A new approach to vision
Today is world patient day and the start of the 75th United Nations General Assembly. A historic virtual gathering, which the world needs more than ever as we fight to achieve the Global Goals and continue the progress that has been made in the last 20 years.
Dr Andrew Bastawrous is an Ophthalmologist and the CEO and co-founder of Peek Vision. He is the Vision Catalyst Fund’s first Global Ambassador and reflects on the story of Theresa leading him to think about future funding in vision.
Theresa kept her eyes firmly to the floor avoiding eye contact with me or any of my team. Her walk was not the familiar walk of someone with no vision, that careful, purposeful movement reaching out with hands and toes to identify potential hazards. No, this was someone whose body language spoke of shame and embarrassment. She sat on the examination stool (four bright coloured plastic market seats stacked on one another) and slowly raised her eyes to me. She had thick pink-white growths on the inside of each eye covering some of the brown iris of each eye. These growths were a common sight to me, known as “pterygium”, found regularly in hot and dry countries and easily treatable with basic surgery.
Theresa and her mother explained to me that the appearance of her eyes had meant she had missed the last years of her schooling. Her self-esteem was through the floor and she had no prospects of marriage or beginning a family of her own - all because of how she looked and how it made her feel.
Although I knew how to do pterygium surgery and had the equipment and access to an operating room at a nearby hospital I wasn’t able to help her.
We had been generously funded to find and treat 100 people who were blind or vision impaired from cataracts. Cataracts are the leading cause of blindness in the world and cataract surgery is a rare “silver bullet”; for very little cost (about $30) and in very little time someone who has lost their sight can seemingly miraculously have their full sight restored within minutes. (See here for yourself) It is absolutely right to invest in the control of cataract related sight loss, however, when the person in front of you needs something different that you could offer if the right funds were available, how can you say “no”?
Theresa’s case is representative of the reality for so many practitioners, institutions and organisations in global health. We are forced into making very difficult choices - do I serve the needs of the person in front of me or do I serve the plan we previously agreed with the funder, donor or other supporters? Eye health is a chronically under-funded area of global health, and as CEO of a social enterprise (Peek Vision), I am well aware of how hard many funders, philanthropists and governments work to secure funding for the sector. That funding needs to be accountable, which is why we work on these plans and carefully-monitored outcomes. The challenge comes when the needs on the ground change more quickly than the plans can allow for - something which most organisations in the field will be acutely aware of following the recent COVID-19 pandemic.
I am also an Associate Professor studying and teaching global eye health at the London School of Hygiene & Tropical Medicine. The funding we have received over the years has enabled us to understand the problems in global eye health and develop solutions to tackle them. However, putting some of that funding into practice has often led to unintended consequences for those closest to the problem being solved.
We tend to agree and finalise budgets based on plans to deliver agreed outcomes or deliverables. Even the best-made plans are full of assumptions and unknowns and as the work starts we reveal all sorts of unanticipated problems or unexpected issues that need resolution if the objectives are to be met, and sometimes we realise we set the wrong objectives. The reality is that the systems we’ve created to enable growth and scale can also create rigidity and unintended consequences.
For all of us playing our part to bring vision and eye health to everyone, we face major challenges. To turn the tide on the growing global vision crisis we need to operate at a scale many times greater than we are today. Thanks to the work of numerous healthcare organisations, charities, governments and companies in recent decades, there are actually many examples of proven concepts for innovations and interventions in eye health that have the potential to help us tackle the vision crisis in low- and middle-income countries. A fundamental problem is that there is often no bridging mechanism allowing those concepts to be scaled up to address the huge challenge we are trying to resolve.
In the private sector, venture capital firms and angel investment can help cross that chasm. The “Vision Capital Chasm” is a major barrier to reaching the elusive tipping point that will see future generations experiencing a reduction in vision loss rather than an increase.
There are many funding organisations who are tackling complexity and developing the know-how and capacity to do much more in each country, hospital and community. Yet despite this, we do not have the enabling environment to deliver our full potential. We need a change, and change often begins with a collective purpose that is catalysed.
As we approach the end of the decade, we’ve witnessed incredible progress and innovation in global eye health initiatives. They have supported the tireless work of eye health professionals across the world to restore sight to literally hundreds of millions of people, as well as building the systems to prevent many more losing their sight. But despite our collective success, the rate of global growth and ageing has outstripped our efforts. Thus, we should celebrate and build on the past, but we need to go from incremental to exponential change.
The Vision Catalyst Fund was established on the collective belief that we (charities, NGOs, private sector, banks, academia and government) had more to gain by working together to solve this problem. While it is still early days, as a global ambassador for the VCF I am hopeful that it will provide a new way to fund programmes, focussing on government-driven initiatives and funding that gap between concept and scale-up, as well as allowing governments, charities and other eye health providers to work more effectively with the private sector to provide flexible care at scale for those who need it most. Vision may be classed as a health issue, but its outcomes affect almost every aspect of a person’s life - health, wealth, safety, education and equity. If ever a time was needed to raise the bar and ambition to bridge the Vision Capital Chasm and ensure no one is truly left behind, it is now.
For Theresa, we made the decision to treat her, and worked with our donors to explain our decision. The trust we had built between us was crucial to allow us to make a choice in the moment that led to the best possible outcome for the patient.
The smile in her eyes was restored, along with her ability to look at me and her future in the eyes.
