If music be the food of love

There was a wonderful moment on our last trip to Mumbai. A young man asked Second Sight trustee Francisca van Holthoon what her day job was.
‘I am a violin teacher’ she said.
His eyes widened.
‘Wow!’ he said.

It was a wow moment for us, too. There is a strict hierarchy of admiration for certain professions in India – ‘second only to God’ status for doctors and now, almost displacing them from their pedestals, engineers (especially daughters). And of course, joining a successful multi-national family business is considered a commendable occupation for many Mumbai offspring – like our young acquaintance. They are also expected to get involved in sewa– an Indian concept referring to selfless service for others. This young man’s father felt that our work in Bihar fitted the description of sewa. He therefore wanted us to inspire his son.
However, no visible sparks of enthusiasm were lit by our tales. But then the young man asked his question. And lo and behold Francisca’s musicality provided an unexpected muse for him – a source of momentary inspiration at least.

And how apt a reaction, I thought on reflection.
Because music - played, remembered, appreciated and experimented with, music sung and danced to and even used as a kind of comfort blanket – well, it has been important in the Second Sight Story right from the start.

What do you think caught my imagination about Dr Victor Rambo?
Was it because this American missionary doctor, an ophthalmic legend in north India, was the first to start mobile eye camps in order to treat patients unable to reach hospital? That he dedicated 50 years of his life to eye care for the poor? That he ensured his legacy in the Himalayas by training my good friend Dennis Kendall, now in his 90s and who is still doing a stalwart job in the foothills?
Truthfully, no.
What captivated me was hearing that, when 15 mules transported Dr Rambo’s baggage across dangerous mountain passes, this baggage included not just ophthalmic equipment, food and clothing…but a record player. Dr Rambo loved jazz and would dance to its accompaniment to relax patients before surgery. I had already heard that Dr Rambo once said that curing the blind was ‘the happiest work in the world.’ Now I totally got it.

When Francisca and I travel to India we try to take an old violin and a cheap guitar. They are wonderful accessories going through Indian airport security. When the diligent and, usually, extremely polite and youthful personnel find my small pocket ophthalmoscope they treat it with mild suspicion – it could just be a small explosive device. When told that it is a solar-powered instrument for examining the eye, they are impressed, then immediately display hyperchondriacal anxiety and ask nervously ‘my eyes are ok?’
With the guitar they might request a quick song or strumming of chords. Far more fun for everybody.

Singing can also be revelatory. What and how people sing can convey much useful information about them.
When I first visited my friend Dr Helen Rao’s eye department at The Duncan Mission Hospital two decades ago, she invited me to Morning Devotions in the chapel. In the front pews were rows of young nurses, wearing the old fashioned traditional white caps. They rocked from side to side, black hair and white caps bobbing in perfect synchronicity, singing like happy angels. Later, their enjoyment of their medical work matched the joyful singing at daily worship.
Years later, Helen headed another eye department at a Christian mission hospital known for its rather fiery and frightening evangelicalism. We were asked to judge a singing competition. We sat through one group after another of stern, unsmiling nurses, shouting hymns at us. Helen told them to pipe down. I laughed at her irritation. What did you expect I asked. The same young women had been in her eye department earlier when she was giving her gentle, informative post-operative briefing to patients.  As soon as Helen had left for her ward round, these nurses had taken the opportunity to bellow Bible readings at the patients as they waited for transport home. Vocal vehemence seemed to be part of the job description.  And proselytising took precedence over caring.

Once, on a freezing winter’s night in rural Bihar, we gathered at a farmhouse. Crammed into a small rooftop bedroom was photographer Jenny Matthews, two of the bosses of Laxman Eye Hospital and the farmer who had helped arrange the very successful village screening programme earlier that day. The locals sang us folk songs; we sang them Leonard Cohen. By the time we went to bed, we all felt a lot warmer. The next morning, on the same rooftop, we each carried out our usual morning routines – yoga, prayers, bodily ablutions, reading the newspaper – as if we had lived and worked together all our lives. Call it due diligence Second Sight Style.

Last summer we finally got round to visiting an eye hospital in the Seohar region of Bihar. They had been asking for our guidance for years but something had always prevented us getting there. The super-excited hospital founder wanted to get the Welcome banner just right. So he sent me a picture of the design before getting it printed.
He had found a photo of ‘me’  on the internet that was actually BBC broadcaster Samira Ahmed and described her/me as the ‘greatest humanitarian’….
Please, no welcome banner necessary I messaged. Just ask a patient to greet us, in their own way.
A smiling post-operative cataract patient did just this. He came from a village famous for generations of sanga players. ( Sangas are traditional Indian wood instruments, resembling giant upside down smoking pipes, the kind my Dad used to smoke) . Anyway, this patient brought three sanga musicians along with him who provided a spontaneous, enthusiastic welcome for me and Second Sight trustee Sabilah Bundhoo.

Sabilah doesn’t herself play a musical instrument. But she has an even more impressive musical ability – she can sing every single song in every single Hindi movie ever made. (I exaggerate only slightly). Nothing else can endear you to more people in India. In Bihar, where Bhojpuri is spoken in many areas, Bhojpuri movie songs are popular. She knows some of these, too. Whether it is a radio in a car, a fellow traveller humming in a bus or a movie poster at train station that sets her off, Sabilah will break into song, with the expressive hand movements, head wobbles and coy eye movements learned from a lifetime of watching Hindi movies. Those who can, join in. Those who cannot wobble their heads in appreciation.
In the India of 2024, there is a more serious side of connecting through music in this way. It was put well in an article I read in NewLines Magazine last month.
‘Historically, the shared passion for Bollywood films united a country made up of multiple faiths. Nowhere is this more evident than in the fact that for over three decades the reigning superstars in India have been three Muslim actors: Shah Rukh Khan, Salman Khan and Aamir Khan. However, in the India of recent years, there has been a worrying polarisation along religious grounds, fed and encouraged by PM Modi’s Hindu Nationalist Government. So every move to remind people of the power to bring people together to recognise that they share more than what separates them is now super important.’

If music be the food of love, play on said Shakespeare’s Duke Orsino. And that’s the page we are on. This summer we were unable to take our guitars and violins and singing voices to Bihar as we usually do. But we have been busy in the UK using the power of music to help the Second Sight work. My wonderful BGA gospel choir – representative of London’s vibrant, open-minded, multi-cultural and multi-faith population, held two fundraising concerts for us. The Second Sight ceilidh band had people dancing at marriage and birthday celebrations in the villages of Devon and who paid for their entertainment with donations that would cure the blind villagers of Bihar.
The summer concluded with the charity’s biggest annual fundraiser -Firestone Music festival, also in Devon. The event is organised by Fiddler Extraordinaire Francisca van Holthoon and her family. Violins had a good showing but there were also electric guitars, drums and bass, brass and wind instruments galore and a domed, metallic instrument resembling a UFO which emitted a rich cosmic sound when played. The Bihari sanga musicians would have felt at home. This year, Firestone raised over £10,000 – that equates to at least 500 blind patients getting their sight restored this coming winter.

I think that might warrant a ‘Wow.’

Lucy Mathen

Lethal heat, precious water

The heated and often vitriolic campaign run by India’s Prime Minister Narendra Modi may have dissipated as a result of the shock General Election results. (His Hindu nationalist BJP party failed to secure an outright majority).

A much more pressing problem, however, remains. It is having a far greater impact on our patients and eye hospital teams in Bihar than any election result. It did not even get a mention from any campaigning politician.
It is the unrelenting heatwave and resulting health crisis.

The tragedy is that I wrote on exactly this topic last summer. But a year’s total inaction from world leaders to combat global warming has meant that 2024 saw the highest temperatures ever recorded on our precious planet. And places like the state of Bihar – one of the hottest and most humid in India and home to millions of her poorest citizens  – are worst hit.

According to Patna-based journalist Mhd Imran Khan, a brief press release dated 31 May 2024 from the Disaster Management Department (DMD)  of the Indian state of Bihar said 14 people died of extreme heat the previous day, including 10 officers on duty during the Indian elections. However, this is likely to be a gross underestimate reports Khan citing the fact that Hindi newspapers counted around 100 deaths across the state, with over 55 deaths on 30 May, more than 40 deaths on 31 May and six deaths on 1 June.

These stats took on a more personal feel last week when Dr Dhiraj Ranjan, who runs the MHKS eye hospital in Motihari, reported that two post-operative cataract patients had died from heatstroke. This was discovered when the hospital team went into their village to carry out their 15-day post-operative ocular examination. This is usually a very happy moment; a previously blind patient can see well, has no post-operative complications, receives a final discharge from hospital care and can resume being an active member of their family and community. Instead MHKS staff found two families in mourning.

To make matters worse, the hospital itself ran out of water. A hospital that we love for its beautiful location, perched on the edge of Motihari jheel (lake) where fisherfolk let down their nets from small wooden boats, migratory birds swoop over the glassy water in the winter, and the local rowing club occasionally holds races. The once beautiful lake is bone dry. The vegetables are wilting in the hospital garden which supplies food for patients and staff. At least the solar panels, installed last year by gallant workers climbing up onto the roof in 40+ degrees, are providing clean energy. Mindful of the hefty carbon footprint produced by healthcare – up to 4% of all carbon emissions globally – our hospitals could not be trying harder to be frugal and efficient in their methods of working, from planning their village outreach programmes to the type of cataract surgery performed.

So what to do about the water crisis in Motihari?

Well, we did as we did before with Bamdah Mission Hospital. We appealed for emergency funds from individual Indian donors to enable a borehole to be sunk. And once again, a handful of committed people sent the money immediately.
Standing in line in 47degrees to cast your vote for a politician may be exerting your democratic right.
But every time you spend money you are casting a vote for the kind of world you want.
So a big Thank You to Horace, Suzanne, Amit, Shalini, Surajit and family and Mahesh.

Perhaps this tale is worth remembering as we in the UK approach our own exercise in democracy in July. Whilst Climate Change was not even mentioned by any Indian politician, our own leaders seem to be using it as a mere debating point.

Lucy Mathen

#globalwarming  #water #climatechange  #NGOcarbonfootprint #actionnotwords

#heatwaveinBihar #water

Ornithology and ophthalmology – a perfect combination

‘The Adjutant half turned his head, sheered a little in the direction of the voice, and landed stiffly on the sand-bar below the bridge. Then you saw what a ruffianly brute he really was. His back view was immensely respectable, for he stood nearly six feet high, and looked rather like a very proper bald-headed parson. In front it was different, for his head and neck had not a feather to them…His legs were long and thin and skinny, but he moved them delicately, and looked, at them with pride as he preened down his ashy-gray tail-feathers, glanced over the smooth of his shoulder, and stiffened into ‘Stand at attention.’
The Second Jungle Book, Rudyard Kipling.

Kipling is describing a greater adjutant and what we saw, en route to a village screening camp in rural north Bihar, was a bird with which it is often mistaken - the lesser adjutant. Our sighted bird had a punk tuft of feathers on its otherwise bald head and its bill was narrower than the wedge-shaped, yellowed version of the greater adjutant. Nor did it have the characteristic pendulous pouch of that bird. First impressions of both birds, however, are the same. Sheer breathtaking size. That’s what caused our collective gasp of awe and the driver to slow down the vehicle.

Bihar is a state with over 100 million of the poorest people in India. But its rural areas are rich in wildlife including a huge variety of birds. Most of its people live in, work in, and love the countryside. Having spent much time amongst them during almost a quarter of a century, this line has crept into many of my funding applications for sight restoration : ‘imagine being able to enjoy once more the iridescent flash of a kingfisher flying low over a river.’
And now we have found a way for anyone who is eager to get off the well-trodden Indian tourist route, to visit rural Bihar and to appreciate the combined wonders of ophthalmology and ornithology. I will explain. But first let me just catalogue some of the birds that we came across on our most recent trip in January 2024.

A couple of hoopoes pecking the ground outside the walls of Bamdah Mission Hospital in Jamui district, southern Bihar. I love to think that this species may have been here for the 130 years that this hospital has been providing eye services to the poor. (The common hornbills that local eye surgeon Dr Samuel Murmu and I used to watch as they gathered in the spreading fruit tree in his garden, suddenly disappeared around 10 years ago.)
Also in Jamui, black Ibis who have deserted the tall palm trees, their previous gathering point, in favour of an ugly telephone mast. Each evening they vie with noisy green parrots in a cacophony of birdcalls.
A golden oriole in Madhepura district, north-eastern Bihar, which caught our eye as we left home for the Anand Eye Hospital.
A common kingfisher executing a rather attention-seeking circular flight for us just in front of this hospital. Many others seen throughout the trip.
A pied kingfisher spotted by one of our group.
Indian rollers galore (often confused with kingfishers)
Egrets
Koels
Mynas including pied mynas

And finally that awesome lesser adjutant which later flew so low over us we could make out the head hunkered into the neck, its huge wingspan, long legs and feet pointed like a ballet dancer. It chose the moment for its magnificent flight when we had identified a patient who, very sadly, was irreversibly blind in one eye, her injury to the cornea treated inappropriately by a quack doctor. Reminding us all of the importance of our work.
(No sightings of the state bird of Bihar, the house sparrow (known as the goureya in Hindi). Except a huge larger than life model in a museum in Patna. It remains an endangered species).

I have written a lot about the devastating impact of climate change in Bihar and the speedy action taken by our associated hospitals to reduce their own carbon footprint. This is the latest example…with an imaginative twist.

In the Bihar district of Madhepura, there is now an Eco Hotel. It is powered by solar energy, serves organic food grown locally, and encourages the protection of the environment and the promotion of good health – for example, there is a lift for disabled guests but others are urged to take the stairs. The hotel is above the Anand Eye Hospital, also powered by clean energy. Both hospital and hotel are the brainchildren of ophthalmologist Dr Amit Anand. He would like income from the hotel to help fund vital surgery for cataract-blind patients who are simply too poor to pay. Hotel Ananda guests who donate in this way need only step through glass doors on the ground floor to enter the eye hospital and watch the team at work. Most patients are farmers whose entire families spend long days in the fields sowing, reaping and transporting the vegetables and fruit that end up on the hotel restaurant tables.

