‘The Last Mile: Essential to Win the Fight but Hardest to Cover’

This photo shows a Ugandan man inspecting an old Ugandan woman's eyes in a field.

Namutumba, Uganda - Ophthalmic assistant James Mukambwe inspects Babawemba Tapenesi, who has trachoma in both her eyes.
© CBM UK

In this interview, eye health expert Dr. Babar Qureshi explains why Neglected Tropical Diseases (NTDs) are often neglected and what can be done to change this.

Dr. Babar Qureshi, CBM Director of Inclusive Eye Health

© CBM

Dr. Qureshi joined CBM in 1997, after having previously worked as an ophthalmologist in Nigeria and Pakistan. Today, he is Director of Inclusive Eye Health and NTDs at CBM.

From revolutionising eye health in Pakistan, to CBM's global NTD work and addressing new challenges such as diabetic retinopathy, Dr. Qureshi and his team is responsible for building quality and affordable eye health services for all.

What are neglected tropical diseases?

Dr. Babar Qureshi: The term encompasses two concepts: On the one hand, we are talking about diseases affecting neglected or forgotten people, often living in remote areas. On the other hand, we are talking about neglected diseases, because until recently there were hardly any funds available around the globe to develop new drugs and diagnostics or to successfully implement existing treatment options.

How does CBM work in the area of NTDs?

Dr. Babar Qureshi: CBM is committed to eliminating NTDs but also to improving the lives of people living with their disabling effects. Our work ranges from preventive care to the treatment and care of people with disabilities to the inclusion of those affected into society – the latter especially on a community level and in close cooperation with local partners. This comprehensive help, which accompanies the individual at every stage, and the inclusive development approach – also called Disability Inclusive Development – distinguish us from many other organisations. CBM can draw on great expertise and many years of experience.

How has Covid-19 impacted NTD work?

Dr. Babar Qureshi: The situation was critical in the beginning when regular services were disrupted and not taking place in any form. Such services could include medication as preventive care or treatment in case it was not life-saving. We were still able to implement most of our planned mass drug distributions. But many programmes were brought to a stop. Luckily, most of the programmes have restarted and are slowly catching up.

Those responsible have fortunately realised then that the structures of NTD work are very well suited for combating COVID-19. The pandemic has proven to the world that a disease does not stop at a border and governments all over the world must realize that they have a common responsibility. We hope this will lead to not just wider engagement in global health, but also a substantial financial engagement, and strengthening of health systems all over the world. What we urgently need to reach this goal is comprehensive coordination by stronger and better-equipped global stakeholders.

Neglected Tropical Diseases Report 2020

To know more about CBM's work with NTDs around the world, have a look at our recently-released NTD Report 2020. 

Read more here.

How do NTDs feed into the cycle of poverty and disability?

Dr. Babar Qureshi: NTDs affect the poorest people in the world – those living in remote areas, in conflict zones or those with disabilities. And as NTDs have a negative impact on their physical, mental, intellectual, and socio-economic development, they become further impoverished. At the same time NTDs are a major cause of disability throughout the world. That is why we can only break the cycle if we eliminate NTDs in every corner of the world. That means we must walk the last mile, which is the most important to win the fight but also the hardest to cover. The commitment to the last mile is key to ensuring that we reach the people ‘at the end of the road’ and achieve our elimination goals.  At CBM, we strive to persevere until we have provided medical assistance to the very last patient in this global fight against endemic trachoma, river blindness or lymphatic filariasis.

Additionally, we also support those people already living with disabilities due to NTDs or other diseases.

Can you provide us with some inspiring examples of successful programmes?

Dr. Babar Qureshi: In general, CBM is strengthening the health systems in the affected countries through trainings of doctors but also environmental improvement, hygiene education and improvement in sanitation standards. But to be more concrete: Since 1991 CBM has been very successfully supporting the annual treatment of those affected with river blindness by providing Mectizan. This drug is provided free of charge by the company Merck. It is distributed by local staff who are supported and trained in CBM projects. For example, CBM has expanded the distribution of Mectizan in South Sudan in 2019. We are also expanding our programmes in Nigeria. Thanks to the coordinated efforts of all partners over many years, the disease has now been controlled in almost all districts in Nigeria - to such an extent that it has even been possible to discontinue the distribution of medicines (under close supervision) in several parts of the country.

In Burundi, CBM is the only non-governmental organisation supporting the national river blindness programme as a government partner for many years. Here, the World Health Organization is currently reviewing whether river blindness is still being transmitted or if joint victory over this scourge can be declared in the next few years.

… and in regard to trachoma?

Dr. Babar Qureshi: In the case of the eye disease trachoma, CBM supports the WHO's SAFE strategy with its expertise, especially in trachoma surgery and antibiotic treatment. (Note: SAFE stands for Surgery to correct trichiasis; Antibiotics to treat infection; Facial cleanliness, and Environmental improvement to reduce transmission). In addition to treating infected people, it is particularly important to prevent the further spread of the disease. This is achieved through the distribution of antibiotics to affected communities, educating the local population, the construction of wells and the improvement of sanitary facilities.

Our trachoma work is currently focussed on Ethiopia, Nigeria, and the Democratic Republic of Congo. We are also still active in Burundi, South Sudan, and Pakistan. Thanks to CBM, over 11 million treatments against trachoma were carried out in 2019. This proves that close cooperation with affected people, governments, the WHO and development partners is an essential prerequisite for sustainable success.