December 12, 2017 – Penny Lyons, Executive Director, Seva Canada

Penny Lyons has been the Executive Director of Seva Canada since 2006.

Prior to Seva, Penny was a management consultant in Taipei and Vancouver working on projects as varied as a fraud audit for a multinational electronics company and mediating discussions between government, first nations and commercial fisherman on the future of the oolichan fishery.  Prior to moving to Vancouver she lived in Bermuda and owned and operated an offshore management company.

Penny has a Master of Business Administration Degree from the University of Alberta.

At Seva, we believe that everyone has the right to sight. Founded in 1982, our mission is to restore sight and prevent blindness in the developing world. Through our unique partnerships, Seva works to establish locally managed eye care programs that will continue to serve people and communities long after Seva’s involvement is complete.

With decades of experience working in some of the world’s poorest regions, we know that restoring a person’s sight and preventing blindness can relieve suffering, reduce poverty and transform lives. Pronounced “say-va”, Seva is a Sanskrit word for service.

Transcript of Penny Lyons’ Presentation:

If you’ll come with me on a bit of a journey, your name is Dhana Kadka, you live in Bajura in far west Nepal. This is the hilly region of Nepal. The rugged, almost impassible mountains to the north of you and hot dry plains to the south. The land is stunningly beautiful. Verdant terraces of rice, tobacco and wheat blanket the hills. Water buffalo bellow from their pens, shaggy haired sheep carry the harvest and everyone is working hard. You’re 80-years-old and a subsistence farmer. Farming in far west Nepal isn’t particularly productive, most families survive on about one hectare of land that is relatively poor soil and suffers from frequent flooding. As a result, you and about 50 percent of your neighbours live below the poverty line. You’ve been blind from cataract for five years. Life has become more difficult and more dangerous. You can’t help with the farming or the animals. You can’t look after your grandchildren or yourself and your wife is now looking after you, feeding you and looking after all your personal needs. You’ve become a burden. You’ve become a mouth with no hands. Your dignity is gone and your wife despairs. You are shut off, marginalized, a burden. You have no idea that you can do anything about your blindness. There are no doctors, no nurses and no social services. One day though, you hear on the radio that a new clinic wants to fix eyes and is opening in Martadi, the district capital. It’s a four-hour walk away. The announcers say that the doctors will fix eyes for free. One of your sons lives in Martadi and you decide to make the journey. You begin to walk, blind and alone, on paths that you had travelled a thousand times. Every step, every rock, every turn is familiar to you as your own home. You arrive in Martadi, it’s buzzing with excitement and every possible camping spot is filled with those arriving from every corner of the district. Each person is blind or nearly blind. Some are in pain, some are resigned, some can be helped, some cannot. Your son takes you to the new clinic, your eyes are examined and someone explains the entire procedure to you. You are confused and frightened by the commotion, the strange medical tests and the strange medical terms that are used. But you agree. After all, what do you have to lose? Your eyes are anesthetized, surgery is performed on one eye and about half an hour in total has gone by. Bandages are placed over your eye and you are told to return the next morning. Your son carries you on his back down the hill to his home. You don’t sleep all night. You are anxious, you are excited, you are frightened.

The next morning you’re back. Someone comes and removes your bandages. You slowly open your eye and you can see. For the first time in five years you can see. Your beloved land is spread before you, your son is crying and they are the most beautiful things you’ve ever seen. Now I’d like to introduce you to Dhana Kadka.

VIDEO IS SHOWN

That film was shot in Martadi in far west Nepal in the hills, about four years ago where SEVA Canada opened up a vision centre which is a permanent eye care facility in the village. It’s like an optometrist’s shop and it provides primary care and periodically, cataract surgical camps are held there as well. Dhana Kadka walked by himself, came and has his sight restored, just like hundreds of other people at the same time.

