The vast majority of blindness in the world is unnecessary—caused by cataracts, actually, and curable with a five-minute surgery.
High costs kept the surgery out of reach for many millions until Nepalese ophthalmologist, Dr. Sanduk Ruit, saw differently and invented a way to cure blindness for the poor, everywhere. This is the work of the Himalayan Cataract Project—the most inspiring, innovative nonprofit you’ve never heard of.
In Ghana, more than half of the people who are blind are blind from cataracts. Zubaru is one of them. But in just two days, on Tuesday, the first of October, Zubaru will receive back the sight that cataracts covered. For two years, he has learned to navigate new darkness, reciting scripture from memory, recognizing people by their voices, and learning to be dependent for all the daily basics, from dressing and eating to visiting friends, family or the outhouse.
This is a stark contrast to the daily work of Zubaru’s preceding 65 years, during which he made a living many different ways, beginning as a driver then a watch repairer. Rubbing the dusty pieces placed in his hand, he remembers: spin bar, balance wheel, key pin, tongue, adjustment, and the kicker, which attaches to the thong for the watch to work.
“Every watch has its parts. Kingsley, Olivia, Pronto, Citizen,” says Zubaru. “I can fix most broken watches to work perfectly, whether it's a broken balance wheel, a key pin, I know how to fix all that. They now just sit in my mind whiling away.”
Photographs by Alfred Quartey
When watches were “no longer fetching,” Zubaru moved on to farming goats, cassava, sugar cane, yams, corn and coconuts. Able to live well but not able to afford a costly surgery at a private center, he, his wife and six children, thought he’d live out the rest of his days in darkness. Until Dr. Andrew came to Bwajaise and told him he wasn’t blind.
Dr. Andrew smiles, “He’s not blind, he just can’t see.” Opacities have developed on the lenses inside his eyeballs, preventing light from penetrating.
Dr. Andrew, an optometrist from the Watborg Eye Center, visited Zubaru’s town of Bwajaise several weeks ago to conduct an eye screening and identify all those with cataracts as candidates for surgery. Most heard about the eye screening through public announcements orchestrated by a young man named Jonika Akum. Jonika had seen his own father’s sight restored a couple years prior and has since taken it upon himself to dispel people’s fears that the surgery won’t work, or worse, that the doctors will steal their eyeballs.
Tuesday we see the fruit of his labor, as three vans arrive at the Watborg Eye Center, and fifty of his neighbors are led one by one to check in and wait their turn to see again. Zubaru and his youngest son, Baba Alidu, among them.
Zubaru registers and receives a number. A nurse calls him back for an eye screening, then into another room to test the surface of the eyeball. He’s led back to the waiting area, now with tape above the first eye to be operated on. He’s given water to drink and drops in his eyes. He waits. He’s called again and led back to the operating theater where Dr. Boateng Wiafe, a world-renowned surgeon, is scrubbing in.
Better to Die
Located 50 kilometers straight west of Accra, the Watborg Eye Center is state of the art—designed and built by Dr. Wiafe, a legend and a leading ophthalmologist in Africa. This week, as he has done hundreds of times before, Dr. Bo (as he prefers to be called) and his team are hosting a campaign to complete as many surgeries as possible—for free. They turn no one away.
With three ophthalmologists in the operating theater, a couple optometrists led by Dr. Andrew in the exam rooms, a dozen nurses and a flurry of administrative staff shuffling between them all, every minute of each fifteen-hour day is maximized to achieve the goal: 400 sight-restoring surgeries.
“Many people say in our local language, ‘It's better to die than to be blind.’” Dr. Bo pauses heavily, “I've also known some patients who have taken their own lives, especially those with glaucoma…and so when there is an opportunity to make someone see again, I make it a priority.”
Photography by Alfred Quartey
Having done this work since 1985 across much of the continent, it’s life or death, he knows. Most cataracts are a result of age, but others can be the result of malnutrition, inadequate eyewear and trauma—these causes more common in young people.
Michael, for instance, is just 29 and was working behind the wheel of a Hyundai Mighty, a water tank truck, until a traumatic injury to his left eye led to blindness. “At least I was seeing with my right eye,” he says. “But three months ago, when I was driving, there was a car coming and when the headlights were thrown on me, I couldn’t see anything so I swerved, not knowing there were four people coming in a queue…I almost killed four people.”
No longer able to drive, his future was dimming fast. A friend directed him to Alpha Eye Clinic in Medina, a not-so-nearby town on the other side of Accra. There, Michael learned what a cataract was and that the fix would cost well over 1,000 cedi (USD 200), which he could not afford.
