Helping the underprivileged to see

Roughly 300 million people are visually impaired-38 million of whom are blind and most of whom live in so-called developing countries. However, there are many institutions with specific campaigns aimed at eliminating preventable blindness (for example, the World Health Organization’s ‘Vision 2020: The Right to Sight’ initiative), as well as associations (Lions, Rotary, Surgical Eye Expeditions, Orbis, Mercy Ships, Sight Savers and CBM to name but a few). Additionally, donation appeals fill post office boxes regularly.

In 1997, my friend and I, both ophthalmologists for more than 15 years at that time with plenty of surgical experience, travelled to Papua New Guinea to take part in a surgical eye camp under the auspices of Surgical Eye Expeditions (Santa Barbara, California, United States). Unfortunately, we were unsuccessful in achieving our goals, which was mostly down to issues such as the lack of infrastructure (microscopes, autoclaves), consumer goods (syringes, needles, drapes, etc.) and trained surgical nurses.

Therefore, we decided to found our own association, which we called “Vision without Frontiers” (www.sehenohnegrenzen.org), to gain donated money to optimise the outflow of an eye camp in 2000. We organised 41 eye camps in Namibia, Zambia, Zimbabwe, Tansania, Nigeria and Nepal.

Our responsibilities lie in creating or improving the infrastructure at the location where the camp is planned. This means perfect microscopes (not fixed on the operating table) are required, as well as at least two autoclaves and supporting kitpacks (including drapes, sutures, syringes, needles, patch, gowns, gloves, cannulas, knifes, keratomes, infusion sets, etc).

We also need to source staff, and it proves quite a challenge to find skilled colleagues and nurses who are physically and mentally strong enough to travel to unknown countries with unfamiliar potentially harmful diseases in their holiday time.

One of the most important persons for a successful camp is the host, who is usually an ophthalmologist who does surgery as well. He or she is responsible for a wide range of tasks including recruiting enough patients for surgery; bringing them to the clinic or an adapted ‘operation’ room; organising facilities for surgery; and ensuring the power supply for microscopes and autoclaves.

Costs have to be factored in from the beginning. For example, the price of transporting equipment from Europe to Africa, including surgical instruments for phaco and ECCE; IOLs; a keratometer; an ultrasound biometer; and several drugs, ointments, local anaesthetics, hylase and eye drops. These will all have to pass customs and be transported to the camp in a timely manner.

Last year we were invited to build an eye camp in a rural town in Nigeria, where a small hospital exists. The costs for infrastructure were €125,000 Euros, for consumables €20,000 and for logistics €20,000.

Our team comprised two doctors, four nurses and two ‘helping hands’, and we performed 139 cataract surgeries within 5 days. Thus, the cost of a single surgery was about €1,200.

However, this high price is expected to decrease over time as the number of eye camps in the country increases. In addition, at this camp a young Nigerian doctor is currently undergoing surgical training and will soon overtake this duty, so sustainability is guaranteed.

Wanting to help deliver ophthalmic care in developing countries is a wonderful idea, but the reality is that costs can be higher than expected, especially at the beginning and because of the high-quality work carried out. This has to be taken into account before you start.

However, whether it’s through the setting up of camps, donating your time or channelling your money to such worthwhile causes, enabling a patient to see again is worth almost any price.

Dr Christoph Faschinger

E: christoph.faschinger@medunigraz.at

Dr Faschinger has been an ophthalmologist for 40 years at the Department of Ophthalmology of the Medical University of Graz, specialising in anterior segment surgery (cataract, glaucoma, keratoplasty). He is founder of the association “Vision without Frontiers”, which encompasses almost 40 eye camps in several developing countries.