Dr Amit is one of the finest eye surgeons I have ever come across. There is no ophthalmic procedure that he cannot perform. When it comes to cataract, he can restore sight to a blind patient in a few minutes. The cost is about the same as a night’s stay at the Hotel Ananda: around £20.
What a win win situation this could be if the newly opened hotel regularly filled its rooms! As for planning your birdwatching? Once installed at the Hotel Ananda, you can hire a local vehicle and start by taking a road well- trodden by Second Sight people. This links the Anand Eye Hospital in Madhepura with the YDMH eye hospital in neighbouring Araria district. It is a brilliant location for spotting all kinds of bird species. Ask the staff at both hospitals where they go for village outreach programmes and you will make further ornithological discoveries.

How to get there:
Flight to Delhi.
Flight or train to Patna in Bihar. Train to Madhepura (telegraph wire birdwatching all the way)
Vehicle to the Hotel Ananda.
Contact: hotelananda79@gmail.com Tel : + 919798536178/ +919234247822

Lucy Mathen

#ecohotel   #ornithologyandophthalmology  #hotelanandamadhepura #smallisbeautifulandlocal

Christmas Past Present and Yet To Come

At this time of year in rural India there are Biblical nativity scenes everywhere you look.

I took this photograph last year, in a tiny village in the state of Chhattisgarh. I was visiting the catchment area of the Canossian Catholic nuns stationed at Laripani.
It was at the end of a wonderful day spent walking through pristine forests or hitching rides on tractors, trailing behind Sisters Jessy and Anita. We went hut to hut checking on people’s mental, physical and spiritual health and exchanging good-natured banter.
We heard about marauding elephants raiding the stores of freshly harvested rice, and how pigs could sense their arrival well before humans. So when the pigs started fussing someone climbed to the top of a home and yelled a warning to everyone in the village and out came the team with firecrackers to frighten away the haathi .
We were invited to imbibe the local liquor by cheerful grandmothers. “12 hours a day they work so hard, this is how they relax’ the nuns told me without any hint of judgment.

When we spotted this new Mum with her radiant smile and in her stable setting, Sister Jessy and I had the same thought – instead of a carol service in the chapel why not a peripatetic service, walking around the village with its readymade nativity scenes, babies, lowing cattle, stars in the bright sky and all?

We didn’t though. The tribal girls resident at the convent school had already planned an exuberant show of Christmas songs with accompanying and compulsory boisterous dancing.
We dared not miss this.

It is hard to hold on to such joyous sentiments during this unprecedentedly bleak period approaching Christmas 2023. Palestine, the birthplace of the baby Jesus, is rocked by violence. Elsewhere in the Middle East world leaders practically laughed in our faces at COP28 at which representatives from indigenous peoples most affected by the climate emergency were vastly outnumbered by lobbyists from fossil fuel companies touting for new contracts. Watching TV news the other night, I found myself almost in tears when Christmas shoppers were stopped and asked about the UK government’s hard-line policy to deter desperate migrants arriving in small boats on our shores (or dying in the attempt). Said one : ‘it’s not nice to see but…there’s no room at the inn.’

So… let me return to happy snapshots of Christmas past and present … from India. A country in which only 5% of the population is Christian but where everyone celebrates everyone else’s festivals. My mother, who spent her childhood in rural India, used to tell us that this was one of the best things about growing up there. To this day, and in spite of the frightening religious polarisation that has taken place in India in the last decade, Christmas Day is a national holiday. And enjoyed by all.

At the Canossian Convent in Motihari, Bihar – down the road from one of our associated eye hospitals, the MHKS - they host a huge event. Some years so many local people want to see the nativity crib that the police have to control the crowds. What’s more, the convent is the perfect setting for an inclusive cross-cultural affair.
Today’s beautiful Sneha Sadan is only there because of the solidarity shown by key members of different communities. Advocate Priya Ranjan Sharma, a Hindu, was seminal to this tale. In his own words:

‘I was good friends with the catholic priest – Father Vijay. At that time the Church owned quite a bit of land near the jheel (lake). Father Vijay wanted to build a convent there. Some local people, very much opposed to Christians, encroached on the land, little by little. So Father Vijay came to me for legal support.’

‘I took on the case. This caused bad feeling. They brought some trumped-up charges against both Father Vijay and myself. These were thrown out of court. By this time I knew we had to come to a compromise. So instead of trying to win back all the land, we agreed on just enough on which to build the convent. Everyone agreed.
But there were some who asked me – why are you supporting the Christians against us? I replied: I am neither pro-Christian nor anti-Christian. I am just human.’

As are we all.

Thank you, dear readers, for your continuing support for the small heroes and heroines in Bihar who help each other regardless of religion, caste, creed or class. If you able to spend time reading more about them in Blogs Past during the holiday season I would be thrilled.
I wish everyone the happiest and most peaceful Christmas possible wherever you are.

Lucy Mathen

#peaceandgoodwill   #happychristmas  #justbehuman   

Tipping point or…business as usual?

Midnight arrival at Indira Gandhi International Airport, New Delhi. Ubiquitous adverts for the upcoming G20 conference to be hosted by India. The slogan: ‘One earth, one family, one future.’

Our taxi headlights pick out emaciated human beings lying on pavements, legs stuck out at crazy angles, heads lolling into the road. Are they dead? No just dead asleep. Utterly exhausted cycle rickshaw pullers getting some shut eye after yet another day of working in 40+ degrees.

We ride the Delhi metro. A cool, quiet, clean, nether region of travel, said to be 30% powered by alternative energy, aiming to be 100% solar powered. Above, people sit in four-lane, all-day traffic jams, vehicles spewing fumes into the heat haze. For Delhi’s automobile addicts, business as usual.

Midday arrival at Patna, Bihar’s capital. A dust storm swirls around us. I borrow the phone of a fellow traveller, a government employee from Delhi (agricultural department) who has come for a pre-G20 meeting.
‘I am here to make sure the famers have a platform’ she informs me. Sounds good. Over 75% of the Bihar population is engaged in agricultural work providing the nation with food grain, fruit, vegetables, spices and flowers.
‘Do you think anyone will listen to them?’ I ask.
She looks faintly amused.
‘Oh no, it’s just like CSR (corporate social responsibility). Our government has to show it consults the people.’
Business as usual.

In the middle of Patna - Tripolia Social Service Hospital. 23 nuns, 45 doctors, a 250 bedded hospital in a well-planned, compact site. Obstetrics, Gynaecology and Paediatrics mainly. Breezy corridors, relaxed parents, happy staff and every incubator in the special care baby unit (SCBU) occupied. Vegetables are grown on site. Hens provide eggs. Cows provide milk and one of the foremost fuels available in India, cow dung.  The Biomass unit sits next to the cowshed. And solar power? Naturally, Sister Manisha tells me, surprised to be asked. Holistic care provided by the Sisters of the Holy Cross. One earth, one family, one future.

Jamui district, southern Bihar.
The relief of staff at Bamdah Mission Hospital is palpable. Their new borehole is working well, the hospital has piped water once again. But staff member Laniel finds it hard to stop what has been his constant work for the past few weeks – he continues to wheel his cycle, back and forth from the well, two water-filled buckets dangling from the handlebars, concentrating on not spilling a drop. Ophthalmologist Dr Samuel Murmu and I make plans for water conservation.

In Patna city, Sightsavers India calls a meeting. 5 years ago they signed a Memorandum of Understanding (MOU) with the Bihar Department of Health. Perhaps the reps from these organisations intend to address the devastating impact of global warming on hospitals and patients? Not so. Invitees are asked to attend to learn about ‘Universal Eye Health, Changing landscape of Eye Health Finance and Policy, Formidable network of change makers in eye care transformation’ etc.
Only 17 people attend, just one ophthalmologist.
Bihar is burning. But in the air-conditioned 5 star hotel conference room it is business as usual.

North-western Bihar. The mercury creeps up to 47degrees. Staff at the MHKS eye hospital in Motihari bless their old-fashioned hospital building – the open verandas provide some breezy respite. But the beautiful lake opposite has so little water that fish are flipping themselves onto the land and dying.
In spite of the heat, gallant workers climb to the hospital roof and install solar panels. A week later they are linked to the grid, supplying clean energy for the hospital and earning income from the electricity board.  

Excursion into neighbouring Jharkhand state. I meet Dr Manisha Oaron. She and her husband run an eco-tourism business. The hope is that income from this business will fund her dental work amongst poor tribal communities whose livelihoods depend on the preservation of the environment. We agree that our professional pledge to Do No Harm has a wider context.
I put Manisha in touch with Azhar Khan who runs Drishti Eye Care Hospital. Back in 2019, 30 people were brought to his hospital who had died of heatstroke in a single day. Azhar vowed then that the protection of the environment would be an integral part of their work as an eye hospital. Each surgical patient is given a fruit tree to plant in their village; you can receive free cataract surgery if you bring in a bag of plastic for recycling. One earth, one family, one future.

In north-eastern Bihar, eye surgeon Dr Amit Anand has a Eureka moment. He has built a guest house on the top of his hospital building in Madhepura. The original idea, almost a decade ago, was that it would be a business venture. But what about this : the first solar-powered hotel in the district, providing organic food from local farms, guests encouraged to visit the untouched countryside with its abundant bird life…and to step through the glass doors connecting them with the eye hospital to meet the rural patients whose families produce the food. Income from the guest house can fund free surgery for the blind. Definitely not a business as usual.

Back in north-western Bihar. Temperatures remain high. Tempers flare.
An outreach team from a hospital located around 100 kilometres away – the Akhand Jyoti Eye Hospital (AJEH) - are in the Motihari area. They are trying to collect patients.
Staff from the local charitable eye hospital are incensed.
Why don’t you stick to your backyard? they ask.
Good question. Particularly on the carbon footprint front.
We are just following orders, reply the hot and harassed others.

The orders come from the bosses of the Akhand Jyoti Eye Hospital – ‘one of the top 5 eye hospitals in India’ (their words not mine). Their soon- to- be- opened new mega hospital at Mastichak is funded by Shankara Eye Foundation USA – also with a hyperbolic self-description : ‘the world’s largest free eye care program’. Guests from all over the world have been invited to fly in for the October inauguration. Sadly, in pursuit of living up to their Big Brand reputation they seem to be pitting Bihari against Bihari. And, when field workers and patients alike are feeling the sharp edge of the climate crisis.
I am reminded of a quote from an article by Delhi Professor of Economics, Arun Kumar.
“Development that has gone rogue pushes India into the growth mania. It needs to be discarded to prevent future catastrophic events and reduce the nation’s vulnerability, especially that of its poor.’

Of course the professor was referring to development as in the consumer-driven growth of Indian cities like Delhi : construction and services geared to catering for the wealthy, promoting over-consumption, generating more rubbish and pollution; everything done with such fierce competition and haste and lack of good planning and leading to environmental damage that is out of control.

However, charities/NGOs need to pay heed too.
Just because our kind of ‘development’ is supposed to be about bettering the lot of the poor, this does not sanctify the work. What is called ‘upscaling’ in the NGO world can rapidly tip into the kind of ‘growth mania’ described by Professor Kumar.

It was a turbulent summer 2023 in north India. Even in the foothills of the Himalayas where we went for some downtime, we were trapped by landslides and floods and were without electricity and phone connectivity for 3 days. But I am grateful. Because it placed the climate emergency at the centre of all our doings and there it will remain. My dearest wish is that every so-called development charity will follow the same path – ask themselves if their policies and modus operandi are actually fit for purpose in the context of the climate crisis.

For them to do so, however, they would have to discard two things
- Rivalry and
- Business As Usual.
Listen to the words of former Indian army colonel, Sanjay Srivastava. He is a familiar face on Indian TV at times of disasters, like the July flooding in Delhi. Whilst politicians yell and point fingers at each other, his is a noticeably quiet, implacable voice. This is not about Blame and Shame he says. We have a global Climate Emergency. We have the forecasts, we have sensible plans as to how to prevent further disastrous events. We have to act.

True to his reputation as a pro-active disaster and climate risk management expert, the Colonel used 20 minutes of our shared time together in Delhi to teach us how to instruct agricultural workers in Bihar on how to save their lives when lightning strikes. (Lightning strikes are increasing in India due to global warming and air pollution). We will pass on the knowledge to the eye teams in Bihar.
One earth, one family, one future…it has to be more than a slogan.

Lucy Mathen

#climatemergency #NGOcarbonfootprint  #lightningresilientindiacampaign #actionnotagendas

Water...and the Ted Lasso effect

I never thought I would get so excited about a borehole.

The video showed a skinny Indian man leaping down from heavy machinery. He peers under it to inspect the narrow, rotating shaft drilling into the ground.  And then, whoosh, there it was. Precious water bursting forth over the parched land. And on the video soundtrack, the satisfied shouts of the workers, and ophthalmologist Dr Samuel Murmu and his team at Bamdah Eye Hospital.

We whooped with delight in London, Devon, Surrey, Singapore and Mumbai. There was an exchange of excited emojis on WhatsApp. Disparate group that we were, we had all played a part in sinking that borehole. Without it, the hospital’s entire work might have literally and metaphorically floundered.
I was reminded of an episode in the TV series Ted Lasso that is currently attracting huge audiences and stimulating much discussion about how we human beings behave towards each other. The series revolves around the eponymous main character, a US sports coach hired to manage a professional English football team. Ted’s prominent character traits are an unwavering optimism and an inability to act with meanness or resentment. Ted Lasso has been called a feel-good series. More accurate would be to call it a Do Good series because, from what I have read from research done on its impact on viewers, people go away after each episode wondering how they can be better people in their specific work/life situation.

