, Charl Laäs and Di Powell’s application for the Jonga programme to be recognised for the Antonio Champalimaud Award.

Right to Sight had the privilege in 2008 of meeting with and seeing firsthand the activities that Di Powell and her team at Jonga are undertaking in the Western Cape Province. We were very impressed by the breath of services offered to those most in need in the Metropolitan region of Cape Town and the initiatives taken to achieve this.

Community and district eye care services are poorly developed in the Western Cape. Two districts do not have any primary eye care services, and refraction services in the rest of the districts are fragmented.

Jonga’s plan aimed at strengthening Community and Primary Care Services and introducing rehabilitation services and managerial and technical support at district level. The project encompasses three basic services that the newly founded NGO ‘Jonga’ (local Xhosa language for ‘to see’) focused on providing. Those services are as follows:

• Community Based Eye Screening
• Retinal Screening Services
• Refraction Services

The main aim of the Jonga team was the strengthening of Community and Primary Eye Care Services and introducing rehabilitation services and managerial and technical support at the district level.

Jonga is essentially an eye care quality improvement initiative set up by Diane Powell and is aimed at improving and supporting  the quality of eye care within the community. This is in relation to the primary care and district eye care services of the Western Cape Province.

The hope is that the plan can in time be spread to other Provinces and rural areas throughout South Africa in consultation with Governmental stake holders. At the same time another core component of the Jonga project is the opportunities for unemployed youth from disadvantaged communities that working in Eye Care provides. These people in turn become upskilled with the chance for career pathing, and become more employable in the formal job market sector. In essence as well as jobs being created, people are being introduced to the job market.

Jonga’s main aim is to improve the quality of eye care in the Western Cape Province and to develop the same eye care services throughout Southern Africa and to improve the overall eye health in previously disadvantaged communities and thus preventing avoidable blindness. Jonga puts particular focus on the screening of eyes and the providing of diabetic retinal screening which facilitates referral pathways to the next ophthalmic care level. ’Easy accessable refractive services for all’.

Jonga’s four programmes are unique in the country and it is our belief that they should be expanded to other districts in the Western Cape.

Diane currently has 18 Community Based Eye Workers (CBEW) who are non clinical but were trained by Di and her team working in the field or at the clinic. These young people were taken from disadvantaged areas and given a chance to learn and develop skills and enter into a career. They were trained in such things as optical dispensing/sales, optometry, refraction and AIDS counselling. Currently at the ‘Bonang’ clinic there are 4 staff that came up the ranks through the clinics programme.

The CBEW go to the townships (the poorest areas of SA) and screen the people at Community Health Centres. When a cataract patient is identified they are referred to the Eerste River Hospital. An amazing 78% of all Eerste cataract surgeries come from this programme. The ‘Bonang’ unit is a high volume refractive service for the poorest people of the area. The figures/results from the programme are very impressive and the programme is well known by the South African Eye Care Community.

Some figures from their work:

• Year 1 - 13,460 screened
• Year 2 – 24,795 screened (The project is currently in year 3)

Diabetic Retinopathy Screenings:

Jonga has identified 58,000 diabetics in the Metropole area and these patients are screened regularly through a very impressive system of mobile screenings where the CBEW’s travel around the Community Health Centre’s of the province. In essence this process means patients do not have to go to the Tertiary Care Centres unless totally necessary. This initiative is free for the public and was helped with funding by the WDF although funding will unfortunately end soon. The hope was that the government would take over the programme at that time but this is now not going to happen, leaving the initiative badly in need of outside help. The diabetic screening programme in the Cape Metropole is the first in the country and very impressive.

Community Based Case Finding:

A Community based screening project for visual impairment has been operational in the Cape Metro since 2006. In 2007 more than 7,000 people were identified with visual problems and 600 presbyopic corrections were made. A total of 20 Community Eye Care workers were supervised by one ophthalmic nurse and employed through the Social Capital programme, six of these workers gained formal employment through their training in the programme. Many of the Community Health Centre’s (CHC) are now relying on the Community Eye Care Workers (CECW) to perform their visual acuity testing.

School Refraction Unit Initiative:

Di feels very strongly that kids and/or parents should not have to take time off school/work to go for screenings so she has initiated School Refraction Units. Jonga undertook to train teachers how to screen their pupils and refer children onwards who need care. In October of 2008, a new refraction clinic opened in the south of the Metropole and another is planned for February 09’ pending funding. The Bonang Clinic run by Jonga is already achieving Vision 2020 targets of 6000 refractions a year which is commendable although this success needs funding to continue at this rate and to grow.       

The final two initiatives below left me suitably impressed as I’d never seen or heard of such novel approaches to eye care delivery.         

Kids day out week Initiative:

The clinic undertakes one week initiatives where disadvantaged kids who have been pre-screened and identified as having refractive error are taken to the beach for a day of fun and learning and treatment. There are treasure hunts and prizes and environmental educators and each child goes home with something, as well as a pair of glasses.

Elderly Screenings Initiative:

The clinic also conducts screenings and events for the elderly. They go to old peoples homes and screen the elderly. They also hold the Golden Olympics which are a games for old people and a day out. Lastly the screeners have been to Parliament and even found Diabetics there to refer for treatment.

These initiatives are all pro-active and new to the area, if not the eye care community at large and this positivity and progressiveness if another reason why Jonga is so deserving. Di believes that by training unqualified people to be Community Based Eye Workers she and Jonga are giving these people ‘hope for the future’ and something to believe in and be part off.

More mobile services are needed and she wants an Ophthalmic Nurse and Optometrist hired full time so they can expand their operation. During the last 3 years thousands of people of all ages have been identified with eye disease and referred, refracted or treated through Jonga’s activities.
 
Jonga stepped into the void where there was no existing services being offered and has done this whilst up skilling local underprivileged people such as their community based eye workers. I personally witnessed these community based eye workers at work and was blown away by the duality of outcomes wherein the marginalised were screened and the youth lifted up and onto career paths. It is my opinion that initiatives such as this are the ultimate sustainable solution for caring for people’s eye health and changing society in South Africa for the better.

Some people do what the person did before them and do it well and change things over time and then there are those who decide that there has to be another way, a better way, and change things now. Di Powell is one of those people.  
 
The projects and Jonga’s work is also fully integrated in the provincial eye plans and is leading the way in many regards in it’s implementation with a far greater reach month on month.

Right to Sight looks forward following Jonga’s progress in the coming years and would like to see the work they undertake transferred into other relevant spheres across the country. Jonga has already accomplished so much with so little (besides a lot of will, hard work and belief) and with the appropriate help could reach even greater heights. A big problem needs a big solution, Jonga is just such a solution. Di Powell has a strength of will and passion the like of which one does not see often anywhere in the world and I get the distinct feeling that this is only the beginning of their work in South Africa and beyond.  

With all this in mind, it is our privilege to support Jonga in their submission for this prestigious award and we hope you agree on its merit.   

With best wishes,

Sincerely

Philip Mc Allister
Project Manager
Right to Sight