Seva Canada: A Solution in Sight

By Penny Lyons, Executive Director, Seva Canada
November 16, 2009

Madagascar, where do I even start? Stunningly beautiful, heartbreakingly poor, rich in culture, language and traditions and complex in its politics.

I travelled here from Tanzania with Dr. Paul Courtright, co-director of the Kilimanjaro Centre for Community Ophthalmology (KCCO) based in Moshi, Tanzania. KCCO has been working with Madagascar eye care programs since 2007 – at first helping create national eye care programs and now also funding training, outreach programs and a pediatric program.

Our task here is to follow up and expand on the work that KCCO has done, as well as evaluate the programs that have been funded by Seva donors. The Canadian International Development Agency (CIDA) has funded outreach in the Vakinankaratra region, as has the May and Stanley Smith Charitable Trust.

Each of these two organizations have helped fund the creation and implementation of community outreach programs in this populous region in the highlands of Madagascar centered around the city of Antsirabe, just 3 hours drive south of the capital city of Antananarivo. In addition, Alcon Canada generously donated an enormous amount of ophthalmological supplies, including intraocular lenses.

Seva programs that I have visited previously have all been well established. National blindness plans were in place, outreach was active and well organized, a comprehensive training program was in place and all programs were working toward both financial sustainability and ensuring services were available to the most vulnerable – particularly children and women.

It has been both enlightening and rewarding to witness the birth of a new program here in Madagascar and to fully comprehend the partnerships at all levels of government, healthcare and community that have to be created in order for eye care programs to succeed. In fact, given the complexities, it is a wonder it happens at all. But here in Madagascar, as in our other programs, there are individuals, hospitals and local governments that have dedicated themselves to making it happen and are committed not only to creating eye care programs but are also committed to creating excellent ones.

Today I visited an outreach program in Mendoto, a small centre about 150km west of Antsirabe. When the team from Fitsaboana Hospital in Antsirabe arrived at about 8am, there were over 300 people in the courtyard of the local hospital. We assumed they were patients waiting to be seen at ALL the hospital departments, but as we started to set up we realized they were all there to have their eyes screened and treated.

The team quickly organized the room we were given. A visual acuity chart and registration desk was set up; there were 2 examination areas for the ophthalmologists; the counselors, who provide information to those requiring more care like cataract surgery or low-vision services, had a small table; and a makeshift pharmacy was created. Patients were divided into two lines, one for children and one for adults, and each ophthalmologist took one line. Periodically someone was sent to scout the lines to make sure those who required the most complex care or who were very elderly were brought to the front of the line.

It was hot, both outside and inside the makeshift clinic. No one complained and no one took a break. Bottles of water were brought to the team, but they barely stopped to take a drink. Everyone knew how many patients were waiting and how far they might have travelled to get there. They could drink later.

In the first two hours, 4 children were diagnosed with congenital or developmental cataract in both eyes and appointments for surgery were made.  Many more children were seen but who could not be helped – children blind because of damage to their corneas – many of whose sight could have been restored if they lived in a developed country. Children with birth defects or severe low vision were referred to the counselors so their families could learn where to find help. Twenty-four adults were scheduled for cataract surgery and, once again, there were many more who simply could not be helped.

The ophthalmologists were unbelievably kind and gentle with all who came and, even after very long waits in the brutal sun, not one patient complained. The last patient was seen at 6:30 pm. All were grateful to be treated and I was grateful to be there.

Our gratitude to the Canadian International Development Agency, the May and Stanley Smith Charitable Trust and Alcon Canada for their generous support in bringing eye care to the people of Madagascar.

On April 28, the award-winning Canadian musician, Terry Kelly, performed a fundraising concert for Seva at the Ottawa school of Seva’s longtime supporter, Alistair Butt. Terry had been impressed with Alistair’s “Eyeballs for Eyesight campaign” and offered to do a charity concert for Alistair, telling Alistair he could give the money to whatever charity he liked. Alistair picked Seva, which Terry fully supported. Both Alistair and Terry know first hand about vision loss. When Alistair was younger, he had severe sight problems and had to wear a patch for 10 years. Terry Kelly is blind.

The event raised $1,231 for Seva Canada’s sight restoration and blindness prevention programs in the developing world. $1000 was donated by Terry Kelly and Alistair raised $231 through the sale of chocolate eyeballs. Every child who attended contributed a toonie.

Terry Kelly’s enthusiasm for life and sheer determination have gained him recognition as an accomplished athlete, award-winning singer, songwriter, entertainer, motivational speaker and a lover of life.