Anyway, the episode I recalled whilst feeling good about Bamdah’s borehole went like this.
The character Sam Obisanya (a talented midfielder in the AFC Richmond squad) owns a restaurant. Just before his Nigerian father visits London, Sam criticises a politician on Twitter. The next day his restaurant is vandalised, a message scrawled on the walls warning him to keep his mouth shut about politics. Mortified, Sam nonetheless takes his father to see the wreckage.
He finds his entire football team there, cleaning and repairing the premises.
This demonstration of collective kindness and timely, practical support is a thread that runs throughout the series. Originally stemming from Ted himself – who demonstrates that acts of kindness come naturally when you really listen to people, understand their predicament and care about them – kindness is the hallmark of this funny, emotional, issue-addressing and entertaining programme. What’s more, team spirit built on kindness brings success. In the most recent episode AFC Richmond made it into the Final of the Premier League.

It was empathy and kindness that brought the borehole to Bamdah.
Hardly a fortnight ago, Dr Samuel messaged to inform me that, for the first time in the hospital’s 130 year history, the main well had run dry. All over India and with alarming speed, climate change has brought higher temperatures earlier in the year and unpredictable monsoons, resulting in massive and rapidly worsening water shortage.

Wrote Samuel :
‘We are using bucket water in the operating theatre. Two of my staff are doing this work morning and afternoon. It is affecting the functioning of the hospital very badly. I have already found a place for a 500 foot deep borehole in the grounds near to the operating theatre. This will work throughout the year.’

He said that contractors with the necessary equipment were in nearby Jharkhand state. They could come and do this work at the end of the week. It would cost around £1500 to pay for equipment and labour.

I forwarded Dr Samuel’s message to two people – Horace in Mumbai and Rajesh in Singapore, both with quick access to money in India.
From Horace : ‘It's been unbearably hot in Mumbai where we have the luxury of A/C and water - I can't imagine how difficult life must be in Jamui district where the basic necessities for supporting the very existence of life are in short supply. Give me a few days.’
From Rajesh : ‘I am sending some money. If you have no other donor I will give the whole amount.’

In the end, together, they made up the money and the contractors did the work last Sunday.
Acts of kindness go a long way. They are after all Actions. Not mere utterances of concern and sympathy. A small number of people, even one individual, can tip the balance of a catastrophic situation into a manageable one with a timely act of kindness. To quote Ted Lasso – ‘doing the right thing is never the wrong thing.’

So let’s hear it for the staff and patients of Bamdah Mission Hospital, for Rajesh, Horace and friends and, most importantly, for Baijun Marandi and Upendra Kumar Gupta, the two drillers who worked in sweltering conditions to get the job done.

Sadly, not all the messages I received this week from Bihar reflected the Ted Lasso effect.
The belief in collective kindness as the core of humanitarian work seems to have been displaced by a belief in ‘spin, hyperbole and the fetishization of performance metrics to project success’ .
(This quotation taken from a critique of the language used in 21st century global health discourse  https://www.bmj.com/content/379/bmj.o2932)

We received an invitation to a new hospital inauguration in Saran district, Bihar. The existing, already huge AJEH eye hospital is to be upgraded to ‘one of the world’s largest eye hospitals…possibly the first Centre of Excellence in Eye Care in a rural area.’ The email was replete with stats, targets, and predictions for the AJEH management’s Vision 2030 agenda. It came from the AJEH boss.
We were truly puzzled as to why we were invited. It is such a well-known fact in Bihar that Second Sight does not believe in the model that places eye care in the hands of one huge behemoth hospital that is supposed to cater for the diverse, scattered and extremely impoverished rural population. Excellence in eye care is provided by people : good eye doctors and their multi-skilled teams. There are many such teams in Bihar. Mega hospital complexes are just bricks and mortar.
I do believe, however, in everyone doing their bit to prevent and treat blindness. And I believe in team spirit, on and off the football pitch. So I asked myself, what would Ted Lasso’s response be to this invitation?

I racked my brains, delving into my memory banks to find a relevant personal interaction within the series that might give me an answer.
And then I had it.
Footballer Jamie Tartt is the most talented player in the AFC Richmond team. He is also a troubled soul and uses his star status to undermine and bully other players, even encouraging others to act in this way. One day manager Ted says to him:

‘Jamie, I think you might be so sure that you’re one in a million, that sometimes you forget that out there (on the pitch) you’re just 1 in 11. And if you just figure out some way to turn that ‘me’ into ‘us’..the sky’s the limit.’

Perhaps I should send this Ted Lasso quote to the AJEH boss. It might make a team player of him yet. On the other hand…this is real life not fiction.

Lucy Mathen

#TedLasso   #kindness  #teamspirit  #climatechange  #watershortage 

Diligence - to whom is it due?

The loose end of Jagtaran Devi’s bright red sari had been draped over her white hair. It slipped off as she suddenly became animated and started to speak.
No, she really didn’t understand all these rules and regulations that we were talking about, she told us. Then she held up her left hand, fingers clenched, little wrinkled thumb sticking up. All she knew was that whenever she used her thumbprint, it generally got her something in the end – a bag of rice for example, perhaps this time a cataract operation.

We laughed, but would have forgiven the staff at Laxman Eye Hospital if they had burst into tears of frustration. Every year, they grapple with Indian bureaucratic systems linked with potential funding for eye surgery. The latest is the Ayushman Bharat, a government scheme designed to help those registered as living below the poverty line (BPL). In theory, such people get free medical care and the hospitals treating them receive financial reimbursement from the government.
The LEH is in the business of curing the blind – as I write, over 2000 patients are getting their sight restored every month. And the majority of their patients certainly live in dire poverty. The hospital managed to get accreditation to the AB scheme, installed specific software and allocated members of staff to be dedicated soley to this work. They diligently collect 15 pages of documentation on each patient, scan and feed this information into the data hungry AB system. The majority of applications are rejected, sometimes for the tiniest mismatch on the multiple and varied documents required (e.g. a one letter discrepancy in the patient’s name). A year into the scheme, the hospital has just about broken even regarding the money they have spent on the AB and the money they have actually received.
So will Laxman Eye Hospital turn away the bewildered Jagtaran Devi if the ‘computer says No’?
Well of course not. LEH staff apply the same care, attention and great effort (= diligence) in both tackling Indian bureaucracy and in treating patients. Established for the sole purpose of bringing eye services to the poorest, they would never turn away Jagtaran Devi. Their diligence is due to her.

I love the word diligence. It is derived from the Latin diligere – ‘to single out, esteem, prize, love.’ This, to my mind, implies that something or someone is being sort out for their worth. Discovering gems of human beings doing brilliant work is what drives me to travel the length and breadth of Bihar, time and time again.
The meaning of the word diligence has obviously evolved through time to a less exuberant, more matter-of-fact definition : careful and persistent work or effort.

 But what of the term ‘due diligence’?
As a legal phrase it came into common usage in the 1930s. It refers to the ‘care that a reasonable person should exercise to avoid harm to others or their property.’  In order to be thorough, this process should be investigative and bring as much relevant information to the table from all sides before a contract or agreement is entered into. All thoroughly sensible.
Due diligence was adopted by the business world and became a kind of financial checklist. It is now part of the lexicon of charities and grant-making organisations worldwide. Within the philanthropic world it developed its own jargon and spawned a kind of industry of ‘consultants’ who offer their services to help decipher this vague, generic language for those desperately seeking funds. It creates and reinforces power asymmetries and, especially in the field of global health, is jeopardising progress. A clarion call to resist becoming part of this can be found in a recent article by the Development and Environment Centre at Oslo University.
Global health nonsense  - read more here

Increasing digitalisation has pushed due diligence processes into being heavily weighted towards the collection of online data rather than on-site and face-to-face transactions. The distance between the human beings for whom charities and foundations were set up to help and those holding the power of decision-making within these organisations has became a yawning chasm.

It need not be this way. In fact, the UK Charity Commission does rather well in sticking to the crucial point of due diligence for charities i.e. that no-one should be ripped off or exploited in the process of either giving or receiving funds.
It’s simple advice is:  know your donor, know your beneficiaries, know your partner.
The only thing I would change about this advice is to put the beneficiaries first. If you always plan your due diligence procedures with them as your priority, I believe you have a far better chance of arriving at the truth of a situation and there is less of a risk of anyone being ripped off or exploited.

All this was going through my mind one day back in December 2022 in Aurangabad district, Bihar. We were at another Second Sight ‘partner’ called Drishti Eye Care Hospital. Gathered together in an office with parrot green walls were : me and SS trustee Francisca, Azhar Khan and his wife Almas who run the hospital, Adrian, a long-term Second Sight funder and two representatives from a huge Indian philanthropic Foundation based in Bangalore. We had originally been approached by the Foundation about a year back because they had heard of our long association with eye hospitals in rural Bihar. They had funds to give to blindness eradication programmes. Outside the room hundreds of patients shuffled around – the ‘beneficiaries’ for us and, should they decide to fund surgery at the hospital, for the Foundation, too.

The two representatives exuded praise for what they saw at the hospital. One of them, a doctor who had previously worked for the Bihar state government, expressed amazement that such excellent work was being done in rural Bihar. And was moved almost to tears when referring to the ‘huge burden’ of blindness for the poor. He marvelled at our wide knowledge of eye services in his home state.
We encouraged them to join the outreach teams in the villages to truly understand how much rural ophthalmology relies on the support of the community. They said they would love to. But couldn’t. The 48 hour site visit was just a small part of a lengthy Due Diligence procedure. The whole process would take ‘some time’ and would depend, in the end, on scrutiny of documentation by their Finance Team who would go into the very minutiae of the financial management of the hospital. Even after that, the Foundation’s board would have to schedule discussion of the project into their busy schedule and there would certainly be more requests for further documentation and signing of papers.

At which point I thought that it might be illuminating for them to hear from the quiet, self-effacing Second Sight donor, Adrian.
‘Perhaps Adrian can tell you why he decided to give his money away’ I suggested.
Heads turned quizzically in his direction.

’I’m a mathematician’ he said. ‘I have money. And I want it to cure blind people. There are so many people needlessly blind in Bihar. And cataract surgery is such a cheap way to help them. I don’t want to give my money to an organisation that will spend it on lengthy due diligence. I give it to Lucy. She is my due diligence. Of course, I also visit and see with my own eyes. I have been to most of the hospitals and have spent a lot of time in the villages with the outreach teams. But in the end, it is down to trust.’

What Adrian didn’t say was that, should he wish at any point to see documentation of all the many many thousands of blind patients whose surgery he has paid for over the past 15 years, I can give this to him.
The surgical data (which the hospitals keep routinely anyway) includes name, age, village, vision prior to surgery and post-operative vision, surgeon’s name and any complications of surgery and how treated.
If you want a due diligence method that guarantees your money is being spent on restoring sight to blind patients there is no better documentation.

However, I think Adrian might prefer the human evidence that his money is being well spent. And perhaps the patient he will remember best was actually operated on by the Drishti team three years ago.
Months after her surgery, Shanti Devi had wandered into the hospital grounds carrying a wicker basket full of hay for her cattle. Called over by staff to meet Adrian she had been asked why she thought he had paid for her surgery.
Without hesitation she had replied : ‘Pyaar hua heh’. He did it out of love.

Know your donor, know your beneficiary, know your partner. It’s a process that should engage, involve and empower all parties concerned. Trust (but not blind trust) is a good basis for success.

 Lucy Mathen

#knowyourdonor #knowyourbeneficiary #knowyourpartner #trustbutnotblindtrust #duediligence

Rajmal's legacy...and reasons to be cheerful

On almost exactly this day ten years ago, my Indian mentor and good friend Rajmal Jain died at his rural hospital in Rajasthan.

He passed away as he lived – with the minimum of dramatics, in the single bed in his modest room at the Shree Bhairav Eye Hospital, with the chatter of patients down the corridor likely to have been the last thing that he heard.

My family visited to mark this anniversary. On my part, with mixed emotions, fearful that after 10 years without his influence the ethos of the hospital might have altered. So much changes so quickly in India. And not always for the good.

What I found was a joy. And such an inducement to cheer in the New Year with huge optimism. So I am fighting jet-lag to sneak in this blog before the midnight hour.

For Second Sight, it all began in rural Rajasthan. On a July day in the year 2000, Rajmal Jain uttered these memorable words to me : ‘people come offering money, offering equipment, but we all need eye surgeons.’
I had no money, no equipment, but I had eye surgeons. By Christmas Day 2000 my friend Mani from Nottingham was at the Bhairav Eye Hospital. His first patient was a blind shepherd. No faffing about on anyone’s part. That was the Rajmal way. That was and is our way.

When we decided to focus our work in Bihar, Rajmal urged us on.
“They are needing you more” he commented. I last saw him in 2011.

So why was I so cheered by our recent visit to the Shree Bhairav Eye hospital in Rajasthan?

Well, I had just spent five weeks in Bihar with a quick detour into Odisha. I had a glorious time with the hospitals associated with us. (More in future blogs). However, in some areas of Bihar, the obsession with building bigger and bigger hospitals seems to have got worse. Private hospitals are popping up everywhere. In addition wealthy NGOs are in fierce competition with each other to construct towering trophy hospitals. Any charitable eye hospital team agreeing to such support is put under pressure  to deliver ‘results’. In other words numbers. The humanity of the work gets lost. To quote the telling words of American ophthalmologist David Apple:

‘One blind person = a tragedy
 Two blind persons = a disaster
 One million blind persons = a statistic.’

This was never going to be the case at the Bhairav Eye hospital in Rajasthan. During his lifetime, Rajmal Jain had been sought out by almost every large international sight charity. And his hospital was a recipient of their funding. However, with time, he distanced himself from them. No patient was ever going to become a mere statistic.

Today, even without the awesome influence of Rajmal Jain, the hospital is  managing to retain its ethics and ethos. It remains a happy hospital in which patients are definitely the most important people. Apart from some tasteful reflooring, upgrading of toilets and washrooms and a new ward, it is the sprawling one storey hospital that Rajmal himself designed and knocked down a mountain to build. It is busy every day of the week.

