Seva Canada: A Solution in Sight

Huge thanks to Zaf and all the folks at Delta Optical‘s four locations.

For the month of June they are donating $30 to Seva Canada for every pair of glasses sold.

For 40 years, Delta Optical has been providing exemplary customer service and has built lasting relationships with their customers. The small optical chain provides service in Square One, Fairview Mall, Hillcrest Mall and Oakville, Ontario.

Here’s their wonderful poster:

The story of Tsultrim Dorje
by Dolma Chugi, Seva Tibet Staff

“I asked the doctors to take my eyes out and exchange them with Tsultrim’s many times, but they kept telling me that such a medical technology wasn’t invented,” confessed Tsultrim’s grandmother. She would gladly have given her precious sight to her grandson and spared his parents, his aunt and herself the many tears they have cried in the past three years. She is pictured here on the far right with Tsultrim and his aunt. Worrying about his eye health has aged her beyond her 68 years.

Tsultrim Dorje with aunt and grandmother

Tsultrim lives mostly with his grandmother and his aunt because his parents work long hours. They only have time to be with him occasionally on weekends and during their holidays. His mother works as a bathroom cleaner at a hotel and his father is a porter. Together they earn only US $192 a month and that has to feed and support Tsultrim, his grandmother, his aunt and themselves.

For three years, Tsultrim’s father lived with the nightmare that Tsultrim’s blindness wouldn’t be treated and that he wouldn’t be able to go to school like all the other children. He shared his fears with me and, after rolling his eyes for a few seconds, he said “You know, nowadays, no schooling means no academic degree, and no degree means no life!” His voice trembling, he continued, “Tsultrim is my only child. The devastation of his life is the tragedy of my life!”

Tsultrim Dorje after his cataract sugery wearing his aphakic glasses

Tsultrim had his first surgery on one eye when he was only four months old. Ever since, he has been terrified of hospitals and doctors. His most recent surgeries were performed by Dr. Judy Newman, a pediatric ophthalmologist and volunteer from the USA. Dr. Newman has been a pioneer of pediatric eye programs for Seva in Tibet. She remembers Tsultrim very well because he cried the loudest and hardest throughout every visit, from registration all the way through examination, vision-checking, eye drops and surgery. He even cried during follow-up visits.

Cataract management for children is more complicated than for adults and, as a result,
Tsultrim has already undergone three surgeries. Intraocular lens implants are not recommended until the age of nine when ophthalmic nerves are better developed.  Now, at last, after all the crying and struggles, his sight has been restored and he can wear aphakic glasses – glasses that work to replace the eye’s natural lens. He can behave like a normal child!

One sunny Sunday morning three months after Tsultrim’s surgery, I was strolling in the Naga Park behind the Potala Palace and unexpectedly met Tsultrim and his aunt. Tsultrim was running energetically around the pathways. His aunt was thrilled to tell me that Tsultrim had been admitted to kindergarten in the fall. Tsultrim never stopped running around during our whole conversation.

Tsultrim Dorje wearing his special aphakic glasses at school in Tibet

On Tuesday, I visited Tsultrim in his kindergarten. It was almost lunch time. All the kids had just packed up their text books and cleared their desks to get ready for lunch. They would eat together and then nap together in a dorm. Tsultrim, however, was waiting for his aunt to pick him up and take him home for his lunch and nap. I felt sorry he couldn’t stay with his classmates but his aunt explained that tuition at kindergarten costs US $176 each year and is double if Tsultrim stays at school for his lunch and nap. This extra cost would be a huge burden to the family because of their meager income. Nevertheless, being able to go to school and get an education – just like all the other children – counts more than anything else to Tsultrim and his family!

By Penny Lyons
Executive Director, Seva Canada

November 20^th

Thirty six elderly Tanzanians sit under the shade of a Poinciana tree in Ndatu village.  All are from the same village in the district of Arumeru, about an hour from Moshi.  They know each other well so the air is a filled with the sounds of laughter and conversation.

