The idea of having accessible Pacific-wide eye care is no longer a pipe-dream and is creeping closer to reality thanks to a Suva-based institute with a multi-faceted approach to healthcare.
The Pacific Eye Institute in Suva Photo: Pacific Eye Institute
The Pacific Eye Institute is a non-profit, supported by the Fred Hollows Institute, which provides specialised care for people around the region but also trains and recruits professionals to aid communities in their own countries.
One such professional is Duke Mataka, the sole ophthalmologist (or specialist eye doctor), in Tonga.
Dr Mataka graduated from the Pacific Eye Institute last year before returning to the kingdom to serve his community.
He wasn't originally interested in working in eye care, until he witnessed the work of a visiting PEI outreach team in the outer island of Vava'u, carrying out over 100 surgeries in just one week.
Dr Mataka said it was then he realised the scale of the problem in his nation.
"So I guess I was thinking to myself, I guess this is an area where Tonga needs a service to be provided."
There are challenges for Dr Mataka, with lunch breaks sometimes being forsaken to get through patient numbers, and equipment not always in the best shape.
Tonga's sole Ophthamolohist, Dr Duke Mataka Photo: RNZ Pacific / Koro Vaka'uta
PEI Workforce and Academic Manager, Clare Luoni, leads efforts to make graduates like Dr Mataka's job easier.
"We figured out pretty early on in the piece that we couldn't just send them away, go back home and everything would be okay,'' she said.
"And a lot of them are going home to places where there's not a lot of equipment or support."
This is exacerbated in countries like Tonga where there is only one eye doctor. This is why the PEI runs a workforce support programme.
"So it covers quite a range of things but includes things like mentorship, continuing education, getting them the equipment they need. It's very hard to check people's eyes without the right equipment and consumables for surgeries and things like that," Ms Luoni said.
Despite these challenges, Dr Mataka said witnessing people's sight being restored made it worthwhile.
"It's an awesome feeling to have an immediate impact on their life and when you remove the pads the next day and they change from not seeing anything to seeing everything."
Dr Mataka will get more help on the ground in a few years when a second Tongan Ophthalmologist graduates from the Pacific Eye Institute.
Another young man working towards graduating from the PEI is Ilaisa Batai, who hopes to become a specialist eye care nurse.
Mr Batai has worked in the medical field for over eight years but became interested in eye care when he spent some time at the institute and saw the amount of avoidable blindness in his home country of Fiji.
He said he saw children as young as seven come in to get medical attention.
"When you see these kind of things, and then you question yourself about how important the eye is to the human body and in terms of your productivity.
"So when I see these young people coming in, it motivates me to, to talk about it more. And I think it's just awareness and taking it back to your community," Mr Batai said.
Awareness around avoidable blindness includes information about cataracts, which are prevalent in the Pacific, and the increasing incidence of Diabetic Retinopathy or Diabetes Eye Disease.
Artika Avikashni is an assistant lecturer at the Fiji National University, which works in partnership with the PEI, and said the emergence of Diabetic Retinopathy impacted what was taught to nurses who came through the programme.
"Our programme changed from 2017. We included a Diabetic Retinopathy course in the whole main programme as one of our major components," she said.
"Since NCDs [Non-Communicable Diseases] like diabetes is on the rise, I think Pacific tops the charts currently, so we have this whole programme that has one special component on Diabetic Retinopathy.
Assistant Lecturer, Artika Avikashni Photo: Fred Hollows Foundation
"They are trained to screen, to grade, to manage and to pick up Diabetic Retinopathy. So when they go back, and the equipment's provided, they are not only doing the general eye care, but they also now screening for Diabetic Retinopathy," said Ms Avikashni.
Fellow Eye Care Lecturer, Ashreeta Lingam, said the new study content meant nurses could step up around the region to fill the gaps that existed.
"One Ophthalmologist can not be everywhere in the island.
"So what happens is that these nurses are placed into those places and then they are the ones who give eye care to their people," Ms Lingam said.
Komal Ram runs the Pacific Diabetic Retinopathy Programme.
She agreed the threat of D.R., as its sometimes called, meant that training and education was really important.
"There's a lot of people that don't even know that they've got diabetes. So when our nurses even go out and they're do screening, they sometimes are the first ones diagnosing someone who's got diabetes that was not aware of it," Ms Ram said.
She was optimistic for the future though, as 10 years ago there wasn't much of a regional presence for her programme and now it had expanded through a number of countries.
Nearly 300 graduates have emerged from the PEI, including about 30 doctors, 170 nurses and another 86 nurses at a sister programme in Papua New Guinea.
The graduates included doctors who were now the only eye specialists in their country, like Dr Mataka and Kiribati's Rabebe Tekeraoi.
All of the graduates have been supported by the Fred Hollows Foundation whose executive director is Andrew Bell.
He was proud of the graduates coming out of the institute, particularly what he called world class Ophthalmologists.
"They can operate, they can treat patients, they can deal with injuries, they can they can do the whole range of medical interventions that are required in ophthalmology."
Mr Bell said they were rock stars.
"Because often they're working in difficult circumstances, especially if they're on outreach. They'll be in some really small clinic that's not really well equipped but they still work their magic anyway, so they really are amazing."
That magic, as Mr Bell calls it, is also carried out on the Suva premises of the Pacific Eye Institute.
In 2018 over 37,000 consultations were carried out, more than 1,500 sight-saving surgeries too place, a similar number of laser treatments took place and over 3,000 pairs of glasses were distributed.
Chandra San Deo is just one of those who have benefited from the services at the institute.
Mr San Deo said his vision had been deteriorating over a period of five years.
"It was painful, in the morning I would wake up and my eyes were in pain and it took me a while to open my eyes," he said.
However earlier this year he had surgery at the PEI and he could now drive a car again, he can work and even tie his shoelaces, things he had difficulty doing in the past.
The Mobile Eye Clinic in Fiji Photo: Fred Hollows Foundation
More people are also being reached through the Mobile Eye Clinic that is sent across the Fijian islands of Vanua Levu and Viti Levu.
Harris Ansari, a senior Ophthalmologist at the PEI, spent many years leading the Mobile team.
Dr Ansari said he would never forget the impact and emotion expressed during his time travelling through Fiji.
He remembered following up with a man who he had operated on and finding him seemingly indifferent at best and unhappy at worst.
The two parted company and it wasn't until another member of the team told him why the man had reacted in such a way.
"He told me because the man had always been so self reliant, he did not know how to thank me, and he could not even talk to me, but he actually went outside and cried because he saw his one and a half year old daughter for the first time in his life," said Dr Ansari.
As the work at the Pacific Eye Institute continues, the hope is more and more people across the region will get a chance to have such a life-changing experience.
Photo: Fred Hollows Foundation NZ
The author travelled to Suva in June to attend the Pacific Eye Care Society conference courtesy of the Fred Hollows Foundation NZ.