Many of the original staff are still there. Champalal, hospital driver and Rajmal’s right hand man, still smoking bidis and recounting how often he saw leopards en route, bemused by the fact that nowadays tourists pay a lot of money to visit special leopard reserves; electrician Prabhu who can fix anything; ophthalmic assistant Sualal, still beaming after a village screening camp at which he had identified many patients requiring surgery. Many others whose names I have forgotten but whose faces I recognized. All still loving the work.

And eye surgeon Dr Gulam Ali now working at his own clinic in the city of Jodhpur. He had worked at Rajmal’s hospital for 12 years. We reminisced about a research paper he had co-written with Second Sight ophthalmologist Raman Malhotra. It was about the excellent post-operative vision they had managed to achieve at the hospital with their 5 minute small incision cataract surgery. The poster was accepted by the British Royal College of Ophthalmologists. It was the first paper ever accepted from a rural hospital in Rajasthan. And that was back in the year 2002! Wow, we were ahead of the times and didn’t even realise it, Gulam and I agreed.

So much of our freedom to do what we do best was down to Rajmal Jain.
He was easily the most principled, honest, informed, undeceived and successful humanitarian that I have yet met in India. He was also very funny and never took himself too seriously. Obviously with such an endearing combination of character traits he made it into both my books – A Runaway Goat and Outgrowing the Big. Appropriately, on the tenth anniversary of his death, the books are now on sale in Rajasthan, at the Rajat Book Corner in Jaipur.
Sadly, Rajmal’s own copy of the Goat ran away in a sense. He was reading it in his Third Class sleeper compartment on the train to Mumbai and fell asleep with it on his chest. It was purloined by a light- fingered thief. Rajmal’s comment: ‘must be good book for thief to be so daring.’
Quintessentially Rajmal.

Happy New Year to all!

Lucy Mathen 

Doorstep delivery

I have received an early Christmas present.

It arrived on my doorstep in London. A brown cardboard box full of : small black rectangular objects with coloured segments on one side and tiny kingfishers on the back, glistening white ribbons, neat black pouches, silky pieces of cloth covered with lettering, USB chargers and 30 funky little plastic monsters.

I interrupted my last-minute funding applications and my packing for India to play with the contents, a big smile on my face.

Fiddling around with a bunch of toys when you should be consolidating funding sources and finalizing your itinerary to rural Bihar?? Frivolous woman.

Not so. Packaged together, these individual items make up easily the most useful method of ophthalmic examination for teams working in remote areas of the world. The rectangular objects are arclights - pocket-sized, solar-powered ophthalmoscopes with additional attachments to be used as otoscopes (for examination of the ear). The ribbons enable them to be hung around necks, the USB chargers in case there is insufficient sunlight (not often a problem in India), the piece of cloth is actually a vision chart and the plastic monsters…well, I have to work that one out.

Our rural ophthalmic teams in Bihar have been using the arclight for years. Optometrist and inventor William Williams designed it, egged on by global ophthalmologist John Sandford Smith. John had identified a great need for a cheap, light, robust ophthalmoscope to examine the eye – front to back, cornea to retina -  in rural settings in developing countries. The heavy battery powered instrument we use in British and most Indian city hospitals is not suitable technology for rural ophthalmology. (The full delightful tale of Williams’ early experiments can be read in my second book – Outgrowing the Big).

These archlights are now sold in the UK and are used by general practitioners and medical students. However, William gave me the first batch to try out in the field in Bihar some years back. Bihari ophthalmic assistants and doctors were very taken with it and William presumably delighted that the invention was in use so quickly. So now William’s brother Roy kindly delivers supplies of each improved model to my doorstep. This time, with perfect timing.

In a few days’ time I will be in villages in Bihar, chickens clucking around my heels, buffaloes lowing and oh dear, yes, the 24/7 barrage of music (it is the Marriage Season again). It is also the busiest season for all the eye hospitals. So outreach workers will be setting up their screening camps every day. We will use darkened huts or corners of temples and classrooms for arclight examination. We will leave them in the winter sunshine to recharge. If we forget them we can be sure that some helpful village volunteer will come running after us.

The boys and girls using the arclights will be largely ophthalmic assistants. This job description is, I think, unique to India. Young men and women are trained to do all kinds of ophthalmology – from diagnosis and treatment of primary eye diseases, to giving anaesthetic injections to surgical patients, refracting patients to see if they require glasses and assisting eye surgeons in the operating theatre. These multi-purpose workers have a hugely enjoyable and varied job. And most seem to be naturals when it comes to explaining diagnoses and treatment to frightened and illiterate patients. Many of them come from the communities their hospitals serve.
Hardly surprising that the multi-purpose arclight is now proving to be the weapon of choice for the multi-purpose Indian ophthalmic assistant.

‘ Truly this is the best equipment for me,’ I was told by a young man called Umesh. Part of the DSN hospital team in northernmost Bihar, he carries out screening camps in a tiger reserve …being able to relocate rapidly with light, portable equipment is an obvious advantage!

So I want to Big Up the multi-skilled, multi-talented ophthalmic assistant in India. And to thank William Williams for the arclights. One will be dangling around my neck for the entirety of my trip to rural Bihar. Apart from its practical use, I think of it as a kind of talisman cum comfort object, a symbol reminding me that throughout our now quite extensive work it has been small, suitable interventions and good people that have enabled the blind to see.

Wish me a safe journey, dear readers, by clicking the LIKE button below this posting. I will be without reliable internet access for much of the next six weeks. It will be nice, once I am back, to see that some people have read my writing in homage to the arclight and in praise of the ophthalmic assistant.

Lucy Mathen

#arclight   #suitabletechnology  #williamwilliams #multipurposeophthalmicassistant

Is anyone here dead?

‘Is anyone here dead?’

These were the words that provoked the only evident response to a brilliant speech by Indian ophthalmologist Dr Helen Nirmala Rao to an evangelical Christian gathering in Bihar. It was one of the highlights of my recent trip.

I will return to the speech and its significance later. But first let me tell you the back story.

I was away for the whole of June, thereby missing the Platinum Jubilee celebrations marking the Queen’s 70 years as a British monarch.
However, in Bihar, we celebrated another historic milestone – the Return of the Queen of Ophthalmology. Now aged 71, Dr Helen, as she is still known to villagers in Bihar, finally arrived at Patna airport to accompany us to her old stomping ground in the north-western part of the state where she had spent most of her working life.

When I saw her standing in front of me at Patna airport, dressed in a patterned blue salwar kameez, white mask hiding her lower face, eyes wrinkled in a smile behind big glasses, I thought it was a mirage. It was, in fact, a triumph.

In 2015 (!) I had stood in front of the pretty lake in the town of Motihari, Bihar with my friend and fellow-ophthalmologist Andy Richards. The water glistened in the sunlight, some fisherfolk cast their nets below its surface, the leaves of the huge banyan trees fluttered in the breeze. Of all our associated eye hospitals, the MHKS probably has the most picturesque setting.  It is also just 50 kilometres away from The Duncan Hospital where Dr Helen’s Eye Department was delivering comprehensive eye services to the poorest patients from 1989 to 2009. And where we began our work in Bihar.

Now we wanted Helen back. Not just because she still had so much knowledge and experience to guide some of our current ophthalmic teams. But also because it was all getting just too exciting for her to be left out.

‘Fish. Helen loves to eat fish’ announced Andy on that day in 2015. ‘And somewhere decent to live.’ That, according to him, was all that it would take to get Helen back working in Bihar. He may well turn out to be right. Albeit it seven years later.

Bubbly young Babul, an ophthalmic assistant from Laxman Eye Hospital was part of the welcoming party. He was beside himself with excitement. He had read about Helen in my two books – in fact, he had helped translate into Hindi the first book A Runaway Goat. Now he was meeting her in the flesh.
I, in turn, was chuffed by Babul’s excitement, remembering that apart from my books there is currently no other written record of the achievements of this remarkable Indian ophthalmologist.

Driving over the River Ganges on the sweeping, modern JP Setu bridge, Helen remembered how in her early days boats were the only form of transport from south to north Bihar. The Patna to Muzaffarpur journey used to take 6 hours. We were there in less than 2. The boats haven’t changed though – wooden fishing vessels with sails, dredgers, wide cattle boats and a few small ferries. All these are still used to transport eye patients to the mainland from the diara, the islands that sit in the middle of the Ganges.

We headed north to Narkatiganj. Our journey was punctuated by telephone calls from Helen’s family in south India. They were seeing reports on TV and social media about riots and the burning of trains in Bihar. These protests were sparked off by something called the Agneepat scheme relating to army recruitment. Instead of a job for life with pensions etc. youngsters wishing to join the Indian army now were to be given only a 4 year tenure and only 25% of them would be eligible to apply thereafter for more permanent posts. Not a popular scheme.

Helen calmly batted away the worried calls with: ‘I am with Lucy. Nothing has happened so far. By God’s grace.’
I told her that she should remind the family that she had worked in a much scarier Bihar of old – when guns were routinely on the streets and it was the kidnap state of India. Helen laughed. And asked the driver Rakesh about the price of tomatoes in Bihar. (15 rupees a kilo if you are interested, compared to 120 rupees in the southern state of Andhra Pradesh).

At the DSN eye hospital at Narkatiagnaj Helen went into the operating theatre to watch Dr Sabit Hassan at work. He is a quick confident surgeon and the OT was purpose-built and fitted her own exacting standards. So she didn’t spend much time in there. Also – ‘ when I am in the operating theatre I never want to leave…it was always like that’ she told me afterwards. And I thought of how Helen used to operate from morn till night at The Duncan Hospital, head bowed in that uncomfortable position peering down a microscope, and dragging the heavy microscope across the floor as she moved from one operating table to another.
This daily routine eventually took its toll. Painful neck problems ended Helen’s operating days… but began our wonderful association. Second Sight surgeons stepped into her surgical shoes. Helen continued in her vital role of heading an eye department that never forgot that rural ophthalmology is not merely about cataract blindness and the quick fix of cataract surgery. All the eye diseases we are still treating now – from childhood blindness caused by malnutrition and Vitamin A deficiency, to corneal ulcers badly treated by quack doctors –  were being treated back then. The halcyon days at Raxaul lasted until the eye department was shut in 2009.

Helen’s best and worst professional days probably happened at The Duncan Hospital. So of course we had to return there. The border town is just 43 kilometres from Narkatiagnaj but one of the worst roads in Bihar connect the two. Our hardy vehicle took a battering, driver Rakesh was sick (possibly on account of eating too many ripe mangoes) and we arrived late.
Greeting us at the gates were two nice nurses, Dorcas and Esther wearing the old fashioned white uniforms and caps still worn at mission hospitals. The Medical Superintendent, Administrator and some others also greeted us. It was all a little stilted as if no-one quite knew why we were there and what to do with us. The MS offered Helen a guided tour of the modern hospital. She was taken swiftly past her now derelict eye department but was shown the extensive construction work taking place to rebuild the entire original buildings.

‘There seems to be a lot of money’ commented Helen as we met briefly at the guest-house.‘ She recalled how the first eye patients had had to sleep on the floor between the beds of the General Surgery patients. Until Helen complained to the general surgeon (her husband Anand) and funds were found to build a separate eye ward. By the time Second Sight surgeons joined Helen each patient had their own bed with bright red blankets to keep them warm in the winter.

‘Can you ask if some of your eye department equipment is still here?’ I urged her. ‘I know of one eye hospital that really needs an extra slit-lamp.’

Helen asked the Medical Superintendent. He didn’t know. Perhaps it was in storage somewhere on the premises, perhaps it had been sent to another mission hospital. She enquired about the old sign, a giant painted eye which used to hang over the entrance to her department and which patients referred to as Dr Helen’s Eye. The MS had no idea about where this had gone.
‘It wasn’t anything…just of sentimental value’ muttered Helen looking, momentarily, a little fed-up.

She was not, however, there to brood. This was beautifully demonstrated the following morning when she was asked to speak to all the staff at Devotions, a morning gathering in the church.

I am not an evangelical Christian like Helen. She consults the Bible for all her guidance and teases me for relying ‘on instinct’ about what is right and wrong. Naturally her speech was centred around the Bible. That did not prevent it from being an extra-ordinarily inclusive, high-octane clarion call to every person sitting in that room to, basically, get off their backsides and work!

She admitted to a kind of rediscovery of the Bible during a bleak time after the death of her husband Anand. She had wondered why she was still alive. She urged those clutching Bibles in their hands to open the book and really understand the messages in the words, and how encouraging and revitalizing they could be. (Her actual words were ‘find Jesus on every page’. Mine is a secular interpretation). Then came the challenge to complacency.

‘How many people here are alive?’ she asked.

‘I don’t mean are you breathing, is your heart pumping…I mean really alive?’

Enlivened myself by this in-your-face approach to a very traditional Christian audience, I looked around for reaction. I saw blank faces amongst the serried ranks of nurses, doctors and hospital administrators.

‘Ok. Then let me ask. How many people here are dead?’

And that drew a murmur. She then went on to quote Genesis 2:15 – the first humans placed in the Garden of Eden to, yes, work and look after it; Acts 17:26 in which each person is said to have an appointed time in which to carry out their work; Revelations 2:12 in which it is made clear that reward will come according to the work each person has done.

Which brought her neatly round to informing The Duncan staff that she was back in Bihar ‘after such a long time’ because there was still so much work to do. And to excuse us hurrying away from Devotions she added – ‘My friend Lucy, who brought me back to Bihar, has so much work in so many different places.’

It took a lot of restraint on my part not to leap up from my seat and punch the air in victory. Before any celebrations, however, there were logistics to sort out. Fish and flats in Motihari.

Lucy Mathen

Postcode lottery - two village women

My blog entitled Behind the Beautiful Facades – brought in more comments than any other to date.
I was encouraged by this one, from the director of a grant-making body:

‘ I’ll certainly be conscious that there is more to healthcare than having our plaque on a wall when it comes to picking projects for us to support next year.’

