Traditional Eye Medicine in Rural Somalia: Culturally Safe Harm Reduction to Prevent Corneal Blindness

Abstract

Abstract: Traditional eye medicine (TEM) remains widely practiced across rural Somalia, where distance, poverty, limited eye care workforce, and low health literacy constrain access to timely biomedical services. Commonly reported practices include instillation of aloe vera liquid or gel, expressed human breast milk, honey, and plant derived sap or rubbed tree material to relieve redness, photophobia, and ocular pain. While these practices are culturally embedded and may be perceived as effective, the ocular surface is uniquely vulnerable to toxicity, microbial contamination, and delayed presentation, factors strongly linked to severe microbial keratitis, corneal scarring, and irreversible vision loss in multiple low resource settings. Importantly, natural does not equate to sterile or safe: case reports and observational studies associate TEM with worse corneal disease at presentation, and certain plant saps can cause acute toxic keratoconjunctivitis. At the same time, purely prohibitive messaging can backfire by eroding trust. Somalia needs a pragmatic harm reduction approach aligned with integrated people centred eye care: community education that distinguishes safe first aid from dangerous instillations, engagement and training of trusted traditional healers for early referral, strengthened primary eye care and community outreach, and research to quantify TEM prevalence, motivations, and clinical impact. This article is a Commentary synthesizing available evidence and field relevant clinical considerations to propose a culturally safe harm reduction and integrated eye care response. Addressing TEM is not a culture versus medicine debate; it is a preventable blindness agenda requiring respectful partnership, access expansion, and evidence informed policy. Keywords: traditional eye medicine, Somalia, microbial keratitis, corneal ulcer, primary eye care, harm reduction, integrated people centred eye care