let’s see if I can patch in the pdf of the whole Dispatch, with photos, which the Dispatches section isn’t allowing me to do but we’re working on it. Here goes. Crikey, it won’t include the photos. you’ll have to go to the dropbox link of the Dispatch, in the Dispatches section, for them
THE GREAT ETHIOPIAN CATARACT INTERVENTION
by Alex Shoumatoff
By the time I joined them, on May 10th, Dr. Geoff Tabin and his team of Ethiopian eye surgeons and ophthalmic nurses had removed cataracts from and restored sight to 1100 people, most of them dirt-poor subsistence farmers Tigray, the northernmost of the country’s nine kililoch or ethnic regions. Now they were in Woldiya, a trading town three hours south, in the highlands of Amhara, where they were hoping to do as many operations. “This is going to be the largest cataract intervention in the history of Africa,” Tabin told me when I met him in New York City in January.
Tabin had come for the annual dinner of the American Alpine Club. An avid mountaineer, he has climbed Everest twice, and the seven summits— the highest peak on each continent. When he was at Oxford, he took the first bungee jump with some crazy risk-junkie classmates, and was the captain of Yale’s undergraduate tennis team two years in a row before that, and he is only 5’8,” a high-achieving, hyperkenetic American who is doing some real good, a refreshing change from our many unaltruistic compatriots. He is one of the Dalai Lama’s Unsung Heroes
The Tabins are a high-powered family. Geoff’s older brother is the chairman of Harvard’s department of genetics. Their father Julius was one of the nuclear physicists in the Manhattan Project, which developed the atom bomb. Their mother is a psychoanalyst who studied with Anna Freud and is still practising in her eighties. Geoff grew up in Glencoe, a largely Jewish suburb of Chicago. His brother recalls him as being obsessed with being the best at everything he did. He now runs the international division of the University of Utah’s Moran Eye Center in Salt Lake City and lives up in Park City, where thousand-foot rock walls he can work off his excess energy on are plentiful. And on top of everything else, the guy plays a mean mouth harp. His voicemail message has some inspired twelve-bar Chicago blues phrases blown by him.
Tabin’s love of climbing brought him into contact with the remarkable Nepali ophthalmologist Sanduk Ruit who had pioneered a sutureless microsurgical procedure for removing cataracts and replacing the lenses they had clouded up with clear artificial ones. There is a lot of cataract blindness in Nepal, and Ruit’s procedure was high-quality and inexpensive and the equipment was transportable to remote mountain villages. Tabin was so blown away by the charismatic Ruit and what he was doing that in l994 the two of them founded the Himalayan Cataract Project. Today more cataract operations are being performed in Nepal than new cases are appearing. Ruit and Tabin, whose story is masterfully and powerfully told in David Oliver Relin’s book, Second Suns, are well on their way to realizing what seemed an impossible dream to all but them 20 years ago : eliminating all preventable and treatable blindness in the Himalayas.
And Tabin has been taking the show on the road in Africa, starting in Ghana in 2006. This is his fourth annual intervention in Ethiopia, which, he told me, has the highest rate of preventable blindness on the continent : 2.3% of its 95 million people, half of them from cataracts— the rest from trachoma, glaucoma, macular degeneration, corneal opacities, childhood blindness, which can be caused by vitamin A deficiency and other things. A surprising number of ocular cases result from kids being attacked by hyenas. Nigeria, with its 190 million people has the greatest number of people with cataracts. World-wide, there are about 39 million blind people, 90% of them in the developing world.
Between 1990 and 2010 the prevalence of blindness fell from 0,6 to 0,46 % globally, and from 0,8 to 0,56 % in sub-Saharan Africa. Due to overall growth and relative ageing of the population this translates to a small increase in the number of people with vision impairment – but this still means there are 100 million fewer people blind and visual impaired in 2010 than would have been the case with 1990 prevalence rates.
The Himalayan Cataract project (HCP), as per its Web site, cureblindness.org, is a small ngo with a budget of four million dollars a year, 48% of which is raised by private donations, the rest (13%, 23% and 16% respectively) from foundations, government, and gifts in kind. 90% of the budget is spent on its programs, its intervention campaigns in Asia and Africa. The thing that makes it possible is that the procedure perfected by Ruit costs only $20. Essentially the same operation, the most common and frequent ophthalmic procedure, in America runs $3000. The interocular lenses (IOCs) are manufactured at the Tilganga Institute of Opthmalology in Kathmandu at a cost of $6 apiece. The first IOC’s were developed from the acrylic thermoplastic windshields of Spitfires, the British fighter planes during World War II, by an ophthalmologist named Harold Ridley, who noticed that splinters from them in the eyes of wounded pilots were not rejected the way glass splinters were and reasoned correctly that they must be compatible with the crystalline proteins that make up the eye’s natural lens. The first IOC transplant took place in l952.