The beautiful facades blog touched on an absurd kind of postcode lottery that is developing in rural Bihar. Absurd because it is based on the faulty premise that building bigger and bigger hospitals and running them like business corporations will mean better eye services for the poor. In reality the opposite is happening – because eye doctors want to make their own decisions about where and how they work and are less willing for their skilled surgeons’ hands to be hired ones.

But what are patients experiencing as a result of all this? (That’s what one responder wanted to know). 
So let’s step into the shoes of two village women.

Aurangabad district, south-west Bihar.

I picked out Lalsha Kuwar from the 100+ post-operative patients because she looked much younger than the rest. It turned out that she was 49, indeed young to have bilateral blinding cataract.
I examined her at the slit-lamp and reassured her that her cataract surgery had been successful. She agreed that she could see well but continued to look anxious.
Later I saw her sitting in the hospital corridor. We had a chat, woman to woman rather than doctor and patient.
She was a widow. Her husband died in a road accident. She had a job - cooking the midday meal for children at a government school. Her monthly salary was 1,600 rupees (about £16). She had noticed that her vision was deteriorating rapidly and suspected that she had motiabind  (cataract). She had heard that there were hospitals in Bihar that offered free surgery. But often middlemen took money for transport to a big hospital far away and there were hidden costs once you had reached hospital – the purchase of post-operative drops and the dark protective goggles worn after surgery. In this way, patients could end up parting with 1,500 rupees – almost her entire monthly income.  

At a village screening camp she met a young man called Ayan who worked for Drishti Eye Care Hospital. He told her that she would not have to pay anything at all, that in fact she was a priority patient because of her predicament. His was a hospital committed to helping people like her. What’s more, it was located in her own district of Aurangabad.
She was loath to believe him. But it had turned out to be true. She had been treated well by the doctors, nurses had explained how to put in her eye drops and she knew that it was important to attend her next follow-up examination. She had not been charged for anything.
Hospital staff then announced the departure of vehicles going back to the villages. As she stood up to join her fellow patients, she managed a small smile.

Saran District, north-west Bihar

70 year-old Seema Devi (not her real name) was standing outside the closed gates of the huge rural eye hospital in her small village.
Social worker Harshvardhan came across her. It was he who described what happened next.

Seema was told by a security guard that she had to phone for an appointment – he pointed at a notice with the relevant number. Only then could he allow her through the gates. H offered to help her. He used his phone to call the number.
They were given a time for her appointment – and about 20 minutes later a loudspeaker announced her name. She was then admitted into the courtyard of the hospital. At the first ‘station’ she was asked her name and age and if she had an Aadhaar card (an identity card). She was then asked to sign a non-disclosure form, releasing the hospital from any responsibility in adverse circumstances. She was asked to pay a registration fee of 300 rupees (£3).
At the next station a young ? optometrist (she did not identify herself) asked her what her problem was, tested her vision with a hand-held electronic device and told her that she would have to put in drops to dilate her pupils. When the drops had worked their effect, another member of staff examined her eyes and told her that she had cataract and would need an operation in the right eye. She was then sent to sit before another table.

Said H: ‘On the table were piles of lenses used in cataract surgery. And they told her the price of each lens, starting with small sums and rising to very large sums. But it was obvious that she could not afford them. So I asked them about free or subsidized surgery – everyone knew that the hospital offered this. They lost interest in us and said ‘then she must go to a screening camp.’ I insisted that she lived just next door to the hospital, so why should she go to a screening camp far away? They said –‘take it up with management’.

The pair then tried to find the management office. En route they came across a patient who had been identified with cataract at a village screening camp and had had surgery. He had paid 1,500 rupees for his treatment. He didn’t mind he said, because he was from the neighbouring district of Arrah and they said the money had to be taken for transport, food etc. It seems the hospital only held screening camps outside their own district of Saran.

At this stage a kerfuffle broke out. A family who claimed that they had paid 64,000 rupees (around £640) for a cataract operation were not happy; they had returned several times to the hospital to see a doctor and were told that they could not. They mouthed off about the bad treatment they had had and warned others not to bring their family members there. By this stage Seema lost her nerve and asked to leave.

Summarised H : ‘So by the time we came out, she had spent three hours at the hospital, was 300 rupees poorer, more confused than when she went in, and wondered who the hospital was for if not for people like her, who lived in the very village in which the hospital was located.’

NB

Both hospitals are charitable eye hospitals. They are operated by Indian Trusts that pledge that they are not-for-profit establishments. They receive donations to help their work.
The first is run by a small group of local people. It has a staff of around 40 including 4 doctors. It was set up to provide permanent and comprehensive eye services for the people of Aurangabad district. And that is what it does.

The second hospital advertises itself on its website as ‘the largest eye hospital in northern India’ and ‘one of India’s top 5 eye hospitals’. Its trustees and advisors include men associated with large Indian corporations like Tata Motors and Sony. It has all the media trappings of a business. But it benefits hugely from that not-for-profit status. One American NGO has pledged $1million towards a $4million project to construct a new 350 bedded hospital in Saran district. (Yes, really – you can watch the YouTube appeal made by the hospital boss, thanking the good folks of America for this ‘legacy’ for the people of Bihar).

This is what they proclaim on every conceivable social media platform:
‘… the hospital works in eradicating curable blindness by providing affordable, accessible and sustainable eye care services and empower women to achieve this.’

Lalsha in Aurangabad is back at her job cooking midday meals for schoolchildren thanks to her eye hospital experience.
Seema will have to travel out of her Saran postcode in order to feel the empowerment of accessing affordable eye care. Doesn’t seem quite right, does it?

#postcodelottery  #behindthebeautifulfacades #peoplenotprofit

Lucy Mathen

Behind the beautiful facades

‘Can you, dear Lucy, help us with some funds for surgery?’

‘No, dear Swamiji, I cannot.’

Brutal? Well, let me tell you the context.

The slightly built monk before me is possibly my favourite Hindu monk in Bihar. I enjoy his company immensely and have had, over the past decade, such good discussions about Life, the impermanence of all things and the need for social reform. These are never pedantically earnest conversations. Rather, playful. Swamiji has a light touch.
His organization runs a 94year-old eye hospital in Bihar’s second largest city. It used to be housed in a modest, old but well-maintained building, perfectly adequate for the workload. In the earliest days of Second Sight, we shared a volunteer eye surgeon who operated at both the Swami’s hospital and one of our partners in northern Bihar. The Swami and I have kept in touch.
This time, four years since our last visit, we had been shown around their new hospital – a vast, spreading building housing three huge operating theatres and a duplicate set of consulting rooms on the ground and first floors. 
Even the tiny intra-ocular lenses used in micro-surgery were housed in a luxuriously spacious storeroom; they were stacked in tidy piles in glass cabinets, all carefully catalogued. You could eat your dinner off any floor in this hospital.
But where were the patients? The few people within the building were dwarfed by their surroundings. We came across one ophthalmic assistant but no eye doctors. Yes, getting and retaining doctors is still the main problem, admitted Swamiji.
And the cost of the new hospital? Mentally computing crores of Indian rupees into pounds we all came up with the answer – a whopping £800,000.
That amount, Swamiji, represents our annual income in a good year. And with that money we can fund the restoration of sight of up to 50,000 blind people in Bihar. Do you understand why we are so amazed that you are asking us for funds?
Poor Swamiji looked forlorn. Banners announcing the contributions of Coal India fluttered on the walls of the beautiful façade.

Moving on to north-eastern Bihar to the district of Purnia. Back in August 2020, I had read on social media about the inauguration of another huge new eye hospital. In the publicity, much was made of the fact that an experienced doctor, born and bred in this area of Bihar, was to be the clinician in charge. We had worked with this very doctor years back and, yes, he is a good ophthalmologist. So, whilst driving through the area, we popped in, hoping to meet him.
Set amongst fields bright with mustard seeds, sat a huge orange and red building reached via a courtyard that was almost as large again. At a small table in front of the building sat a member of staff with a few members of the public.
We wandered into the building, past the reception counter (unmanned), along the main corridor whose walls displayed a few framed photographs of doctors at work and many others displaying the name of the British-based charity that had proudly funded the building. We passed wards with comfy-looking beds but no occupants. Our movements were monitored by CCTV.
It all felt less like a hospital and more like a cross between an art gallery and a jail.
And then, at last, some people -a small group of patients with a patient counsellor. We enquired about the doctor we had hoped to meet. No, he only comes once in a while, we were told. Were there any regular doctors at the hospital? No. Doctors come when they are needed.

Just 60 kilometres away, is the YDMH community eye hospital. The team moved into their new purpose-built but modest premises just a few months before the Purnia hospital opened its doors. And here staff were working flat out from early morning till late at night. Local council elections were disrupting outreach activity but never stopped the team from bringing in blind patients. With a workforce of 21 including 3 eye surgeons, the operating theatre was busy every evening. An isolation ward was set aside for the depressingly high number of farmers coming with infected eye injuries. (It was rice harvesting season). Doctors here are needed, and available, every single day of the week.

Let’s move on to Gaya district. Prior to the pandemic, this area was most well-known for an annual surgical eye ‘camp’ carried out by a visiting Gujerati Trust. Many, including us, criticized these camps because of the unnecessarily large numbers of operations they carried out without adequate follow-up; also there was little or no involvement of local ophthalmologists. So a permanent hospital in Gaya district seemed like a good idea.  And we knew the bosses of the Indian NGO running it.
When we made our impromptu visit we found, hoorah, a great eye surgeon we knew well. We congratulated his current employers on recruiting this experienced ophthalmologist. The hospital manager replied that the doctor had already indicated that he wanted to move on, to a hospital nearer his home. However, the good news was that they had the funds to build an even bigger hospital – a 250 bedded unit!!

Something is amiss here, surely. The expression ‘ putting the cart before the horse’ springs to mind.

Back in 1989, Dr Helen Nirmala Rao started her eye department in northern Bihar. She told me that the Indian head of Europe’s largest sight charity visited and encouraged her : you, the eye surgeon, are the most precious resource,  start working, even if it’s in a broom cupboard, and we will find the money to build up your department as the work grows. They did, and the rest is history. (Plug: read my books).

Then at the start of the 21st century, the cry to pour money into ‘infrastructure’ was on the lips of many in the charitable sector. This was a highly pragmatic approach, they said, because it attracted wealthy donors who liked to see their names or that of their organizations on the front of hospital buildings.
Now, in the third decade of the 21st century, there has been a kind of numerical inflation in both the number of charities funding building in Bihar and the size of the buildings. Whereas once the construction of 100 bedded eye hospitals in Bihar was enough, now nothing less than 250 beds will do! Gala dinners in London, California and Australia are held and raise millions of dollars and pounds. They successfully sell the idea that bigger hospitals equate with eye services for more poor people. In reality, those left to run these hospitals are faced with massive running costs, an increased need for office staff for the required paperwork but with a perpetual shortage of clinical personnel.

The irony is that there are more Bihari ophthalmologists choosing to remain in small town and rural Bihar than ever before. That’s the success story.
You just need to look beyond the beautiful facades to find them.

#behindthebeautifulfacades    #smallisbeautiful 

 Lucy Mathen

Twenty-one...a coming of age

We did it. We made it back to Bihar, in our 21st year of existence and after an absence of 21 months. And it was probably the most important visit to date.

We travelled almost 2,000 kilometres, mostly by road and in various hospital vehicles and over a period of just about a month. We crossed Bihar’s major rivers many times – the Ganga, the Gandak, the Burhi Gandak, the Son and the often troublesome River Kosi. It was the rice harvest. Men, women and children were bent double in the fields from morning till night, slicing away with scythes. At least the weather was kind.

With hungry eyes, deprived for too long of people and places that were once very familiar to us, we saw with fresh sight. A different kind of second sight you might say. Our ears tuned back into Hindi as the main language of communication.

There were surprises along the way. Some shocks. Moments of pure surrealism. I will fill the blog with these tales in weeks to come.

But as we approach Christmas Day 2021 and mark the 21st year of Second Sight’s work, I want to tell you how reaffirming this latest trip to Bihar has been and why I feel that the charity has come of age. I think its’s the best festive news that I can give you.
  
Back in the year 2000, our first act as a charity was to provide visiting eye surgeons to cure the blind. This timely intervention transformed thousands of lives and altered the rules of engagement for delivering eye services in neglected regions of India.
‘Actually, you changed everything in Bihar’ I was told by ophthalmologist Dr Kumar Krishnan with whom we were reunited on this trip.
In Bihar in 2021, there are more ophthalmologists who have chosen to work in the areas of greatest need than ever before! They are skilled, motivated and provide the full gamut of eye services. They are earning the respect and support of the communities they serve. Actually, they are very much part of these communities. This will guarantee the stability and longevity of the hospitals at which they work.
All this warms the cockles of my ophthalmologist’s heart.  It makes me feel as if Second Sight has truly come of age.

So, here is a flavour of the best Feel Good Moments of my trip.

-       In the quiet town of Madhepura, north-eastern Bihar, two nights running, two very difficult surgical cases landing on Dr Amit Anand’s operating table, both trauma victims with complicated facial injuries. I watch as Dr Amit meticulously reconstructs each face and most importantly realigns the eyelids so that the patients will not suffer problems in the future. Whilst operating, he explains every step to his paramedic staff. Each case takes two hours.
Earlier in the day, the team were busy with out-patients and 30 blind people had their sight restored with cataract surgery.
No-one complained about the late hour at which we went to bed.

