A cataract patient looking forward to a new life after having his sight back at Project Vision eye center.

 

Dr Dennis Lam Shun Chiu could easily reflect on his great achievements, like the day he undid the bandages for a patient who could suddenly see after living his whole life in darkness.

Instead, one of Hong Kong's leading eye specialists is forever haunted by a darker memory of the time he was asked by two pleading parents to delay the operation their son had been waiting for.

"I examined the boy and he had congenital cataracts," says Lam, recalling the day over a decade ago. "It had always been very difficult to operate on children who developed the condition but it had just become curable by the time I met the boy."

On hearing that the condition was treatable, the boy's parents were elated - but within seconds their deep joy turned to pain and the father posed the shocking question of delaying the sight-saving procedure.

"I couldn't believe my ears when he asked me whether the operation could be postponed to two months later," says Lam.

"My instant reaction was to ask why."

It turned out that the boy's parents didn't have the money to pay for the operation. What they did have was a litter of piglets, which they intended to sell two months later, and in the meantime they hoped to borrow the balance of the money from relatives.

"I was shocked and deeply saddened," says Lam.

Since then, he has repeated the story to various people - reporters, colleagues, students and everyone involved in Project Vision, a charitable foundation he set up in 2006 to help cataract patients in the impoverished areas of rural China.

The aim is to bring quality, affordable cataract surgery to the very people most blighted by the disease.

Since the early 1990s, Lam has often been to the mainland, especially its rural areas, to help treat patients afflicted by severe eye diseases. Despite managing to cure many people relatively quickly, usually in 1-2 weeks, Lam and his colleagues were acutely aware how many had gone without each time.

"If there's one thing that causes a doctor the most pain and frustration, it is the inability to reach his patients," he says. Lam resolved to put an end to the lamentable situation, once and for all. Project Vision is his answer.

State-of-the-art equipment for conducting cataract surgery is donated to county hospitals involved in the project and participating doctors from those hospitals are selected to undergo training by experts from Hong Kong and the mainland. The ultimate goal is for the county doctors to become independent so that they can serve the surrounding regions by themselves.

"An old Chinese saying goes: Give a man a fish and you feed him for a day; teach him to fish and he can eat for a lifetime. The passing on of skills is much more important," says Lam. "Through training local doctors we've turned our peripatetic clinics into permanent institutions."

So far, Project Vision has established three eye centers - one in Inner Mongolia and the other two in Shaanxi province in northwestern China - which have treated 700 patients.

A cost-effective procedure was needed for the particular needs of poor rural patients and, since no suitable method existed, Lam invented his own.

"The new method is fast, safe, cheap and easy to learn," he says. "Given the multiple constraints we have working in rural settings, it is the best way to remove the backlog of cataract blindness among the country's poorer population."

Lam's patients are now charged 700 yuan ($100) for each operation, one tenth of what they had been asked to pay at city hospitals. His eye centers made bulk purchases of the artificial crystals used in the operation to replace the damaged lens, and thus slashed their price from 400 yuan to 80.

The large volume of operations conducted in the centers, around 1,000 per center per year, has also helped minimize costs and due to their charitable status, the centers enjoy tax exemption for all their imported equipment.

"The 700 yuan we charge is based on careful calculation," says Lam. "The goal is to offer patients the cheapest cataract operation that we can afford while maintaining the sustainability of our centers."

Liu Yulan, 75, from Gaojia village, Shaanxi, had her blind left eye operated on two months ago. The elderly woman, who was not particularly eloquent, says she went to the eye center as soon as she learned about it.

According to her son Ren Yongmin, the whole family was extremely worried about his mother. "We didn't want to put her through further suffering unless it was totally worth it," he says.

Ren recalls the day he and his elder brother visited their mother to see how the operation had gone. "My elder brother was standing about 10 m away from the hospital bed and hadn't said a word. I asked my mother: 'Do you recognize that person?'

"She answered correctly and we all cried."

Since then, Ren's family has often been visited by fellow villagers who had previously been told either to go to a city hospital or to accept blindness as a fact of life. Five of them have since booked their own operations.

The project's success hinges as much on the quality of the operations as on the rate at which they are performed.

According to Lam, each of the three centers has two doctors specifically trained in cataract procedures at the Joint Shantou International Eye Center, which he co-founded back in 2001. The new trainees then go to the county hospitals to teach the doctors "in their own setting".

A trainee needs to perform and observe at least 400 operations before he becomes independent. This usually takes about six months but is expected to be cut by half once the project is in full swing.

The task ahead, however, is massive, considering that the ultimate goal is to establish 100 eye centers by the end of 2012, with 1,000 operations at each center per year.

The initial phase will be very slow but once each center's two doctors have been fully trained, the center itself will become a teaching center, says Lam. The first step is to set up one teaching center in each province but eventually all the eye centers will become teaching centers and the total number of eye centers will increase exponentially.

Lam stresses, however, that the time-frame is not as important as the vision driving the project. "The road of tomorrow belongs to those who have their visions today," he says.

(China Daily October 22, 2008)