An eye-screening camp in Ethiopia. Photo by: Sasipriya M Karumanchi / Community Eye Health / CC BY-NC

ALICANTE, Spain — Many years ago, Elie Bagbila — Burkina Faso country director at disability and development organization Light for the World — came across an elderly man who had cataracts in both eyes, leaving him completely blind. Despite Bagbila and his colleagues’ many attempts to offer him restorative surgery, the man repeatedly refused because the local charlatan — a person who falsely claims to have certain knowledge or abilities — wouldn’t sanction it. Two years later, the man died having never regained his sight.

This is not a unique case. Various religious and spiritual beliefs are preventing people in many countries from seeking eye health services, say sector professionals.

“As vision is very important and crucial in people’s lives, community members and eye patients go through religion and spirituality to reassure themselves and get protection,” Bagbila said, adding that “religion and spirituality are the heart of human existence.”

According to the World Health Organization, at least 2.2 billion people have a vision impairment or blindness. Just under half of these cases could have been prevented or have yet to be addressed. A lack of access to eye care services in remote, rural, or lower-income areas is often to blame.

In some cases, however, a belief in curses, godly punishments, and bad spirits are the culprits.

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Research showed that 84% of the global population identified as religious in 2010, with 6% practicing folk or traditional religions.

While the sector recognizes that faith and spiritual leaders can make strong partners for NGOs working to help communities access the services they need and achieve improved development outcomes, the various beliefs pertaining to religion and spirituality can also act as a barrier. Not limited to any one religion or part of the world, development organizations globally are looking for ways to work alongside religious organizations to ensure access to vision care.

Other beliefs preventing access to care

“There are some who believe that blindness is a punishment or a curse from the gods as a result of a crime committed by the sufferer or his/her family or past generation,” Dr. James Clarke, ophthalmologist and medical director of the Crystal Eye Clinic and Unite For Sight in Ghana, said in an email. Speaking about the Ghanaian context, he explained that this belief can prevent people from seeking clinical eye health services that may be available, as can the belief that poor vision cannot be treated by man.

Instead, some choose to visit a fetish priest — a person who acts as a go-between for the living and spirit world — or a mallam — a learned person in Quranic studies as considered in some West Africas communities — for healing rituals, Clarke explained. Alternatively, some people in Ghana may go to prayer camps, or to their local pastors for prayers to be offered on their behalf, but the travel and costs involved can be greater than clinical eye care, Clarke said.

It is also common in certain Ghanaian communities for people to fear “incurring the wrath of the gods,” Clarke said.

According to Bagbila, should a person want to seek clinical eye health services in Burkina Faso, traditionally they may seek the advice and protection of the spiritual world and ask their ancestors for protection against bad spirits. If they believe the response is “don’t get eye surgery,” patients may refuse to be operated on, Bagbila explained. “They prefer living in blindness to offending ancestors,” he said.

Meanwhile, in Yemen — a predominantly Muslim country — reading Quran verses and duas has been used as treatment for glaucoma and retinal eye diseases, according to research. In many rural communities around the world, Ruby Holmes, Humanity & Inclusion’s technical adviser on inclusive governance, told Devex in an email that it is common for traditional healers to believe that disability — including vision impairment — is caused by witchcraft or is punishment for something that the family of a person with a disability has done in the past.

One example of this is the killing and maiming of individuals with albinism in countries such as Tanzania, Kenya, and Uganda, Holmes said, explaining that albinism creates a lack of pigment in the eyes, causing vision problems. “Many traditional healers and witch doctors believe that the body parts from persons with albinism can be used in spiritual practices. Others believe that their body parts will bring wealth. This violence clearly restricts access to health care and other basic services [for people with albinism],” she said.

Such beliefs affect more than just access to health care, but other services such as education and meaningful participation in the community, Holmes said.

Overcoming beliefs to improve access

While there is not a specific target on eye health within the Sustainable Development Goals, several of the goals touch upon, and can be influenced by, people’s ability to see — including access to education and work, economic, social and political inclusion. To reach the 1 billion people with preventable vision impairment and increase the chances of achieving the SDGs, organizations will need to work with and through some of the beliefs preventing access to care.

“We believe that it is important to eliminate barriers to care by providing eye care within communities, and at an affordable cost. Once care becomes available, education, which is the next major step, becomes meaningful,” Clarke said, adding that education should be provided using accessible language and local dialects with pictures and testimonies from people who have benefited from available ophthalmic services. This can help to explain why some vision impairments occur and counter the idea that they are a curse or punishment.

But before conducting any awareness raising or education activities, Bagbila said a knowledge, attitude, and practice study on eye conditions and beliefs should be done. “You should involve traditional healers, charlatans, medical doctors, and religious leaders as a target group,” he said, adding that the results will help the creation of awareness raising tools and developing domestic strategies. These might include image boxes, radio shows, theater and drama, and role-play, Bagbila suggested.

Clarke advised encouraging those who have had their eyesight restored to share their success stories. In addition, people who have suffered the negative consequences of other types of interventions could also be approached to support an educational campaign, he said.

Regardless of the method, advocacy and awareness raising needs to happen in partnership with organizations of persons with disabilities, Holmes said. By working with people with a vision impairment, organizations will be able to determine the support they need and break down any misconceptions about access to care. And by doing so, “harmful religious and traditional beliefs can be expelled and attitudes can change,” Holmes said.

She also recommended working with faith and spiritual leaders who often play a big role as community leaders. As a result, their engagement is important in terms of respecting the local community and ensuring meaningful participation, she said. “The beliefs of these leaders can [have] a large effect on what community members believe and therefore how persons with disabilities are treated,” Holmes said.

As a first step, Clarke advised identifying certain leaders within communities for health education and then sharing information about various eye diseases and the services available. “There are some spiritual leaders who believe in clinical health care, and they can be engaged in the education of their colleagues who may not be familiar with medical treatment opportunities,” he said.

If such leaders are on board with clinical treatment, it may help to make communities more amenable to receiving clinical eye health services, something Unite For Sight’s partner clinics have seen some success with. “Because of the education offered about medical treatment opportunities, many patients feel comfortable proceeding with ophthalmic care,” Clarke said.

Vision care organizations with religious ties are another way of reaching those with a vision impairment and working to dispel any beliefs they may have about seeking care. Sight Ministries International conducts eye clinics sponsored by local ministers in communities across Africa, providing glasses and eye medication. Eyes of Faith — through the sales of glasses in the U.S. — is able to fund the provision of eye care and glasses in lower-income contexts by working with pastors. It helps fund Christian missions and prints biblical scripture on the frames to help spark conversations about faith. Muslim charity Al-Mustafa Welfare Trust also runs eye camps in countries in Asia, Africa, and the Middle East, screening patients for cataracts, providing children general eye health checks, and distributing glasses.

“As vision is very important and crucial to people’s lives, community members and eye patients go through religion and spirituality to reassure themselves and get protection,” Bagbila said. “Religion and spirituality are the foundation of humanity. Most acts are related to these two sectors.”

Devex, with financial support from our partner Essilor, is exploring challenges, solutions, and innovations in eye care and vision. Visit the Focus on: Vision page for more.

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