Miraculously Tilganga survived the 7.8-magnitude earthquake that levelled much of Kathmandu on April 25, days before this intervention was to begin. One of its crack surgeons who was going to join the intervention is no longer able to, but the lenses are here, thank God.
Cataracts in Ethiopia can be caused by a host of things, Tabin explained. Age— the crystalline lens loses elasticity and focus over time and becomes more susceptible to clouding by changes in its proteins, water content (the lens is 65% water and 35% proteins), enzymes, and other chemicals. Age is the main predictor of cataracts in Ethiopia and everywhere. The older you and your eyes are, the greater your chances of developing cataracts. And with the world’s population getting older, not only is cataract blindness not going to go away, but, with with diabetes levels rising, another cause of age-related blindness— diabetic retinonopathy— is looming as the next big vision-loss epidemic. The diabetes rate in Africa is projected to rise by 109% by 2035, and four out of five cases of diabetic retinopathy are expected to occur in the developing world.
Lack of doctors— in Ethiopia there is only one ophthalmologist per million people, as opposed to the U.S., which has one per 18,000— exposure to u.v. light, lack of antioxidants in the diet, diarrhea and extreme fluid shifts, some genetic aspects and things like trauma and some infectious things, Tabin continued the multifactorial aetiology. Other sources have among their causes of cataracts : lack of hygiene, sanitation, and clean water, proximity to animals and fesces, house flies drawn to the eye fluids of infants, close quarters, smoke-filled kitchens. Females in Ethiopia throughout their lives are more likely to get cataracts and men’s health is prioritized and they are more likely to be treated— the usual pattern in the developing world. But more females than males have them pretty much everywhere, from the U.S. to Sri Lanka. There is a study linking cataracts to estrogen. Afro-Americans are twice as likely to get cataracts as white Euro-Americans.
The same populations in Ethiopia that are at risk for cataracts are also at risk for trachoma and glaucoma. Not infrequently patients have two of the conditions at once, sometimes even three, in which case removing the cataract doesn’t do much good. Trachoma is an infectious disease, caused by the same virus, Clamydia trachomatis, that causes gonorrhoea. It can be treated with antibiotics like azithromycin, but if the underlying causes, lack of hygiene and sanitation, particularly facial hygiene, are not addressed, it comes back. It can cause corneal scratching under the eyelid which can be irreparable and only an eye transplant can alleviate. The Fred Hollows Foundation, which has the lab at Tilganga that makes the IOCs, has a big trachoma initiative in Ethiopia, as does the Jimmy Carter Foundation. Fred Hollows, who died in l993, was Sanduk’s Ruit’s mentor and a giant in the field. He and his foundation are credited with enabling a million people to see. He did a lot of work with the indigenous people in the Australian outback, who also have severe eye problems. He had a big house in Sidney whose door was always open, to visiting foreign medical students, local artists, and people who just needed a place to crash. He described himself as an egalitarian and an anarcho-syndicalist who wants to see an end to the economic disparity which exists between the First and Third worlds and who believes in no power higher than the best expressions of the human spirit found in personal and social relationships.
Glaucoma, Tabin explained, is genetic. People of African descent are three times more likely to get it than Caucasians. It’s actually a group of optic nerve disorders that are treatable by surgery and a variety of drugs.
This intervention is focusing on cataract blindness. The screening teams did their best to identify visually impaired people who have only cataracts and will benefit most from having them removed, as opposed to ones who also have trachoma or glaucoma, whose visual outcome is uncertain. It’s part of a global effort to reduce avoidable visual loss by 25% of its 2010 level by 2019. HCP and its partners in Ethiopia are hoping to give sight to 7000 of its cataract-blinded citizens around the country this year.
Geoff— it didn’t take long before Tabin and I were on a first-name basis, and this is how I am going to refer to him from here on out— told me that after he joined to Moran Eye Center he started bringing people and lenses from Nepal to its partner hospital in Ghana. Then in 2008 he got involved with Jeffrey Sach’s U.N. Millenial Development Villages. Sachs believed that all the extreme poverty in Africa could be eliminated in twenty years and to prove it he had chosen twelve of the most destitute villages in the world and removed the impediments that were preventing them from progressing, providing clean running water, plumbing, electricity, good health care and schools, steady jobs, decent roads— the amenities the free-market capitalist democracies of the developed world take for granted— and their overall well-being, morale, and dyanamism, improved dramatically, almost overnight. One of the villages, a cluster of villages, actually, called Korara, was in Ethiopia, way back in the barely accessible desert highlands of Tigray. Geoff did the first survey of the blindness in Korara, and then HCP’s first cataract and trachoma surgeries there in 2011, and every year since then he has come to Ethiopia and the number of people he has enabled to see has grown, starting with a few hundred, to now ten times as many.
