Dar es Salaam — Eye specialist Dr. Margaret Mumbua Muthoka is at the forefront of healthcare in Chalinze District, providing much-needed eye care services once lacking in the area.
Her journey into eye health wasn’t driven by a personal calling, but by circumstance. “There wasn’t any special reason that inspired me to become an eye specialist,” she said. “I was already a medical practitioner. Later, when the councils of Chalinze and Bagamoyo were divided in 2016, Bagamoyo did not have an eye specialist. That is how I ended up coming here.”
When Sightsavers came to her district in 2017, Muthoka was selected to serve as the district coordinator of eye health services. To strengthen her skills, she pursued further training, completing a three-month course in eye health at the Mvumi Institute for Optometric Assistants. After completing her course, she worked as an eye coordinator for Sightsavers, but the three councils – Chalinze, Bagamoyo, and Kibaha – still lacked an eye surgeon. As a result, she trained in Dodoma as a surgeon specializing in trachomatous trichiasis (TT), and has performed more than 200 surgeries since then.
In Tanzania, trachoma remains a major public health concern
Trachoma, caused by the bacterium Chlamydia trachomatis, is the leading infectious cause of blindness worldwide. Trachoma is also one of the neglected tropical diseases that the World Health Organization aims to eliminate by 2030. The disease disproportionately affects poor, rural communities that have limited access to clean water and sanitation. Repeated infections with this bacterium cause scarring of the inner upper eyelid. This scarring can make the eyelashes turn inward, scratching the eyeball. Left untreated, this leads to irreversible blindness, though surgery can prevent it when diagnosed early.
The battle against blindness relies heavily on trachomatous trichiasis (TT) surgeons like Muthoka, as well as non-ophthalmologist health workers such as ophthalmic nurses and clinical officers. These professionals undergo training, face challenges in their work, and deal with obstacles within their communities.
But the fight against trachoma is not without challenges.
“Most of the patients that come are not aware that they have trachomatous trichiasis. So I sit them down and explain that if it is left untreated, it can cause blindness. I tell them that surgery will help them avoid blindness, and eventually the patient understands and accepts it,” she said.
Many patients hesitate to have surgery because of fear, a lack of information, or the long distances they must travel to get to surgical camps. Even when services are available, issues like shortages of supplies and trained professionals can make access tough. The recurrence of trichiasis after surgery is another major challenge. For patients who experience it, trust in treatment and in the health system can waver.
Cost can also be a barrier.
The cost of surgery, Muthoka said, varies depending on the council and hospital, since each sets its own prices. At her facility, a Bilamellar Tarsal Rotation (BLTR) costs 30,000 Tanzanian shillings, or about U.S.$15 for one eye. “The challenge with eye health is that many people do not take it seriously. When they develop such conditions, they often think it is normal or believe they have been bewitched,” she said.
She said health education is crucial for addressing local beliefs and misconceptions. Teaching villagers that the condition is a normal disease that can be treated and even eliminated is important. Still others believe they can manage the condition on their own, or they avoid surgery because they lack someone to accompany them, or worry about discomfort after the procedure. She added that public health programs can help overcome stigma and misconceptions, such as accusations of witchcraft.
“I’m not sure why so many people avoid seeking eye health,” said Muthoka. “In the villages, people often do not give priority to their eye health. But I would encourage young professionals to get involved. With more opticians and eye health specialists, we could reach far more people in rural areas and work toward eliminating this problem.”
Surgery’s impact
After surgery, Muthoka said that most of her patients see their lives improve after the surgery, allowing them to resume daily activities. She said that many patients call to express their gratitude, saying that they had this condition, but now they have been treated and are doing well, earning a living, and leading normal lives.
“Some call for follow-up questions or to ask about their relatives, sharing what their family members are going through so I can provide advice and support, helping them maintain a good quality of life,” she said.
Muthoka said Sightsavers carries out several follow-ups after surgery.
