Eye Testing In Rural Kenya

From the Carlow Nationalist May/July 2008 ©

by Brendan Harding

We swung from the main highway which runs towards Garissa and the Somali border, pointing our jeep along the red murram road that stretched before us towards the village of Nuu; the village which would be our base while another series of eye-tests was conducted in this remote Kenyan outback. It took only moments for us to realise that something had changed since our last visit a year ago; no longer did the vehicle lurch and kick beneath us, fighting for its survival among the potholes that last year had threatened to swallow us whole. Now, the recently flattened and tempered surface we glided over was a testimony to the promises made in the run up to the elections; elections which had threatened to devastate the country just months earlier. So, at least some small measure of good had come from the whole tarnished episode that had left up to two thousand human beings dead and almost a quarter of  a million homeless. The blue volcanic hills that wrapped around the horizon welcomed us back once more and the bright flash of a hornbill’s wings as she flew from the branches of a fat baobab tree shouted, welcome back to Kenya.

But the reality of this harsh land soon became apparent in the guise of the dry and withered maize stalks bending in the shambas. No greenery sprouted from their fragile forms, and the earth, baked brown and hard, mocked their failed attempts at life; the rains, it was clear to see, had failed once again.

Thirty three kilometres later the village of Nuu and the welcome respite it promised came upon us at a bend in the road. From the airy doorway of a small brick building a group of carpenters stopped from their work and waved happily before returning to the business of creating furniture and coffins. Children ran beside us wearing t-shirts which bore the names of Manchester United, Barcelona and other such legends; the legacy of Europe’s hand-me-downs. Donkeys weighted down by plastic containers that dripped with life-giving water shouldered their burdens with the aloofness that only a donkey can manage. And the elders of the village sat in the shade contemplating whatever it is that those so needy must contemplate.

The promised respite in the convent of Mercy was welcome, but short-lived, as already the first of the eye tests had been scheduled for that very afternoon. The nuns flustered around us making sure of our every comfort; Sisters Goretti, Bernadette, Jennifer and Anne the latest addition since our previous visit. After a quick bite to eat and a long drink of cooling water it was off to the village of Mutyangome, a sleepy collection of red mud huts, lazing dogs and parched shambas some thirteen kilometres distant.

Although tired and hot, the opticians Bernard and Miriam set straight to their task. The clinic to be employed was typical of all Kenyan bush clinics; a bare windowless brick building painted in cream and blue, with a roof of blue galvanised metal that managed to convert the structure into an oven-like furnace in the forty degree heat of early afternoon. Outside, a long, covered verandah and well placed shade trees allowed some reprieve from the bewildering heat of the sun to those who waited patiently. Even the fawn coloured, long-snouted dogs that appear everywhere in this country, stayed well hidden from the frazzling heat. Above us in the trees weaver birds darted in and out of their elaborately built conical nests, the females testing the sturdiness of the males handiwork.


Mutyangome provided the opticians with barely forty patients to be seen that afternoon, and among them was not one serious case requiring referral to the far-off Kikuyu Eye Clinic in Nairobi. Perhaps, it was wondered more than once, had all of the serious cases been seen in last year’s round of tests? As we gathered our equipment together and turned for home a phalanx of angry, dark, heavy clouds had started to gather and conspire on the horizon, with them came a distant throaty rumbling and flashes of white light that distracted the eye from hilltop to hilltop. Soon, leaden, pear-shaped drops of rain lashed the roof of the jeep and turned the earth to blood red, the rains had come, but would it be a case of too little too late? The deluge with its thunder and lightening continued well into the night, providing those of us who watched from the safety of the convent’s well-aired verandah with a spectacle that could never be equalled by the world’s best pyrotechnical experts. Nothing is done by halves in Africa.

Next morning, Good Friday, the air was alive with the sound of birdsong and the world felt freshly washed, but the only visible evidence of the rains that had danced on the convent’s corrugated roof through the night was the welcome news that the water tank had been replenished. It was now full to overflowing, all 24,000 litres. Just like last year, at the slightest sign of rain, we had wondered if we might be trapped in this distant outpost of humanity, cut off from the outside world by the torrents that can fill the dry riverbeds at any given moment. But we were here, and it was pointless to worry about something that even our good-natured hosts with a hotline to the Man above had no control over.

