The John Fawcett Foundation in Bali

Wayan is over sixty-five years of age and lives on the Indonesian island of Bali. Nobody is entirely sure of his exact age, even Wayan himself is vague about it. Counting birthdays obviously hasn’t been a priority for him. He’s worked all his life in a rural community and has raised a family. In recent years Wayan’s eyesight has deteriorated, finally reaching the point where he is clinically blind.

Wayan suffers from a common problem. He has cataracts in his eyes, the lenses have clouded gradually until the point where they are almost completely opaque, shutting Wayan off from the visual world. He arrives at the mobile eye clinic in Jambayan accompanied and aided by his adult grandson, who guides him patiently by the arm into the University building where the clinic has been set up for the day.

I spent a day working with the staff of the John Fawcett Foundation, meeting just a few of the many thousands of Indonesian people who receive medical attention each year through the work of the Foundation.

Wayan’s solid expression shows great dignity. His grandson explains to Wayan that I have asked permission to take photographs and Wayan nods his agreement. I quickly appreciate just how much I rely on eye-contact when I make portraits and realise how redundant my encouraging smile is to Wayan. He cannot see me. It’s a sobering realisation and I am gripped by my imagination as I try to understand what life must be like for Wayan.

Wayan and I do not share a common language and my usual method of communication: body language and theatrical gestures, is useless here. So Wayan and I remain frustratingly disconnected. I assume that the rest of the world must seem like this to him, remote, distant and removed. I place what I hope is a reassuring hand on his arm, hesitating as I pull-back from an instinctive motion to show him his own portrait in the LCD screen of my camera. I show his grandson instead, who graciously gives a smiling nod of approval.

Wayan waits whilst his grandson completes the registration process. According to the John Fawcett Foundation, there are 3 million people in Indonesia who are blind as a result of cataracts and, as the Foundation points out, cataract blindness is easily treatable in the vast majority of cases.

Wayan soon reaches the front of a queue of people who have come to have their eyes tested. He is seen by a series of specialists who test his eyesight, determining how badly the cataracts are affecting his vision.

The tests show that Wayan’s cataracts are very mature, which means that they have reached a stage where they are allowing very little, if any, light to filter through. Wayan has only been in the clinic for 30 minutes but already it has been possible to determine that a simple operation to remove the cataracts could be performed before he goes home.

Wayan is prepared for surgery, his eye-lashes are cut, his blood-pressure is measured and he receives a queue number attached to a cord, which is hung around his neck. Wayan is number 9. He will be the ninth patient to receive cataract removal surgery today. It is just after 10 am.

Wayan joins a queue of patients outside the university building, where he waits quietly. Meanwhile, other patients arrive, keen to have their eyes tested. The John Fawcett Foundation offers free eye-tests for all and provides a range of spectacles to people who need them. The spectacles are free and it is this that motivates many of the patients to visit the clinic.

This is Depi. She is one year old and has a cataract in her right eye. Depi cannot see out of this eye and despite the fact that a cataract operation only costs about US$60, like the majority of Indonesians, her parents would struggle to be able to afford the surgery. At the clinic, Depi can be tested and an appointment can be made for her to visit the local hospital at a future date where one of the John Fawcett Foundation surgeons will quickly remove the cataract whilst she is under general anaesthetic.

Depi and I play together on the floor for a while and it seems that she is also a keen photographer, although that camera is probably as heavy as she is so she decides that stroking it would be the best approach. Perhaps she’ll grow up to be a photographer. All the best people do.

Outside, by the bus, more patients wait for their turn to be called. Each patient has a cataract which might have troubled them for years yet, by the time they leave, their sight could well have been restored.

The John Fawcett Foundation mobile clinics are sophisticated surgeries-on-wheels that allow the expertise and machinery required to perform cataract surgery to be taken into Indonesia’s rural areas. Residents in rural communities are often cautious about travelling far, even if they can afford to. The mobile clinics allow the solution to find them.

Inside, the mobile clinic bus is small but well-organised. Patients are prepared at one end of the bus, given a local anaesthetic and dressed for surgery.

When their turn comes, the patient walks a few steps to a second bed and lays beneath a powerful microscope, through which the opthalmic surgeon can see the cataract removal procedure in great detail.

A nurse stands by with a tray of sterile equipment. The bus has just enough room for one surgery table, a stool for the surgeon, a nurse, assistant and, when I’m very lucky, a photographer breathing-in and trying to make himself and his cameras as small and unobtrusive as possible.

A monitor connected to the surgeon’s microscope provides an astonishingly detailed view of the procedure. It’s possible to see how the surgeon makes a small incision and then carefully cuts away the core of the cataract.

It is painstaking work that requires the steadiest of hands and complete concentration. Here, Dr. Wayan Gde Dharyata, completes his sixth operation of the morning. Despite the concentration required, he is so practised in this procedure that he is able to chat cheerfully with his colleagues and with the patient. I ask how many of these operations he has completed and he laughs, “I am not sure. Many, many operations”. Back at the John Fawcett Foundation later in the day I ask how many operations Dr. Wayan has performed. Careful records are kept which reveal that he has removed over 16,000 cataracts.  I would consider it something of a miracle to restore the sight to one blind person. If the experience of watching a cataract surgery left me feeling somewhat awe-struck then the thought of 16,000 eyes seeing again leaves me speechless.

The care and precision required to perform surgery like this seemed, to me, to be quite extraordinary. But then I struggle to sew a button on straight so watching expert hands working on such a fragile part of the body was quite something.

The patient experiences very little discomfort and the initial anaesthetic injection is probably the only sensation that they feel. The entire operation takes about 15-20 minutes. In not much longer than the time it takes to make a decent cup of tea, this patient’s eye-sight has been restored.

Blind.

Not blind.

From the sense of distance and remoteness that gradual blindness must obviously bring to a return to inclusion and participation in 20 minutes. In terms of investment versus reward, that’s a very big win. This isn’t only about restoring sight, it’s about restoring people to being an active part of their community. It’s about bringing grandparents back to their grandchildren, it’s about enabling people to work again, it’s about providing people with a better quality of life. Every 20 minutes.

The cataract, removed. Dr. Wayan explained that opthalmic surgeons visiting from western hospitals and clinics are often surprised to see cataracts in such an advanced stage of development. In the west, cataracts are usually removed long before they reach this stage.

Whilst Wayan, who I met earlier in the day, is waiting nearby for his turn in the mobile clinic, this patient, also called Wayan, has been treated and sits quietly to recover. A few minutes after this picture was taken I saw Wayan climb onto the back of  a moped driven by his son and ride off down the road.

He will wear the bandage overnight and return to the mobile clinic the following day to have it removed and the eye, now cataract-free, will be checked. He will receive medication to prevent infection and within a month the incision will have completely healed. The operation has cost him… nothing. Other than the time to visit the mobile clinic, his treatment has been absolutely free.

Wayan waits to go home.

In the last 20 years, over 30,000 people like Wayan have received sight-restoring operations through the John Fawcett Foundation.

Posted on Saturday, September 24th, 2011 at 4:18 am. Filed under: Charity, Documentary, Travel Tags: bali, charity, indonesia, john fawcett foundation, NGO RSS 2.0 feed.