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