Terry was a double silver medalist at the 1979 Canadian Track Championships, a member of the Canadian Track Team that competed in the 1980 Paralympics, and distinguished himself as the third blind person in the world to run the mile in under five minutes.

This Newfoundland native has been making music since his childhood years. He has recorded six full-length recordings, was nominated for four Canadian Country Music Awards and a JUNO, and has received seven East Coast Music Awards.

Seva is deeply grateful to both Alistair and Terry for their generosity and compassion and for giving the gift of sight to people in the developing world.

Seva’s logo is the Buddha Eyes, also known as Wisdom Eyes, which are painted on virtually every stupa or Buddhist shrine in Nepal. These eyes look out in the four directions to symbolize the omniscience or all-seeing nature of a Buddha. Although Seva is not a religious organization, we believe in compassion in action. Our logo was derived in part from the fact that Nepal was the first country where Seva started working to restore sight and prevent blindness over 30 years ago.

Between the Buddha’s eyes where the nose would be is a curly symbol that looks like question mark. This is the Nepali character for the number 1, which symbolizes unity of all things as well as the one way to reach enlightenment—through the Buddha’s teachings. Above this is a third eye, symbolizing the all-seeing wisdom of the Buddha.

The word seva means “service” in Sanskrit. The founding of Seva was inspired by the global eradication of smallpox that took place in the mid-1970s. Seva founders who were involved in that global effort wrote, “The eradication of smallpox from the world is tangible proof that many forms of suffering can be lifted from the shoulders of the poor and oppressed.”

Seva’s vision is the elimination of preventable and treatable blindness. Although many thought that the eradication of smallpox was impossible, it became a reality. With your support, we will achieve our vision of a world in which no one suffers from blindness that could be prevented or treated.

Join us and visit www.seva.ca

12-year-old Estefany was bullied because she had two eye conditions – strabismus (squint) and ptosis (drooping of the eyelid).

She lives in a two-room wooden house in San Jose Pinula, Guatemala with her three brothers, father and stepmother.

Her father, a farmer, makes less than $8 a day and her stepmother, a maid, who makes even less. They were unable to afford treatment for Estefany at one of the clinics they approached.

Then they found Visualiza, Seva’s partner in Guatemala, in December 2008. Estefany had first surgery in February 2009 for strabismus and the next week she had surgery for the ptosis. The surgeries have helped Estefany greatly and she has not had to deal with the pain of being called “ugly”. She does much better with her school work and has great visual acuity. Her beautiful smile speaks volumes.

To learn more about Seva’s work in Guatemala and how you can help, visit http://www.seva.ca/sevainguatemala.htm

Yesterday we received this very moving story from Guatemala:

Fidelia Silverste Fajardo, age 84, began to lose her vision 20 years ago, making it nearly impossible for her to do her daily activities at home like cooking for her five family members and cleaning the house. Fidelia lives with her family in the town of San Jose which is a few miles from the Mercado Municipal. One of the consequences of her vision loss was a bad fall that caused her to fracture both hips. With little sight and the inability to walk, she was limited to a wheelchair. Fidelia thought that her life was over being bound to a wheelchair and unable to see. She felt useless because she could no longer contribute to her family. In Guatemala, the working poor work and contribute to their families till the day they die. Without a purpose Fidelia was starting to lose hope. Also, Fidelia’s family was beginning to struggle to care for her. Someone had to stay home from work to take care of her. This meant a loss in one person’s wages. This was a loss that the family, which was already struggling, could not afford. Then a member of her family found out about Seva’s partner, Visualiza, where Fidelia was diagnosed with cataracts resulting in light perception visual acuity in both eyes.

She had surgery on her right eye first on February 12, 2009 and she received an operation to her left eye on February 26, 2009. After the second surgery she told the doctors, “I am so happy that I can see again and little by little I am able to walk. I am able to cook and serve my family. I thank you so much and do not know how to pay you. May God bless you for helping me!”

Yesterday I saw this amazing photograph in The Globe and Mail of a poor Mexican woman farmer, blind from cataracts. If this woman had access to a 15-minute cataract surgery costing about $50, she could see again. This cost is based on the 7 countries where Seva Canada works to prevent blindness and restore sight.

This photograph was taken by Mexican photographer, Marco Antonio Cruz, and is one of a series he has taken of blind people.

Marco A. Cruz’s work is on the short list for the Grange Prize, a $50,000 award given by the Art Gallery of Ontario, with Aeroplan as a partner. Of the 4 finalists, the winner will be chosen through online voting on the website.