I can’t think of anything that is doing so much direct good for so many people.the world. As a heroic narrative, it doesn’t get any better than what Ruit and Tabin are doing. People need to know about this. So when Tabin invited me to join him in May I accepted instantly. I had been to Ethiopia twice, in l991 and 2002, but never out of Addis and into the interior, which has one of the most ancient Christian civilizations anywhere. Only five percent of the people in the highlands have electricity and most of them are living on a dollar a day. Only Tibet is more exotic and not on the modern wavelength. This is where mankind began, where both the earliest hominids and the earliest homo sapiens bones have been found. The hominid record goes back 4.4 million years, the homo sapiens one 195,000. People have been living here continuously. Only at one point, from 1936 to 1941, was Ethiopia ever conquered, by the Italians under Moussolini.
I get a grant from the Woodward Foundation, a small ngo created in the memory of a dear college friend by his widow. It has two schools for dirt-poor kids who live in the streets of AddisAbeba— it gives them an education, a square meal, a chance in life. Our mission is capacity building. Lisa Woodward, who runs the foundation, explains modestly and succinctly. I will visit one of the schools on the way back from Woldiya. The kids happen to be Kechene, one of the lost tribes of Dan, like the better-known Falasha, the Beta Israel who came with Menelik I, the son of Solomon and Sheba, and the Arc of the Covenant from Jerusalem in 1000 B.C. Now the Kechene are among the poorest and most marginalized of Ethiopia’s 81-some ethnic groups. Several of the kids I notice have eye problems. Every fiftieth Ethiopian does.
I fly to Addis and from there to Lalibela, the sacred city with a dozen 12th century churches carved down into its bedrock.
Above is an ancient worn staircase in the ancient underground complex, which I will visit on the way back. There are some 450 of these sunken rock-hewn churches in Tigray, Geoff tells me. Some of them are really hidden away.
A van is waiting at the airport to take me and two ophthalmic nurses from Harar to Woldiya. Harar is an ancient walled city on the Somali border that peaked in the sixteenth century, when it was a Muslim sultanate, and it is still considered the fourth-holiest city in Islam. The French surreal poet Artier Rimbaud lived there from 1880 until his death eleven years later at the age of 37, when it was under Egyptian rule. Rimbaud had stopped writing and left the wild bohemian scene in Paris at the age of 21 and gone off to see the world. “I sought voyages, to disperse enchantments that had colonized my mind,” he explained. After stints in Java and Cyrus, he arrived in Abyssinia and got a job in Harar trading coffee, musk, and skins to the seaport of Aden, across the Red Sea in Yemen. He procured guns for the Negus of Shewa, who united became the emperor Menelik II and united Ethiopa, and he became a close friend of the city’s mayor, one of whose sons became the tiny but almost godly emperor Haile Selassie. Harar is thought to be where both coffee and the amphetamine-like narcotic plant khat were originally domesticated. I’d love to visit the city, but with Al Shabaab undoubtedly having a presence there, this is not the best time for an American nominally Christian ferenji (Amharic for white guy, from foreigner). Harar is on the edge Ogaden, a forbidding desert that Somalia invaded in l978, triggering a two-year war that the Polish correspondent Ryszard Kapu?ci?ski wrote about harrowingly in The Soccer War, when a different set of combatants flying on khat were bombing around in “technicals,” pick-up trucks with 50-caliber machine guns mounted in back.
We drive for three hours through the rugged, dry, dramatic Ethiopian highlands, a tableland of mesas and occasional lone peaks of obdurate magma sticking up like thumbs known as ambas. The tableland ranges in altitude from 5,000 to 15,000 feet and is dissected by deep, steep valleys terraced wherever possible with tef, the small grain that is the mainstay of Ethiopian’s millions. The day begins and often ends with injera, a moist tortilla of tef, dipped and rolled in chickpea and chile pepper paste. Injera is nutritious but fattening. Obesity is not a problem in Ethiopia. The fertile valley floors far below the road, where all the soil washes down, are planted with tef and maize which have just come up with the first rains of the season and are luminous light velvet green.
a less deep valley on the way down from the highest part of highlands, whose valleys are twice as deep or more
It is from the villages and towns in these remote mountain valleys, which have poor roads or none at all, that a thousand-plus patients are being brought down to Woldiya for Geoff and his team to operate on. The hospital in Woldiya removes cataracts for 600 birr— $30— the rest of the year, but this is way beyond the reach of most of the rural people, who can’t even put together 50 birr for the bus fare to get there. And everything is taken care of by the Himalayan Cataract Foundation, transport, food and lodging for two nights at the hospital, the operation and the post-op meds. It works out in the end to $70 a patient, $161,000 for the whole intervention. I can’t think of a better way money could be spent.
