One hundred blind patients in threadbare robes sit shoulder to shoulder against the wall in a converted warehouse in rural Ethiopia. They wait for surgery that will allow them to see again.
Tomorrow, a new group of a hundred will wait.
An ophthalmologist makes quick incisions into the eye of a patient and removes a cataract. The procedure is efficient, sterile and takes about seven minutes. Medford doctors Matthew Oliva and Paul Imperia recently worked side by side in this fashion with an Ethiopian doctor, treating hundreds of patients over the course of a weeklong visit.
Oliva and Imperia volunteer their time and expertise for the Himalayan Cataract Project, a nonprofit organization founded in 1995 dedicated to creating a model for sustainable eye care in the developing world.
"The leading cause of blindness in the world is cataract blindness. "… In the developing world there are so many people with cataracts you need to be able to do high-quality surgery, and do it very fast, and have it be low cost," Oliva says. "So what HCP has done is help develop techniques to do high quality, suture-less cataract surgery quickly."
The need in northern Ethiopia is especially great, says Imperia, where his African colleague is the main ophthalmologist for five million people. The incidence of cataracts is especially high in developing countries, which makes the need even more urgent.
"It's nutritional, there's a lack of basic health care, and we know that people who are sick in general and have poor health get cataracts earlier "… there's also exposure to ultraviolet light, vitamin deficiencies, trauma. Genetics are also involved," Imperia explains.
Treating so many patients so quickly requires a mental shift.
"When there are so many people waiting, it really motivates you to concentrate. It's worth the effort but there are long days. The inspiring part is that the Ethiopian surgeons are doing this day in and day out, 50, 60 patients a day. There are doctors in Nepal who do 100 surgeries in a day, every single day," Oliva says.
"You walk down the hallways to do surgeries, and they're lined as far as you can see with patients who have come from God knows how far in bare feet and robes, completely blind. You're not just going to quit at five," Imperia adds.
Performing surgeries is only one piece of this new sustainable eye-care model.
These two Medford doctors also help train ophthalmologists from developing countries at the Medical Eye Center, their new facility on Barnett Road in East Medford, as well as at HCP facilities abroad. A Nepali doctor will be coming for corneal surgery training in September, Oliva says, and next month they'll be leaving to work in Malawi for the first time. Another partner, Dr. Paul Jorizzo, will also be traveling with Oliva to Ethiopia this summer to teach glaucoma surgery.
"When Paul and I go with HCP, really our goal is support and training more so than just doing the surgeries. It's really about education and developing a model that works, because we think that's more effective than ourselves going and doing a few surgeries.
"What we see is that doctors who are trained in this type of surgery can then teach it to the other doctors and it grows," Oliva explains.
Unlike surgeries that take place in the U.S. with expensive equipment, the HCP facilities use basic but effective tools.
In 2005, HCP reported that an initial investment of $100,000 was required for high-tech equipment to start a cataract surgery clinic in California. A clinic using the HCP model required only $15,000. Both facilities reported 98 percent success in restoring vision.
This lower-tech approach, when combined with donated time by U.S. doctors and financial donations from around the world, results in sight-restoring surgery that today costs a mere $20 for the poorest patients.
According to Imperia, Medicare reimburses $600 for the more elaborate cataract surgery performed in the U.S. The situation is much different in Ethiopia.
"It's a simple, quick intervention that doesn't require hospitalization. It's a lot of bang for your buck. It's not just $20, it takes 10 to 15 minutes and they can see and go back to their village the next day," Imperia says.
HCP started its operations in Nepal. Today, 175,000 cataract surgeries per year are performed in that country, compared to 1,000 in 1990. HCP doctors are now expanding their vision of global eye care.
Oliva is on the board of directors of HCP and recently returned from Nepal. He and his colleagues met to develop a plan to tackle corneal blindness, the second-leading cause of treatable blindness worldwide.
"They're only able to do about 200 corneal transplants a year in the entire country because they do not have access to enough corneas, which come from cadavers," says Oliva.
Their solution is to develop an eye bank to increase that number to 3,000 transplants a year. HCP has developed a partnership with the SightLife eye bank in Seattle, where Oliva, who moved to Medford from Seattle in 2007, is an associate medical director.
All of this work will be the subject of a book coming out next year by David Oliver Relin, who co-wrote the bestseller, "Three Cups of Tea", Oliva says.
"We are hoping this helps us build awareness of the extent of curable blindness in the developing world and of our efforts to train doctors, develop infrastructure and treat patients in the remote parts of the world," he says.
The words from the song "Amazing Grace" — "was blind but now I see" — could easily describe the feeling of gratitude expressed by many of the Ethiopian cataract surgery patients. This often takes form as ululation, a high-pitched wail accompanied by rapid movement of the tongue.
"There are 150 post-operative patients who have their bandages taken off in a day, and their vision is restored," Oliva explains. "To give thanks, all together, they ululate.
"It is quite a sight to behold."
Daniel Newberry is a freelance writer living in the Applegate Valley. Reach him at firstname.lastname@example.org