Vision

Early morning, in a village amidst the Nepal Himalayas. With chill water from a mountain stream, a small girl has just washed her face and is now cleaning her teeth with ash from the family hearth. She looks into my eyes and I look into hers, her left eye colourless, unseeing, ... so young, ... and I'm reminded how vulnerable and precious is the gift of sight.

"Although there are 147 ophthalmologists in Nepal, around half are located in the urban areas, despite the fact that more than 90% of Nepal's blind population lives in rural areas. The effects of blindness impact the country socially and economically and of the 125 people who become blind in Nepal each day, seven are children." - The Fred Hollows Foundation.

During my time working in the rural, mountain villages of Nepal, I would see children and adults, especially girls and women, with blindness such as you see in this photograph. Either one or both eyes were like this. I learnt from villagers that this loss of sight is often caused through daily work, such as husking grain by hand, (work usually done by women and girls), - husks fly in the wind and can cut across the surface of eyes, these injuries can lead to blindness,- as was probably the case for this child. Working in the fields, harvesting crops etc. can also cause similar eye injuries. I also regularly saw people with cataract blindness (often caused by a lifetime of exposure to high altitude UV radiation), confining them to a minimal existence.

As the statement from The Fred Hollows Foundation makes clear, so few Doctors for eye care, mostly based in urban areas, is certainly insufficient to care for a mostly rural population of approximately 30.5 million.

Most villages in mountainous Nepal are far from any medical care, such as Doctors, Health Posts with paramedics, (rarely are there any doctors), or hospitals. For severe illness, usually only when a person is so ill that they may die, the sick person is carried on a villager's back, in a bamboo basket, (modified for a person to sit in it ), or if it's possible (depending on how steep the path is that they must climb or descend), on a home made stretcher, trekking for several days or longer to get the person to some form of medical help. ... that is, IF a poor family can afford medical treatment,- many can't afford any at all. Sadly, there are deaths in Nepali villages, daily, often children, that could easily be prevented with adequate medical care.

So, in many cases of avoidable or curable blindness, such as eye infections or cataracts for example, be it adult or child, most people have just continued with life as best they can, often suffering in darkness, with little or no understanding that their sight can be restored and, anyway, most can't afford surgery. In the daily life of remote villages in Nepal, with it's many challenges, blindness can be an extreme physical and social hardship,- even leading to premature death.

"In the developing world,... In rural areas, a family member who becomes blind changes from being a contributor to a family burden. A husband cannot work in the fields, a mother cannot walk over rough terrain to take her goods to market, or collect water, and a child cannot attend school (if that is a possibility.)" - The Himalayan Cataract Project.

In Nepal, 80% of blindness is avoidable. 65% of all who are blind, suffer from cataracts that now can be removed with a brief surgical procedure.

There is "light in the darkness" to this story, again, quoting The Fred Hollows Foundation;-

"In 1980 a national Prevention of Blindness Program was established in Nepal but it was hampered by lack of equipment and training. Five years later, when Fred Hollows visited the country as a consultant for the World Health Organization, he met Dr Sanduk Ruit who was working on the program. They found they were both passionate about ending avoidable blindness in Nepal and, in 1988, the Nepal Eye Program Australia (NEPA) was established by Dr Ruit, Fred and Gabi Hollows, Tim Macartney-Snape and other friends and colleagues, with the aim of supporting Nepal’s program.

When The Fred Hollows Foundation was set up in 1992, NEPA came under The Foundation’s umbrella. In 1994, the Tilganga Eye Centre (incorporating the Fred Hollows Intraocular Lens Laboratory) was opened, just one year after Fred’s death. Dr Ruit was appointed Medical Director.

Today, The Foundation’s contribution to blindness prevention is a collaborative effort with what is now the Tilganga Institute of Ophthalmology (TIO), still led by the indefatigable Dr Ruit.

The Fred Hollows Foundation continues to provide funding for initiatives aimed at increasing the accessibility of eye care services to poor and remote communities in Nepal. The partnership's groundbreaking work has built facilities, trained staff, conducted outreach clinics, and implemented programs that make a real difference."