Teams of nurses and doctors-in-training set up eight screening centres in the Semien Wollo (North Wollo) Zone,
one of counties which Amhara ethnic region is divided into. They brought in people from remote communities no ophthalmologist has ever been to, and the best candidates for the procedure were selected, and are now being bused down by woreda, the townships into which Ethiopian zones are divided, which are made up of kebele, districts or clusters of villages. One woreda, 200 patients or so, a day, will be getting IOC transplants from three to four surgeons.
Sections of the passing highlands are extremely dry, high desert with only the rare cluster of conical mud and thatch huts like a colony of mushrooms, encircled by a toxic euphorb fence. These compounds are known as cata or kulet. The sheep and goats and cattle are brought into them at night.
Flat-topped acacias in gauzy white flower punctuate the exposed earth and rock whose palette— delicate rose-pink, blood-orange, burnt umber, cadmium yellow, emerald green— shot with ink-black shadows, is unlike anything I have ever seen. There is no running or standing water in sight, only a few herds of white sheep and goats, a few scrawny cows, but no pigs, because “we don’t eat animals with separate hooves,” our driver explains. “It is prohibited by the covenant.” The one that Menelik I brought in the arc from Jerusalem to Axum three thousand years ago.
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I catch a glimpse in a narrow gorge sliced in the rolling plateau by the ferocious short-lived torrents of the rainy season, of a huge outlandish bird— an Ethiopian ground hornbill, which I recognize from Louis Agassiz Fuertes “magisterial 1930 Album of Birds and Mammals of Abyssinia. There are all kinds of amazing animals in Ethiopia.
In the next zone to the south, Debub or South Wollo, is Amba Geshen, one of the three sheer pinnacles on whose flat tops the children of the emperor were kept imprisoned, at various points centuries ago, for their own safety and malleability, until it was time for them to assume their royal functions, which for some offspring never came. Samuel Johnson’s novel Rasselas— not one of his memorable works, he knocked it off in a week in 1763 to pay a pressing debt—is about them. But Thomas Packenham’s The Mountains of Rasselas, is a small gem of British travel and exploration literature. Fresh out of Oxford at the age of 21 Packenham located all three ambas and scaled two of them in l955. The other one, I tell Geoff, is waiting to be climbed by him. The old wooden stairs up its sheer wall rotted away long ago. It was unscaled as of the 1998 re-edition of Packenham’s erudite but humorous and self-deprecating account. Packenham went on to become one of Ethiopia’s great ethnohistorical scholars. Now 85, he still publishes
prodigiously. Before Packenham there was Wilfred Thesiger, who grew up in the British Embassy, the largest embassy in the world, with its own golf course, little mountain, and horse trails. He was the first Brit to venture into the hinterland with a camera and went on to produce many of the iconic images from this part of the world, and to document the vanishing 5000-year-old culture of the Marsh Arabs of Mesopotamia, in which everything was made of reeds.
All kinds of cultural and natural wonders are waiting to be discovered or rediscovered in these forbidding highlands. There are ancient monasteries tucked way up in them, way off the beaten path, that are only visited by the rare pilgrim seeking of forgiveness and redemption and no tourist or ferenji has ever been to. There are still hermits in the apocalyptic tradition of John the Baptist, known as bahitawi, who have renounced the world and are living in caves, waiting for the end of days. A few of them, the dendrites, are said to spend their lives up in trees, like St. Simeon on his pillar, and there are even some who are supposedly so adept at wind meditation that they are can become airborne for short distances, like the lamas lungom-pa of Old Tibet. Sometimes a bahitawi will suddenly appear in a town or even in Addis dressed in a lion skin with his hair a dirty mat of dreadlocks, or disguised as an ordinary citizen, and will make a prophetic pronouncement about the local or national political situation or the moral decay of the society, or will whisper something portentous into the mayor’s ears. Haile Selassie always consulted his personal bahitawi before making any important decision.