I’m going to talk a bit about global eye care and some of the innovative ways Seva Canada restores sight and prevents blindness. Today there are 36 million people who are blind but 29 million don’t have to be. Why am I here? I am here because of Dhana Kadka and 29 million people who are waiting to see. I’m here because I believe we can rid the world of preventable blindness. We can rid the world of a debilitating, poverty-inducing condition. Increasing the rate of eye care delivery worldwide is the only criteria for success. I believe this because Seva Canada has experience in eradicating disease. In May 1980 the World Health Organization finally confirmed the global eradication of smallpox which was the first disease ever to be completely eradicated. I think it might be the only infectious disease ever completely eradicated as well. Some of the people who worked on the eradication of smallpox in India dreamed of recapturing the faith and determination which drove the smallpox campaign to its success and applying the same spirit of service to other efforts designed to alleviate human suffering. So Seva, which means “service” in Sanskrit, is a result of that.

We started in India and with Dr. Govindappa Venkataswamy, a retired Indian ophthalmologist, we started the Aravind Eye Care System which is now the largest eye care facility in the entire world and it performs close to 400,000 cataract surgeries every single year. Since our beginning in 1978 Seva has restored the sight of over 4 million people. I’m just going to go through a few of our milestones so that you know how our work has progressed.

As I said in 1976, the Aravind Eye Hospital opened. In 1978 the first Seva started in Berkeley, California. In 1981 the first national blindness survey was done in Nepal and it was the first blindness survey done anywhere. The reason that was important was because it finally told us how many people were blind, who was blind, what were they blind from, were they men, women or children? You cannot begin to start eradicating a disease until you know what the disease, where it is and how it is. That’s why it’s important. In 1982 Seva Canada was established here in Vancouver so we are celebrating our 35th year this year. In 1992 Oralab was formed and the reason that is important is because Oralab is an interocular lens manufacturing facility. Interocular lenses are the lenses that are put into your eye after cataract surgery. Primary to the formation of Oralab, which is in Aravind, India, lenses cost about $300 a piece. With the formation of Oralab, funded by Seva Canada and the Canadian Government, the price of the interocular lens has dropped to $2.50 making cataract surgery available to anybody who needed it. In 2001 the Kilimanjaro Centre for Community Ophthalmology based in Moshi, Tanzania was formed. That’s really important to Seva Canada because it’s our partner for all of the countries in Africa in which we work. Finally, in 2015 Seva Canada won the Champalimaud Award. This is an award out of Portugal and it’s like the Nobel Prize for eye care. It’s awarded to organizations that have made outstanding contributions to the alleviation of blindness. So we were really honoured and pleased to receive that.

Why sight? Why after dealing with smallpox did the people who began Seva decide to focus on sight? Well, because it’s a solvable crisis. It’s the seventh largest health disability in the world but 80 percent of blindness can either be treated or prevented. Restoring sight breaks the cycle of poverty. The majority of the world’s blind live in low-income countries and it’s a vicious cycle. Poverty and disease lead to vision loss and blindness and poor vision keeps people trapped in poverty. The restoration of sight has been proven by health economists to be one of the single most cost-effective ways to reduce poverty. There are 18 million kids who suffer from blindness or poor vision. These kids can’t go to school and have far fewer chances to lead productive or successful lives. The majority of the world’s blind are women and girls and not because they go blind more often than men and boys but because it’s so much more challenging for them to access care. A 15 minute cataract surgery, and some surgeons can do it in about five minutes, restores sight. A $5 pair of glasses changes lives and a $2.50 bottle of antibiotic drops can save an eye from infection. Restoring sight quite simply transforms lives for generations. As Dave said, it’s not just one person in a family that’s affected, it’s another person. Even losing one person to blindness can make an entire family and an entire village descend into poverty.

Who are blind?

There are 36 million people in the world who are blind, the majority as I said are women and girls, there are another 217 million who are visually impaired and the vast majority of these people live in low-income countries?

What are they blind from? The majority of blindness is caused by cataract, which as I said, costs about $50 and takes anywhere between five and 15 minutes to repair. Why? Because of lack of available care. Because of difficulty in accessing the care that might be available. Because of a lack of awareness that whatever is wrong with a person they could actually be helped with that. Because of social, geographic and financial barriers. The biggest challenge is to overcome the fear. The fear of foreigners, the fear of doctors and the fear of travel. That’s the biggest hurdle to overcome.  

So what’s the solution?

In order to restore sight or prevent blindness, surgery, glasses and medicine are the only three things required. Seva provides all three as well as the capacity and structure to deliver all three to people in remote and rural areas. With the surgery, medicine and glasses, 29 million more people could see today.

