Eyes Wide Open

Earlier this week as part of the due diligence I am performing for one of Acumen’s investments, I had the opportunity to visit one of the local missionary hospitals, and specifically the eye unit within the hospital.

Although I’ve read about eye units many times – there are countless missions in Africa and India addressing various sight robbing conditions through a multitude of different models and methods – I didn’t really understand why they were so prevalent.

It was complete myopia on my own part. In developed economies there is a lesser incidence of preventable blindness, a natural consequence of better nutrition and medical care, not to mention plentiful eye doctors with a variety of early interventions for those of the fortunate who face sight threatening conditions despite all the advantages.

Consider, for example, retinal surgeons. There are two in Kenya and five in all of East Africa. The missionary hospital I visited contracts one of these surgeons and his clinic is booked until mid-November. Retinal surgery is generally an urgent matter; waiting an entire season often means that your condition is inoperable by the time your appointment comes around. Especially since your diagnosis likely came very late, only after your vision is impaired enough to make a potentially day-long trip, loss of whatever income you would normally earn, and a cost of $3 (remember, this is a population living on just dollars a day) to see a doctor who may or may not be able to help you worth it.

And that is if you even know about the doctor. With 90% of the population without health insurance, and 80% of the population living in rural rather than urban areas, most people rely on personal networks to find out about those two retinal surgeons in a population of 38 million.

Two of the patients to be seen were young men, boys really, each of whom was blind in one eye from an earlier retinal detachment that went untreated. Since each boy could still see through their other eye, no one thought to send them to a doctor … until the second retina detached. One boy came from the far Western edge of Kenya, the other came from Mombasa, in the Southern part of Kenya. One has a good chance of seeing again, but the younger one, a boy maybe 10 years old, has only a slim chance.

The only part I thought I understood was that in a society without excess resources, in a community where people live on just dollars a day, in a community where everyone must contribute to the household the loss of sight is a profound burden.

But I didn’t fully appreciate its reality. Every eye patient had an escort: a spouse, a child, a parent, a guide to help them navigate the matatus and chipped pavement. Everyone sat patiently while the doctor asked questions and explained conditions. And I could feel the anxiety rising up in myself, imagining sitting in front of a doctor nervous to learn if my significant loss of sight was permanent or temporary, and what sort of treatment my eyes would receive if there was anything to be done.

At the clinic outside, a waiting area four times the size of my apartment in New York had been filled with people since daylight. It was raining, and I was told it was an easy day. The patients and their aides sat on long benches under a high roof in this open-air room nestled between the operating wards, an administration building, and the various diagnostic and consultation rooms. To be allowed to wait, you had to call a month or two in advance to secure an appointment.

And inside, the doctor saw patient after patient, with almost no pause in between, sometimes providing good news but often explaining just how much of the patient’s sight would not return, outlining the ongoing care (involving more trips to the eye clinic) to salvage what sight was left. And recognizing that this is one tiny sliver of what is going on, I am starting to understand why I so often read about eye clinics.