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With deft, precise touches, Mastura Khatun goes about her work. On the operating table below her is a three-year-old girl, one eye staring upwards, a small brown disc visible through turquoise surgical sheets.
Working through a microscope, Khatun starts to remove Erina Hossain’s cataract, making precise cuts as she moves around the girl’s clouded lens, before finally winkling it out. Then Khatun, senior consultant at the Islamia Eye Hospital in Dhaka, introduces an artificial lens, which she nudges into place. It is skilful work, requiring very steady hands. “At any moment you can rupture the lens capsule,” she says.
Half an hour later, Erina is on a trolley, being wheeled back to the children’s ward with its wall paintings of Bengali jungle scenes – prancing tigers and fish – and regimented rows of wrought-iron beds, overseen by a starched matron. The girl is accompanied by her mother Bilkis, 29, and father Ismail, 35, who clutches his daughter’s cuddly toy.
For the Hossains, who live in one tenement room on the edge of Dhaka, this is a bewildering encounter with the world of modern medicine. For Dr Khatun, 54, it is just another operation – but one that should spare a child from a lifetime of blindness. “I was the first trained ophthalmologist in Bangladesh,” Dr Khatun says.
Dr Wahidul Islam, Bangladesh country director for Sightsavers, the international development organisation supported by this year’s Financial Times’ seasonal appeal, says: “Eye health is a very big issue in Bangladesh – a lot worse than in other developing countries.” Lack of money has forced policymakers to make hard choices; it has also contributed to ignorance and the spread of conditions that cause visual impairment. “There is a big link between blindness and poverty, it causes a huge economic loss,” says Dr Islam.
Founded in the UK in 1950 (originally the British Empire Society for the Blind), Sightsavers tackles preventable blindness, and has been working in Bangladesh since 1973. Its staff assess need and deliver treatment and supplies. The charity also works strategically, lobbying government officials for the inclusion of visually impaired people in schools and workplaces, and to give more prominence to eyecare.
The World Heath Organisation estimates that preventable blindness accounts for as much as 80 per cent of the 314m worldwide cases of visual impairment. And the number one cause of preventable blindness is cataracts. Formed when the lens of the eye clouds up, cataracts prevent light from hitting the retina. In 2010, partners supported by Sightsavers carried out almost 65,000 cataract operations on adults and children in Bangladesh.
In the developed world, cataracts are a problem faced by the elderly. In poorer countries, the condition is common in children and can be caused by maternal illness, such as measles, during pregnancy; or by genetic problems. Infections or traumatic events such as an accident can also trigger cataracts.
Any cases of child cataracts in the UK each year are typically swiftly treated through health screening in the NHS. Not so in the developing world, where child cataracts are often not picked up because healthcare systems are patchy, at best, and there is widespread public ignorance of the condition and how it can be treated.
Erina’s mother Bilkis, who works as a seamstress in a garment factory, first noticed her daughter had a problem about a year ago. If she stood beside her daughter, the girl “did not notice me unless I called out”, she says. Erina stopped venturing into the small yard that the Hossains share with three other families.
Her worried parents turned first to traditional medicine. One healer massaged Erina’s back with leaves, another told them to “put garlic in the ground and when it disintegrates the problem will be gone”. (Other traditional cures include the application of “snail water” from a squeezed mollusc and “couching” – punching out the lens of the eye with a needle.)
Ismail works as a casual labourer, and one of his employers told the family they should take the girl to a doctor. From there, one of Sightsavers’ local partner organisations referred Erina for free treatment at the Islamia Eye Hospital.
Erina’s condition has taken its toll on the family’s life and its already precarious finances. Ismail gave up his job tending cattle to spend more time with his daughter. His current work – ferrying bricks from the many brickworks whose smokestack chimneys punctuate the surrounding neighbourhood – is less well-paid, bringing in about £40 a month.
