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The eyes have it: Compassionate coalition saves sight in India

Posted May 19

"Hope" sometimes meets "Need" in serendipitous fashion.

Just ask Hobble Creek, Utah, family practice physician E. William Jackson or Dr. Arun Sethi, an ophthalmologist from Delhi, India. During an unplanned encounter in India, Sethi mentioned he and his wife Reena, an eye surgeon, had created a charitable foundation to provide eye care to India's poor, who had vision problems in distressingly high numbers but little access to help.

They had an organization and a dream, but it was hard getting everything they needed to actually launch, Sethi said. His list included $100 for transportation each month and some inexpensive lenses to insert in the eyes of patients who'd undergone cataract surgery.

Jackson peeled $100 from his wallet and reached into his briefcase, where he happened to have 100 post-cataract eye lenses.

The next day, the two and those with them went into a village where, beneath a banyan tree, they sorted individuals by need: You need glasses. You need surgery. That was 25 years and more than 2 million eyes ago, if one is counting patients treated by the resulting partnership for everything from cataracts to glaucoma, myopia, retinal disease and about any other imaginable eye malady.

The meeting between Jackson, then head of the Deseret International Foundation (now Charity Vision), and the Sethis, who had just founded the Arunodaya Charitable Trust (ACT), was the birth of a collaboration that has launched village eye care camps, clinics and school-based vision screening, and the construction in 2005 of the Arunodaya Deseret Eye Hospital. Much of the funding for the hospital in India came from Utah donors.

Looking back, Jackson's not quite sure why he had the lenses in his bag. "I was traveling, visiting other programs (the foundation) had started in Africa. I suppose I shoved them in my briefcase and forgot them."

Jackson jokes that they started with a "ready, fire, aim" approach. And it worked.

One country, two populations

At any given time in India, as many as 25,000 people are going blind, many unable to access quality eye care, Arun Sethi said. Hypertension and diabetes have become rampant, both adding devastating eye problems. While ACT has long focused on cataracts, none of the other eye-health issues are ignored.

Like all developing countries, India has two population segments: One has access to the best health care. The other, poorer group tends to neglect health.

"They are the ones who really need the service," he said, adding losing vision can set those who are impoverished back even further. "There is no source that will sustain them if they cannot sustain themselves; 22 percent have been dragged into poverty only because of health care costs."

Prevention is better than cure, Reena Sethi said. Early treatment when problems are more manageable is better than late care. Indian women are a particular challenge because the men, as the wage earners, seek care. Children get care because they are children. Women may not seek care or may receive it late. They also neglect their own nutrition and health in general.

The doctors have found that men come to ACT's fixed-site clinics while they are less likely to seek care in the camps that move from village to village. Women are the opposite. They come to the camps with their women friends and it's both practical and sociable for them — an outing with a purpose.

A different model for help

ACT and the American foundation have built quality eye care from inside the country. Where some international medical collaborations bring experts in from outside — doctors flying in from the United States and other countries to operate or screen or treat, then leave — this collaboration is founded on talent and resources within India, according to the Sethis.

High-quality eyeglasses are inexpensive in India, so there's no point bringing in glasses from outside and trying to find people they fit, which was a useful practice in the past and works in some countries. Also, donated materials require a certain amount of logistics and effort. They purchase what they can in-country. Donations from outside, though, have been essential to get high-tech equipment. They also rely on international volunteers for help such as very basic screening or other tasks.

India has its own trained physicians, so foreign doctors come in not to take over care, but to work with the locals as needed. The flow of ideas and expertise goes both ways.

"The key is getting the local doctors to do surgery," Jackson said. "Local doctors are far better at dealing with any complication after. There are fine ophthalmologists through the world. Can we find those doctors with skills and heart to want to take care of the poor? Our goal is to find and support them, to encourage them in any way possible."

If they can get doctors in India when they are training and interest them in caring for the poor, those doctors will continue to do that as a regular part of their practice throughout their careers.

The eye surgeries take place in a very fine, professional hospital, said Jackson. "We are not doing them in some classroom or converted hut, which has been the tendency in the past."

They also focus heavily on prevention, education and making sure that children's needs are met, whether it's for timely cataract surgery or a pair of glasses, said Reena Sethi. Between the fixed-location clinics, the in-village portable camps and the school screening efforts, they see and care for thousands of eyes a year.

There's a popular old saying about charity care that talks about giving a man a fish vs. teaching him to fish. Jackson said neither applies to the efforts to preserve sight in India.

"We are not teaching a man to fish. They know how to fish in their pond and they know how to do it better than we do. But we are going to give them a bigger net, we may give them the latest hook, we may provide more bait, so their work can be more efficient."

For more information on the collaboration, visit actforvision.com.

Email: lois@deseretnews.com, Twitter: Loisco

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