Traditional Cataract Treatment and the Healers Perspective: Dialogue with Western Science and Technology in Nigeria, West Africa

Background: Approximately 18 million people are blind from cataract in developing countries and this number tends to double every 20 to 25 years. Cataract is curable by a simple surgical procedure. The surgical output is not keeping pace with the growing needs. In rural Sub Saharan-Africa, Morocco, India, Nepal and China, blinding cataract is still frequently treated by traditional techniques of couching, a locally available treatment at affordable costs. Couching is a dislocation of the lens by a sharp artefact or by blunt manipulation. According to some retrospective studies, couching can result in blindness due to rupture of the lens capsule. Complete loss of sight with 50% of the patients treated is reported. Other authors reported better results in prospective studies and in clinical settings.
Methods: In Wura Hausa, a community of approximately 12,000 inhabitants near Yola, Adamawa State, in the southern part of north eastern Nigeria, during a ten-day period in December 1994 a retrospective study took place. The data were collected in co-operation with the traditional healers themselves. Consecutive patients of a traditional eye centre who had been treated for cataract by couching were interviewed and examined.
Results: Forty-two (65%) of the 65 eyes examined showed a corrected visual acuity between 20/20 and 20/40. Sixteen eyes (25%) showed a corrected visual acuity between 20/40 and 20/200. The median refractive correction for optimal vision was + 10.0 D (range -2.00 to + 13.00 D). There was neither observed evidence of an invasive technique having been performed nor evidence of infectious consequences.
Conclusion: In Nigeria, couching is still performed as an alternative to restore vision to those blind from cataract. The Nigerian Organisation of Traditional Herbalists recently has started to participate in research programmes and strives for integration into Community Health Care development. This recent change in attitude opens possibilities for collaborative programs.