Keeping an Eye on Blindness

George Naveen Thomas

It is estimated that 284 million humans just like us around the world are visually impaired. Of these, 39 million are blind. Shockingly, 90% of those with visual impairment live in the developing world. And perhaps the most striking of these facts is that 80% of visual impairment can be avoided or cured. Gloominess and bewilderment is one response to these numbers; the other, which overcomes me, is hope.

I spent my summer at the Public Health Unit at the Centre for Eye Research Australia (CERA), where I had the opportunity to work with some absolutely amazing people who spend their lives trying to challenge and overturn these statistics. My glimpse of an encounter with the work was just that, a glimpse; they spend the ins and outs of their days collecting data from all around the world, monitoring the vast network of NGOs and government teams out in the field, evaluating the impact of programs, attending meetings with stakeholders around the world. The list goes on, much too long for this space. Research is another pillar of the movement; the known unknown and even more importantly, the unknown unknown. This is the Vision 2020 movement: The Right to Sight; an attempt to understand and put a framework, a net around the evasive animal of blindness.

My elective was less of an elective and more of an experience. I could not think of any other way of making sense of it all except to stick my fingers into as many pies as I could. I had a chance to attend meetings with Vision 2020 Australia, mainly to discuss my project: the collection of data about a number of countries in the Asia‐Pacific region, for the purpose of establishing baseline statistics with which the impact of current eye programmes could be measured. We collected a broad range of data for each country, from the prevalence of blindness and visual impairment to economic and social indicators to education and childhood literacy to infrastructure and resources to demographic data. It sounds good on paper but trawling the Internet for a particular country’s half‐existent Bureau of Statistics data is not an easy task. However there was always someone who knew what the state of the matter was when I couldn’t find data – Prof Jill Keeffe who is the Director of the WHO Collaborating Centre for the Prevention of Blindness, was always there to come the rescue. It is entirely inspirational, how these individuals have become experts at deconstructing a problem into its very essential constituents, and then knowing as much about them as anyone around can possibly know.

One of my other fingers was stuck in one of the other projects, the Knowledge, Attitudes and Practice (KAP) Reports; informally pronounced ‘The Cap’. Recently, KAP surveys were conducted by Christian Blind Mission International and CERA in Cambodia to evaluate what its name suggests – the knowledge, attitudes and practices of the people in the country as it relates to blindness and visual impairment. It is a way of understanding what and how the local people think, which gives insight into the best way to implement solutions and programmes that will work to improve eye health in practice. A general example of this would be the knowledge of eye diseases and its causes, attitudes to eye health and finally their practices; such as health seeking behaviour in response to an eye infection. I realise my involvement in the KAP was rather shallow, as might be expected during such a short exposure but the amount of insight that I received as being part of it was overwhelming.

What was strikingly obvious to me from the results of a recent KAP in Cambodia was that the most basic of eye disease knowledge was often scarce amongst those who were visually impaired. Almost half of those over 50 years had not been to school. Quite a few people had another disability. Most people didn’t know how to avoid an eye infection, for example by using clean water and washing hands. About 1 in 2 didn’t know how a person could become blind or what the treatment for cataract was, with many thinking that traditional medicine and steam from boiling rice was useful. It struck me that these challenging and revealing facts came out of a well‐planned and executed study. Only 1 in 5 sought an examination if they had an eye problem. Half thought that if a child was vision impaired, he/she could not go to school. It is not hard to see how society’s views contribute so much to its eye health, or lack thereof.

I learnt many things from this elective, especially the some of the complexities in addressing avoidable blindness and in meeting the targets for Vision 2020. I learnt that blindness survives and feeds off the poverty of finance, education, literacy, gender inequality, childhood disadvantage and disability, to name a few. While I knew before that throwing money into the issue wouldn’t mend it, I didn’t understand how much coordination and synergy is needed to maintain some order over the vast network of NGOs and government teams, research programmes and financiers. I realised the importance of the involvement of a research institute in the process and got a taste of some of the fundamental activities at that level.

By far, the biggest impact for me was the pure inspiration of working with people with a minds of steel and hearts of gold; with the often unglamorous tasks of the day being executed in various rooms and buildings all around Melbourne, around the streets of the city that I walk through obliviously every day. All while lives are changed in countries far beyond our shores. Sometimes I wonder what things will look like when 2020 does stop by, but all one has to do is look back on the milestones made in the last 10 years by pioneers in our Country and City, to realise that there is much hope for things to come.