We drive through a Muslim town. The Christians and the Muslims in Ethiopia have no problems with each other, although this has not always been the case. They are an example to other countries where Muslims, Jews and Christians are locked into inexorable cycles of slaughter and vengeance. There are no jihadists here, knock on wood. According to the national census of 2007, over 32 million people, or 43.5%, were Ethiopian Orthodox Christians; over 25 million, or 33.9%, were Muslim; just under 14 million, or 18.6%, were Protestant; and just under two million, or 2.6%, adhered to traditional beliefs, the old animism that evolved here and has been here since the dawn of time. There is bewildering variety of Cushitic, Semitic, Nilotic, and other peoples in present-day Ethiopia, each with its own culture and language. The lingua franca is Amharic. The Amhara are the second-largest ethnic group, after the Oromo. They are more Caucasoid, and the Oromo are more black Africa, but everybody is extremely mixed. Everybody knows what ethnic group they belong to, but physically the population is so mixed it’s probably more accurate to say that Ethiopians are Afrocausians and leave it at that. A lot of the old racial categories are perniciously simplistic and obsolete.
We pass the mourners at a big funeral that has just ended, hundreds of people in the road shrouded in white gauze, militias of old men with old rusty rifles that fired the
salutes, heading home. The person who died must have been important, I say to a man from Addis who is riding with us, and am telling him how I was just reading that in China, it is so important for lots of people to come to your funeral that in some places strippers are hired to beef up attendance, and the government is cracking down on the practice, when, speaking of the Chinese, we t into a big highway, a major truck route that has just been paved by the Chinese.
They are also paving the road from Lalibela we just got off. The first few miles have been completed and the whole thing has been graded. Once it is paved, life in this part of Semien Wollo, where only 6% have electricity, will change. New markets, new mobility, new goods, progress will arrive with its mixed blessings, more people will be on the grid. “Every time I go to some new African country like Uganda, Zimbabwe, Rwanda, it has just been paved by the Chinese. They are the new big player in Africa now, the new colonizer,” I tell the man from Addis, and he says, “The Chinese are running like ants all over Africa. They got the job here because their bid was lowest and unlike the U.S. they don’t give the government a hard time about its human rights record. But the asphalt they’re putting down is of poor quality. Already it’s washing away in places.”
The highway runs down to Woldiya, a trading town of 70-80,000 in one of the mountain valleys which is enjoying a spurt of growth, probably due to the improvements in the road system. Its main drag is lined with new three-story buildings in various states of completion, their ground floors already occupied with shops, clothing stores, parts stores, cafes, hardware stores, hotels. Big black-diesel-fume- belching trucks are constantly passing through, and dozens are parked along the main drag. Woldiya is basically a big truck stop, the regional centre with a hospital, the big city for the people in the back country of Semien Wollo Zone who living on a dollar a day and the round trip bus fare costing four, seldom make it here. The town is getting a new stadium, the university is being expanded, and one hillside is shiny with the tin roofs of a new low-income housing development. From a touristic point of view there is nothing to see in Woldiya. The occasional camel still being used as a beast of burden, the Pool House Game Zone where a dozen young men are sitting under a jantela, an “umbrella” of interwoven branches and leaves on poles, what would be called a ramada in Navajo country or a baraza in East Africa, to keep out the sun, which by noon is head-splittingly hot, even now when the rains are beginning. We are waiting for the pool table to come, one of them explains. No of them are smoking. Nobody smokes in Woldiya, or anywhere in Ethiopia as far as I can see. It’s considered to be unclean and is forbidden by the church. So even poor Ethiopians are ahead of the game in terms of that major life-shortener. Not that they could afford to smoke even if they wanted to.
There are half a dozen night clubs in Woldiya, which were empty on Friday night, when we all went out to celebrate the end of the intervention. Several were blasting canned disco, one had live Wollo music, a guy playing the masinko or one-string violin while another pounded a big drum and a girl in traditional dress danced with a lot of delicious wriggling of her shoulders. The people of Wollo love to dance. One time as I was walking back up from the hospital to the hotel a loose formation of men, mostly young, maybe fifteen of them, came marching down the street wildly waving four-foot canes, barely missing each other in a scary display of cane-wielding prowess. “This kind of dancing and waving of canes is called chefara and is connected to some kind of celebration, maybe a marriage or a holiday,” a man who had stopped next to me explained in good English. Then he asked if I had a book called Unlimited Power. This must be— I said I wasn’t familiar with it, but later looked it up on Amazon— Tony Robbins’ best-seller, subtitled “the new science of personal achievement,”
In the morning after breakfast at the hotel with Geoff and the nurses they would take a van to the hospital and I would walk down. Once Geoff joined me. It took fifteen minutes. Through the main commercial district, then past a school where boys and girls in purple uniform were playing soccer. Sometimes on the way back up a cluster of kids from the school would surround me and try out their English and the girls would sneak up close behind me and I would wheel around and they would shrink back in mock terror and dissolve into fits of giggling.
