Saving Sight with a Smile
by Steve Heilig, MPH

The following article appeared in San Francisco Medicine, the journal of the San Francisco Medical Society — reprinted here with permission.

When I was a kid, my friends and I would sometimes pose hypothetical questions such as, "If you could only keep one of your five senses — touch, taste, sight, hearing, smell — which would it be?"  As I recall, everyone without exception, chose sight. 

Much later, I was priveleged to assist the Berkeley-based Seva Foundation on blind-ness projects in the Himalayas.  Impaired vision in that region of the world — where there is extreme climate, much poverty, and no roads — can be a death sentence.  Blind people, including young patients in their thirties with severe cataract, trachoma, and trauma, become wholly reliant on their families for survival.

One such patient was a middle-aged man who had never seen his grandchildren, having become functionally blind years before. The volunteer eye surgeon completed the surgery and the patient wore bandages for a couple days. When the bandages were removed, he gazed upon his family at last. Within minutes, everyone in the area was in tears — including me. It was one of the most moving experiences I’ve ever had.

The story of Seva has been widely told: how a seemingly unlikely band of intrepid public health experts and sixties counterculture heroes came together in Asia in the 1970s to choose an intervention with the best chance of having real and lasting impact in alleviating suffering there. More than two million surgeries later, Seva (the name can be translated from Sanskrit roughly as “service with a smile”) has trained multitudes of clinicians, built hospitals and clinics, and provided much direct care and public health support. Patients sometimes walk for weeks to get to an “eye camp” or hospital for services.

A professed goal of much international health work is that visiting experts and clinicians should train locals to provide the services needed, so that the work in the field does not remain dependent upon visitors and the sponsoring organization. Most international programs do not attain this. But Seva does so, both in Asia and in its other projects in Mexico and with Native Americans. 

East Bay ophthalmologist and UCSF assistant clinical professor Naveen Chandra, MD, has volunteered his services to Seva at its hospital in Lumbini, in Nepal, partly for that reason. “The most impressive aspect of Seva’s work is that the model aims at making a charitable medical institution selfsufficient,” he says. “When I actually saw the magnitude of what they do, it was just staggering. The energy and passion these doctors and staff bring to their work is so inspiring.” As for his own visits, he explains, “At my last visit to Lumbini, I performed cornea transplantations on good candidates. We did other sophisticated ocular surface disease surgery: corneal limbal autograft, for example. In addition, and more importantly, I proctored their cornea specialist, Manoj Sharma, on cornea transplantation. Lastly, I gave lectures to the doctors on staff and in training on cornea topics.”

“I feel like I received more than I gave,” says Chandra. “This is why I went into medicine in the first place: to be able to help at a grassroots level, and to care for people who are so appreciative of the benefits of my work — it makes me re-energized and passionate about being a physician.”

San Francisco ophthalmologist David Heiden, MD, also works with Seva at its new Center for Innovation in Eye Care in Berkeley, California. “CMV retinitis is causing profound blindness in a substantial group of AIDS patients,” he notes. “We’ve launched the AIDS Eye Initiative, and our next step is to figure out how and what to teach overworked doctors on the front lines, learning from what San Francisco ophthalmologists did at the height of our AIDS nightmare. In such places as the slums of Rangoon or rural Africa, how can we teach AIDS doctors with almost no resources to do the crucial parts to prevent AIDS-related blindness? It’s exactly the sort of problem best addressed at a creative place like Seva.”

The late David Sachs, MD, an ophthalmologist and SFMS past president, first went to Nepal with Seva in the late 1980s, after I returned from a trip there and told him about Seva’s work. When he returned from that first visit, he reported that “this was the best ‘vacation’ I’ve ever had, and I’m going back.” He did so, repeatedly. There’s just something about Seva that speaks to the best in people.


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