Dr. Bo (left), Dr. Debrah (center), Dr. Andrew (right)
Michael was desperate for healing, which Dr. Andrew could see in the way he pedaled his bicycle up to the eye screening in the town of Nyanyano weeks ago. “When he came, we were about to close so we nearly left him out,” remembers Dr. Andrew. “I thought it was probably a normal eye, so I'd just examine quickly and he'd go. But when I shined the light to see such an obvious cataract there, I was like, ‘Wow, this guy would have been really disadvantaged if we hadn't attended to him.’”
“Most of the time when you mention surgery, they kind of become reluctant,” Dr. Andrew admits. But not Michael, who is smiling, knees bouncing: “I want to be the first person to be there. He told me that I shouldn't worry, they will do everything for me—they’re here to help us.”
Michael is one of a million new cases of cataracts that arise every year in Ghana—that’s a million piled on top of a 200,000-person backlog. To make a dent, the community of ophthalmologists needs to perform at least 20,000 cataract surgeries annually—a goal they’ve come close to only once in the past ten years. And it wasn’t recently.
Photography by Alfred Quartey
In Ghana, it’s just a handful of ophthalmologists performing these surgeries in the rural towns—those determined to use their skills where they’re most needed, with little regard for whether or not it makes them wealthy.
“You see, when someone is blind from cataract, especially those in the villages, they can’t go to the farm. So they are not productive. Somebody has to sit with him or her. And then in Ghana, most people who are blind, you see them with school-age children holding their hands, so the child stops school to take their grandfather or father to the hospital. So apart from the man who is not productive, the child who is leading them is going to be affected. So there is the need to ensure that we can tackle these cataract problems, so those who are in the active age can go back to school or work and be productive,” explains Dr. Oscar Debrah, director of Himalayan Cataract Project (HCP) in Ghana.
“Motivation? We only want to assist our people,” says Jonika. “If there is such an opportunity as this for my people to take advantage of, all that I can do is to also help them to get the information. That is what motivates me. Because if I don't get them informed, most of them will be living with blindness.”
Cost of Sight
Eliminate needless blindness. The three word goal of doctors Sanduk Ruit and Geoff Tabin when they co-founded the Himalayan Cataract Project (HCP) in Nepal in 1995. It remains their goal today, though the work has since scaled to include Ethiopia, Bhutan, India, Myanmar, Rwanda and, of course, Ghana.
When they began, more than 70% of blindness in Nepal was caused by cataracts—all of that sight needlessly compromised, and amidst such treacherous terrain. Imagine.
Though cataract surgery takes only minutes, the material costs put it well out of reach for the Nepalese, exceeding what most families earn in a year. The most expensive and most essential element is the intraocular lens, which replaces a person’s natural lens. I won’t explain how—you can YouTube it if you really want to know, but be prepared for a surprising and rather strong yank at one point.
Dr. Ruit solved the cost problem by building a manufacturing facility in Nepal to produce high-quality intraocular lenses at just $4 per lens, rather unbelievable when the global alternatives were no less than $200. Dr. Ruit’s innovation made surgery and sight accessible for those he’d grown up with—those living a four days walk from the nearest road in the vast Himalayas.
Now that the cost of surgery has dropped to a total and average of just $25, HCP has been able to scale cataract surgery, making it one of the most cost-efficient global health interventions ever. This is particularly true when holistic livelihood is considered and economic productivity is factored in, then multiplied by the number of family members no longer relegated to full-time care of their blind mother/father/aunt/uncle/sibling.
“Especially if you take the costs and then the number of the hours or minutes that the doctor spends operating in theater, and then the next day the patient who is blind sees and then about one week later goes back to work,” says Dr. Debrah.
Still, it has been increasingly difficult in recent years to attract global health funding that will help Ghana, at least, make a dent in their backlog. “Most think that eye care is the least need—why put their money there?” asks Dr. Debrah, playing devil’s advocate. “If children are dying of malaria, women are dying of pregnancy-related deaths and hypertension, HIV and all those things, obviously, they would shift the money to where it is needed. And then the donors who have given the money for TB, for malaria, for HIV, they expect to see results. So people are concentrating on that. Eye, yes, it doesn't kill people so who bothers.”
Point made. But it’s clear in Ghana, Ethiopia, Bhutan, India, Myanmar, Rwanda and Nepal that sight restoration does save lives. And builds families, communities, and countries. “Yes, we are doing well, but not well enough to clear the huge backlog that we have,” stresses Dr. Debrah.