I would usually buy a bag of oranges at one of the fruit stands to pass out to the patients.
The hospital was a couple of hundred yards down a road off the main drag to the right. Soon after entering its gates there was a cluster of wood- and cement-sided silos with straw on their floors and signs on their sides with the names of the ngos that paid for their construction. This was where the patients spent the night after being bused in from their woreda. Many of them had an entourage of relatives and other caregivers, and in the morning they all went up to the OPD building for biometry and other pre-op processing.
But before they could take their places on the benches in the building’s large roofed-over front porch, the benches had to be cleared of the patients who had been operated on the day before, who had already come up from their second night in the silos and were sitting with one or in a few cases both eyes covered with bandages, waiting to have them removed and for Geoff to see how their vision was now. This was a joyous, chaotic scene, as Geoff moved among them and took off their bandages and in most cases they could see again, or some even for the first time. Some ululated, one man pounded his heart, to convey to Geoff that he was grateful from the bottom of his heart. In a few days they will look five or ten years younger, they’ll be able to walk on their own, and happy they’re no longer taking someone out of the work force to look after them, Geoff tells me. After the third morning at post-op, I recognize several of the most recent bilaterals— they had gone completely blind only a few months ago, who were completely helpless yesterday, hardly even able to stand up. They are already walking with confidence today. The transformation is amazing, night and day.
A more colorful and exotic and marvelous-looking crowd could not have been imagined, swathed in robes and turbans and shawls of every colour and weave.
Some of the men were priests or monks and wore long purple robes and round or four-cornered white or red qobs with crosses on the front and had long staffs tipped with bronze or wood crosses.
A light-skinned women had black slashes tattooed on her chin and along her jawlines and a line circle (the Egyptian ankh, minus the two lateral arms ?) on her forehead.
A lot of the women had intricately beaded necklaces and bracelets. Some of them looked dignified and aristocratic, but they were basically peasant farmers, what Jack Kerouac called “the Fellahin Indians of the world, the essential strains of the basic primitive, wailing humanity that stretches in a belt around the equatorial belly of the world,” whom he encountered in Mexico.
Several of the patients had high cheekbones, hollow cheeks and pointed chins, their face was a triangle like the San “bushmen” who have been living in the Kalahari Desert for 75,000 years. Another ancient, more Khoisan-looking breed of Ethiopian, like this woman :
Geoff himself stood out as the only ferenji in the crowd, the centre of energy, a still cherubic 59-year-old with a radiant white smile. He was lit up with euphoria himself at so many positive visual outcomes.
The joy was contagious. It was a deeply moving collective experience, an inspiring way to start the day. What are we here for if not each other ? I am regretting that I did not become a doctor, which I was planning to be when I started high school. I took ancient Greek, thinking it would give me a leg up in the medical terminology, and fell in love with it and with language in general, and physics and chemistry left me cold, so I ended up becoming a writer. But I could have been a doctor who was a writer or poet, like Checkhov or William Carlos Williams. The two aren’t mutually exclusive.
What do these people think about Geoff ? I ask one of the nurses, how do they see him and what he is doing ? and she says, “They see him as a messenger of God.” It is inevitable that such a religious people would see what he is doing in religious terms, especially since bestowing and received the Light, is such an important image in the Christian faith, and Jesus cured two blind men in the gospels. In John a disciple asks him if the man is blind because he or his parents were sinners, and Jesus says no, this happened “so the works of God can be displayed in him.” Then he says, “As long as I am in this world, I am the Light,” and spits in the dirt and rubs the mud in the man’s eyes and tells him to wash them off in the Pool of Siloam, and when he does, the man can see.
After they were examined, the patients received two types of medicine. Chloramphenicol, which Geoff says is the best antibiotic for bacterial conjunctivitis and other eye infections. And dexamethosone anti-inflammatory drops. Then they went out to their waiting relatives and caregivers and they all got on the waiting buses and were taken home. The small percentage who did not have positive outcomes are told to come back in a few weeks to be reexamined. Some will be able to see in a few days, others’ visual impairment will remain unchanged. I’m not sure how the follow-up works, if there is any follow-up at all. HCP doesn’t do it. Its job ends with the intervention. So who is going to give the patients who need to come back the bus fare ? Most of the negative (i.e. no change) outcomes I suspect do not come back for reexamination. If they can see, they probably think there is no reason to. If they can’t, some of them get into next year’s intervention and have the other eye operated on. There are quite a few of these second-timers, including ones with positive outcomes.