As I mentioned, Seva has restored the sight of over 4 million people and let me just tell you what we did last year. In our 2016-17 fiscal year, Seva gave the power of sight to 96,084 people through life-changing cataract surgery and provided basic eye care services like glasses and medicine to 1,448,969 more people. 

How do we do that? What is it that Seva delivers?

What we deliver is what our overseas staff and partners ask for and that has changed significantly over the years. We used to send North American doctors to provide service but now our local staffing partners provide the vast majority of services. What we’re doing is helping them shift from incremental progress to long-term transformational change, at least in terms of eye care services. So we do that through a number of ways. The first way is what we call universal access which is all the innovative ways we provide high quality affordable care making sure that those who need the care the most – the very poor, women, and those living in remote and rural areas – get the kind of care that they need. We ensure universal access by implementing community-based ophthalmology programs. We know that people will not access care unless it’s close by or there’s a really effective referral system for people to access care. Some of the ways we deliver universal access are quite innovative. We’ve learned to work with microfinance groups. We don’t start microfinance groups and we don’t give them money but these are women in a community who already have a large amount of status because they do have money and are in small business. We engage with them, train them to detect eye disease and ask them when they are consulting with other members of the community to look at everybody to detect eye disease as they see it and refer them to people for care. No money changes hands. The training we provide the microfinance women and the new role that we have given them gives them even more status in the community and that’s why they are willing to do it. They always want to help their community.

We also engage what we call our key informants and these are women in villages that we hire and pay. They go door-to-door to every single home in a community and ask to look at the children. We train them to check for eye disease and when they find a child who has eye disease they make sure the parents get counselled and the child gets referred for care. Another way we reach people through remote areas is through screening camps. These screening camps are supervised by an eye care professional like an optometrist. They advertise that free screening is available and treat on site for glasses and medicine and those people who need further care like cataract surgery are referred to the hospital.

The other method we use is called vision centres, sometimes called community eye centres and sometimes called primary eye care centres. Like the one in Matardi, these are permanent eye care centres, like an optometrist’s shop, that provide primary eye care year-round and that helps prevent significant vision problems later on and also acts as a way to refer patients who need surgery onto the hospital.

The second strategy that Seva uses is that of sustainability. When we talk about sustainability in terms of eye care we’re talking about both financial sustainability as well as sustainability in terms of human resources. Eye care is one of the very few health interventions that can make money while still serving those who are too poor to pay. We do that by charging a sliding scale of fees so that the rich subsidize the services for the poor. The money that’s generated by the surgical services will also subsidize the screening camps and the surgical camps. In terms of human resource sustainability we ensure that all levels of eye care professionals are very well trained because quality is very important to everyone. No matter how poor you are you know what is good quality and what is bad quality and so we need to make sure that our cadre of professionals are very well trained and experts in what they do.

Finally, the third thing we provide to our staff and partners are the tools and training. In order to ensure universal access and sustainability we have to give our staff and partners the training they need so we invest in all levels of eye care training, management training, quality control and we make sure that everybody has adequate equipment to do their job properly.

I did this little diagram just to show how it works with Seva Canada. Our job is to restore sight and prevent blindness so we have to give our partners the tools and training they need to build their own local capacity so they can ensure universal access for all and sustainable programs in terms of human resources and financial resources. Those programs then generate evidence and data about what needs to be done, what has been done and what still needs to be done. We use that evidence for our marketing, communications and fundraising. We use it to educate our donors and partners and to raise more money to do our programs.

So it’s very circular and it’s very important that every piece be there. We have to generate the evidence, we have to generate the data, we have to provide the tools and quality programs otherwise the cycle breaks down and we’re not doing our job properly. Seva works around the world but what is common to each country is; a very poor infrastructure, geographic challenges, corrupt unstable and inefficient political systems; underfunded, underequipped, undersupplied, understaffed, undertrained pluralistic health systems; complex social units with leaders, factions, ethnic groups, patriarchal classes and castes.

