Doctors for Life

Doctors for Life's Project Manager, Johan Classen, shares about the transformational impact of 245 sight saving surgeries carried out by the team of eye surgeons between 1-12 February in a remote area on the border between Sudan and South Sudan.

Story by Jenny Davies & Photos by Johan Classen

Five-year-old Salma was tapping a rock on the strange metal cylinder she discovered whilst playing. It was about a foot or two long with fins at one end. An instant later, her life was changed as an explosion ripped through her tiny hands. The bomb had exploded in her face. Days before Christmas 2022, she was rushed to the hospital where thankfully, her life was saved.

The explosion left Salma (not real name) with traumatic cataracts. The visiting surgeons operated at the beginning of the outreach to remove the cataract in her better eye. A few days later they operated on the second eye to remove the shrapnel which had penetrated the retina.

In the days following that, her family watched as her sight steadily improved, until one day, ‘we saw this traumatized little girl begin smiling,’ Johan reflects with satisfaction. ‘It was wonderful to see as she became a child again.’ If it were not for the team’s timely visit, the explosion could have left Salma permanently blind.

A strong team of experienced surgeons can do a cataract surgery in just ten minutes, and thankfully, lead surgeon, Dr Jonathon Pons, is an expert in his field. He was accompanied on this trip by his daughter, Dr. Emma Jane Johl, also an eye surgeon, who screened patients and tackled some of the more straightforward cases. Each person in the team had an important part to play moving patients between the clinic, operating theatre and recovery ward. The team of eighteen included the eye clinic staff as well as volunteers who took medical histories and offered reassurance. With two tables running side by side, Dr Jonathon would finish operating on one patient and quickly move to the next.

Dr Pons estimates that one in five cases of cataracts was caused by traumatic injury. Some of these were children with thorns in their eyes or splinters from chopping wood. These cases are a priority. ‘You have to do surgery quickly with children, to stop them becoming permanently blind. If the eye is not used in children, the brain will eventually forget what it’s for.

‘Except in the case of children, the surgeons typically perform surgery on just one eye, which restores enough functional sight to help them live their everyday lives. If we did both eyes, we would reach half the number of patients,’ Johan pragmatically points out. The majority of surgeries were carried out were on older people who’d arrive, guided by a relative, tapping away with a stick over uneven ground. Cataracts are a natural part of the ageing process regardless of where you live in the world. The challenges of accessing healthcare vary considerably depending on where you were born.

It requires determination just to reach the hospital. Johan estimates that most of the patients travelled for three or four days, using a combination of walking and public transport, although journeys of between five and ten days were not unusual. They arrive days, sometimes weeks, before the surgeons so they can be at the front of the queue. Knowing this motivates the Doctors for Life team to see as many patients as possible. ‘I watched one older lady arrived walking timidly behind her sister, concentrating on every step. When I met her after her surgery, she was walking so fast her sister was trailing her! They were both laughing as the sister struggled to keep up! It was a joyful sight.’

‘It is rewarding to see older people get a new lease of life after the surgery. When you’re blind, the limitations on your life are very big. You lose your independence and become dependent on family. When I speak to the patients and ask them, ‘How is your life going to change?’ they tell me. ‘I can work again. I can eat food without someone stealing from my plate. If I put something down, I can find it again. I’m not reliant on people who don’t always want to help. I can use the toilet alone. I move around without risk from snakes and dangerous animals. It is less likely that I will have an accident on the way.’

Sadly, there are cases where the patient will remain completely blind Johan shares. ‘These patients put all their hopes on coming. They’ve been walking for days in the hope that they might be able to see again. Breaking the news that we're not able to help them is quite devastating. Especially if they're young,’ he adds solemnly.

One case in particular sticks in his mind. ‘There was one case of a soldier who came to us completely blind from a bomb blast during the war. He was hoping that we could do something for his eyes. He had already lost one eye that had been removed. The damage in his other eye was a retinal detachment. Sadly, if you don’t fix this right away the damage becomes permanent. We had to break the news. I watched as he processed the news via the translator. He just sat there devastated with his head in his hands.’

By the end of the outreach, hundreds of people have been touched by the skills of the surgeons. The total number of patients helped over years touches well over a thousand. For the team, it all adds up to some powerful testimonies, as Johan explains.

Having taken several MAF flights over the years, and spent days on the road, Johan is realistic about the commitment it takes to undertake these outreaches. ‘The bumps and turbulence you get in a smaller plane don’t bother me. I’d be bumping around a lot more if we travel by car. I’d rather bump and little bit than a lot!’ he laughs.

‘MAF are reliable. With other operators, we run the risk of them cancelling - and to be honest we don’t have time to waste. Travel is the single biggest cost of running an outreach. Getting our people and equipment to this particular location is an enormous challenge. Every day we’re delayed means 20-30 patients who are not regaining their sight. ‘Receiving and handling our cargo is another thing we appreciate about MAF. Some of our equipment, like the specialist microscope we used for glaucoma surgery, is heavy, fragile and expensive to replace. We need a lot of medical supplies for the surgeries. Everything has to be shipped.

‘Planes are just a tool that help us reach our end goal. An important tool, because realistically, if we can’t fly to this location then we won’t go there. The doctor’s time is precious, they are often taking unpaid leave or holiday time they could be spending with their families. We don't have the time to spend two weeks on the road to get there.’