The old woman walks out of her tiny house in the small village of Que Phuc near Da Nang in central Vietnam.
The two-room house is beautifully kept, but there is no running water and certainly no sewerage. The floor is bare earth.
Around the house is an intense garden, the size of a suburban garden, but with every square centimetre cultivated. This house has a tiled roof, though many of its neighbours have thatch. It is raining, adding to the richness of the green.
The old woman walks uncertainly and turns to find a stool on the tiny veranda. There is something wrong here. The woman gropes with her hands to find the stool. At last she finds it and sits down. The woman is blind. Her name is Pham Thi Ke and she has been blind for seven years and she is now 77. Her eyes are opaque from cataracts.
Blindness in Vietnam or any Third World country is a death sentence. You degenerate. There are no mechanical or technological aids. You have to rely on family, who invariably are barely making ends meet. No social security.
In any event Mrs Ke is utterly dependent.
Today she is with her daughter, Nguyen Thi Tien.
As she walks on to her veranda something else goes wrong.
Several metres away Karl McPhee is video-taping and the rain has dripped off an umbrella over the lens, ironically making it difficult to see his subject matter.
“”It’s no good; we’ll have to shoot it again,” he bellows. “”Can she turn left immediately she comes out of the hut?”
McPhee is shooting the video for the Fred Hollows Foundation.
Today Mrs Ke is to have an operation on her eyes. McPhee wants to film the whole sequence, from her village till after the end of the operation.
Like all television documentaries it has to be somewhat stage managed. But for that it will reveal events more truthfully than a hotch-potch of grabs on the run.
Miss Tien leads her mother the 300 metres across the paddy field to the village primary health centre. It has half a dozen rooms and a veranda on which a dozen patients are lying on beds with bright white bandages over one eye. The white pops out amid a palette of greys and browns.
Mrs Ke is sat down and Dr Vo Ngoc Can looks into her eyes with a $2 torch. He then uses more a more sophisticated instrument to gauge what strength lens she will need.
She gets some drops and lies on a table outside the operating room.
Then I wince as Dr Vo inserts a needle in her eye. McPhee (or Mr Karl as the Vietnamese call him) is unmoved as he is filming. This bit can’t be re-enacted.
The operating room needs a coat of paint and good lighting. There is an old stove in the corner to sterilise instruments. The nurse is in bare feet.
Dr Nguyen Quoc Dat has just washed his hands and gloved. There is no expensive sterilising room with clean white basin here. He washed over the veranda wall. An assistant pours water over his hands from a sterilised drink can and Dr Dat, aged 37, goes in to the operating theatre.
It can be done. A cocoon of sterile conditions can be created amid the crops and rural animals in an unsewered Vietnamese village.
The essentials are sterile — surgical instruments, doctors’ and nurses’ hands, the area around the patient’s eye and dressings — while Mrs Ke has not changed out of her peasant’s clothes.
Outside, two dozen patients are waiting. There is an extraordinary silence among the patients and their relatives. Perhaps it is just the rain muffling voices. Or is it the silence of the blind?
Cataract blindness is a common enough disease. It is caused by opacity of the crystalline lens of the eye. Sometimes it is just dots or opacity of the peripheral part of the lens. But the big problem comes with age as the opacity hits the central part of the lens, blocking vision. Typically it attacks both eyes in fairly quick succession.
For a long time the only treatment was removal of the lens and the use of Coke bottle glasses. Nowadays an intraocular lens made from plastic half the size of a 5c coin can be inserted into the eye to give virtually full vision.
In developed countries the lens cost as much as $200 and the whole operation costs as much as $3000.
Only the very wealthy in the third world could afford it. The rest went blind. In the developed world, of course, the operation is done well before blindness sets in.
In the late 1980s, Australian ophthalmologist Professor Fred Hollows thought he would do something about this. There was no reason, he thought, why the lens could not be made cheaply. There was no reason why the operation could not be done by mobile teams, even in places where there is no electricity.
Mrs Ke is hooded with a sterile cloth with a hole for the eye. Dr Dat sits on a wooden school chair on a makeshift platform. The floor is bare concrete. There is no air-conditioning. There are fields outside the glass-less window with crops and cows just a few metres away.
Dr Dat is looking through a microscope.
The microscope is another Hollows initiative. The foundation has got the cost down to $4000. The optics have to be very good. Mere magnification is easy, but obtaining a good depth of field so the whole eye is in clear focus for the surgeon requires a quality instrument.
Dr Dat stitches back first the lower eyelid and then the upper. The nurse cleans away blood and keeps fluid on the eye.
Mrs Ke, under her hood, has almost been depersonified. All eyes are on the eye as an independent entity.
Dr Dat uses a scalpel to cut into the eye at the edge of the iris. I am so intent on watching his skill that I forget to feel queasy.
He works away and then slides in some tweezers and out comes a roundish piece of clouded orange jelly the size of a pea. It is this that has prevent Mrs Ke from seeing for seven years.
The nurse passes Dr Dat a small plastic pouch which has come out of a white cardboard carton. The label reads: Fred Hollows Foundation 13 Africa Street Asmara, Eritrea. It is bizarrely out of place. Hi-tech surgical accoutrements are supplied by Germany and the US. Not Eritrea, the former province of Ethiopia stricken by famine and civil war.
But it can, and has, been done. Thousands of hi-tech lens made with precision instruments have be produced in sterile conditions in factories in Eritrea and Nepal. They are equal or better than lens produced in the developed world, for less than a tenth the cost — about $10 each.
Dr Dat takes the lens with his tweezers and inserts it in Mrs Ke’s eye. He then squirts in some fluid with a needle and her eye clears. It sparkles in the microscope’s light.
Dr Dat then stitches up the incision with a thread thinner than silk. HE does several loops pulling the needle with pliers each time. Then he knots the thread and remarkably pulls the knot inside the wound to reduce irritation and the chance of infection. The stitches will dissolve.
It looked so easy, as difficult tasks always do when done by someone with high skill. It was all over in 15 minutes.
Mrs Ke is lifted from the table and taken outside to a bed on the veranda.
There the patch is taken from her eye and she see her daughter for the first time in seven years. Fifteen minutes, a $10 lens and perhaps $40 of other costs is the price of sight.
Dr Pham Binh, aged 46, is the driving force of ophthalmology in Da Nang province. He is at this clinic as part of his rounds. He obliges Mr Karl to act out a cameo with Mrs Ke. Dr Binh holds up two fingers. Mrs Ke then holds up her two fingers to indicate she can see.
“”Can we do that one more time?” yells Mr Karl.
“”Yes, we need some more spontaneity,” I mutter under my breath.
But despite the stage-management, it is a very moving sequence. And later the rushes reveal that Mr Karl has very professionally captured the moment.
The miracle is that Mrs Ke has regained her sight. The sadness is that she was unnecessarily blind for seven years. The tragedy is that there are 750,000 people in Vietnam unnecessarily blind with cataract and perhaps 20 million in the world.
But there are many obstacles, and not just money, to repeating Mrs Ke’s operation 20 million times.