5 Minute Miracles
It is sight, yes, but also surgery. A strange sense of fear and anticipation is mixed in with all the blue and orange plastic chairs scattered around the waiting area. Those with tape above their eye await the operating table, those with patches patiently await post-op.
Emerging with a patch over one eye, Zubaru is led back to the waiting room where he is reunited with Baba, his son, who helps him with the mackerel and macaroni lunch that’s been provided. His and all the other patches will be removed first thing tomorrow.
In the hours between, patients and accompanying family members are fed dinner then brought to the second floor where sleeping mats have been provided. By dawn, many will have congregated back downstairs eager to go through the whole process again for their second eye.
“The morning after the surgery when you open the patches on eyes and you see some of the patients excited. That is wonderful,” says Dr. Debrah. This week he and the staff enjoy that moment nearly 400 times, including twice with Zubaru.
"What I am looking to get out from the operation is to have my sight back and be able to see my family, see my wife and children. That’s all,” says Zubaru.
The women are particularly expressive when their patches are removed. Emily Tovika can’t wait to go to church Sunday to testify and happily points out the colors on my shirt. Her joy is a welcome encouragement to those still waiting, either with patch or tape. Today she can see colors, and in coming weeks her vision will sharpen slowly, slowly. Every other sentence she pauses to sing a song of thanks:
Across the room I see a young 10-year-old boy with a patch over his right eye. It looks to me like a badge of honor. How brave—and how much life he has yet to live.
“Our aim is actually to, yes, provide eye care services to the community here and also to train younger doctors and the nurses to do their work better than they're doing right now,” says Dr. Bo. “This facility has the capacity to provide services up to the tertiary level to be able to train residents in ophthalmology and also nurses in eye care. This place will become a one stop shop for eye care.”
This place will become a one stop shop for eye care. What the hospital needs now is a road.
What the hospital needs now is a road.
It’s a wonder that anyone makes it to the hospital at all, given the condition of the path leading there from the main road, many trenches (not potholes) of water and piles of rubble along the way. It’s difficult to drive, to say nothing of walking it blind. Even the most skilled get stuck. And this is the dry season.
Dr. Bo's of the World
“How many is the target today, doctor?” Dr. Bo responds with a smile and only, “There is a crowd.”
“I sometimes wonder whether he doesn't get tired, because even though I have gray hair, Bo obviously should be older than me,” says Dr. Debrah waiting for agreement, “And yet he goes everywhere to operate, apart from his own center. After here, he will come and support us in Cape Coast next week. Can you can imagine that?”
I cannot. And I, too, have wondered if Dr. Bo gets tired and weighted down by the backlog—he and every other ophthalmologist intent on serving the poorest of the poor with no end to the need. “No,” he says quickly when I ask. “In fact, that has been my life. And when there's nothing like this happening, I get so bored because it's so invigorating to see people who couldn't see yesterday, able to see today.”
Dr. Bo and his wife, Ruth, a nurse and the heart of the hospital.
According to Dr. Debrah, there are about 92 ophthalmologists in Ghana, including retirees and those working in administrative roles. Half are in the Greater Accra region, a quarter each in Kumasi/Ashanti region, and the final quarter spread throughout the country. “Most regions have only one ophthalmologist, and they're in the regional hospitals or in their own private hospitals, so they don't serve the needs of the majority of the people in the community—their mind is only on making their money,” he says.
“Yes, there’s so much money in ophthalmology if you set up in the city where people can afford it,” says Dr. Bo. “But, I thought, if it wasn't for the facility where my grandmother went, I'm sure she would have died blind. So I just needed to give back to the community, and that's it.”
Photography by Alfred Quartey
And give back he has, tens of thousands of times since his professional beginning in the early ‘80s. “When I graduated I got a service request to go to Zambia because they were so needy. I was one of the only eight ophthalmologists in the country over a very long period of time,” he says.
“I've not lacked anything from doing good to people. That's my calling, I think. I dream about eyes, I everything about eyes.” Dr. Bo smiles humbly.
Never in my life have I met a man who leaves restored sight in his wake, sustainably and generously everywhere he goes. And he keeps going wherever the need is. With a humble spirit and a smile.
“As far as I'm concerned, he is a hero. I've been with him through thick and thin and on horrible roads and up and down. For me, I think that he's a hero,” admits Dr. Debrah.
Photography by Alfred Quartey