All of the countries in which we work are on a continuum from dependent to very independent in terms of eye care. For all countries in Africa, as I mentioned before, we work with an African non-governmental organization called the Kilimanjaro Centre for Community Ophthalmology. In Africa we work in Tanzania, Burundi, Malawi, Benin, Congo-Brazzaville, Ethiopia, Uganda and Madagascar. So the budget line items that we fund that you see here we fund some or all of these in every country in which we work. I’ll just explain a little bit about each one of them.

Direct services are providing glasses, medicine or cataract surgery, so that’s quite simple. Pediatric is the creation of a pediatric program. That typically happens fairly far along in the development of an eye care system in a country because pediatrics are very difficult. It’s very expensive, you need highly trained individuals, the children require a lot of care both during and after the surgery and for year after year. The pediatric program typically comes quite near the end of the life-cycle of a program. We do training at all levels as I mentioned. Both for the ophthalmologists as well as the hospital managers, the finance people and the people who look after the equipment.

We create vision centers which are sometimes called primary eye care centres or community eye centres and these are the standalone clinics in the remote and rural areas that provide primary care year-round to people at an affordable price. We do community outreach which might be screening camps or surgical camps or the key informants or the microfinance groups. There’s always a community component to all of our work otherwise we’ll never reach the people because people will not walk into a hospital on their own. They need to be referred. The fear and the uncertainty is too great and no one will come from a small remote village into a city to get their eyes checked or done. It just doesn’t happen. We teach everybody about cost recovery and I talked briefly about cost recovery. The fact that we can be financially sustainable in terms of eye care and it’s not just by charging the sliding scale of fees, it’s also by the efficiencies that we implement in our programs as well. Both at the hospital levels and the community level.

I’ll give you one example of that. I would suspect that many of you have had cataract surgery. You probably went into the hospital and were the only person in the operating room aside from the medical staff, you had your surgery and left. If you were in India, Nepal or many places in Africa there would be four beds in that operating room and there would be two or three operating microscopes and the surgeon would do one surgery and then he’d turn to the side and do the next surgery and the beds would be flipping so fast. While there is definitely sterile technique it’s not quite as obsessive as it is in North America. It’s much less expensive, many more surgeries can be done and that’s why it can be so much cheaper than it is here.

Equipment and supplies. We provide supplies both in terms of medical equipment and other computers they might need as well as research. One of Seva Canada’s hallmarks is research because we really believe that we need to know that what we are doing in the field is actually working, otherwise we’re wasting everybody’s time and money. We do a lot of publications. We’ve been published hundreds of times. Not only do we do the research within North America, we also train our partners in the field how to do research as well. So they are publishing their own papers and becoming first authors on papers as well, which is really important for the quality and continuity of the programs.

We also work in Nepal and Cambodia. We have office and staff in each of these places primarily because the volume of work we do in these countries and the lack of local partners.

We used to have an office in Tibet but the Chinese government disallowed any kind of foreign non-government organizations in the Tibet Autonomous Region so now we partner with a hospital in the Tibetan region of China. These countries, along with India, are our oldest partnerships and probably our strongest partnerships as well. In India, Egypt and Guatemala, we work with local partners and provide more opportunistic funding rather than program funding. For example, we have been unable to work in Egypt since the Arab Spring because of the political situation. The country is much more stable now and we will likely start funding again in the next fiscal year. We will probably start small with cataract surgeries or something like that.

In Guatemala we’re consulting with the country’s most successful eye care program called Visualiza. We’re helping them develop a funding and operational plan for small referral centres like the vision centres around the country that will provide accessible eye care to those living in the remote areas of Guatemala.

In India we provide support for a lot of research. A lot of research is done through our Arvand Eye Care System and we support that. We also build vision centres throughout India as well.

People are always interested in where we get our money. The majority of our funding comes from foundations and grants and from individuals. There’s very little corporate support because we are international and that makes it challenging. However, the good news is that Global Affairs Canada is much more interested in funding international development particularly as it applies to gender equity. Because one of Seva’s hallmarks is gender equity and the treatment of blindness, we think it’s likely that we will be funded by them over the coming years and they tend to be quite generous, which is good.