Click here to see this stunning series.

There are 45 million blind people in the world, but it doesn’t have to be this way. Eighty per cent of this blindness is either preventable or treatable. In a word of seemingly unsolvable problems, there is a quick fix and cataract surgery is it.

Looking at these images, I feel intensely grateful for my own eyesight and for my work at Seva Canada helping the blind see again.

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.

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

Susan Erdmann writes from Nepal:

With all the thoughts and anticipation, nothing prepared us for the reception at the eye camp in Gulmi.

Behind the gates to the school where they has set up the eye camp, a crowd was waiting. Being one of the first through the gates, I was presented with one flower garland after another, most of them made out of local flowers or greens. One old woman placed a garland over my head that she had carefully made from little bits of evergreen. It was one of the most touching moments I have ever had, save the gratitude expressed by the Tibetans.

The entry into the eye camp for everyone was so moving that anything that happened after after paled in comparison.  The townspeople
were so happy, deeply grateful  and excited that we would even make the long journey (if they had any perception of what that meant) for what was happening for them;  the only way for them to express it was through their handmade garlands , ‘Namastes’ and smiles.  I was crying by the end of the line to the door as was Maureen and I am sure everyone else.  It was so moving and so worth the long arduous journey to get there.

Just the greeting, the welcoming had such a impact that the rest of what happened couldn’t come close to the impact of  the entry.  We were shown where the people were screened , eyes tested for glasses and those checked for cataract. They would continue the eye camp until everyone was looked after, and it was projected to last for 3 days.

Dr. Salma was doing all the surgery and a few of the group went in to the room designated for operating to  view her at work.  As we anticipated, going to Lumbini and we didn’t have a lot of time, not everyone who wanted to see surgery got to, but those that did were overwhelmed, not only by her deft skills but the speed at which she removed the cataracts.

Outside the building where the checking and operations took place was a area where people were being checked for general eye sight with a
chart at one end and a little stool at the other. One by one, people would sit down and a woman from the eye team would stand behind and hold one hand over the person’s one eye and then the other while her colleague pointed to the eye chart. Those who passed moved on, while those who did not went to have further tests and perhaps receive eye glasses.

One young woman we came upon as I was walking to the camp said she had an eye that weeped all the time and was instructed to return the next day to have it checked and hopefully fixed.  I am sure that everyone in the village and surrounding area was there. What a thrill.  I said to Kandel…this is really remote and he replied that despite the difficult journey in, this was not nearly remote as some eye camps.  I can’t imagine.

The following video of a Seva eye camp in Pyuthan, Nepal will give you a sense of what a Seva eye camp is like.

[youtube=http://www.youtube.com/watch?v=mz0yREq0N4M&hl=en&fs=1]

Seva Foundation’s Sight Program Director is Dr. Chundak Tenzing, a Tibetan ophthalmologist from Nepal, who lives and breathes Seva’s mission of restoring sight and preventing blindness. Anyone who has ever met Chundak cannot help but be impressed by his caring nature and his deep compassion.

Chundak is also a poet. He sent the following message and poem for Seva Canada’s blog:

I am sharing with you
Voices from the field
Where the blind
Receive sight restoration
And walk unassisted
To live a life
With  dignity

When a heart opens its petals
Like a blooming flower
And hands deliver
A gift of sight

The expression of gratitude
Rolls down a cheek
Like dewdrops
Glistening in the sunshine

To wonder and say
What a journey
It is to be giving
And receiving
Happiness
In its purest form
With no strings attached

Let’s face it — everyone loves Dr. Spencer.

Marty has been a Seva board member for over 20 years and is a respected and much-loved ophthalmologist on Vancouver Island. He has both performed surgery and trained eye care specialists in India, Nepal, Tibet, Malawi and Guatemala. He was one of the first doctors in the world to travel to India, Nepal and Tibet to set up eye camps in remote areas.

As a volunteer, he receives no funds and pays for the trips himself. He has voluntarily operated on thousands of cataract patients, transforming their lives by restoring their sight.

In February 2009, Dr. Spencer travelled to Nepal and Cambodia to train eye doctors and to perform surgeries. His youngest daughter, Justine, accompanied him and said it was amazing to see the reception that her father received.  She said it was like her dad was going home again; everywhere Marty was welcomed with open arms.

We could go on and on about how wonderful Marty is (especially since we have the password to the blog and he doesn’t!), but instead we’ll share some of his excellent photos that he took in February in Nepal.

Click here to view a slideshow of Dr. Spencer’s photos of Seva’s sight programs in Nepal:

slideshow of Dr. Martin Spencer’s photos of Seva’s sight programs in Nepal

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!