“The first is a one-day follow-up, usually the day after surgery, when we remove the bandage and check how the eye is healing. If it has been over-corrected, we adjust it, and if it is under-corrected, we correct it again to the right amount.
The second follow-up takes place between 7 and 14 days, when we remove the stitches and assess the outcome.
Then, at three to six months, we check for any recurrences or eye granuloma. If a granuloma is found, we remove it, and if there are recurrences, they are corrected. In cases of bad outcomes, ophthalmologists step in to handle the corrections.”
Beyond surgery, Muthoka plays an important role in community education.
They started a program to raise awareness at the grassroots level by training caretakers. These caretakers now act as case finders within their villages. “We provide education to the caretakers so they can understand the disease,” she said. “After we explain things to the case finders, they visit homes to check and test people. They explain to them, and most people understand now.”
She said, in addition to training the case finders and caregivers, they also educate the community health workers who oversee the case finders so that they understand how to manage or deal with patients with this type of disease.
The awareness campaign has begun to change perceptions.
“I see that the community is more aware this time,” Muthoka said. “Some people even call and ask, ‘When are you coming to test or treat us?’ This is all because the case finders have done a great job.”
Perseverance in surgery
Trachomatous trichiasis surgery can sometimes present unexpected complications, especially in patients with additional health concerns, requiring surgeons to adapt and respond quickly to ensure successful outcomes.
“I faced this challenge during an assignment in Bagamoyo on April 28, 2025, said Muthoka. “A patient came, but he said that he also had a heart condition. He was also on blood-thinning medication. In addition to his heart problem, he had trachoma and needed eye surgery. At first, I was hesitant because of his condition, but I went ahead and performed the surgery. He was discharged, but just two hours later, he returned. He had removed the bandage, and his eyes were bleeding.
She had to repeat the surgery and stitched him up with more stitches than usual. The following day, he was doing fine. But five days later, after she had returned home to Chalinze from the operation in Bagamoyo, she received a phone call at night. The patient was bleeding again, this time from the second eye she had operated on. He was in Mapinga and came by ambulance, already bandaged.”
“When I saw him, I prayed because his condition was so bad,” she said. “I called Peter Kivumbi, the NTD Programme Manager at Sightsavers, and explained the situation. He told me to do what was necessary, and if nothing could be done, the patient could be transferred to Mwimbili, the national hospital. I removed all the stitches and re-stitched his eye with many more stitches than usual. After that, he stopped bleeding and went home. Fourteen days later, I removed the stitches, and he was fine. Even now, he calls me to update me that he’s doing well.”
Muthoka also recounted a case involving a patient who had previously undergone surgery by an ophthalmologist at Mwimbili but developed a recurrence and was transferred from Mwimbili to Bagamoyo due to heavy bleeding. “They called me and said there was a familial problem similar to the previous case. I went there more confidently since I had handled a similar situation before, performed the surgery, and the patient has recovered. Up to today, I haven’t received any complaints,” she said.
To eliminate trachoma it requires years of organized efforts.
Water, Sanitation, and Hygiene (WASH) is a crucial part of this. Other important strategies include mass drug distribution and the SAFE strategy, which consists of Surgery, Antibiotics, Facial cleanliness, and Environmental improvements aimed at eliminating trachoma by 2030. These initiatives need to continue until the disease is no longer recognized as a public health threat. The World Health Organization has set a goal for 2030 to eliminate trachoma as a public health issue.
“What is really needed to eliminate the disease for good is financial support. With funding, we can reach people in the hamlets where the case finders are located. These projects help us get into villages and wards, but without money in the councils, it is very hard to reach them,” Muthoka said.
Chironda was in Tanzania as part of a workshop and field visits hosted by Sightsavers and Tanzania’s Ministry of Health, in collaboration with other partners, including Uniting to Combat Neglected Tropical Diseases, a global advocacy organisation that exists to end NTDs by mobilising resources.
