The Fred Hollows Foundation hopes to give sight to 500,000 people worldwide by 2000. It is ahead of target. But the task is more than just raising the money.
The foundation began its work in Eritrea, one of the poorest countries on earth, beset by famine caused by civil war with Ethiopia. Now the war is over and Eritrea is independent. The foundation’s work in Eritrea has resulted in Ethiopian-trained ophthalmologists using lens made in an Eritrean factory to restore sight to people blinded by cataract.
The foundation has done similar work in Nepal and now hopes to expand its work in Vietnam.
Fred Hollows visited Vietnam in 1992 and saw similar tragedies as in Eritrea and Nepal — people unnecessarily blind.
In Vietnam about 750,000 people are unnecessarily blind. A comparatively simple operation to remove the opaque lens and replace it with a plastic one costing $10 can give them sight.
Vietnam has a better health-care structure and more trained ophthalmologists than most third world countries, but there are other difficulties.
Getting government permission, prejudice, and the activities of pharmaceutical companies from developed countries make the job harder.
In most third world countries people with cataract blindness stay blind unless they are in the rich elite. In some third world countries they do an irreversible out-dated operation where the lens removed and not replaced, people have to ware Coke-bottle glasses instead.
In 1992 the foundation began training a core of Vietnam’s 650 ophthalmologists in intraocular lens replacement surgery.
The aim has been to work with Vietnamese institutions, hospitals and the Vietnamese Institute of Ophthalmologists to train a core of surgeons and to train them to train others. Two hundred and fifty have now been trained.
The foundation also wants to provide hardware and help the Vietnamese provide their own hardware. The key to that is microscopes and the lens and sutures for each operation. Laser machines to help prevent secondary cataracts are also important.
The lens are made in Eritrea and Nepal and could be made in Vietnam quite easily if the Government gives the go-ahead. The microscopes are being made in Australia at a much lower cost than the usual surgical microscopes.
A major aim of the foundation is to spread beyond the major cities, into smaller towns and villages, using portable eye stations if necessary.
Training a few ophthalmologists is not enough. They will inevitably go into private practice for the rich, or might migrant to the west. The aim is for saturation coverage to make the operation available to anyone who needs it however poor.
Ultimately, the Fred Hollows Foundation does not want to be in Vietnam, Eritrea, Nepal or anywhere else. It wants to see indigenous control. It wants all the backlog cases cleared — 750,000 in Vietnam — and the infrastructure in place to deal with new cases as they arise without outside help.
When the foundation began producing the lenses in Eritrea and inserting them in thousands of people at low cost, the large pharmaceutical companies in the developed world did not care much, but now they are being produced in Nepal and may be soon in Vietnam, they are concerned to get part of the action and not to lose existing market share.
I saw some evidence of large companies trying to undermine the Hollows lens by bad-mouthing it. Given the choice between a $10 lens made in Eritrea or a $200 lens made in Europe or North America, most people would easily succumb to prejudice.
One of the keys the foundation’s success and ability to resist this tactic, however, is its work on the ground. Thousands of blind people who can see and have had their sight for five years or more with further difficulty is a good advertisement.
“”How do I get an Australian pearl?” is a common request from blind people in Vietnam. Word of mouth is a powerful force.
One major charity we went to in Vietnam which wanted to provide 10,000 people with sight had obviously been targeted by the big companies. The extra cost of their lenses though would mean 4000 fewer people getting their sight back.
The foundation’s Mike Lynskey offered scientific research, explained that the Hollows lens was made from the same base material because there was only one manufacturer in the world. The same standards or better had been reached in (pardon the pun) blind testing.
The charity admitted there had been no problem with the first 1600 cases done in 1997 but still wanted “”further testing”. There was some extraneous motive here, I thought.
Also the old tricks of pharmaceutical companies buttering up doctors with trips and dinners are not exclusive to the developed world. And it can be more effective in a country where doctors get paid $US40 a month.
Then there is the bureaucratic nightmare. Approvals to import microscopes and lens or to manufacture lens must be sought and import taxes paid. At any stage it is easier for the bureaucratic mind to say no rather than approve something new. Or worse, demand a price for approval.
Helping others help themselves is not easy.