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Homemifeature“It’s Up to Me”

“It’s Up to Me”

Shaun Chang (left), founder of Eyes4Everest with Pemba Sherpa, chairman of the Himalayan Trust Nepal, exchanging signed copies of the Memorandum of Understanding documenting each organisation's responsibilities regarding the provision of primary eye care in the Everest region.

In February 2013, I visited the Khunde Hospital following an unsuccessful trek in the Sagarmatha National Park. The doctors and hospital assistant gave me a tour of the hospital. Upon learning that I was an optometrist, they asked me what I could do for uncorrected refractive errors.

The hospital had an old Nikon vertometer, three bags of donated glasses, and a trial lens set from 1966. The lenses did not come with labels, and most were not in the box. I later learned from Dr John Heyden, a former volunteer GP stationed at the hospital, that the best they could do for patients with uncorrected refractive errors was to go through the bag of donated glasses and find a pair that provided the best vision.

I taught the doctors how to use the vertometer that cold afternoon. Our first mission was to return all the trial lenses to their appropriate slot. Upon completion, the hospital manager discovered that a -1.75D lens improved his distance vision significantly. I left knowing I had made a difference, but more work needed to be done.

After a few unsuccessful appeals to help the Khunde Hospital, my colleague, optometrist Dr Carina Trinh, helped me realise it was up to me to find a solution. And so our first team of three optometrists and one pharmacist travelled to the Khunde Hospital for our first eye camp in 2014. One of the optometrists got sick, so it was up to two optometrists to see 152 patients over two and a half days. A total of 32 pairs of glasses were prescribed. Our examinations involved refraction, binocular vision, and ocular health. Given our limited resources, it was little more than a visual screening and very tiring work. I was proud of our efforts, but patients were still waiting outside. Some had travelled three or four hours from their villages to see us and had to walk home in the dark. We left the hospital exhausted and heartbroken.

Stories from the 2014 trip brought us more volunteers in subsequent years. We decided to walk to the villagers rather than have them walk to us. Our equipment was limited to portable devices that had relatively good battery life. Occasionally, we would hear about a person who was so visually impaired that we had to examine them in their own homes.

Most of the time, we could identify the ocular condition affecting a patient’s vision. We could make and deliver prescription spectacles, provide ophthalmic eye drops for anterior eye conditions, and/or write a referral letter to an ophthalmologist if we identified cataracts or other UV-related damage. We wanted to educate patients about their ocular condition so that it would never limit their ability to travel to an ophthalmologist.

Eye camps organised by the Tilganga Institute of Ophthalmology (formerly the Tilganga Eye Centre) in Kathmandu, or the Visiting Ophthalmologists’ Scheme (VOS), run on a two-year basis between the Khunde Hospital and the Lukla Hospital, a Swiss funded hospital. We would pass on the patient’s contact details, so they could be contacted about cataract extraction surgery. Post-operative care was limited to one week, so complications following surgery were not uncommon.

As mentioned, some patients could not access eye care because they were confined to their homes or remote villages. Some did not want to access eye care at all.

I remember a case of ocular albinism in a Sherpa girl in 2015. Ideally, we would have provided her with prescription sunglasses and referred her for low vision management. We could not do the latter, and I am sad to say we never saw her again. The family decided in later years to isolate themselves from the community. Sherpas are devoted to Buddhism and consider medical ailments to be the work of evil spirits. If prayers from the lamas and Western medicine do not work, many consider isolation a sensible option.

As the years of eye testing went on, we were joined by Nepalese optometrists and health assistants of Sherpa ethnicity. They had the cultural background to reverse outdated thinking and were passionate about improving their people’s lives. Some of them became our good friends.

During the COVID pandemic, sending Australian and New Zealand volunteers was impossible, so it was up to our Nepalese team to continue our work. However, we agreed that a collaborative approach was the best eye care for the mountain communities.

In 2023, 70 years after the first ascent of Mt Everest, we opened a dedicated eye clinic within an existing room at Khunde Hospital. The clinic is equipped with an autolensometer, digital letter chart, slit lamp, and refraction and binocular vision equipment. The next challenge is to determine the best way to staff the clinic, so it can continue to provide reputable primary eye care. I am reminded that when the hospital opened in 1966, volunteer Kiwi doctors took care of it. The Sherpas at the hospital were assistants but slowly built up their own experience from working there. One of these assistants was Kamitemba Sherpa, who later received a scholarship to study medicine in Fiji. He returned to the hospital as a qualified Sherpa doctor.

I don’t know if this will be the story for our eye clinic in the cloud. However, I am confident that the solution will find itself.

Shaun Chang graduated from University of NSW in 2008 and is the owner of Eyes2Learn, a behavioural optometry practice in Newcastle in the Hunter Region of New South Wales. He is a Fellow of the Australasian College of Behavioural Optometrists and holds a postgraduate ocular therapeutics degree from the University of Melbourne. He founded Eyes4Everest in 2014.

Judy Nam Bsc, MClinOptom is a clinician researcher at the Centre for Eye Health with interests in improving early diagnosis and using imaging technologies to develop enhanced health management systems. She is the chair of Optometry NSW/ACT Early Career Optometrists committee, where she advocates for young optometrists, ensuring the profession continues to be an integral part of the healthcare community.