After negotiating the rutted tracks that double as roads in these parts we arrived at the tiny settlement of Kavindu. Not quite a village, a collection of rural mud huts and small brick buildings speckled throughout the scrubby bushland. Already, in the cool of the morning, women were gathered in their shambas, busy hoeing and digging to make the most of the valuable rains that had come in the night, fighting an unwinable battle against the unforgiving Sun.  And meanwhile, the men rested in the shade.

As I stood outside the old government clinic an eagle soared in slow circles overhead, just like it had done last year in this very same spot, a moment of deja-vu which made me think I was always destined  to return here to this small place.

The clinic was quickly prepared and testing soon began. Here, eye tests would be conducted in the same manner as would occur in any high street optician’s, but with one notable exception: most of the people in these parts do not possess the ability to read, and so an eye chart was devised using outlines of everyday objects:  instead of letters patients were asked to identify the shapes of items common to the local environment; a cow, a chicken, a scorpion, a person, a butterfly, and a bird. A simple solution to a complex problem, but one that appears to work quite well.

With the line of people that waited, the list of cases grew steadily as the day wore on; irritation of the eye caused by the direct glare of the Sun, here so close to the Earth’s Equator; short-sightedness and long sightedness; mature cataracts; these were the lucky ones, the ones who could be helped. And then there were the cases that cause you to despair, children without hope because of a thrown stone, or a piercing from a savage thorn in the undergrowth. A man who had been ‘squirted’ with the milky resin from some unknown plant he had attempted to hack away, had left him without the sight of one eye. But then there were things that made you laugh; a man who complained that he could not read his watch, (it made us wonder, what did he need a watch for anyway?) until Bernard examined the watch to find it so scratched it was impossible to read the time anyway.

With both opticians working in tandem the workload didn’t seem as heavy as we had remembered, and in the quieter moments there was even time for a song or two from some of the patients. The Kamba people who inhabit this area have a great love of songs and singing and when asked for a recitation they will rarely refuse. Their songs are usually accompanied by an indigenous and infectious dance which is performed by the dancer bending forward and rolling his shoulders one at a time, a truly curious sight to behold but one that never failed to raise the spirits of everyone concerned.


Returning home after the day was done we stopped in a small village called Kii where we learned the reason for the recent upgrading of the road to Nuu. From every wall of the village the serious, moustached image of one Mr Stephen Kalonzo Musayoko beamed. Kalonzo for President they screamed. Mr Kalonzo, a local-man-made-good, had run for the country’s presidency in the recent tumultuous elections and although he hadn’t won (but then again who had it was asked?), regardless of the formation of the next cabinet Mr Kalonzo has already appointed as the country’s next vice-president. This is good news for the impoverished community, access to a member of parliament is one thing, but having a vice president, a local boy, on your doorstep couldn’t possibly do any harm either.

Once again as night fell and we sat on the verandah taking stock of the day, another storm rolled in over the hills from the far-off Tana River. The light show we witnessed stole our breath, only Africa can manage to perform her miracles of nature on such a grand scale. Forked lightening rending the navy sky, thunder pounding deep into the cavity of your chest and as the wind rose you knew the rains would not be far behind. When the rains did come they fell like a single silver sheet that bounced knee high from the hard earth. All manner of creature made their escape from the downpour and towards the relative safety of our verandah. Moths the size of small birds whirled like wind-up toys around our heads. Beetles and crawling insects of all sizes, shapes and colours brought the floor beneath our feet to life. These in turn were followed by bats skimming silently through the darkness, and then the sight of a deadly foot long millipede which can inflict a painful bite – a bite that may be fatal to the young or infirm – put us all firmly on edge. As if that wasn’t enough to contend with, scorpions scuttled beneath our chairs drawn by the possibility of an easy meal. And so we left our night-time visitors to their own adventures and retired to our rooms, making sure in the darkness to check every corner by flashlight, before bunking down under the safety of our trusted mosquito nets.

As an urban dweller I was led to believe that the cock crows once in the morning as the Sun rises. Not so, not in this part of the world at any rate. Their screeching rehearsals began at least one hour before dawn and carried on long after the Sun burned high in the sky, curiously ending once certain that all were wide awake and risen from their slumber.

