A man of vision
Pointing to the clock on the wall of a clinic in Sanrao, a small town in Chaozhou, about 400 kilometres from Hong Kong, the elderly woman asks: 'Is it half-past nine?'
For more than two years, the woman, from a rural family, had lived in darkness. She was blinded by cataracts in both eyes and relied on her senses of touch and smell to accomplish chores such as preparing meals for her family.
Like millions of cataract patients in small mainland villages, she had resigned herself to a life without sight.
But on Boxing Day her life changed completely - she regained her vision, a day after she underwent a cataract operation. For the first time in two years, she could see the clock, and the faces of her loved ones.
Standing next to her at the clinic that day was Chinese University professor Dennis Lam Shun-chiu, who recently set up the first cataract clinic in Sanrao.
The disease, the clouding of the eye's crystalline lens that works like an auto-focusing lens on a camera, is the leading cause of blindness worldwide.
There are 50 million people living with blindness worldwide and about half of them suffer from cataracts - most in developing countries.
On the mainland alone, an estimated 4.5 million people are blinded by cataracts, with the number of new cases rising by 500,000 a year. Most sufferers live in rural areas.
For the past 10 years, Professor Lam, chairman of the university's department of ophthalmology and visual sciences, has been doing voluntary work on the mainland to help eradicate blindness. In 1997, he and a team of specialists helped set up a programme called Lifeline Express, which now has three trains shuttling from one town to another on the mainland, providing free cataract operations to patients.
Professor Lam said that, although the Lifeline Express programme - which conducts 9,000 cataract operations a year - was successful in helping mainland patients, it had to rely heavily on donations and had failed to be self- sustainable.
'For those 9,000 patients, a cataract operation is a big gift - it changes their lives completely,' he said. 'But with 4.5 million blind people on the mainland, 9,000 is still a small number. Lifeline Express is a very good project, but do we need another model of service to help more people?'
The urgent need for a self-sustainable programme prompted Professor Lam - also the director of the Hong Kong and Shantou University/Chinese University of Hong Kong Joint Shantou International Eye Centre (JSIEC) - to set up rural cataract clinics at which local doctors learned the skills needed to help their communities.
With his colleagues from the Shantou eye centre and a team of volunteer doctors from Hong Kong, Professor Lam opened the Sanrao clinic.
The centre, attached to a local hospital, was officially opened on December 26. So far, 60 patients have undergone cataract operations and a further 100 patients are on the waiting list.
Professor Lam said cataracts were chosen as the subject of this 'poverty-relief' project because they were the leading cause of blindness worldwide and the condition was reversible.
'Unlike blindness that's caused by glaucoma or diabetes, cataracts are a reversible blindness. A cataract operation is very effective. The skill transfer is easier [than required for other illnesses] and equipment needed isn't that expensive.'
Professor Lam said the problem facing the mainland was that only hospitals or clinics of the provincial and city level had the skills and equipment to conduct the operations.
Patients living in counties, towns and villages had to travel long distances to cities for the procedure, assuming they could afford transport expenses and fees - up to $7,000 per operation.
'The transport costs and operation fee are more than the annual income for most village families. Many are left with blindness until they die. Medical facilities in rural areas are not up to standard, and cataract operations are simply not accessible and affordable to villagers.'
Professor Lam said the programme, launched with a $10 million donation from the Li Ka-shing Foundation, was self-sustainable.
'We used the $10 million for equipment and the set-up cost. We charge each patient 700 yuan for cost recovery. As it is a poverty-relief programme, we have bargained a good price for the equipment.'
Five other rural cataract clinics will open this year in Chaozhou, with a total of 10 centres scheduled to be opened by next year. Each clinic will conduct 2,000 operations a year.
The trainee doctors are local general practitioners, some of whom were doubtful they could learn the necessary skills to conduct eye surgery in such a short period of time.
But Professor Lam said the key to success was a narrow curriculum. 'We're not there to teach the local doctors to be all-round eye specialists, only to be specialised in cataract operations.' He said the programme needed to train local village doctors because it was difficult to attract eye surgeons from city or provincial hospitals to work in rural areas.
Under the programme, each trainee has to conduct 100 operations on animals and assist experienced doctors in 100 operations. The trainees then carry out 100 operations under close supervision.
Professor Lam said the two local doctors trained so far had picked up the skills quickly, and were still working under supervision.
'We believe that this is the new model to eradicate cataracts on the mainland, and we hope that, in the future, such a model can be applied to other illnesses,' Professor Lam said. 'We hope that, within five years, 100 rural cataract clinics can be set up on the mainland with the same model.'
But the professor admitted he had to take measures against any possible corruption or mismanagement that could compromise the programme.
Local doctors were banned from receiving 'red packets' from patients, a practice to ensure better service that's still common on the mainland.
'On the walls of the Sanrao clinic, there is a big poster saying 'No red packet'. It's a very strict rule.'
The mainland is not alone in being under-resourced to deal with cataract patients. The waiting lists at Hong Kong public hospitals are so long that some patients have to wait more than three years for an operation. Many can't afford to consider the private sector, where the procedure costs anything from $8,000 to $150,000.
Professor Lam said the standard of eye surgery in Hong Kong was among the best in the world, but people had to decide how the health-care system should be funded.
Professor Lam, who shuttles between his teaching and research in Hong Kong and the voluntary work on the mainland, said one of his best assets was good time management.
Every week, he spends one day teaching students surgical skills and takes two sessions seeing patients at clinics. On weekends, he flies to Shantou to teach doctors there.
He also spends his holidays doing voluntary work on the mainland. 'We don't have time to do all the things we want to do, but we should have the time to do the most important things,' he said.