I have come to this village with a team from KCCO.  There are 4 of us:  Herieth Mganga, KCCO’s new gender and blindness coordinator, Fred the driver who doubles as the visual acuity tester in the field,  Dr. Amadou Bio from Benin,  who is training to be an ophthalmologist, and myself.

Fred at the Kilimanjaro Centre for Community Ophthalmology in Tanzania

All 36 of these people have agreed to participate in a study (there will be 150 participants in total from 4 different villages) to determine the effect that correcting presbyopia (or age related far-sightedness) has in their daily life.  Do reading glasses make an elderly Tanzanian’s life easier?  Most are illiterate but if they can now pick the stones from the rice, thread a needle and take thorns from their fingers will this significantly improve their quality of life?

A patient has her eyes examined in Tanzania

There is very little refractive error in Africa and most of these people have distance vision that someone 40 years their junior would envy.  The flip side of that great distance vision is that many of the 36 have difficulty seeing things that are close so “reading” glasses (even though most do not read) are provided to them free of charge.  While doing the vision testing, four cases of cataract were diagnosed and referred on to hospital for treatment and a few infections were treated.

Each person who received reading glasses will be visited in their homes in three months to determine what difference, if any, the reading glasses had on their daily life.

Heriath Mganga, KCCO’s new gender and blindness coordinator, working with women in rural Tanzania

At this point you might be asking yourself if this study is important, or even relevant, to the elimination of preventable and treatable blindness.  It is because it illustrates the cornerstone of all of Seva and our partner’s work; together we create programs that are based on evidence.  Evidence tells us a problem exists, it tells us the extent of the problem and it tells us what should be done to correct that problem.

With evidence, we can spend our donor’s dollars effectively and get the maximum benefit – whether we are studying presbyopia, childhood blindness, the incidence of cataract in a population or the barriers people face when trying to access treatment.

The following is a special post by Laura Spencer, a Seva volunteer:

I have been privileged to work with Seva projects in Guatemala that have been developed by amazing Seva staff. The highlight so far has been Seva’s three-day eye care outreach excursion to isolated villages, reaching indigenous Guatemalans who had never received eye care services before!

Seva eye camps - a joyful thing to witness

The three-day eye camp was funded and organized by Seva, with community development links made between the eye hospital – Vincent Pescadore in the northern region of Guatemala – and the community health promoters in various villages.

A crew of six Guatemalan eye clinic workers from Vincent Pescadore and I made the journey into the hot jungles of Guatemala’s mountainous central region. We ventured off with supplies of glasses, instruments and charts. After a four-hour drive, we arrived in Coban, the nearest town.

Outside of Coban, we transported ourselves and the supplies into a pick-up truck along with some local villagers. We made the slow, bumpy ride along the uneven, rocky road through mountains of corn and coffee fields to the community of Chilten.

The road was long, with a broken down van on the way holding us up. The difficulty in reaching the community was a testament to the difficulty the people have in reaching services on their own. Many of them had trekked even further from Chilten, from surrounding villages even deeper in the mountains.

Hundreds of people lining up to be seen at the 3-day Seva eye camp in the remote village of Chilten, Guatemala. Photo by Laura Spencer

An hour and a half later, we arrived! Over 500 people were waiting in line to receive eye care. Excitement was in the air! The eye camp was set up in a school and the children were given the day off. As a result, they were either getting their eyes checked or running around adding to the excitement!

The organizing staff quickly set up six stations for smooth service delivery. They included an area for registration, for a visual acuity exam, a consultation with the optometrist, a meeting room for cataract patients, and another location for dispensing eye glasses.

A Guatemalan ophthalmologist examines patients at the Seva eye camp in the mountainous central region of Guatemala. Photo by Laura Spencer

For patients in need of cataract surgeries, transportation to Vincent Pescadore, food, and accommodation were free of charge. Those in need of glasses were provided with them at low cost or free of charge. It is such an amazing opportunity for these people and it was priceless for me to see the people’s faces as they went through the emotions of being offered free surgery and eye care.

