by Sonia L. Pelletreau

Long, white beaches line the fish-rich southwestern coast of Madagascar; further inland, villages lie among forests with canopies of towering baobab trees. In remote Ambohifotsy, a rural village 60 kilometers inland from the coast, Tafitasoa was born with bilateral congenital cataract, rendering him completely blind. His parents and the community of Ambohifotsy, two days’ journey from the capital city of Antananarivo and without any access to eye care, believed that he would remain blind his whole life. Thanks to SightFirst and the Lions of Madagascar, however, Tafitasoa was able to receive the double cataract surgery necessary to restore his vision, and his future. 

In Madagascar, a country where the GDP is US$240 and nearly three-quarters of the population survives on less that US$1 a day, the effects of blindness can be economically devastating. The country’s major cause of blindness is unoperated cataracts, and it is estimated that 15,000 new cases develop each year. In 1998, The Lions of Madagascar and their partners, the Ministry of Health and the French cooperation, launched a pilot program aimed at reducing the number of cataracts. This project received $250,800 from SightFirst and moved the Lions of Madagascar from their routine activity of distributing eyeglasses to the development of a sustainable eye care delivery system. The Lions SightFirst Madagascar (LSFM) program was born. 

Through LSFM, the Lions of Madagascar have created an enormously successful model for providing eye health care to a previously unserved public. In addition to drastically increasing the number of cataract operations that are performed annually in the country, LSFM has strengthened Madagascar’s permanent capacity to provide eye care services through improved infrastructure, increased access to services, particularly in rural areas, and training of much-needed ophthalmic personnel. 

Prior to the establishment of LSFM, only 600 cataract surgeries were performed annually in the entire country. Most of these were done in private clinics in Antananarivo and were too expensive for most of the country’s population. The difficult-to-access rural parts of the country, like the village where Tafitasoa lives, had no access to eye health care in spite of the large unmet needs. The first LSFM project changed that, providing 1,650 surgeries and equipping six hospitals throughout the country. More importantly, the project mobilized political will, which led to a second, expanded project. As Lion Fidy Rakotozafy, the project chairperson, explains, “Our first SightFirst project was a complete eye-opener. Before Lions were involved, there was no recognition of the prevalence of cataract. We not only helped to build capacity for services but also gained the respect and trust of the Ministry of Health.”

Building upon the success of the first project, a second project for $946,876 was approved for four years in 2000. This grant equipped three additional eye care centers, provided for 8,000 cataract operations and trained ophthalmic personnel. This work was continued when another SightFirst grant was approved in August 2003 for $500,000 for two years. Through this grant, 12,000 surgeries were completed. Under this project, the government took over funding of the training of ophthalmic personnel. When the program began, governmental involvement in eye care was minimal. Today, the government funds ophthalmic degree training and each year equips additional centers to carry out cataract surgery. 

Since its inception in 1998, LSFM has provided more than 16,700 sight-saving cataract surgeries, nearly all of these on indigent patients who would otherwise be unable to afford cataract surgery.  Each year, LSFM reaches more people in the most remote parts of the country.  The latest grant from SightFirst to LSFM, made this May for $731,230, will allow LSFM to continue its important work by providing 16,000 surgeries in the country over the period of the next two and a half years. 

In the course of seven years, the Lions and their partners have turned around public health services for eye care in Madagascar. The program’s coverage of the cataract needs of the country continues to increase each year, and the Lions have dramatically raised awareness of cataract as a public health problem and of the need for improved eye care not only among the people of the island, but also among the government. The Malagasy Government now actively supports blindness prevention activities and the SightFirst initiative.

Today, Tafitasoa is a happy three-year-old who will soon be attending school. Thanks to the initiative of SightFirst, he will be able to read, study, work, and contribute to his community. The Lions of Madagascar have made this possible and are continuing to ensure that more children like Tafitasoa have the same chance.