A special guest post from Battambang, Cambodia by Dr. Gary Barth, ophthalmologist and Seva volunteer Western Cambodia is a rural area where cash is hard to come by and has an economy in which the average worker only earns one dollar a day. Therefore, when blind Cambodians and their accompanying family members travel long distances by public transportation to regain their sight, surgery is usually scheduled for the same day. As Seva’s Dr. KC says, “These patients have contributed a lot to get here for surgery; we should oblige them and make it possible.” Such “surgery on demand” is rarely done in the West for a variety of insurance and malpractice reasons. In rural Cambodia, however, the patients do not have medical insurance and often are unable to pay for the surgery anyway, so surgery is performed the same day. Staying in a strange city waiting for surgery would only add to the financial burden of these blind patients. One telling example was seen on day #3 of Seva Canada’s Battambang Eye Camp. The man pictured here with the white cataract in his left eye was led in by his grandson. He walked in slowly and tentatively. His dense cataracts were consistent with his vision of only “counting fingers” acuity in each eye. He had heard about the cataract camp and came two hours by bus to Battambang in hopes of finding someone who could remove his cataracts. The grandfather and grandson had paid $10 apiece for the bus ticket. The eight-minute sutureless cataract surgery was performed a few hours later on his right eye. The next morning, he walked confidently into the exam room, tracked conversations, and found the stool to sit on without using his hands. He was ecstatic and asked to have the other eye done that day. Again, the schedule was opened up, and he had a second cataract surgery less than 30 hours after being initially screened. On the next day, he was a changed man. He declared he would go back to his village and encourage others who were going blind to come in and have cataract surgery.

Another example of surgical flexibility at the other end of the age spectrum occurred that same screening day. A young boy of seven was seen at a Seva-sponsored school screening. The boy had marked crossing of his left eye and was referred in for surgery to straighten his eye. However, when he was examined by Dr. KC and myself, we found he had a cataract that was evident with dilation and our office-based exam equipment.

We just switched the surgical plan; and, later that day, he had a posterior polar cataract and primary capsulotomy accomplished. By the next day, his vision had improved from “count fingers” to 20/200, and his eye was much less crossed. With luck, he may not need a strabismus muscle surgery to straighten his eye now that the eye can again focus and attempt to align with the other eye. Another example of “same day consultation/surgery” scheduling occurred today. The last day of the Seva Canada-sponsored eye camp. A young girl came in after the consultation sessions had been completed and surgery was finishing up. She was severely cross-eyed. She had been identified as needing surgery at the rural outreach last week; but, for logistic reasons, her dad could not get her into the government hospital on time. After the scheduled surgeries were completed, Dr. KC went back to the closed consultation section, examined her, and negotiated with the nurses to re-open surgery after lunch. His reasoning was that the government doctors were reluctant to do cross-eyed surgery, since it took much longer than doing five cataract surgeries. Secondly, once the Seva-sponsored eye camp moved on to another city, it would be a year before free surgery would come back to Battambang. It was a bit of a hustle to make it happen, but the next morning she was so happy to look in the mirror and see that her eyes were straight.