I want to talk a bit more about sustainable revenue. I already said that eye care is one of the few health interventions that can actually make money while still serving those who are too poor to pay by using a sliding scale of fees. There are, of course, other conditions that need to be met and we talked about the need to increase the volume and speed of surgery while reusing as many supplies as possible. But the basic premise is that you use a sliding scale so that the rich cover the fees for the poor and then some.

But even if every hospital and clinic we worked with was sustainable in every single way and required absolutely no more support, there are not nearly enough services to meet the current annual future need. Estimates are, because of our aging population worldwide, the number of blind will increase 36 million to 115 million by the year 2050 if access and treatment are not improved and increased dramatically. The majority of those 115 million are likely to be women and almost certain to be girls.

So how do we even begin to access the kind of funds that we need to meet the scale of the problem?

I’ve already talked about it. Because eye care generates revenue it is investable. I have seen both vision centres and hospitals in some of the poorest places in the world become financially sustainable and quite quickly. Burundi, for example, is one of the poorest places in the world. In fact, it’s always in the bottom three in the list of the poorest countries in the world. As many of you know in the not-so-distant past, it went through a terrible civil war as well. They’ve created a number of these small vision centres. They cost maybe US$25,000 to US$30,000 to renovate the building and equip it and train the staff. I’ve seen those vision centres recoup their capital costs within 18 months and their operating costs within about six months. So even in a place like Burundi where the population is incredibly poor, these vision centres and hospitals can make money.

One of the answers to increase eye care worldwide is to find additional partnership opportunities and funding sources. Besides governments, corporations, foundations and individuals who support eye care, there are also investors who will provide both debt and equity financing to support social good. By using funds not typically available for charitable services we can significantly ramp up eye care services worldwide. We’re currently working with some of these social impact investors to create an investable model of eye care that even has the potential to franchise, particularly the vision centres. It’s not often that you will hear the head of a charity talking about debt and equity financing but it is truly the only way we are going to meet the need where it actually exists.

So why Seva?

Because we build local capacity at every level that is self-sustaining in every way. Our staff and partners have autonomy and responsibility for our own program decisions and Seva mentors and facilitates mentorships and provides oversight and expertise only when required.

We use a public health approach to provide the best care for the most people and nobody is ever turned away from services if they are too poor to pay. Our community outreach programs ensure eye care services are truly accessible to those most in need. We help our partners towards self-sufficiency by training in clinical, program and financial management while we do capacity-building for eye care health care workers at every level.

We objectively evaluate through data collection our impact on blindness and populations to guide all of our program decisions. We simply have no time or money to waste.

Questions & Answers:

 

  1. I’m somewhat familiar with Operation Eyesight. I know that Seva’s focus on sustainable programs and research is probably more significant than almost any other eye care organization in the world so I would say that is likely the difference. We are so focused on trying to make things sustainable because there isn’t an ever-lasting pool of money so we need to find a way to do this in a better and more efficient way.

 

Because we focus on that as well as the research to make sure we are not wasting our time and money I would say that is what differentiates us from other eye care organizations.

 

  1. You spoke to the percentage of revenue sources. Could you speak to the budgets both in Canada and international?

 

  1. Seva Canada’s budget is about $2 million. The Seva Foundation in Berkeley, California has a budget of about $8 million. So it’s a relatively small amount of money for an enormous impact, I have to say.

 

  1. I have two questions. Firstly, infectious diseases are probably one of the greatest causes of blindness in Third World countries so how does Seva work with organizations on the infectious disease side? Secondly, it sounds like you have your act together on administration. What could you teach our Canadian health care system?
  2. Frankly, I think I would just move them all to Nepal for a year and show them what they could do because the waste is enormous.

 

In terms of infectious eye disease the largest cause is cataract, it’s not infectious diseases. Currently there is an enormous worldwide trachoma endeavor. It’s an infectious blinding condition that is typically brought on because of poor hygiene. So people don’t wash their hands and their eyes get infected and the corneas start to scar because there are so many infections on the eyelids that the eyelids start to turn and the lashes scratch the front of the cornea until it’s agonizingly painful and start to cause blindness as well.

 

So there’s a major trachoma offensive going on right now that Seva partners with in terms of personnel and equipment. There’s I think hundreds of millions behind the eradication of trachoma right now so we kind of work alongside that.