Erina’s brother Billal, a lively eight-year-old, stopped going to school so that he could look after his sister, feeding and playing with her and ferrying her to the tenement’s single shared toilet.
On the day of Erina’s operation, FT photographer Charlie Bibby and I drive out to the family’s home, through the enervating treacle of Dhaka’s traffic and rickshaws. (“Behind the Turag police station and west side of the Exper Take Knitting Ltd,” read the directions that take us out of the centre, past waterways and factories.)
The Hossains recently moved here, escaping one of the capital’s slums, in the latest stage in a journey of modest progress that started five years ago when Bilkis and Ismail left their home province of Sher Pur in central Bangladesh, one of the poorest parts of the country.
Inside the family’s room, Billal is playing with his sister on the bed; she laughs along, though her stare into the middle distance betrays her limited vision. Outside, Ismail is tense and tearful. A lot rests on the success of Erina’s operation. In this society, girls with bad vision (even those who just wear glasses) do not “make a good marriage”, he says. As they walk down the dusty lane towards the car that will take Erina and her parents to the Islamia, it is Billal who comforts his father with a reassuring pat on the back.
Treating childhood cataracts is more expensive than it is for adults, costing, Sightsavers says, on average £75 per eye – compared to £17 for adults – as the operation and follow-up care is more complicated. But the longer-term benefits of giving children sight-saving operations is considerable to the patients and to society. “It is the most cost-effective thing in the whole world,” says Dr Deen Mohammad Nourul Huq, director of Bangladesh’s national eyecare plan and president of the country’s opthalmologists’ association.
Arriving a little late for dinner in one of the city’s smarter hotels, this self-confident and jovial surgeon explains that he has just finished operating – eight procedures between 4pm and 7.30pm. After dinner he will return to his private practice, where he will work until after midnight.
In Bangladesh, surgeons who work for the public sector in the morning can swap to private work later in the day. Allowing doctors this freedom boosts operating capacity in a country that suffers a severe skills shortage, but Bangladesh still lags far behind its neighbours, India and Pakistan, in terms of the numbers of cataract operations it carries out. There is a backlog here of an estimated 600,000 people needing treatment for cataracts.
One of the challenges facing organisations such as Sightsavers and its local partners lies in identifying children who need care and treating them before it is too late (generally, before the age of seven). Dr Huq wants to establish 5,000 community eye clinics to find people who need eyecare – especially those living in rural areas, far from projects in Dhaka. (In the capital, for example, Sightsavers supports, together with Standard Chartered bank, a project aimed at delivering basic eyecare in the slums that are home to almost a third of the megacity’s 15m inhabitants.)
Huq is optimistic about his plans, citing successful health campaigns that centred on nutrition and vitamin deficiency and involved close co-operation between local officials and international non-government bodies – known in the acronym-ridden jargon of the development world as “Ingos”. If his project succeeds, Bangladesh may yet make significant steps towards meeting its commitment to Vision 2020, the international initiative led by the World Health Organisation to eliminate preventable blindness by the end of the decade.
Huq is a key player in policymaking in Dhaka, and works with the country’s health ministry on devising strategy. But, he says, the basic appeal of his surgical work has not diminished. When dinner is over, Huq still has an eye on the clock and is mindful of his waiting patient, but allows himself a moment of reflection. “Immediately after the surgery, the patient starts seeing. The satisfaction for a surgeon is tremendous,” he says, beaming. “No other surgeon gets that.”
A day after the operation, Dr Khatun gets exactly that satisfaction when she arrives to take off Erina’s bandages. She tests the girl’s eye and pronounces it good. The Hossains are discharged but reminded that they will need to bring their daughter back to have the other eye operated on – some families do not bother, thinking, as Khatun says, that “one eye is enough”.
Erina will also need to keep taking her medication for a few weeks – something that the family cannot really afford. (“I will help them,” says the doctor, who says that she occasionally subsidises patients with supplies from her own stocks or her own pocket.)