Seva was one of the supporters, having developed the community link between the health promoters and the hospital Vincent Pescadore. The local volunteers were an integral part of the process, acting as translators for the hundreds of indigenous people who could not speak Spanish, but the Mayan language Quechi.

The first day was a great success! Thirty cataract patients were driven the 5 hours and back with free food, board and surgeries fully paid for by Seva and partners.

Cataract patients at the Seva eye camp in Guatemala being given free transportation to the hospital for surgery. Photo by Laura Spencer

My personal contribution has been conducting research for my MA on why so few rural women are taking advantage of free surgeries, as is also the case in most developing countries. With the help from volunteers with translating, I surveyed or interviewed over 80 women over the course of the weekend, collecting information regarding the barriers to service for themselves and with regard to the women in need of eye care who were not present. I also enjoyed the company of the local children who were running around the school and waiting for me to finish interviewing their mothers and grandmothers!

Interviewing Guatemalan women at the eye camp with support from a young friend!

The second and third day we drove a few hours more to another village, meeting the needs of the other surrounding communities. More free surgeries and eye care services were delivered and received.

Just before leaving the last eye camp, a truckload of the first patients from two days before arrived. They were returning from the northern clinic where their surgeries were conducted by Guatemalan surgeons. Their post-operative eyes were healing behind their large, protective sunglasses. Accompanied by the community volunteers, they made their way home, with new hope for survival, with the ability to contribute to their family again and with an increased quality of life.

The first cataract patients returning from hospital after their sight-restoring surgeries. Photo by Laura Spencer

The six of us made the four-hour trip back to the northern eye clinic which is located in the largest, poorest and most secluded province of Guatemala, El Peten. Once we arrived, the patients from the same day and the others from the day before were either waiting for their surgery or waiting a day to have a post-operative examination. Whether through translation or directly in Spanish, the patients shared their fears and excited anticipation of their restored vision.

I will remember well many of the patients. In particular, I will remember one man who said to me, “Vision is the most important thing. Without it, all is painful.” Another patient, an older woman in traditional dress, will remain in my memory because of her smile. She smiled throughout the whole experience, which is unusual for the culture (but she would not smile for the camera, more common for the culture!). I was honoured to see her through the whole process: from the line-up for services, the waiting room for cataract care, on the bus up to the northern clinic, before, during and after surgery, at meals in the hospital and finally to see her off as she got on the minivan back to her village.

One of 500 Guatemala patients who received eye care at the 3-day eye camp. Photo by Laura Spencer

Thank you to all the donors, sponsors and Seva staff for making this eye camp a success!

In February, I wrote about a little girl in Madagascar with such severe and unusual myopia (nearsightedness) that there was no help available to her in her own country.

This morning we received these photos of 8-year-old Andoniaina (Ando for short) wearing her new glasses specially made for her in Canada.

Ando wearing her new glasses

Ando lives on a small island in the Mozambique Channel, off the southwest coast of Madagascar. To seek help, she and her father travelled one hour by speedboat to Tulear on the mainland, then drove 1,000 kilometres to the capital of Antananarivo to get her eyes examined. They were eventually referred to a hospital in Antsirabe, 170 km south of the capital for a second opinion. That’s where Dr. Henry Nkumbe, Seva’s partner in Madagascar, saw the little girl and asked Seva Canada for help.

Seva then called on longterm supporter and optometrist, Dr. Larry Louie, for his expertise. Together Dr. Louie and his colleague Wayne Trieu of I-Lab Optical in Edmonton created a very special pair of glasses. The glasses were then hand-delivered to Madagascar in time for Christmas by a representative of Sherritt International Corporation, a Canadian resources company.

“Something like this is not usually done and isn’t readily available. That’s what made it challenging,” said Dr. Louie. The typical eyeglass prescription is 2.00 to -3.00 points, but Ando has a prescription of -27.00 points for her right eye and -23.50 points for her left eye. This means that, without glasses, Ando can’t see much beyond the tip of her nose. Ando was essentially blind and would not have been able to see the faces of her family.

