Longevity

Just back from India. And I am delighted to be the bearer of ‘tidings of great joy in this Christmas blog.
Mother Nature and the good folk of Bihar are responsible. Longevity also plays its part.

India’s capital city was choked by the worst pollution ever experienced. ‘Apparently it’s like smoking 40 cigarettes a day’ Delhi-ites told us…then stepped into their air-conditioned automobiles to take them to homes furnished with air purifiers, avoiding the option of using the city’s efficient Metro system run on clean energy.

But then we were in rural Bihar and it was a different story. After two hellish years of summer heatwaves and poor monsoons, this year the rains were adequate and the paddy harvest was good. The early morning mist lifted to reveal yellow fields glistening in the winter sun. The rice waited for collection in tidily arranged bundles. From dawn to dusk, processions of straight-backed workers carried away the harvest, heads invisible under their wispy burdens, bright saris or loose trousers distinguishing women from men.

These conditions are ideal for our village outreach programmes. Adapting to the harvest routine, the ophthalmic teams stay overnight close to the villages they will screen for eye diseases; they can catch the agricultural workers before they set off for the fields at 7am. Eye injuries are all too common during harvesting. They must be treated promptly and advice given not to go to quack doctors. (Inappropriate treatment by these village quacks results in irreversible blindness in the affected eyes for thousands of people in Bihar every year).

Once most of the adults are out in the fields, the villages become lively playgrounds with hordes of young children and the grannies who look after them. With the team from Laxman Eye Hospital (LEH) we met a Super Gran – rather a super great great grandmother. Binda Devi was surrounded by generations of her family… and armed with a scythe. With an agility Jacky Chan would have envied, she demonstrated how she still dug the earth and planted crops and had never had any health problem whatsoever, not even with her eyes, thank you very much.
A sadder granny sat with her 6year-old granddaughter in her lap. The child had cerebral palsy (a neurological disorder). Ophthalmic assistant Babul, trained in paediatric ophthalmology, wondered what we could do for her. Golden rule of paediatric ophthalmology I asked? Refraction, he replied. (Testing the child for a refractive error that could be helped with glasses). Precisely. Careful refraction back at the hospital could provide a set of glasses that could improve vision and the quality of her life.
I left the logistics in the safe hands of Babul.

Identifying and collecting cataract-blind patients for surgery is the other part of outreach. At this time of year every charitable eye hospital in Bihar should be teeming with such patients. This certainly was the case at LEH. In addition to those collected from their outreach programme, they get plenty of  ‘walk in’ patients who have made their way from neighbouring districts. The surgical data I had been receiving all year show that as many as 20 a month come from Samastipur district.
We were curious about this. Because Bihar’s biggest and wealthiest charitable hospital – the Akhand Jyoti – has had a satellite hospital in Samastipur for 4 years. So why are so many patients – all fitting the blindness category - making their way to LEH in Muzaffarpur district?
We paid the Samastipur hospital an impromptu visit. A spacious, saffron-coloured building set amongst beautiful fields. We met the manager whom we knew from 12 years ago when he was a hospital accountant. We saw two white buses unload a handful of patients. We were introduced to a local lass who was a senior optometrist. We were told that their one ophthalmologist was in the operating theatre. They hoped to carry out 4,500 cataract operations this year for which they had adequate funding. No the patients they collected did not necessary fit the blindness category. (Which explains the exodus of the blind to LEH). As for treating primary eye diseases and emergencies in the field? They ‘referred’ the patients i.e. told them to come to the hospital by their own means…or even to go to their big tertiary hospital at Mastichak, 100 kms away.
At this point, and my colleagues are my witness, I almost got down on my knees and begged. I asked the manager, for old times sake (!) to please direct his village teams to address the harvest horror of infected traumatic corneal ulcers. They could transport patients in those big buses if necessary, anything so that they would prevent irreversible blindness right under their noses. Perhaps that senior optometrist would relish this work and claim, as LEH’s Babul once did, that she had the most rewarding job in India. Perhaps greater job satisfaction might alleviate their staff recruitment problem?
‘Yes, ma’am…we will do this,” said the manager.
I need to believe him.

