Elimination of mass blindness: Is it a basic human right?

By Rita A. Widiadana

SINGAPORE (JP): Arthur Lim Siew Ming is the clinical professor and head of the department of Ophthalmology at the National University of Singapore and the head of the Singapore National Eye Center.

At 65, the inventor of Lim's lens, an artificial lens implant used in thousands of cataract operations to restore normal vision, has been restoring the eyesight of more than one million people blinded by cataracts in Southeast Asia, China, India and Bangladesh.

As president and founder of the World Cataracts Surgeon Society, he has long been an outspoken critic of international organizations which have failed to effectively manage and treat mass cataract blindness in Asia, where an estimated 20 million people suffer from the disease.

Calling the elimination of eye diseases a human right, he has criticized these organizations for "discriminating against" the third world by continuing to use outdated methods.

In his fight against blindness, Lim has helped raise millions of dollars and trained eye doctors in the region. "When I was young, I was taught to give 10 percent of my pocket money to charity," said the professor, the son of a wealthy lawyer and politician.

Tan-Hoong Chu Eng, the general manager of corporate marketing and physician relations at Parkway Group Healthcare, warned that the professor often appeared a quiet and sometimes reticent person unless he was in a good mood. His tight schedules have often prevented him from meeting with the media.

An interview with the man long recognized as one of the world's leading ophthalmologists, however, turned out to move easily along with him sharing his thoughts from eye diseases, cataract blindness and health care in Asia, to his hobbies and his great passion to arts and literature.

A friend of President Abdurrahman Wahid, Lim said he used to talk with him about eye problems, health, social issues to pop, jazz, classic music, arts, culture and new books.

"Certainly not politics. He is a broad-minded and multifaceted man," Lim said as he showed several photographs in which he posed with the President, Malaysian Prime Minister Mahatir Mohammad and Chinese leader Li Peng, all of whom are his close pals.

Lim acknowledged that he had direct access to Abdurrahman as he had his private telephone numbers. "He said he would not be able to read my letters or my faxes so he gave me his personal numbers," Lim smiled.

He has numerous Indonesian friends from all walks of life, including eye surgeons and business tycoons such as the Riadi family of Lippo Group and art connoisseur Sutedja Neka.

Lim is an avid art collector (listed by Art International magazine as one of the 200 great art collectors in the world) an aspiring painter and sculptor. He has written medical text books, short stories, novels and poems.

Entering his spacious office and eye clinic at Gleneagles Hospital was a journey into the art world. The professor was proud of his collections of paintings by Affandi, Srihadi, Jeihan and many others. His Chinese paintings by Chen Wen Hsis were scattered everywhere on the office's walls.

While painting his self-portrait, the professor talked about eye problems in Indonesia and other Asian countries. The following is an excerpt from the interview.

Question: How do you view eye problems in Indonesia and other Asian countries?

Answer: Similar to other Asian countries, eye problems in Indonesia are very serious, especially when the economic crisis hit the country.

Many children are malnourished and older people suffering from cataracts and other eye diseases find it difficult to get proper eye care because of escalating medical costs.

I have frequently visited Jakarta and places outside Java. The situation between a capital city and remote islands is of such contrast. I am so concerned over the health condition, including eye problems, of children and adults in remote places because they have no access to quality health care.

In Asia, eye problems and mass blindness are mostly caused by malnutrition and infection. These kinds of eye diseases are actually preventable and curable but little effort is made to eliminate them.

Do you mean that people and governments in Asia have done nothing to solve the problem?

Why have we failed to prevent blindness from trachoma when we have known the cure for decades? Why do a quarter million children become blind from vitamin A deficiency each year when we know it takes just an annual nine cents per child to prevent this? Why are there millions who become blind from cataracts when the condition can be simply cured by removing the opaque lens?

The reasons for the failure of Asia's eye care delivery system are complex. They are dependent on the political, socioeconomic and cultural factors.

The majority of Asian countries are developing nations. Their governments have been working hard to improve basic needs like housing, education and other primary needs. Eye disease is not the only problem.

It requires a strong political will to change this frame of mind. Vision is important in the lives of people. When thousands or millions of people are blind or visually impaired, a country will suffer from major social and economic losses.

Mass blindness is a manifestation of poor organization and poverty and will double by the year 2000. The main reason is the failure to mobilize knowledge and technology into effective action.

Is there any quick solution to such problems?

There are a lot of things people and governments can do to help reduce eye problems. People should be encouraged to take care of their eyes. In the past, the World Health Organization (WHO) delivered vitamin A tablets to cure vitamin A deficiency among children, especially in third world countries like Indonesia. It was so impractical. Mothers can cook their children a large variety of cheap green vegetables in their daily meals.

Mobilization of medical people, eye surgeons, the government and the community is important. I believe Indonesia and other Asian countries have capable eye doctors and surgeons but they are concentrated in urban areas.

It is urgent to persuade them to go out to rural and remote villages. Prevention of blindness has for decades been the role of nutritionists and public health workers combined with lay volunteers.

Your ideas sound excellent. Do you think it feasible for the Indonesian government to adopt it?

For me, this is the best time for Indonesia to move on. Your President is suffering from eye problems so he will really understand and feel the urgency of having quality eye care centers and other health facilities.

But it will require quite a lot of funding which Indonesia is now lacking. Do you see any possible resources or help?

It is the job of the United Nations, rich countries and international organizations like Lions International, the Rotary Club, Helen Keller Institutes and other agencies to help nations in need.

Two years ago, a number of international eye surgeons, including myself, established the World Cataract Surgeon Society. It works to mobilize eye surgeons to utilize their skills to the benefit of less fortunate people. It is not just an international and professional organization, it is about humanity -- the willingness to help the needy. It is a challenge the eye surgeons of the world should accept.

How does society work to carry out its mission?

The number of eye doctors and surgeons in Asia is still limited compared to the rocketing number of patients. We would like to train and share experiences with our colleagues in Asia and around the world on the latest technology for curing eye problems. I would be very much willing to train Indonesian doctors. In the past, many doctors from developed countries came to poor countries and performed several eye operations, and that was all they could do.

We prefer a different approach. If you give a man a fish, you feed him for one day. If you teach him how to fish, he can feed himself for a lifetime. If you operate on one man, you restore vision to one man, but if you train your colleagues on how to perform low-cost quality cataract surgery, they will help save the world.