Andoniaina and her family

To keep the glasses from becoming too thick and thus brushing against her eyelashes, Dr. Louie and optician Wayne Trieu used special myodisc lenses with two bi-concave lenses on the front and back of each lens. Another challenge was getting a frame that was strong and durable and that would last a long time.

Andoniaina’s story and the way in which Canadians in three provinces came together to help her was featured in the Edmonton Journal and on Global news.

Andoniaina at school with her new glasses

On behalf of Andoniaina, her family and our partner in Madagascar, Seva Canada would like to thank everyone who helped change this young girl’s life by giving her the gift of sight.

Andoniainia in her classroom off the coast of Madagascar

Today I’m heading out to Vancouver airport to visit our great friends at Worldwide Animal Travel who, together with KLM Cargo, very kindly ship children’s glasses to Africa for Seva. Three boxes containing 1,066 of lovely children’s eyeglass frames were donated to Seva Canada by OGI Canada Inc. and soon they’ll be winging their way to Kilimanjaro. Big thanks to Dick Murao at KLM Cargo for his compassion.

I think this is the fourth shipment of children’s frames I’ve sent in the last 2 years. Although adult glasses are easily procured in eastern Africa, children’s frames, especially the infant ones with hooks for behind the ears, are as precious as gold dust. Seva Canada and our partner in Africa, the Kilimanjaro Centre for Community Ophthalmology, is extremely grateful to OGI Canada Inc. for this very generous donation. Thanks Guy, Jamie and Sue for all your kindness!

The number one intervention for children with low vision is refraction and the prescription of the appropriate glasses. When I was in Tanzania in September 2008 attending a workshop on childhood cataract, I heard many sad and frustrating stories about the lack of kids’ glasses. A young girl was washing in the river and her glasses fell off and were lost. By the time she was seen by an eye specialist two years later and given a new pair of glasses, she had lost much of her vision, never to be recovered.

One ophthalmologist from Gondar in Ethiopia told me, “There are so many children with uncorrected refractive error. I work 700 miles from the capital, Addis Ababa, and even if parents can afford them and want to buy children’s glasses, it is impossible to get them. They may not even find children’s frames in the capital.”

Without glasses, children cannot reach their potential and many risk blindness from ambylopia. Providing children with the glasses they need is an urgent issue. Thank you OGI!

I was pleasantly surprised to be greeted at the Kathmandu airport by Parami Dhakhwa, Seva Nepal Program Coordinator, who whisked me away to the Seva office to meet Shravan Kumar Chaudhari, Finance Manager.  Due to some logistical constraints, Shravan had arranged for me to travel south by Lumbini Eye Institute (LEI) vehicle from Kathmandu in order to meet up with Ram Prasad Kandel, Seva’s Program Manager.

Kandel has proved to be a consummate host, and I am greeted warmly wherever we go.  En route to meeting Kandel, I briefly toured Bharatpur Eye Hospital the evening I arrived in Chitwan District.  The next day proved to be rather interesting.  Due to a bandh (strike) because of student elections, the LEI vehicle could not take me to Butwal.  Instead, I took a rather crowded public bus (I was lucky to have a seat!) to Butwal.

From there, Kandel and I went to Tansen, where the Palpa Lions Lacoul Eye Hospital was conducting a three-day surgical and screening camp.  With the exception of a minimal registration fee, all services were provided free of cost to the blind and visually impaired patients who filled the rooms and lined the hallways.

I met Dr. Salma KC, the eye hospital’s resident ophthalmologist, in the operating room, where she was performing one of many cataract surgeries that she would do that day.  Dr. Salma will be going to Vancouver soon for a pediatric ophthalmology fellowship.  Her specialized skills are much needed in a country of 29 million, where there are currently only three pediatric opthalmologists.