After the benches are cleared the next batch of 200 or so came in and sits on them. Keeping everything moving and on schedule was being overseen by Trudy Agbozo, the director of HCP’s Africa program, who was in a million places at once and being a New Jerseyite of Liberian-Ghanan extraction and having served in the Peace Corps in rural Ethiopia and being fluent in Amharic is a huge asset to the operation.
The new arrivals are slowly fed inside into the OPD and into its biometry room. There the eye that is to be operated on is identified with a strip of white adhesive over its brow and the thickness of its cornea is measured with a keratomer and its axial length is measured with an ultrasound. This tells you the size and power of the IOC the patient needs. Getting the right IOC is essential if the patient is going to see 20-20 and not going to need glasses. Their blood pressure is taken to determine whether they should get their interocular shot of local anesthetic, lidocaine,with adrenaline or without.
The patients are given a piece of paper with their lens number and blood pressure written on it and proceed to two long rows of benches that go down a covered walkway and at the end of the walkway continues left to the entrance of the O.R. building. It takes most of the morning to do the biometry and the rest of the day, until eight p.m. or so, to do the surgeries. Some ladies and men waiting their turn prefer to squat in the dry runoff ditch along the covered walkway than to sit on the benches.
Geoff and the Ethiopian surgeons, three for the first few days, two for the remainder of the week, are doing 200 implants a day. If all goes well the procedure can be done in five minutes. Most of the time there are no complications.
Geoff compares the surgery to removing the peanut from a peanut M & M, or slipping the inside of a grape out from under its skin. It starts with a delicate incision at the top of the cornea. But the eye is really complicated. The outer surface of the cornea is transparent, then there’s the white, and in the middle the iris and pupil, and behind them, way back in the eye, is the lens, which refracts light back to the retina, much like the lens of a camera. The lens is consists of three parts, the capsule, the cortex, and the nucleus, any or all of which can have cataracts. And after you slip out it out, the peanut of the M & M from its candy shell, you have to scrape out all the chocolate that is holding it in place.
The final tally for Woldiya : 1253 surgeries were performed, 724 males, 529 females, 57.8% to 42%. Why is this, when cataracts are dramatically more prevalent in women here and the world over, they have a higher percent of lens opacity, especially cortical lens opacity. This skewed, unrepresentative sex ratio is typical of developing world interventions. More men were operated on because more men showed up at the screening centres. Men are more socially mobile, they come first. If anybody is going to see again, it is the pater familias, the head of the family, the breadwinner. The line to the op room has most of the time slightly more men than women, but the women are more talkative and colourfully dressed, so it isn’t really noticeable. Once two old men started fighting over who was ahead of the other in the line, when it was perfectly clear. Nerves are on edge. With sight again soon to become a reality for most of the patients, there is none of this last shall be first, blessed are the meek business. Survival is the operative word. But most of them are humble, patient and accepting, good people, good-natured, good-humoured, good-hearted, god-fearing. Only one man of about forty who sits next to me after he comes out of the op room one afternoon I don’t have a good feeling about. He has a really dark hard cruel face. No one has come with him and he talks to no one, just leaves after taking a few moments to get his bearings. This one looks like a killer, I say to my translator, who reminds me how Christ said to the two thieves crucified with him “today you will be with me in paradise.” “This operation is available to everyone who has cataracts,”he tells me, “even sinners, which is how it should be. We are all children of God.”
I spend a lot of time sitting and talking with the patients on the final line of benches to the O.R.,where they first go to a room and have the lidocaine injected into their eye and a soft yellow rubber ball taped over it to reduce the resultant swelling. The two ophthalmic nurses from Harar and four others Quiha are assisting the surgeons, and nine other nurses from Woldiya are helping the patients on the benches and in the anesthesia room and when they come out of the operation.
a patient getting the anesthesia injection :
The nurses are absolute pros and are putting in twelve-hour days with the surgeons, handing them the instrument they need exactly when they need it so not a moment is wasted. They are naturally up and caring people and are going around making sure everybody is okay and reassuring them and seeing if there is anything they need.
The ones from Woldiya are
from Quiha :
Tiblets Gabre Mariam
Abeba Woldu Teferi
and the two from Harar :
Marta Yeshitela Abebe
Munira Mohammed Yusuf
three of the nurses from Mekelle and one from Harar, with Dr. Abreham and Mulu the driver
There is great camaraderie among all of us. It’s like we’re all part of an ecosystem, in which each of us has a role to play.
