A simple, cost-effective operation has brought new life to those suffering from cataract blindness
Meagan Shaw
Maseabi Mokhatlane, 68, had a death sentence hanging over her. According to the World Health Organisation (WHO), people in developing countries usually die within four years of losing their sight and she had been cataract blind since last September.
Mokhatlane, from Limapong Village in the Mokhotlong district, Lesotho, had already set fire to herself in a cooking accident and her tiny body showed signs of malnourishment from not being able to feed herself properly.
In an austere hospital room earlier this month, she sat alone. She was hurting, lost and felt the world had collapsed around her.
She was asked by a nurse to smile but replied: “How can I smile when I don’t see?”
Mokhatlane was one of an estimated 20-million people, according to the WHO, suffering from cataract blindness. Cataracts occur when the lens of the eye becomes cloudy, usually due to old age.
Cataract blindness accounts for up to 80% of blindness in developing countries. But a simple, cheap and fast operation can remove the cloudy lens and replace it with a perspex intraocular lens, restoring a person’s vision overnight.
Not only do the patients regain their independence and ability to earn an income, but children and grandchildren who give up school to look after their relatives can continue their education
An Australian non-government organisation, the Fred Hollows Foundation, has pioneered a simple surgical technique and developed low-cost surgical equipment and lenses. This ensures people in developing countries can have access to the most effective cataract surgery possible.
The foundation will launch its latest programme at the Frontier Hospital in Queenstown, in the Eastern Cape, on Tuesday.
The foundation was set up in 1992 to continue the international sight-restoring work of ophthalmologist, Fred Hollows, who died of cancer in 1993.
Professor Hollows helped treat about half of Australia’s rural Aboriginal population with eye problems, began the first Aboriginal medical service and trained doctors in Eritrea, Nepal and Vietnam to do cataract surgery.
He believed that everyone is entitled to the same quality of health care. But he also believed people had to be given the means to liberate themselves from inequality.
Following this approach, the foundation has provided the training and equipment needed for 750 local doctors in 26 countries to work in their own communities removing cataracts. As a result, nearly one million people have had their sight restored.
The foundation has developed a method of surgery that uses a cushion of air rather than expensive visco-elastic to help slide the replacement lens into place and, in some cases, removes the cataract in such a way that stitches are not required.
The foundation produces low-cost, high-quality perspex intraocular lenses at factories in Nepal and Eritrea, and has also developed cheap, robust and portable microscopes, lasers and surgical instruments.
These technological advances have meant the cost of surgery can be drastically reduced from between R5000 to R8000 to about R350 an eye operation. They also mean cataract surgery can be performed in rudimentary settings in community eye clinics away from hospitals.
The foundation works in Eritrea, Nepal, Vietnam, China, Cambodia, Pakistan, Thailand, Papua New Guinea, the Solomon Islands, Vanuatu and with indigenous Australian communities.
Between 1995 and 1999, the foundation also worked in Africa, training 133 eye surgeons in Zimbabwe, Kenya, Tanzania, The Gambia, Lesotho, Swaziland, Botswana, Ethiopia, Malawi, Zambia and Uganda. But the programme, which was based in Harare and run by two experts, wound up in 1999 due to the emerging political instability and a desire to have a programme run by locals.
Building on the lessons learned from the initial Africa programme, the foundation has employed South African Fiki Nxumalo to manage its latest project, which will be run in conjunction with the Eastern Cape Department of Health.
It has also adopted a broader approach than just training doctors.
The Eastern Cape was chosen because it is the province with the greatest need for eye surgery. According to the latest national Department of Health figures, surgeons in the Eastern Cape performed 390 cataract operations per million people in 2000, while the national figure was 850 per million.
About 70% of cataract cases are in the former homelands of Ciskei and Transkei but the six public hospitals equipped to do cataract surgery in the Eastern Cape are in urban areas. Of these six hospitals, two have no ophthalmologist and the other four have waiting lists of up to six months.
The foundation has employed Nigerian-born ophthalmologist, Ayodeji Adu, to train nine local doctors in six key rural hospitals over the next three years to perform cataract surgery. By the end of 2005 it is hoped each doctor will be performing 500 cataract operations a year.
The programme will fund 18 places for ophthalmic nurses six a year at the Edendale Nursing College in Pietermaritzburg to assist the cataract surgeons and patients.
To ensure sustainability, the programme will train hospital management and administrative support staff in equipment maintenance. Training will also be given in developing cost recovery systems to fund more lenses and supplies, and subsidise patients who cannot afford surgery.
It will also contract a community trainer to teach all rural health clinic staff to identify cataracts and to develop education programmes for schools and communities.
The R8,5-million programme aims to halve the estimated backlog of 27000 people in the Eastern Cape suffering from cataract blindness by the end of 2005 and treat the estimated 5370 people who become cataract blind each year.
The foundation’s chief executive Mike Lynskey said the programme was beginning in a limited, achievable way so that it had a better chance of ongoing success but he hoped it could expand throughout the country.
For Mokhatlane, her operation earlier this month at Maseru’s Queen Elizabeth II hospital, gave her back not only her sight, but her life.