Amanda Marr from our sister organization, Seva Foundation, writes about the great work being done by Seva Cambodia:

After a three-hour drive from Siem Reap province, Roshelle, the USAID (United States Agency for International Development) Child Blindness Project Manager, and I arrived yesterday in the  province of Battambang, where Seva Cambodia’s office is located.  I had the pleasure of meeting for the first time Dr. Bal Kumar KC (“Dr. KC”),  Seva Cambodia’s technical advisor and ophthalmologist, and Diro, the Child Blindness Coordinator, as well as seeing Ratana, Seva Cambodia’s Program Manager, again.  Today was a full day, starting early in the morning when Battambang Ophthalmic Care Center (BOCC) opened to tour the facility and meet the staff.

We then toured the nearby Eye Unit at the government-run Battambang Referral Hospital. One ophthalmologist is stationed there, along with a refractionist who also does school screenings when he is not working at the Eye Unit.

Upon returning to BOCC, we met a 5-year-old girl who came for her first follow-up visit after having her second cataract removed during the recent eye camp in Banteay Manchey.  Her story was featured in the recent Seva Canada newsletter. (http://www.seva.ca/newsletter.htm)  Life for both her and her family has improved drastically: her mother can now work in the fields while her older sister takes care of her, and she is now much more engaged with her surroundings.

Then it was off to a remote district about an hour away, where a BOCC outreach worker had gathered the community at the nearby pagoda (temple) to be examined by Dr. KC.  Along the way, we picked up a woman with ptosis (drooping eyelid) whom Dr. KC had operated on.  Her son also has ptosis but is too young for the operation.  We drove to her father’s house, where 3 of her siblings had been operated on for the same condition.  They are doing well, and the other 2 siblings with ptosis plan to go to BOCC to get the operation in May.

At the pagoda, Dr. KC identified patients with several different eye conditions, including a number of elderly people with cataracts and one woman with pterygium, a fleshy growth in the eye that can eventually lead to blindness.  We filled the van with these patients and drove back to BOCC, where they received surgery.

Within one hour, we witnessed 4 cataract surgeries, all of them elderly women, conducted by BOCC’s resident ophthalmologist, Dr. Heng Ton, who was trained by Seva in Nepal at partner institution Lumbini Eye Institute.

Later in the afternoon, we drove to a school screening, where the eye unit refractionist was determining the strength of lenses needed by children with low vision who’d been identified by their teachers.   They will receive custom-made glasses within the next few weeks, allowing them to see the blackboard, read, and hopefully excel in school.

We are returning to Siem Reap tomorrow, when we will tour Angkor Hospital for Children, another one of Seva’s important partners in Cambodia, before I take off for Nepal.

This has been a wonderful opportunity to witness the great work being done by Seva Cambodia.

Amanda Marr
Seva Foundation Sight Project Manager

We have just completed three days in the mid hills of Nepal under the shadow or the Annapurna range. Breathtaking views in the early morning, but there many forest fires that have been burning for a while. This is because of the six-month drought.

We are in Pokra in a lovely Hotel in the middle of the lake. We have lost a few pounds after taking a showering off all the dust we which we collected from not having running water for three days. It is a lovely spot.

We were witness to a remote eye camp in Gulmi where we were treated like royals. Our arrival stirred celebrations in the town and we were greeted with flower garlands, tea and our own security. The whole town was out for this event. There were hundreds of people, young and old, who had travelled for miles to have their eyes checked. We also had the opportunity to witness a cataract surgery performed by Dr Salma, who will be coming to Vancouver in June for her fellowship at UBC.

All the equipment was powered by generators as there are severe power cuts all day. Our trip to Lumbini was changed due to 11 days of strikes in the southern part on the Indian border. There many political issues and it was felt that it would safer to avoid this part of the trip, as we may get stuck with no road or air access out.

The people of Nepal have been wonderful, kind and really friendly. In the morning, we will head back on a flight to Kathmandu for a cultural tour of some of the historic sites and some culture. So far we have loved every moment of our experience of this trip.

Nagib

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.

Last summer, a Seva Canada donor funded three eye camps in remote hill districts of Nepal. The first of the three camps took place in Khandbari in December 2008. To view a series of images from Seva of the eye camp, click on this link:

Seva-sponsored eye camp in Khandbari, Nepal in December 2008

In the next couple of days, our donors who are travelling in Nepal will get to see an eye camp in Gulmi. Watch this space for some of their images and impressions.