When Charlie and I next arrive at the Hossains’ home, we are greeted by a beaming Ismail, clutching Erina, who now sports fetching red spectacles. “This morning she moved across the yard and back,” says Bilkis, proudly. The effect on Billal is almost as marked. “Now my sister is OK, I can go back to school,” he boasts. “I can do everything.”
Frederick Studemann is the FT’s analysis editor
See Charlie Bibby’s photographs of Sightsavers’ celebrity supporters on FT Magazine: Mirror image
Letter from the editor
The Financial Times is delighted to be launching its 2011 seasonal appeal to readers. This year, it is in support of Sightsavers, which works in more than 30 developing countries to prevent and cure blindness. Some 39m people are sightless. Yet 80 per cent of all blindness can be prevented or cured, often inexpensively, transforming the lives of sufferers and their families.
Frederick Studemann, our analysis editor, has travelled to remote parts of Africa and south Asia to look at Sightsavers in action – be it treating river blindness and trachoma in Nigeria or children’s cataracts in Bangladesh. In the next six weeks, his reports will feature in the paper and on FT.com with pictures by our chief photographer Charlie Bibby. Our seasonal appeals have raised £6m in the past five years for the featured charities, chosen in a vote of FT staff worldwide.
This year we are lucky to have extremely generous support from two large donors.
Standard Chartered bank, which has a longstanding charitable relationship with Sightsavers, will match all donations, pound for pound and dollar for dollar. The UK government will match all donations from individuals in Britain. The effect will be to double all donations, and those made by the UK public will be tripled – a huge incentive for giving.
The FT is mounting two other fundraising events: an auction of superb pictures by international photographers; and an auction of lunches in the company of star FT writers and editors, generously provided by some of the world’s leading restaurants.
You will also find messages from Richard Meddings, finance director of Standard Chartered, and Andrew Mitchell, Britain’s international development secretary, explaining why the bank and the UK government are supporting the FT appeal. I hope you will be equally inspired.
Lots of ways to multiply donations
Donations to the Financial Times 2011 seasonal appeal will go much further thanks to two generous agreements to match readers’ contributions. The effect will be to double all donations and to triple those made by the UK public. Further funds will be raised by an FT photographic auction and an auction of lunches with FT writers at leading world restaurants.
● Standard Chartered, the global emerging markets bank, already a strong supporter of Sightsavers, will match all donations to the appeal – pound for pound and dollar for dollar – through its longstanding community investment programme, Seeing is Believing. Richard Meddings, the bank’s finance director and chairman of Seeing is Believing, says: “For Standard Chartered, the case for tackling avoidable blindness is compelling. Even a relatively small contribution can be the difference between a life of sight and a life of blindness. That’s why we’re proud to support this appeal by matching all contributions.”
● The UK government will match donations made by individuals in the UK. Andrew Mitchell, the international development secretary, says: “The British public has repeatedly shown its generosity during tough economic times, supporting charities’ life-altering work in some of the world’s poorest countries. We are responding to that generosity of spirit by matching public support for Sightsavers pound for pound – and working with Standard Chartered means the charity can triple its impact.”
● Caroline Harper, chief executive of Sightsavers, says: “The appeal will enable us to change the futures of those in the world’s poorest countries who are blind for the lack of access to simple and cost-effective treatments. Readers could help us raise more money for the appeal by asking your employees, friends or colleagues to donate their last hour of pay for 2011.
“Standard Chartered is asking its global workforce to donate their last hour, which after matching we expect will raise at least $600,000. To find out more and to calculate your hourly rate, visit www.sightsavers.org/ftappeal or email email@example.com.”
● The FT and top restaurants have combined to offer readers the chance to bid for lunch with some of the paper’s leading writers and editors.
The auction will start on December 1 and will run until December 11 at www.ebay.co.uk/ftappeal
● The FT will also hold an auction on November 30 of images donated by leading international photographers. To view the photographs go to www.ft.com/appeal