-       In another small town Chakia, I marvel at the most realistic prosthetic eye I have ever seen, in a patient my own age called Jhanti Devi. Her clinician, Dr Ajeet Dwivedi (a well-respected Glaucoma specialist whom I first met more than 10years ago), then proceeds to demonstrate to Jhanti’s son how to remove the artificial eye for cleaning and the best way to replace it. Jhanti had lost the eye in a childhood accident and first came to Dr Dwivedi with rip roaring infection in the socket, plus cataract reducing the vision in her only seeing eye. He treated the infection, arranged the fitting of the prosthetic eye in Patna city, then carried out her cataract surgery back in Chakia. For this complete ophthalmic treatment Dr Dwivedi charged only what Jhanti’s barber son could afford. Is it surprising that a young Bihari doctor, who qualified at a prestigious south Indian eye institute, has now made his way here, to work with Dr Dwivedi? Young Dr Shankar beams with job satisfaction. His presence means that small town Chakia now has excellent ophthalmic care for three days a week.

-       In a field near Drishti Eye Care Hospital in Aurangabad, meeting Mahendra Ram, wife Shakuntala, daughters Arti and Sheila and their three goats as they harvest the rice. If you get injured please don’t go to quack doctors, come to the eye hospital, we urge them. Do we have to pay? We have no money. For all this work we get only 20% of the takings, explains Mahendra. No, of course you won’t have to pay, interjects Drishti outreach worker Bunty – if you delay after an injury you will lose the eye, your job, everything. Please come to us. And he gesticulates to the hospital sitting like a landed space-ship in the adjourning field.

-       An eye screening camp at a school, the pupils still occupying part of the building. The hospital team leave us leaflets about eye diseases and blindness in Bihar, the headteacher tells me, dragging his withered polio leg behind him as we walk across the small campus. This way we extend the education of the children.  And help the eye hospital, I add.

-       Ragib Hussain, who owns shoe shops, and has paid for his cataract surgery, sitting bolt upright on his hospital bed. Most of the other beds had been occupied by blind patients who had been given free surgery. We are all treated well, the surgery is excellent, he tells me. He is more than happy to pay and the cost is nothing compared to other hospitals in Bihar. Yes, this is a community hospital for all, I add, perhaps a little unnecessarily as he already gets it, dah.

-       A small commotion as the female post-operative patients file out of their ward and down the stairs; one diminutive woman answers my question about what colour my shirt is (to test her vision) by bursting into tears. She has had such lovely treatment she tells us all, but now she has to go home and none of her children are there to look after her, they are scattered all over Bihar. Everyone forms a protective circle around her and murmurs sympathy. A few moments later, she is laughing: hospital manager Azhar Khan is warning the male patients not to go home and make life a misery for their daughters-in-law by demanding pampering. A simple cataract operation doesn’t warrant such treatment. Just a year ago, Azhar was in ICU with COVID and we all expected to lose him.

-       And finally, two angels – I am not making this up (photographer Jenny Matthews is my witness). They are dashing across the dusty courtyard in front of Aurangabad town’s oldest madrasa, built by the British. It is the wedding season in Bihar, a time when poor families can fall into dreadful debt. But a wonderful organisation of volunteers has arranged a Group Wedding for four brides and their grooms. ‘We provide absolutely everything for each couple’ a young teenaged boy informs me and gesticulates to beds, kitchen utensils, clothes and glittering trunks…and even a solar light! But my mind is on those angels…there they are again, two little skinny girls in white frilly dresses and beautifully made wings, flitting in and out of sight tantalizingly. It is such a joyous occasion, full of goodwill and caring for the poorest in the community … a perfect Christmas tale. So what more fitting that a couple of Bihari angels.

Happy Christmas to you all!

And keep reading this blog…

Lucy

Founder

Participation - not copping out

‘Participation – that’s what’s gonna save the human race’ -Songwriter Pete Seeger 

There was a bit of a tussle over the potted mango tree, the first time they were given out.
Two gents, formerly blind, now benefitting from good vision after their cataract surgery, frowned at each other and engaged in a determined tug of war. There were enough trees to go round. But this was the last mango tree.
The situation was quickly resolved when eye hospital manager Azhar Khan stepped in to mediate.
Afterwards he said: ‘I think the lesson is that we should give them all mango trees.’

At the Drishti Eye Care Hospital, a small community eye hospital in the Aurangabad district of Bihar state, every post-operative surgical patient is presented with a tree to take back to their village to plant.
In addition, anyone bringing in a bag of plastic waste collected from their village, can get free surgery.
The modest purpose-built hospital is located in the midst of low-lying hills and verdant fields. And to preserve that precious environment they have a water purification system that ensures all the water the hospital uses is purified before being put back into the river system. Earthquakes being increasingly frequent occurrences in Bihar, the building is also earthquake-resistant.

Behind all these actions is Azhar Khan, surely the most Green hospital manager in Bihar. Perhaps it’s because he remembers a happy childhood playing in the beautiful forests around his home in neighbouring Jharkhand state.
In September 2017, in a bid to protect the environment Jharkhand joined around 17 Indian states to ban the use of plastic bags. In spite of this, people continued to use them.
Said Azhar; “It’s always about people really understanding the problem and being prepared to change their behaviour.’ (Ring any bells?)
So when Azhar started his own eye hospital he was determined to establish a working practice that took the lead on environmental actions, reduced waste and encouraged every patient who entered the premises to think of ways that they, too, could participate in combatting the climate emergency that is impacting their lives.

(Fourteen out of the 50 districts most vulnerable to current climate risks in India are in Bihar, according to a latest study (2019-20) by the Indian Institute of Technology (IIT) and the Indian Institute of Science in Bengalaru).

Two decades ago I don’t remember seeing much plastic waste at all in the villages of Bihar. Now it is recognized as a major problem.
This extract is from the Plastic Waste Management Resource Report for the Government of India a few years ago:
’More than 15,000 tonnes of plastic waste are generated across India every day. An increasing fraction of this plastic waste is found in rural areas, as the reach of retail corporations and commercial organizations grows…it is becoming increasingly clear that plastics are posing significant environmental and health challenges in rural communities.
Plastics are disturbing local ecological balances and show up in water and land as micro-plastics. In their macro-form, they act as physical barriers, degrade soil quality, and get ingested by livestock and also other fauna, lead to blockages in drains and streams.’

Government advisory groups are very good at collecting data and warning of problems.
But if we want action to solve this crisis, we all need to participate.
This week’s gathering of world leaders, celebrities and British royalty at the COP26 climate conference has been billed as a last-ditch attempt to save our planet.
Very, very sadly the conference has ended up with the majority of frontline communities worst affected by climate change not being able to attend.
According to the Cop26 Coalition -which represent indigenous movements, vulnerable communities, trade unionists and youth activists around the world – up to two-thirds of those it was helping to travel to the UK gave up, overwhelmed by a combination of visa and accreditation problems, lack of access to Covid vaccines, changing travel rules and expensive accommodation. In other words, not many Azhar Khans present.

Exclusion from the corridors of power, however, does not prevent us participating in combatting climate change in every way that we can. And every single day.
If some of the poorest people in the world – the patients and families who attend Azhar’s eye hospital – are doing their bit and also spreading the word in their wider communities – surely we in the affluent West can do more?

This is what I saw this morning as I walked through my own area of London
-       Every other person holding a non-recyclable coffee cup. This in spite of a high-profile campaign by a celebrity chef alerting people in the UK to the fact that, whilst clever marketing gave the impression that these could be recycled, the majority ended up in landfill – in fact 2.5 billion every year. There was also a 2017 report from the UK’s House of Commons Environmental Audit Committee which suggested that these coffee cups produce an annual carbon footprint equivalent to what 33,000 cars produce in a year.
(Is it really so difficult to always put your own re-usable coffee container in your bag?)
-       Shops dispensing blue plastic bags to customers who had ‘forgotten’ to bring their re-usable shopping bags. (This is an area with a Green Party representative who has worked tirelessly to try to change habits of both shopkeepers and the public).
-       Huge piles of black bags outside homes (it is rubbish collection day today), some of which must contain some of the 70% of food waste in the UK that households are responsible for. According to the organization called WRAP which monitors these things, we did well during the first UK lockdown in cutting down on the food that we throw away. Now we are back up to pre-pandemic levels!

My mother, born in India, used to berate us for not eating up everything on our plates. There are children who are starving and you waste good food she chided. And, found guilty, we would get annoyed and respond with smart-aleck comments about the inability of getting our leftover food to them.
The point is that she never shied away from pointing out personal responsibility. And she was right. There is no copping out when you realise this.

 Lucy Mathen

Blah blah blah

My old boss at BBC TV has died. Edward Barnes launched John Craven’s Newround the news programme for young viewers in 1972, after discovering that only 0.7% of his target age group watched TV news: ‘It was a man in a suit, talking, and it was boring,’ he said with characteristic bluntness. However, few people at the helm of the BBC thought that Newsround would be a success.

Last weekend I attended a friend’s Golden Wedding Anniversary. His son reminded me that he had watched me reporting for Newsround and how it had sparked his interest in global affairs. He introduced me to his young daughter – ‘we now watch the programme together.’ So the naysayers were proved wrong and Newsround has inspired generations of children.

Edward’s newsmen in suits, talking, are still around. Now women too, albeit in brighter coloured suits. They were out in force at the British Labour Party Conference this week. They discussed ad infinitum just how ‘inspirational’ or not the speech of leader Keir Starmer would be/should be/ had been.

Meanwhile, at the Youth4Climate Summit 18 year-old activist Greta Thunberg was fed up with words that achieved nothing.
‘Hope is not blah blah blah. Hope is telling the truth. Hope is taking action.’

Once you get off the Blah Blah Blah circuit, there are people who inspire everywhere. People who dig others out of a rut of complacent thinking and force us to open wider our eyes and minds.
It can produce ripples of positive action.
It continues to sustain me.

I was on the phone to my friend Sister Jessy the other day. She is a catholic nun doing fabulous social work in Bihar. She was updating me about a girl called Asha, now aged nine. Asha is one of the students at a school run by the convent.  She had recently sat the entrance examination for the local government school – passed everything with flying colours…except Maths, which she failed. She was turned down for a place.
Instead of accepting her lot, she took on the school authorities, telling them that they were wrong and simply had to admit her. She suggested they ask for a reference from someone who knew her well – Sister Jessy.

‘I was away at the time,’ said Jessy. ‘Otherwise for sure she would have been admitted. We have put her in another school. That one will always get her way.’

I wasn’t at all surprised to hear this tale. The last time I saw Asha she was one of six young girls I took to our nearest eye hospital – the MHKS at Motihari. They were given a tour by staff member Sumant and saw hundreds of cataract-blind patients waiting for surgery. I showed them how to examine the back of the eye with my pocket ophthalmoscope. Then Sumant asked if they had any questions.
Up shot Asha’s arm.  ‘Sir, how exactly do you remove the cataract from the eye?’

What is inspiring about all this is not just one small scruffy and super-alert child called Asha. Or even the fact that she comes from a family of so-called ‘untouchables’; had she and her sisters not been taken out of their village to be educated by the nuns from an early age, their lives would have been bleak.
What I find so joyful is the overwhelming confidence that Asha demonstrates time and time again. And this comes from the way the Canossian Sisters educate their charges.
In most Indian schools, discipline is tough, rote-learning the norm, and there is little attention given to the importance of play. Not so at any of the schools run by these extraordinary nuns. The children thrive and learn fast because they are happy. They in turn ‘excite, encourage and instil confidence in others’ – which is one definition of the verb ‘to inspire.’

Nearer to home, I have been inspired by someone at the other end of the age spectrum – 92 year-old Elizabeth Jones. This sparky nonagenarian, blind in one eye from an accident, and partially-sighted in the other, runs Talking News Islington – a free service for blind residents. They receive a CD every month which contains a summary of local news and other snippets of information, recorded by a band of volunteers.
TNI used to have a studio provided by the council. This stopped during the first lockdown. So Elizabeth set up a studio in her kitchen. CDs are produced on a machine in her living room.
A few months ago she fell and broke her hip and thigh bone. ‘That slowed me down a bit’ she admitted. ‘But I am getting mobile again.’ And indeed she was as she led me down to her kitchen to make me a cup of tea.
Elizabeth’s only frustration is that she is not reaching enough blind residents who would benefit from receiving the CDs. So anyone living in the London borough of Islington please contact her if you know of anyone. (elizabeth.jones2@googlemail.com). Or call her on 0207 272 5481.

Women Who Inspire was this month’s theme for an Indian publication called Seminar sent to me by a friend. The introduction explaining why they had chosen this subject veered a little towards the blah blah blah spectrum. But the article my friend wanted me to read was about our mutual friend, the late Chandralekha. She was a dancer, choreographer, poet, activist and all round extraordinary human being. Do look her up and experience a shiver of wonder and excitement.

What I liked about the write-up  – by Tishani Doshi - was that it refused to contextualize Chandra, the default position for many writers when trying to explain why they find someone ‘inspiring.’ Instead, Tishani tells a series of stories so that readers get to know Chandra better. My favourite was this:
‘At a consultation with her doctor, one of Chennai’s top heart surgeons, Chandra berated him for the ugly poster of the human heart hanging above his desk, objecting to its literal interpretation of the heart as a giant pumping machine. ‘This is not what my heart looks like,’ she insisted.

Some months later, tells Tishani, at the doctor’s request, Chandra’s dancers performed Sharira (Body) at a conference for heart surgeons, so they could understand that it was possible for audience and performer to share a heart – ‘sahridaya’ being the Sanskrit word for this.

 Lucy Mathen

#sahridaya   #sharingaheart   #nomoreblahblahblah   #hopeistakingaction #gretathunberg

History...and Hope

We are returning to India! For the first time since the pandemic began.
On the day we booked the flights, India came off the Red List for Covid. An encouraging sign.

The ‘we’ are two Second Sight trustees and Jenny Matthews, the photographer whose beautiful photographs you see on our website and who has documented our work almost from the start.

Jenny spent lockdown very productively, producing the most extraordinary quilts incorporating a lifetime of photography from areas of conflict. I do urge you to take a look at her website https://jennymatthews.photoshelter.com/index and to buy her book Women and War.