Saturday is market day in the nun’s home village, and so it made perfect sense that this should be our venue for testing once again. With crowds arriving from far and wide there would be no shortage of of customers, or so we thought, but, strangely, unlike last year, when the crowds waiting from early morning had numbered over fifty, today there would be no such scenes. The nuns appeared disappointed; maybe the word hadn’t spread as they had hoped? But the real picture soon became clear, the picture that last year’s clinics had been such an overwhelming success, the few patients who had arrived early had come from much further beyond the the boundaries of the immediate locality. This lull in activity afforded me an opportunity to see first hand what happens in a Kenyan village on market day. The roads were full with herds of bleating, long-eared goats being driven with sticks by children, some as young as five or six. Overworked buses spilled their human cargos from within and the assortment of precious goods to be traded which were piled dangerously high upon its roof. Honey sellers stood by their sweet and sticky caches amid a cloud of loudly buzzing bees. Women sat weaving sisal ropes and baskets. Giant cauldrons of porridge were sold by the bowl-full to those hungry enough and wealthy enough to afford it. Bicycles trundled over the bumpy road with pairs of staring live chickens hanging upside-down from the handlebars, and the tinny sound of African guitar music blared from the drinking houses. All human life was here.

Back at the testing clinic the crowds had finally materialised, and by the day’s end over seventy people had been seen by the opticians. Although not the numbers we had been used to on our last visit, the addition of Miriam as an extra optician had made all the difference. During the day we had met all manner of peoples, from Jeremiah, the first chief of the village after Kenya’s independence from Britain to the latest assistant-chief, a woman who spoke of her belief that education was the way forward for her people to rid themselves from the burdens of poverty and disease. One old lady wore a leso – the multipurpose wrap-around length of cloth worn by most women – that bore the image of vice-president Kalonzo, a fashion item I could never imagine catching on here in Ireland. (The image of Brian Cowen emblazoned on a ladies skirt?) And again teenagers had come to be tested in the hope that they too might be lucky enough to receive that most sought after Kenya fashion accessory, a pair of spectacles.

A torrential downpour marked the end of the day’s proceedings and equally marked a renewed worry on our behalf that the rivers would flood, trapping us here for only God knew how long. But the rains were short lived and it being Easter Saturday the preparations were well under way for the Easter vigil that would take place in the evening. At the nine-o-clock that night, beneath a cloudless sky, we stood outside the little church, a tall bonfire of dry wood waited for a spark from the parish priest Father Emmanuel to begin this most holy of Catholic ceremonies. The voices of the children singing in the church remained as magical this year as it had the last, a sound which I hope will stay with me for my whole lifetime. The ceremony continued into the small hours of the morning, ending with the congregation dispersing into the blackness of the African night, their voices in the total darkness lilting into the distance.


After a day of rest on Easter Sunday, a day we spent touring the stunning countryside around us, Monday brought no relief in the optician’s gruelling schedule. The early morning had once again brought rain and left the roads to the thirty kilometre distant village of Nyanni almost impassable in places; thank God for four-wheel-drive vehicles. Midway through our journey we stopped in a tiny settlement named Kavuti where and elderly couple were tested in their tiny mud and wattle hut. A small boy, the grandson of the couple, sat outside in the shade, a tawny dog with visible ribs sat panting by his side. When I photographed his beloved dog and showed him the image on my digital camera, the look of astonishment on his dust encrusted face was a prize in itself. He looked at the image, and then to his dog, then back to the image once more; how could his dog be in two places at once he seemed to ask, and how could such a big animal get inside such a little box?