Dr Salma, one of 3 pediatric ophthalmologists in Nepal

The following day, we took a rather bumpy and hair-raising ride northwest to Gulmi District to observe a school screening.  All students with anything less than normal vision will be fitted and provided with eyeglasses.  Refractive error is especially prevalent in Asian countries such as Nepal, and by identifying children in schools, the Primary Eye Care Centre (PECC) in Gulmi is reaching children who may not otherwise come to the center for glasses.  They are also detecting eye conditions that can be prevented or treated before the affected children go blind. At the same time, this outreach will result in increased awareness among the community about the eye care services available. The children will go home and tell their families about the eye screening at school and the whole community will benefit.

The Primary Eye Care Centre itself is very well run under the capable and inspired leadership of Chairman Bharat Bahadur Chand, who proved to be an incredibly generous host: he invited us to his home for dinner and provided me with a very comfortable room to sleep for the night.  We also managed to squeeze in a quick trip to the Hindu temple of Yagyashala at the top of Resunga Peak.

On our return ride to Bhairawa, home of Lumbini Eye Institute (LEI), I got to hear one of Seva’s radio messages advertising free cataract surgery for children at LEI.  Although I do not understand Nepali, my ears perked up with I heard mention of Seva.  We also stopped by Butwal Lions Eye Care Hospital, which is quite an impressive facility with much space to expand.

I look forward to seeing the services at LEI today and tomorrow.  I have already met Sanjeeb Adhikari, Seva’s Child Blindness Coordinator, and hope to meet Dr. Karthikeyan, one of LEI’s two resident pediatric opthalmologists, soon.

I am both inspired and humbled by the dedicated staff and partners I have met.  Seva really is carrying out its mission of serving those most in need with high quality, affordable, and accessible eye care and truly embodies compassion in action.

Amanda Marr

Who knew that little bits of plastic windshield embedded in people’s eyes could turn out to be a good thing?

Sir Harold Ridley, a British ophthalmologist, saw WWII pilots who had pieces of shattered windshields in their eyes and noticed that the plastic shards were inert. He performed the first cataract surgery with an intraocular lens (IOL) in 1949. IOLs are human-made lenses that are used to replace clouded natural lenses in cataract surgery.

The first lenses used were made of glass, they were heavy and were prone to shatter; Sir Harold’s observation led to the use of plastic materials.

For decades, cataract surgery using intraocular lenses was out of reach for the developing world, because of the cost of the lenses. Patients who had cataract surgeries in poor countries were forced to wear thick, cumbersome glasses which, if lost or broken, meant they returned to near blindness.

Seva Foundation board member, David Green, is another visionary. He says if you truly want to serve as many people as possible, analyze the most expensive item involved and then figure out how much it really costs to make. Start making it more affordably. Repeat.

The solution was to do a technology transfer to India, with the help of Seva Canada and CIDA, so that IOLs could be made at a tiny fraction of the cost in the West. Thus Aurolab was born in 1992 and has since supplied more than 5 million lenses to its customers in India and more than 120 other countries worldwide. The cost of IOLs came down from over $300 to about $5 each.

Good news!

This Nepali woman was seen at a recent Seva eye camp in Doti. Notice her broken glasses and mature cataract.

Tibet has the highest rate of blindness in the world.  Most of this blindness is due to cataract. For $50 Cdn, a 15-minute cataract surgery can restore sight and completely change people’s lives.

Seva has been working in Tibet since 1995 and is the leading eye-care provider, responsible for two-thirds of the cataract surgeries in both the Tibetan Autonomous region and in Tibetan areas outside the TAR.

In the Tibet Autonomous Region, Seva works in:
•    Lhasa, through Menzikhang (we’ve set up a tertiary eye care program there with Tibetan eye specialists)
•    Chamdo
•    Nyiri
•    Ngari in the far northwest
In Amdo:
•    Yushu
In Kham:
•    Dartsedo, where we are establishing the Kham Eye Centre
•    Ngaba
•    Liangsham

Each year Seva runs up to 25 mobile eye camps and each camp serves between 300 and 400 people and does up to 300 sight-restoring cataract surgeries.