Jenny’s usual modus operandi is to visit a war zone after the Press Pack has gone and to spend quiet time with her subjects. The results speak for themselves. Her silent witnesses face the camera so convincingly as themselves – regardless of whether they are brutalized and oppressed women in war zones or exuberant female fighters and empowered grandmothers. If you have ever been amongst such women in any corner of the world, look at her photos and you too may recognize the ‘thing with feathers ‘ that perches in the soul, singing the tune without the words and never stopping at all. To quote Emily Dickinson’s famous poem on Hope.

It is difficult to retain hope for the people of Afghanistan this week, as history repeats itself in a depressing way. But we must. And I feel it incumbent on me to write about this because neither Jenny nor I would be doing what we are now doing, were it not for a seminal trip we made to Afghanistan back in 1988. During this trip, 33 years ago, we both reset our plans for the future. I decided to stop being a journalist and to retrain as a doctor; Jenny decided to make women the focus of her photographic work.

The Soviets were the occupying foreign power then. We were part of an all female film crew making a documentary about women. Our team included a British sound recordist who was last there as a child in the 1960s, travelling freely around the country in a Fiat 500 with her Mum and sister.
The Afghan women we met and interviewed in the late 1980s were as varied as women all over the world. But what they wanted most, they agreed on: better health for their families, food, education, Peace and for women to be an integral part in any process to attain this.
Afghanistan was then, as it is now, one of the poorest countries in the world.

The Soviets pulled out, the varying Mujahedeen groups (backed by other foreign powers) continued to fight each other, the Taliban took control until pushed out by the Americans with help from the British. The US Bush administration, with supreme insincerity claimed that its War on Terror was ‘also a fight for the rights and dignity of Afghan women.’ So often has this been reiterated by well-known US women from Laura Bush to Hilary Clinton, that many in the West now think of the Americans as the ‘liberators’ of Afghan women.
Twenty years later, they are pulling out. And the Taliban, with a history of the most hardline oppression of women, is back in power.

This is what Afghan MP Fawzia Koofi said a few days ago: ‘Peace and security will only come if women are part of the peace process.’ The same message she has been trying to convey and working to implement all her life. The same message we heard back in 1988.
It is a sane, consistent approach to getting lasting Peace. The world has consistently ignored it.
Women like Fawzia Koofi will continue to work for this. She has survived two assassination attempts and has sat at negotiating tables opposite those who tried to kill her. She says ‘there is no option.’
Sometimes she sounds angry, frustrated, but I have never heard her sound hopeless. Not even now.

Meanwhile, as we plan to return to India, I actually look forward to history repeating itself in a good way.
Back in March 2020 I was due to meet up with my friend and fellow ophthalmologist Dr Helen Rao. (Covid cancelled the trip.)
We had rail tickets booked to Bihar and were to join up at the station in Bihar’s second city, Muzaffarpur. Then we were to travel together to eye hospitals in northern Bihar.
The trip was to be a triumphant accomplishment – the Return of the Legendary Dr Helen to Bihar where she has spent most of her working life and is so well-loved.
Now, I wanted to resurrect this abandoned travel plan.

 ‘Where are you?’ I asked over the remarkably good telephone connection.

I could hear a rooster crowing loudly in the background and a more distant, low grunt, probably a water buffalo.

‘I am on the globe’ replied Dr Helen Rao, tantalizingly.

‘Meaning?’

‘In Guntur, Andhra.’

So Helen was still in south India, where she had returned before the first Indian lockdown to be closer to her family.

Her rather teasing answer to my question was on account of the fact that she had just come out of a rather challenging period with some family members succumbing to Covid and others suffering from exacerbations of chronic health problems. For a while life had seemed very precarious and she was unable to make plans.

‘Now we are all OK’ she said.

‘Shall we meet in Bihar?’ I asked.

‘ From October 15 I am free to travel anywhere’ she replied.

Now wasn’t that a stroke of luck. We had booked to arrive in India just about then.

Buoyed up by this news, I messaged young Babul, a twenty something ophthalmic assistant at Laxman Eye Hospital in Muzaffarpur. He once told me that he had ‘the best job in India.’
He had always wanted to meet Dr Helen. He messaged back with his own news.

 ‘We have new lady doctor at Laxman Eye Hospital. It will have impact on majority of our patients. This is the first time for LEH and for me personally to work with lady surgeon. Her behaviour is very good with patients and staff. Also in recent Tokyo Olympics our Indian women’s team performance was very good and they won medal for India. Indian people appreciating the efforts and hard work of these ladies and our new doctor is no less than those Indian women Olympic team.’

Wow. With support like that who could ever fail?

Lucy Mathen

 #jennymatthewsphotogrpaher #hope

#historyrepeatingitself #fawziakoofi #womeninafghanistan

More than talent on the field

Madhu Singh, aged 29, sat on the grass of the village football pitch in Bihar, India and commented : ‘Football is more than a game.’ This was in 2010.

My friend Madhu is a professional footballer, former Vice Captain of the Indian women’s national team. She was the first woman from the state of Bihar to hold this position.
Her family are not well-off. They had been hoping that she would end up with a rather dull but permanent government admin job. But when, and only at the age of 16, she first took up football and immediately showed talent, her siblings and parents backed her all the way.
At times, Madhu struggled – Indian women athletes are not paid well and she found it difficult to survive in between tournaments. Regardless she kept going and travelled around India and the world playing the game she loved.  
Madhu was recruited to coach the girls’ team attached to one of Second Sight’s partner eye hospitals at the time. That’s how we met. On one of my many trips, I brought with me Permi Jhooti, Britian’s first female Asian professional who has played for Millwall, Fulham and Chelsea Football Clubs.
Watching the Bihar girls training, Permi had remarked : ‘This was me at their age. I was a small, insecure Asian kid growing up in Britain. It was only when we got onto the football pitch and I found myself flying down the wing, did I feel, this is me!’

These words came back to me when I read Gareth Southgate’s open letter to our nation prior to the UEFA Euro Championship. (For those who don’t follow football, Southgate is the manager of the England men’s team which lost the Final in a penalty shoot out last Sunday).
Southgate described his team as ‘humble, proud and liberated in being their true selves.’
Which is exactly what Permi was describing. And what Madhu meant by football being more than a game. Indeed, all their sentiments resonate with me and countless numbers of those who have discovered the endless possibilities and thrilling sense of freedom one can feel when participating in the Beautiful Game and which. can positively affect all aspects of your life.
When an entire team can feel this, it is a triumph.

On Sunday July 11, 2021, the England men’s team - brought together with much care, thought and absolute commitment to fairness by the quietly confident Southgate -  stepped out onto the pitch at Wembley embodying all that is best of 21st century England.
As journalist Hugh Muir wrote :  ‘The practical and moral argument that our diversity is our strength has long been made. This team proves it.’

It was painful to see them lose – especially as they played their hearts out. And the ghastly bigots (who already hated the idea of such a team having finally come together) made the most of this by targeting the penalty-takers who missed, who just happened to be black.
We should not even give them the time of day.
Because what led up to that team reaching the Final was a massive achievement.

Football has been plagued by racism for all too long. (Sexism too – but that’s another story for another time). In Britain, the attempts by officialdom to tackle this have involved, quite frankly, a lot of faffing around. Meanwhile Southgate and others, from around 2016, have been quietly and determinedly working to relegate hatred and racism from the game. Not with mission statements and diversity policies. With actions.
When the Black Lives Matter movement erupted on the world stage in 2020 it instilled an urgency and an even more committed spirit into all those who are serious about outlawing discrimination of any kind.

So let us remember that last Sunday, both teams, Italy and England, ‘took the knee’ – kneeling briefly on one knee being the physical act that publicly declares your support for the fight against Racism and is a reminder that the campaign is ongoing.
This togetherness was in marked contrast to the patronizing and vacillating  statements emanating from our own PM Boris Johnson and his infamous Home Secretary Priti Patel. The latter, of Ugandan - Indian origin, called this act of solidarity ‘gesture politics.’

Water off a duck’s back that kind of statement. It is sheer hard work and commitment over years and years that has led us to a place in which our national men’s football team reflects the country.  As well as being the most talented group of players we have had for a very long while, Southgate’s team are black and white players and players of mixed heritage, players from the north of England and from the south of England and more than a few who had to fight poverty and discrimination from a young age. What these mostly very young men share is a commitment to fairness – the majority are involved in charitable work close to their hearts. The players donated their match fees to our hard-pressed National Health Service.

The footballer most notable in this respect is Marcus Rashford who is a campaigner against child food poverty in the UK. He raised and donated money to feed hungry kids missing their free meals when schools were closed during lockdown. He shamed the British Government into making a U-turn on their decision to withhold this free food for poor children.

The solid support for these footballers comes from the fact that they are still grounded in the communities from which they came – visiting their old schools and clubs even now that they are big football icons. In addition, a wonderful bunch of mums and step-mums and dads and aunties and sisters and brothers offer sense and sensibility when the bigots vent their anguish and anger.
However, none of these modern footballers are naïve or gullible. They know that discrimination can rear its ugly head at any time. Unlike past generations – when I grew up in 1960s Britain, it was very much a case of ‘don’t make a fuss’ when faced with racism – they will not be unnerved.
Especially when they are doing so much that is of benefit to all of our country, and all of the world.

So, can we please take the spotlight off the thugs that are spewing out their racist messages wherever they are allowed a forum? They relish it. Let us treat their incoherent and bitter utterances for what they are – alienated commentaries.
Let us keep cheering a brilliant team and its manager and all those supporters who do not behave in a manner that shames us into owning up to being English.

The England men’s team are lucky to have a manager like Southgate.
Madhu was not so lucky. In spite of being the perfect role model, she lost her job training the village girls’ team in Bihar. Why? Because the project became a bit of a political football. Marketing men took over the team and now the once feisty girls are paraded before the cameras to tell how they were victims of discrimination rescued by a scheme dreamt up by men in order to ‘ empower’ them. Interestingly, this has become a bit of a competition in India – there are now at least three such schemes in rural Bihar alone all claiming to be ‘the only team ‘empowering rural girls to play football.

So, we all have different footballing battles to fight.

And Madhu? She is now studying for her official coaching qualifications and still plays regularly, continuing to be the best kind of role model for Indian girl footballers – ‘humble, proud and liberated’ , in Southgate’s memorable words.

Lucy Mathen

#humbleproudandliberatedintheirselves  #footballheroes    #redcardforracism

The Power of Plain Speaking

Probably the most courageous contributors to the Plain Speaking Webinar in which I took part last week were two social workers from India.

In their second, possibly third language, and addressing a gathering of mostly CEOs, Directors, Heads of Department and Board Members of large British charities, they voiced their concerns.

‘You must be knowing about the situation in India and how bad it is’ said one. Then he referred to the social media fundraising campaigns by huge international charities that were launched in the wake of the devastating second wave of Covid in India. These emergency appeals, he had read, had raised a lot of money.

‘But here, on the ground, we just don’t see any of these organisations at work, ‘he told us.

Also on the subject of the role of international charities, the other Indian social worker reported witnessing ‘a very worrying trend.’
Heavily influenced by international charities, Indian non-governmental organisations (NGOs) were now handing over their Monitoring and Evaluation to ‘third parties’, usually private companies.
These third parties, he said, use business models to judge the effectiveness of projects without engaging with the local people who actually plan and implement the programmes.
Oh, and the fees these third parties charge are normally 10% of the total project cost.

These two plain speakers had taken time out from their frontline work to log into the webinar (late at night for them), because it was a rare opportunity to be heard by charity leaders.

The webinar had been organized by the Centre for Charity Effectiveness, part of the Cass Business School in London. And I had been asked to give a talk to kick off the discussion. https://www.cass.city.ac.uk/faculties-and-research/centres/cce/events
In many ways I was an odd choice of speaker. On its website the CCE calls itself ‘the non-profit sector’s academic hub.’ It draws on ‘sound research and the shared experience of academics, consultants and clients to offer support and guidance to nonprofit leaders who want to drive change – be it governance, strategy, leadership.’
Second Sight is an organization that could not be further removed from such a world – our strategy, governance and leadership have evolved very much away from the corridors of academia and in the villages of rural north India.

Ah but that was fine, said the organisers. Tell it like it is. We want to stimulate debate.
So I chose the title : The Power of Plain Speaking. And they added – ‘how a small charity punches way above its weight’.  Which of course Second Sight does.
However, we agreed that the webinar should be as interactive as possible and everyone encouraged to engage in some Plain Speaking in order to widen the discussion.

In one sense it was terrific. I was reminded of my days as a TV reporter on the BBC’s John Craven’s Newsround in the 1970s. That programme had broken the mould and succeeded in conveying important news and current affairs stories to a child audience – with much clarity of language and no patronizing tone whatsoever. No surprise that it was popular with adults, too.

Similarly, having established the tone of the webinar in the only way that I know – with my own plain speaking- when the Q and A started I did not detect any of the jargon or verbosity of language that, sadly, has become part and parcel of the charitable sector.
There was an honesty and openness in the questions and comments. Well done, all.

There was, however, a resounding silence from one group – the representatives of the large charities. This was surprising for two reasons: firstly because one would have thought they would have a great deal to say about the Second Sight creed – Small is not just beautiful but highly effective – but also because most of the contributors ended up asking questions that they were more fitted to answer than me e.g. why is it so difficult to get information out of a big charity, and (the plainest speaking question of the lot) –‘are big charities conning their donors?’

I tried to draw them in. Anyone out there who would like to answer that? I asked more than once.
That’s the drawback of webinars, however. I couldn’t eyeball individual audience members or ask them directly if they wanted to speak up.
There is a limit to Plain Speaking on Zoom.

But why this reluctance to speak, from a group usually most ready to hold forth.

A cynical explanation to the marked silence would be that they could not adequately answer the probing questions.

On the other hand, there could be a more encouraging explanation.
Could it be that some were experiencing a Damascene moment? Perhaps, listening to the natural, conversational language used by most of the attendees to share their own experiences or to make a point, they recognized that they, themselves, had lost the habit of plain speaking.
Perhaps they were able to answer some of those tricky questions or believed that they could justify some of the practices being criticized…but realised that the language they normally use might appear a little weak, even suspiciously opaque in an environment in which everyone else was indulging in plain speaking.