 

The other infectious disease is river blindness. A pharmaceutical company, I think it’s Merck, has donated all of the drugs to combat that so that actually is also well in hand. It has not been eradicated but they anticipate that it will be in the not-too-distant future.

 

  1. In your comments you mention that eye disease affects females more than males. I wonder what the reason for that is.

    A. It’s not because women and girls go blind more often, it’s because they are able to access care far less than men and boys so that’s why so many more girls and women are blind than men and boys. Cataract typically develops at the same rate for men and women as boys and girls but the girls and women can’t access care for all of the cultural, social and economic reasons you might think of. They would typically be the last to get care in a family.

 

  1. Could you talk about the applications on iPhones that allow you to take pictures and diagnose diseases?

    A. It’s a gadget that people like to have and to use and to try and sell but in the field in reality it does very little because you have got a patient in front of you who clearly has an eye disease, you take a picture of it and then so what? How is that person going to get treated? Who is going to pay for it? How are they going to get to the hospital? Has the person in the hospital been trained for whatever eye condition they have? So identifying the disease that someone is suffering from is not even the first step.

 

It is barely anything and from a photograph on an iPhone you can’t tell someone how to treat that if they’ve never been trained properly in how to treat it.

 

Where it does work, for example, is in the vision centres or community eye centres. They often have what is called teleophthalmology where you have an optometrist type trained person in the vision centre and the surgical centre or referral centre is 300 km away. If they bring in a patient and the optometrist doesn’t quite know what is wrong with that person then they could take a picture and use teleophthalmology for the doctor in the hospital to look at the picture and decide whether or not the patient needs to be brought in.

 

In terms of teleophthalmology it’s great but if it’s just a picture with no system of follow-up, referral or payment, it has no value.

 

  1. When you have bad corneal scarring from infectious diseases then typically the next step would be to transplant the cornea.

 

  1. In my presentation I talked about how challenging it was to start a pediatric eye care program because of the specialty, cost and care that is needed so the same would be true for corneal transplants and that kind of program would be introduced in a country at the very end stages of its development of an eye care program because it takes such skill. You need to build an entire facility to house the corneas and it’s hard to get the corneas.

 

In a place like Nepal, for example, where you do not give away or take body parts it was really challenging to overcome that but now they do have a cornea eye bank and they do corneal transplants. That’s really the end stage of a country’s eye care program and it takes a lot of work to get people used to the idea of even donating their corneas.

 

  1. I’m interested in the reach of the organization. It would appear that the Canadian part of it is serving roughly 25 percent of your clients and the US part serving the balance. Is this only in undeveloped or underdeveloped countries?

 

  1. Yes. Seva only works in low-income countries and we only work in those countries where we have a partner or someone we can work with because, as I said, we don’t send doctors to do flying eye camps to do surgeries because it’s not sustainable or effective and frankly it’s not good quality in terms of long-term eye care. So yes, it’s only in low-income countries and where we can find partners to work with.

 

  1. So the US part serves three-quarters and you service a quarter?

    A. Well, it’s not quite like that. Most of the African countries are only funded by Seva Canada. In Nepal or Cambodia where we have eye offices they fund considerably more but we fund things we excel at like helping them with research and data analysis as well as the surgeries.

 

It is quite symbiotic. They spend a lot of money in India where we do not because we spend a lot of money in Africa so every year it’s a budget negotiation between Seva Canada, the Seva Foundation and within the countries to decide who is going to fund what. It’s really intermingled and we each focus on what we do best. They have a lot of money and we have a lot of know-how so it all works.

 

  1. I’m interested in your training. I am amazed that you have people qualified who will turn around and operate four times within an hour. Have you developed from using ophthalmologists or trained eye surgeons to using lower-ranked people to do surgery?

 

  1. We use both. Every country has different rules and some of them can be quite stringent. Most places use ophthalmologists but in Africa they have what are called cataract surgeons which are technical surgeons. They may not be able to do anything really complicated but they are extremely adept at taking a cataract out and inserting an interocular lens and they are trained by the hospital ophthalmologists. There are simply not enough people going through ophthalmology to do it so that’s why we would use cataract surgeons.