To learn more about how you can help Seva help Tibet, visit http://www.seva.ca.

Providing eye care in Africa is full of challenges. Poverty, the shortage of eye specialists and transportation are all major obstacles.

Cataracts are the leading cause of treatable blindness in the world. Most people have no idea what is wrong with their eyes or that there is a solution. A 15-minute cataract surgery to remove the clouded lens costs about $50 Cdn and can restore sight. But because cataracts develop gradually and are painless,  most people in Africa won’t spend the money to travel to hospital to seek help.

Even once people know that they can have an operation to restore their sight, there may be a lot of fear and misconception. Hospitals are often viewed as places where you go to die, not to get cured. Moreover, many people have no conception of what cataract surgery is all about. Two of the common beliefs are that doctors will replace your eye with a goat’s eye OR that during surgery they’ll completely remove your eye, work on it on a table, and then put it back in again.

Both pretty scary thoughts…

Shamimu, a 5-year-old in Tanzania was going blind from cataracts. After counseling from the Kilimanjaro Centre for Community Ophthalmology, she and her family agreed to go for surgery. However, Shamimu was very nervous about the operation because all of her friends told her that she would get goats’ eyes. Here’s a picture of Shamimu struggling to read and write prior to her successful bilateral eye surgery.

At Seva Canada we’re often asked if we’ll take used eyeglasses and send them to the developing world. The fact is that it costs a lot to collect, sort, ship and distribute used eyeglasses and, in all of the countries where we work, you can buy inexpensive adult frames.

But the story is different for children’s eyeglasses in Africa. There’s a huge need for a steady supply of infant and children’s frames. Thanks to KLM Cargo and the nice folks at Worldwide Animal Travel, plus some very generous donors, we’ve been able to send multiple shipments of kid’s frames to Tanzania.

Last month I took another 4 huge boxes containing over 1,400 children’s glasses to YVR for shipment to Kilimanjaro. Pascal at Worldwide Animal Travel was happy to help. Seva’s boxes were easier to deal with than their next item for shipment — a real live polar bear being shipped from Edmonton to Luxembourg Zoo. How do you ship a polar bear? In a very large cage with a groom to travel alongside it.

Heather at Seva Canada (www.seva.ca)

I’ve just come back from a full day with Patrick’s trachoma research and education team. I don’t think I’ve ever been quite so dusty. Nine of us crammed into the KCCO jeep and headed out to Masai villages to examine children’s eyes and take swabs from all the kids aged 1-9 in two village areas.

It was a fantastic and fascinating day. We split into two teams and walked from house to house through dry corn fields and along narrow dusty paths. I had the best job. Not only did I get to sterilize the ophthalmic nurse’s hands, but I was the one who got to give the kids pipi (sweets) after they had their eyes checked and swabbed. Since this involved flipping the eyelids to check for trachoma, some kids weren’t too happy about it.

Most of the kids had English names and there was even a Brenda! (like my sister) One little chap was called Manager, and, as Odilia, the ophthalmic nurse, put it, “If Manager cries, they’ll all cry.” …. And they did. But all parents were happy to have the team come and check the children.

Because these places were seriously off the beaten track, we needed both a guide to help us bounce down the very rocky roads and also the help of village elders to guide us from house to house. It’s a very poor area – unlike what I’ve seen around Moshi or up Mount Kilimanjaro. The Masai like to live close to their cattle and the flies help spread trachoma. But I’m pleased to say that today, after dozens of swabs, we didn’t find a single case in that area, so I assume that the education about face washing, hygiene and latrines is working.

Tomorrow (Wednesday) I’ll rejoin the Childhood Blindness Workshop. Monday’s session from 9-5 was brilliant. There are program people and ophthalmologists here from Cambodia, Nepal, Uganda, Kenya, Ethiopia and of course Tanzania.