Perhaps they had simply lost the habit of plain speaking.
Perhaps the silence was a humble admission of loss.

Nevertheless, I cannot help feeling a touch of impatience, post-webinar. At myself, too.
Poverty, blindness, domestic abuse, climate change are ALL emergencies. For the people suffering most from these situations they have always been crisis situations. And there are countless great people out there, never forgetting this, and refusing to slack on the job.
All in all, it does seem a bit of a luxury to keep spending time and money on nurturing charity leaders to learn how to reconnect with these people, don’t you think?

So now I am back to doing what I normally do – staying in close touch with the do-ers in Bihar. Until the day when we can once again be amongst them in the flesh.
I have just talked to the doctor in charge of an eye hospital in north-western Bihar. It seems that an inexperienced eye surgeon from neighbouring Nepal has set up a temporary hospital on the Indo-Nepalese border in order to practice his surgical technique on poor patients. Action on several different fronts is required.
Watch this space.

Lucy Mathen

#powerofplainspeaking   #smalliseffective 

Blackouts, black fungus, but still...empathy

‘Ma’am, there is no electricity. So couldn’t locate phone.’

This message from Dr Utkarsh Bhardwaj from his flat in Patna, explaining why he had not answered my call.

On top of a devastating second wave of Covid throughout India, the north-eastern states are also suffering the effects of Cyclone Yaas.

Year on year, cyclones brew in the storm-friendly cauldron of the Bay of Bengal. The Indian states of West Bengal and Odisha bear the brunt of the high winds and torrential rain. But then the storm brings heavy rain to neighbouring Bihar, the roads get flooded, unstable buildings collapse, electricity pylons go down and the lights go out.

This year Cyclone Yaas – named after the sweet-smelling jasmine flower – brought a trail of filth and debris and unsavoury smells to a city already known for its dirtiness. For a while it shut down Patna Airport disrupting the delivery of essential medical supplies.

Nonetheless, Dr Utkarsh and I were able to have our conversation, he standing in his darkened kitchen and me in a sunny bedroom in London.

We wanted to discuss the latest Covid medical complication –  the deadly black fungus infection, mucormycosis. It is particularly frightening for people because its manifestations are so gruesome and visible, darkening the inside of the nose, mouth and skin around the eye.

The mucor fungus is breathed in from the air and can hang around harmlessly in our noses. However, in patients whose immune system is compromised by an infection like Covid and whose nasal passages are severely damaged by the illness, this opportunistic organism can take hold and kills over 50 % of patients.
In India so far, almost all these unfortunate patients are diabetics whose disease is poorly controlled and made worse by steroids given as part of their Covid treatment.

The last resort surgical option, to try to save life, falls to an ophthalmologist. This is because mucor tries to reach the brain – via the nasal passages, the sinuses, the eye and the orbit. To avoid it causing a fatal stroke, the eyeball and surrounding structures are removed.

This radical surgery- known as orbital exenteration -  is utterly traumatising for both patient and surgeon. The task is usually undertaken by an eye doctor specialising in plastic and reconstructive surgery…like Dr Kasturi Battacharjee.

Both Utkarsh and I had seen Dr Battacharjee’s presentation on a webinar organised by the All India Ophthalmological Society. She was speaking from her hospital in the north-eastern state of Assam.

Dr Battacharjee discussed mathematical models designed to help surgeons decide when they should go ahead with exenteration. And expressed concern that there was ‘no clear evidence’ in medical literature to confirm that exenteration actually helped survival rates.

The most moving part of her presentation, and indeed the section that evidently moved her most, was when she put up data about the psychological consequences of removing an eye and the disfigurement caused even with reconstructive surgery and prostheses. (The data came from patients in the past who had had the surgery for conditions like cancer). These were the findings:

All patients were 100% happy with the medical result.
But when it came to the way they looked, only 50% were OK with this.
60% reported suffering routinely from unwelcome comments and 50% from unwelcome stares.

Dr Battacharjee added, with emphasis: ‘This is so sad...60%, reported feeling uncomfortable even when in the company of their closest friends and relatives.’

Dr Battacharjee urged her colleagues to think very carefully about going ahead with removal of the eye and to spend time preparing the patients and their families for the long term psychological and social effects.

In Bihar, Utkarsh is working at one of three centres in Patna city dedicated to handling patients with mucormycosis. I asked him what happened when removal of the eye was discussed with patients.

‘Actually Ma’am they are not giving their consent. When we go through all the details with them and show them pictures, they don’t agree to go ahead with surgery even if we say that it may improve their survival rate.’

Early diagnosis and treatment with the anti-fungal drug called Amphotericin B is considered the best approach, along with some surgery to remove the fungus from the nose or mouth.

However, Amphotericin B is not available where I am, said one doctor at the conference. Supplies are not guaranteed, announced another. There were a few sympathetic head shakes from the postage-stamp images on the webinar.

‘Well, this is where we are right now’ said an ophthalmologist in Delhi, with a sigh and weary voice. ‘We do what we can do for every patient.’

The reason I am telling you this story is not to add to the gloom over what is happening out in India.
I want to highlight the empathy that I witnessed amongst this group of ophthalmologists at a hastily convened medical webinar in unprecedented times. It cheered me up.

Dr Battacharjee had reminded her colleagues that exenteration was a shared trauma for doctor and patient. Her colleagues sombrely agreed.
This is where we are. We do what we can do for each patient. Let’s hope we learn more for the future. Sentiments shared by doctors all over the world, empathising with their fellow professionals as much as with their patients.

Sadly, the pandemic has not brought out empathy in everyone.
On the same day of the webinar, I was forwarded a shocking video called ‘If I die, it’s your fault.’
Made by the Institute of General Practice Management, it contained a catalogue of the worst verbal abuse endured by receptionists at doctors’ surgeries in the UK during the pandemic.

The words– ‘if I die, it’s your fault – was the most common abusive accusation aimed at receptionists.

Only a serious shortage of collective empathy could normalise such behaviour.
Only the loss of the ability to empathise would result in the IGPM having to remind the British public that doctors’ receptionists, like patients, had suffered bereavements, caught COVID, had had to self-isolate and not see families…and that some had died during the pandemic.

The concluding appeal was ‘In a world where you can be anything, be kind.’

I think the empathy muscle sometimes needs reminders to exercise. Which may be why I found scribbled on the cover of one of my old diaries, this quote from JM Barrie’s The Little White Bird:

‘Shall we make a new rule of life from tonight: always to try to be a little kinder than is necessary.’

Lucy Mathen

#ifIdieitsyourfault #theempathymuscle

#wedowhatwecando #blackfungus #kindness

Every precious life

 Friday April 30

With news bulletins beaming distressing videos of people in India gasping for air, I receive this message from Dr Dhiraj Ranjan who runs our partner eye hospital in Motihari in north-western Bihar. This area – in the district of East Champaran -  is probably the most deprived area in the most deprived state in India.

‘Ma’am there is an oxygen factory 30km from Motihari, in Harsiddhi. We are buying cylinders with donated money and taking it to the Sadar (government) hospital.’

The ‘we’ are a group of committed and organized local people including social workers, doctors, medical students and others, the kind of people I run into every time I am in Bihar. People who make the world go round. Even when the planet appears to be off kilter.  

And it is because of this group that I can begin with a positive story about an otherwise horrendous week of events in India. It is about a young newly-wed couple called Anku Tiwari and Nutan Kumari from the village of Barharwa Kala.

Anku and Nutan eke out a living as ‘daily wage earners’ usually ending up with roughly 300 rupees (£3) at the end of each long day. They are in their early 30s and Nutan is in the early stages of pregnancy.
Anku developed a fever, bought some tablets at a pharmacy and returned to the dilapidated hut that is their home. His condition worsened so a worried Nutan brought him to the Sadar government hospital. He was admitted. But the hard-working and desperate team of doctors had run out of oxygen.
A hospital employee rang Dr Dhiraj. He sent two of his eye hospital team, well trained and experienced in patient care. They took with them an oxygen cylinder and money for food for Anku.
They returned the next morning to discover that Nutan was now sick. She, too, needed oxygen. After receiving supplementary oxygen for 48 hours and 72 hours respectively, Anku and Nutan were out of danger. They remained in hospital until well enough to be discharged.
Two precious lives, and a life in the making, saved.

 Sunday May 1
‘You safe, we safe’ wrote Dr Faisal Siddiqui from West Champaran district, always concerned for his honorary Bihari friends in the UK. Then: “Situation is very scary. It seems the world is going to end. Oxygen supply here is just manageable.’

From Laxman Eye Hospital boss Thakur Dharmendra Singh, a man with his finger on the pulse of northern Bihar, this message:

‘We have stopped eye surgery, seeing only emergencies, and will watch the situation. In Muzaffarpur there are two active oxygen plants so, so far, there is no oxygen shortage. Our team is safe and we have explained to all patients and their families that we will restart our normal work as soon as we can.’

Monday May 2

Update from East Champaran.
Many villagers are selling their precious bakaree (goat) in order to pay for treatment, any treatment that is available. This is indicative of absolute desperation. I remember the Bihar floods of a few years back. My friend and Canossian Catholic nun, Sister Jessy was involved in trying to rescue villagers in danger of drowning. They refused to step onto the rescue boats unless their most valuable possession – the bakaree was safe in their arms.

Tuesday May 3

Some reassuring news from eye surgeon Dr Utkarsh Bhadwarj. He lost his mother to COVID a few weeks ago and the entire family (which includes two doctors) were infected by the virus.

‘Ma’am we are getting better. Papa is keeping busy with his legal work. While I have been recovering, the eye hospital in Araria was able to continue restoring sight to the blind and seeing patients in the Out Patients department - that is credit to my colleague Dr Navin. Now I am thinking we should start a vaccination centre (in a side building). We should play our part to stop Covid.’

Wednesday May 4

Everyone is talking about oxygen concentrators. I receive numerous appeals by email and WhatsApp from other organisations about sending them out to India. Some confused reporting in the media gives the impression that they are a straight alternative to oxygen delivered from cylinders – they are not.

The very sickest COVID patient can need 10-12litres of oxygen per minute. The concentrators can deliver up to 5litres per minute. So they are useful for less sick patients being cared for at home and to try to stabilise a hospital patient waiting for an oxygen bed to free up. The Bihar state health department has just issued a directive to Covid-designated hospitals - medical staff should utilize concentrators for those patients requiring less than 5litres of oxygen per minute.

But what do they cost?
I am told by social worker Jestin Anthony in Delhi that these machines are now selling for 50,000 rupees (around £500). In Bihar one shop has priced them at 65,000 rupees, a price few can afford in this state.

This concentration on oxygen alone worries me.
In Bihar, the drastic shortage of medical personnel is at least as important as oxygen supplies when it comes to saving patients.
In the past week, four doctors have died in the town of Motihari alone.
There was a new batch of qualified doctors from a local medical college. However, they have not applied for advertised vacancies…and one can understand why.
In return for risking their lives treating Covid patients (not to mention risking the lives of their families) the state government is offering them 5000 rupees a day (around £50) and only a three month contract.

I am reminded of  Spitfire pilots in the Battle of Britain in the second world war – whose life expectancy was just four weeks.

Thursday May 6

Some great news. Almas, wife of Azhar Khan messages from the town of Aurangabad in southern Bihar.

‘Azhar now fine. Can walk and speak freshly. He also wants to talk to you whenever you are free.’

39 year-old Azhar Khan, who runs Drishti Eye Care Hospital, spent 14 days in intensive care in Bihar’s capital city of Patna. He was in a very poor state. Luckily, though, there was no shortage of oxygen in Patna at that stage.
Now back home in Aurangabad, he is the sole patient at his own eye hospital. As Dishti is located amongst green fields and low lying craggy hills, away from main roads and polluting traffic, it is an ideal rehabilitation centre!

Friday May 7
The WhatsApp message I most dread. This time from Dr Amit Anand in Madhepura, north-eastern Bihar.
His father had been admitted to hospital at the beginning of the week.

‘Papa nahi rahe’ wrote Amit in hindi.
Papa is no more.

Apart from his personal grief, Amit, like so many medics all over the world, also expressed a sense of collective helplessness and feelings of failure that doctors are unable to save patients in such circumstances.

‘This virus is very dangerous.’

Four times a year Dr Amit’s hospitable parents allow us to squat in their home, spend hours planning eye screening camps, talking shop and engaging in raucous discussions about politics, global warning, you name it. During the last year, these discussions continued via Zoom. Just a few weeks back we were all looking forward to the inauguration of the new Anand Eye Hospital and Amit was commiserating with us for not being able to be there in person as we were then in lockdown and rural and small town Bihar had been almost unaffected by the Covid virus.

Life on a knife edge.

Saturday May 8

I wake to the sound of rain on my windowpanes and grey skies in the heavens.

I read my first WhastApp message from Bihar.
1857 people had been admitted to the Sadar Hospital in Motihari. (The hospital is officially a 50 bedded hospital but has been admitting 200-300 patients daily till now).

I read that Dr Dhiraj and his friends had already bought and delivered 206 oxygen cylinders that morning.

‘The corona bomb has been fired in Motihari’ wrote Dhiraj. ‘I will make every effort to save my town. We will provide oxygen cylinders for those who have God and no-one else.’

I send money via Western Union. A few hours later I receive email conformation that that cash has been picked up.
‘I am returning to the Harsiddhi oxygen factory right now’ messages Dhiraj.

I suspect that he is travelling in one of the same hospital vehicles that has transported so many of us all over Bihar.
In normal times we would be collecting patients to bring them to hospital for eye surgery – giving sight to those who cannot see.
Did we ever anticipate that we would be transporting oxygen for those who cannot breathe?

Lucy Mathen

#everypreciouslife #communityishumanity #basichumanvalues