 

  1. Do you do any work on preventing cataracts?

 

  1. There is really no way to prevent cataracts. They will happen to every single person if you live long enough. There is some thought that ultraviolet radiation or diet may have an impact but that’s not been proven as of yet. We are all destined for cataracts if we live long enough.

 

  1. Are there other countries other than the United States and Canada that are involved in this process?

 

  1. There are only two offices of Seva, in Canada and the US as well as our country offices in Nepal and Cambodia but there are literally dozens of eye care organizations doing essentially the same, but clearly not as well as Seva Canada, around the world. Almost every developed country has its own eye care charity. There’s Fred Hollows in Australia which is gigantic as well as Sight Savers in the United Kingdom which is also gigantic.

 

  1. You need money and money will go a long way when you go to places like Nepal. When I had my cataract surgery why didn’t my ophthalmologist tell me about Seva?

 

  1. I don’t know why. Should they? Yes they should. It’s unconscionable that something so easy, simple and relatively inexpensive is not provided to every single person who needs it. I would agree.

 

  1. Can you talk about neglected topical diseases that get in the eyes and whether or not you get involved in dentistry?

    A. No, we don’t do anything with dentistry. We focus on what we know and do best. We think we are more efficient and effective by focusing simply on eyes. There are others who are far better at looking at oral hygiene which, I agree, is incredibly important. That’s not what we do.

 

In terms of strategies to prevent infectious diseases like trachoma we use the SAFE method which is about making sure your hands are washed. Essentially it’s about keeping clean because that’s what transmits the disease which causes the infection. We do a lot of prevention where we can.

 

  1. You mention that patients can get lenses for $2.50. I think I paid $500 for each of my mine! Who subsidizes the cheaper lenses?

    A. If you make something in a big enough volume in an efficient way in a place where the overhead and resource costs aren’t astronomical then you can make things for a lot cheaper which is why Aurolab can produce and sell interocular lenses for $2.50. These lenses have different qualities so you have your Rolls Royce and your Toyota. There is a spectrum of lenses that you can choose from.

 

  1. When you initially started a number of years ago you were very dependent on ophthalmologists and other eye care professionals going and treating and setting up programs in other countries. Is this still the case?

    A. It wasn’t very long after Seva started that we started training and funding in-country resources so it wasn’t very long that we were completely dependent on outside eye care professionals. There are still people who will train in a particular technique. You saw a picture of a small man with glasses named Marty Spencer from Nanaimo who has done more cataract surgery than anyone alive, I’m sure. He will go to train a particular technique so we still depend on them to train in a particular specialty or surgical technique but we never do eye surgery tourism that is still quite prevalent and extremely damaging both to a country’s economy and healthcare system.

 

  1. Could you just expand on that last statement? I don’t quite understand why eye care tourism is so damaging.

    A. Eye care tourism or any kind of development tourism is when people go and provide a service and then leave and while they are there for a short period they may train local professionals but what that does is move resources from the country itself to train their own professionals to do continuous training and create their own programs because they are so focused on waiting on the professionals from Canada to come.

 

In fact, it is so damaging that when the population knows that people from North America are going to come to do whatever service it is they will wait, maybe longer than they should, before they will get the services. They think that Canadian professionals must be better than their own local professionals which is categorically not true. I would suggest that most ophthalmologists in Canada would have a hard time taking out a rock hard lens from someone who has been blinded from a cataract for a number of years whereas someone in Nepal could do it in an instant.

 

It diverts resources, it limits the training and the capacity building done in-country and it makes the population wait. You cannot be financially sustainable if you don’t have your own population paying for and accessing services so they will always be dependent.

If you want to go on a plane and train someone in a particular surgical specialty or technique, fine. But it should be rare and it should be done in conjunction with the system in the country because they will have some kind of medical training program.

 

  1. There are a number of young people with cataracts in these populations. Are there more young people with cataracts in those populations than we see in our population and if so, why?

 

  1. The answer is definitely yes and they are not entirely sure why it is more prevalent with children in the developing world but it likely has something to do with nutrition, nutrients and genetics that makes them have more pediatric cataract.

    At Children’s Hospital I think there might be two or three kids born with a cataract in their eye whereas in Nepal there are hundreds.

 

We don’t know why that is the case, we just know that it’s more prevalent.


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