Now, each year, Tilganga Institute of Ophthalmology, in collaborative partnership with The Fred Hollows Foundation and The Himalayan Cataract Project, has clinics known as Outreach Microsurgical Eye Clinics (OMEC) traveling to remote areas of Nepal, (over 20 this year). These surgical teams give free eye surgery, (especially cataract surgery) to poor villagers. Numbers of local volunteers are involved and assist in the setting up and support of these clinics and surgical teams. TIO eye screening camps, give free eye examinations before and after the arrival of an outreach eye clinic in an area. Throughout each year, these eye camps regularly travel to various regions of the country offering free eye screening to village communities. In Kathmandu, intricate surgery such as cornea transplantation is performed at TIO, free of charge. Other surgery and medical services at Tilganga are subsidised, making it affordable for the poor, for those in hardship, treatment is free. Through eye clinics and various awareness programmes, people all over the country are now becoming more aware of causes of blindness and treatment. Many who had suffered for years with blindness that surgery can remedy, now, have their sight restored,- thanks to these mobile, in-the-field, with the communities, outreach clinics.

These clinics offer such a fine standard of eye health care, that the OMEC from TIO Nepal, have now treated people with impaired vision and curable blindness and trained doctors in their surgical techniques in other countries, including Bangladesh, Bhutan, Cambodia, China, India, Indonesia, North Korea and several African countries.

As well as eye surgery and care, training doctors and support staff, plus educational awareness programmes, Tilganga Institute of Ophthalmology, in collaboration with The Fred Hollows Foundation, specializes in the production of world-class, state-of-the-art intraocular lenses (IOLs) for use in modern cataract surgery. These fine, affordable lenses are now exported to over 60 countries. TIO played a major role in helping refine and adapt a practical, safe and affordable technique of intraocular lens implant for cataract surgery in developing countries. TIO is continuously involved in research activities for the development of eye care.

This and much more (please see links) has become a reality due to the vision of Dr. Fred Hollows, his wife Gabi, Dr. Sanduk Ruit,- without Dr. Ruit's caring, determined dedication and his fine medical team, eye health care in Nepal would not be advancing as it is today,- Dr. Geoff Tabin, of the Himalayan Cataract Project and many others who care to improve life for people in need of eye care. The Tilganga Institute of Ophthalmology, The Fred Hollows Foundation and The Himalayan Cataract Project continue their wonderful collaborative work, restoring sight to thousands of people throughout Nepal every year.

At the time I captured the moment above on film (1991), there was little or nothing that could be done to help such blindness in remote areas of Nepal, however, since then this has changed dramatically and those with avoidable, curable blindness, eye disease or in need of glasses, no longer need to suffer as they did in the past and can again live a full life.

"It's such a small organ, the eye ... and what a big role it plays". - Dr. Sanduk Ruit, Tilganga Institute of Ophthalmology.


* * * * *

In memory of Fred Hollows,... because he cared, took action and helped make a difference. His vision was of eliminating avoidable blindness from the world. Fred Hollows's legacy continues to improve lives in poor communities, in many countries, restoring sight to nearly a million people in the last five years.

If you wish to learn more or help support this good work, here are some links for you, ...

UPDATE, June 9 2013 : A short film about Dr.Sanduk Ruit's work in the remote villages of Nepal, www.youtube.com/watch?v=8WCxSf…

UPDATE, June 24 2013 : We can eliminate Trachoma. Video. www.youtube.com/watch?v=ra3O1e…

Tilganga Institute of Ophthalmology, www.tilganga.org/

The Fred Hollows Foundation, www.hollows.org.au/our-work/Ne…

The Himalayan Cataract Project, www.cureblindness.org/


A retrospective image, 100 ASA Fujichrome FILM, converted to B/W.

© Copyright 2012-13 Lindel Caine. All Rights Reserved. This image may not be reproduced, printed, manipulated or used in any way or form without my written permission. This image may not be transmitted, uploaded to or posted on sites or blogs other than deviantArt without my written permission, feel free to contact me regarding this. Please respect this statement and Protect Creative Copyright.

July 15 2013 : It's so good to see that Vision has received a DD today. Thank you to ^1pen for the feature. This is an honour for all the dedicated people, and those who support them, working to prevent and cure avoidable blindness in Nepal and everywhere there are people in need of such eye care.