In north-west Bihar, the MHKS hospital team enter the village of Harihara in East Champaran district.
A landowner caller Bihari Singh falls into step beside me and gives me some useful demographics. His village has approximately 6000 people. 70 per cent were from the lower ‘scheduled castes’ in the Hindu caste system, and including musahars who occupy the lowest rungs of this system. There were also some Muslim families. The village minority were upper caste rajputs.
Of the 6000 people, over half were under 5 years-old. Woah. That was a lot of kids needing Vitamin A supplements. And indeed, there were plenty of little urchins running around with the unmistakeable blondish hair characteristic of malnutrition. Adapting their outreach programme on the hoof, Dr Dhiraj and the team decided they would come back the next day especially for the children. And they did.
One nice surprise – the families told us that the government measles vaccination programme had actually come to Harihara and had even vaccinated the musahar kids…something that doesn’t always happen in rural Bihar. (Measles exacerbates Vitamin A deficiency).

NB The MHKS and LEH outreach teams are continuing with their Vitamin A distribution in spite of a huge setback. An international charity called Vitamin Angels (VA) used to supply these supplements to all Second Sight affiliated hospitals – free of charge and with remarkable efficiency. This has now stopped. VA has run into a problem with their manufacturing source.
This leaves these two community eye hospitals having to buy the supplements from local sources, an added and large cost for teams already operating on a shoestring budget. Vitamin A deficiency is still the leading cause of childhood blindness in rural Bihar.

Meanwhile in Bihar’s capital city of Patna there appears to be plenty of money to spend on eye care. We were asked to visit a Government Super Specialty Eye Hospital, spread over six storeys, with acres of wards, 5 operating theatres and clinics equipped with more expensive ophthalmic equipment than all our rural hospitals possess in the aggregate. There were also large conference rooms set aside for training.
When we arrived, a posse of security guards bore down on us, before we spotted the neat, slight figure of our friend Dr Ajit Dwivedi. He recently became the hospital’s Director. And for a super specialty eye hospital you couldn’t do better – his super specialty is paediatric glaucoma, the first ophthalmologist to bring this treatment to Bihar. What’s more he is utterly dedicated to making such treatment accessible to the poorest and implements this at his own small Trust hospital.
So what’s the problem?
Well, in theory, a family from anywhere in Bihar who have a child born with glaucoma can come to this government hospital and see the super specialist in this field, the skilled Dr Dwivedi. And all treatment is free of charge.
In practice, because of a dearth of medical staff willing to work here (in a city in which the majority of Bihar’s ophthalmologists are located), the family would have to go to a private clinic in Patna for preliminary tests before being seen in the glaucoma clinic; and because they are no ward nurses, they cannot be admitted as in-patients and so would have to find somewhere to stay in the hectic and expensive capital city.
Unfortunately those high-stepping, readily saluting security guards are not trained in patient care.

Nor is this the end of the surrealism surrounding the Super Specialty Eye Hospital Scenario in Patna. The day after we visited the government hospital, these were the headlines in the Hindu newspaper.
The Nitish Kumar-led Bihar government has given 1.60 acre of land to the Coimbatore-based Sankara Eye Foundation India on conditional lease at token amount of ₹1
For what purpose has this south Indian-based eye foundation been given Bihari land?  Wait for it….to build a ‘super specialty eye hospital in Patna’. Where? Right next to the existing Government Super Specialty Eye Hospital.
You couldn’t make it up could you.

Thankfully, this is when the advantages of longevity kick in. We have seen it all before.
In fact, it is why we exist. 25 years ago international charities were already building eye hospitals which were then unable to cure the blind because of the paucity of eye surgeons. Second Sight was launched to provide those missing clinicians and to relentlessly support Indian ophthalmologists wishing to work for the poor.
In Bihar, this kick-started a reverse brain drain of local doctors. A network of community hospitals are now the backbone of the eradication of blindness in rural Bihar. Their buildings are not lavish. But their wards are full, their staff long-serving and patently enjoying their work, their patients happy.
So, frustrating though it is to see the unabated ‘growth mania’ in the form of behemoth buildings in Bihar, I no longer froth at the mouth over this waste of resources. I am content.

Finally, I would like to dedicate this Happy Blog to a dear friend and stalwart Second Sight supporter. Whilst in Bihar, I received the sad news of the sudden death of Ramesh KD Shah. He had funded the restoration of sight of many thousands of blind men women and children. He had given personal guidance and encouragement to so many of us and always with a touch of humour.
My favourite WhatsApp message from him was written 3 years ago.
 ‘Honoured to be a partner in this journey of 22 years. Doctors carrying on their empathic work as they have done for millennia. Also admire your Keep it Simple Stupid approach.’

I wish you all a Happy Christmas and Peaceful 2025. Btw that’s the formidable Binda Devi in the red sari. (I have her scythe). If you have enjoyed reading this anniversary blog, please click the LIKE icon below and encourage us into the next important decade.

Lucy Mathen

#keepitsimplestupid #longevityhasitsplace #secondsight #saynotogrowthmania