Together with the welcome visit of the eye clinic, the village of Nyanni would today host a wedding party. People arrived for testing dressed in their Sunday best, a blaze of garish colour among the burnt brown hillside; the women in their brightest wrap-around Kangas, and the men wearing loose-fitting, stylish, patterned shirts and light, crisply-pressed trousers, shook hands in elaborate ceremonies and smiled big beaming smiles. There was an air of excitement in the whole village. The kinyozi, or barber shop, had a queue almost as large as the clinic’s and for hours before the ceremony people waited in small groups talking and laughing joyfully. Along with the laughter and human song – again the children of the village practiced their hymns in the cool of the church – the air in Nyanni was also full of birdsong. From every tree a different species seemed to call. The wonderfully named and beautifully feathered Go-Away bird with its distinctive warning cry of “Go Away, Go Away!” sat in the high branches of a leafless tree near to the clinic. An Eastern paradise whydah bird barely managed to lift itself into the air, dragged heavily down by its splendid metre long tail of shining black plumes, its call like the sound of a child crying in the distance as it disappeared into the bush. Sunbirds with as many colours as there are varieties darted in and out among the foliage allowing only tantalising glimpses of their magnificent plumage. They too had come dressed for the occasion. And in the clinic, as another batch of patients were diagnosed as treatable, their sight could be restored, there really was an air of genuine celebration in this far flung outpost of humanity.

Later that evening as the Sun bathed the giant boulders of the hillsides in gold and red, I met a man who had been treated during last year’s campaign. A man who had been totally blind for many years, but now, here he sat outside his hut making baskets to sell in the village market, once again he could see, and freed from his blindness could make a living capable of feeding his family. In this most basic of communities a person’s ability to work is the single most important factor in their existence.

Wingemi, another remote village was to be the scene of our final day’s testing in rural Kenya. Because of its distance from previous clinics the majority of patients were elderly and suffered from cataracts or other treatable ailments. With so many possibilities the day was greeted as a huge success. But, it was not all about treatment for tired and worn eyes, a young girl of fifteen who we were told was completely deaf and had never attended school accompanied her father to the clinic. She was a bright smiling child named Mwele who interacted easily with the strangers around her and it was plain to see she would make a good student, given the right attention. Through a mixture of sign language and crude drawings it was asked if she would like to attend a special school for deaf children in the town of Mwingi, sixty kilometres away: the cost, about one hundred and fifty Euros. Her face beamed as she hugged her father’s arm at the news that this could be arranged. As she left for home, she turned and waved wildly, her face filled with a smile as bright as the midday Sun, and left us to wonder how many more Mweles were out there?

And so with these thoughts and so many others fresh in our minds, the clinics came to an end for another year. How much had been achieved? How do we measure this achievement? If that measurement was to come in the guise of mere numbers, the conclusion would be simple. Almost four hundred tests carried out; of these, seventy five would result in sight-saving medical treatment, the rest would receive specatcles and eye drops, ointments and unctions, their condition would be monitored by the mobile clinic that would come throughout the year from Nairobi. But such an undertaking can not be measured in statistics. What is the value of sight saved and a life improved beyond expectation? Only the people themselves can answer that question.


Without the aid of so many who never got to see the lightening rip apart the sky over the semi-desert of Nuu, nothing could have taken place. Without the time given freely by the opticians Bernard and Miriam things would stay the same. Without the guidance of the Sister Goretti and her fellow Sisters of Mercy and their constant struggle to improve and dignify the lives of those they truly care for, this area would remain a forgotten backwater in the wilds of Kenya. The invaluable assistance and generosity of David Walsh and Niall Kelly at Netwatch security can not go unmentioned, or that of Braun Ireland, whose donation and expertise assured our equipment arrived on time, in place and perfectly intact – no easy task in the bureaucracy of Kenya. The Waterford-based charity ‘Fight For Sight’ whose financial donation ensured the purchase of a vital piece of surgical equipment which will go on improving lives long after we have left. The extraordinary Dr D.S. Walia, director of clinical services at the Kikuyu eye clinic; a man whose word is as good as a deed performed, simply, a man who gets things done and has made it possible for the provision of a clean-room surgery in Nuu itself. And along with those named above there are hundreds of others whose donations were as vital and as life-changing as any, space does not permit their names to appear in these columns.

The work will continue and flourish, of that I am sure. And when all are asked to dig deep once again, as they are on so many occasions, the response will be as amazing as it was in the past. My thank you will never be enough. But rest assured, that I for you, will carry the image of a man – who only last year was completely blind – as he played with his young daughter he had never seen, amid the clutter of a work place that now fed his family, and smiled a big smile before saying, ‘thank you, thank you’.