I am, besides frantically scribbling notes and trying to document this event, doing what I can to be useful and to give moral support to the patients who are excited but nervous at the threshhold of this potentially life-changing event. On the one day when there are four surgeons I help Geoff assemble a portable $14,000 Zeiss operating microscope that has just arrived, which increases the number of operations that can be performed over the next two days by roughly 25%. Then Dr. Tilihun Kiros who has been operating since Mekelle and accompanied Geoff and the nurses down here, has to return to Quiha Zonal Hospital, where he is the chief eye surgeon and the head of ophthalmology. Quiha is the referral hospital for eye problems in Tigray, and Dr. Kiros has no shortage of patients. He trained with Sanduk Ruit in Nepal and with Geoff in Utah.
The other two doctors doing the surgeries, are Abreham Aregay, the eye surgeon here. He does about a thousand cataract operations a year for which Woldiya Hospital charges 600 birr, or $30 per. And Mihret Deyessa, a 28-year-old general practitioner who has come up from the Menelik Eye Institute in Addis. She speaks English and is going to do nine months of eye surgery training in Nepal, then three in Salt Lake City, like Dr. Kiros, then she is going to be the first and only ophthalmologist in a area southwest of Addis where three million Oromo live and there is a huge backlog of untreated cataract blindness and other eye diseases. “There are only 110 ophthalmologists in all of Ethiopia, and 40 are in Addis, and 10 of them don’t actually practice,” Geoff tells me. “We are really excited and proud of Mihret,” Geoff tells me. “It gives me as much joy to tune fine surgeons like her in Asia and Africa as it does to see the positive visual outcomes I operated on.” Geoff is giving her special attention whenever he can.
Dr. Mihret, third from left
Sometimes in the late afternoon I play my guitalele to keep everybody’s spirits up. Not a few of the patients are second-timers, originally bilaterals who had one eye done last year or the year before, now they’re coming back for the other. So there is some familiarity in their communities that there is this free operation that works, and probably there are some among them, too, for whom it did nothing, so they know the outcome is in the hands of God and Mother Mariam, to whom some of the patients about to go into the O.R. are murmuring imprecations while nervously fingering prayer beads.
I don’t know any Ethiopian tunes, except for Mulatu Astatke’s classic jazz piece “Yekermo Sew,” which is in the scale of tizita minor, a seductive pentatonic sequence unique to Ethiopia used in many religious and popular sons that I am still getting down and not ready to perform. Here it is :
So I play and sing an early reggae song “Take Me Back to Ethiopialand” that was big in Jamaica when I went there in l972. One of the nurses knows it. “I haven’t heard that since I was a kid,” she tells me. But it leaves the patients cold. So I try Curtis Mayfield’s “People Get Ready There’s a Train A-Comin’” and they like it, but it doesn’t get them going. Finally I do Leadbelly’s driving jailbreak song, “Take This Hammer.” This is in their musical wheelhouse. Everybody starts clapping and the line is rocking and swaying like a church revival. Nothing like music for easing tension and breaking the ice and bringing everybody together. While not understanding the words, they pick up that this is an uplifting song of strength and determination. We don’t want no cold iron shackles. We want to be freed from our darkness.
I follow a 60-year-old woman named Enanu Hailu through the entire two-day process. She has a great face, lips pursed in wry, mischievous appreciation of the curveballs life is always throwing, a classiness and dignity that enable her to handle them, and will sail through her intervention without the slightest problem, a model patient with the model positive outlook who will have a model positive outcome, as if it were a foregone conclusion.
Here she is after the operation. Discharged !
Enanu tells me she was completely blind for ten months, before she had her left eye operated on last year. Now her right one is being done. She owns a lot of farmland but has no family. She couldn’t have children and never married. She grows maize mainly. Her neighbour’s daughter— Enanu is her godmother— has brought her here. After she got her left eye operated on she couldn’t farm because she was afraid to get dust in it. After the right one is done she still won’t farm because she doesn’t want to lose her eyesight, because she doesn’t have anybody to help if she does. Her sister, who lived in Mekelle, is dead, and she has no other relatives close. So she rents her farmland to sharecroppers.
In biometry Enanu gets a slip of paper that says
OD right eye
size of lens
K1 =43.05, K2=42.5, A1=20.08, jol.20-50 D, B/P=/20/70. which means lens 21. When she enters the o.r. she gives the slip to the nurse who takes a lens out of the 21 box and puts it on the tray next to Geoff’s microscope. The nurse removes the yellow ball from her right eye, and Enanu lies down on the gurney and a grey sheet is put over her with a hole over the right eye which is pried and held open by a clamp. Geoff makes the delicate incision on the upper surface of her cornea. Miles Davis is playing on his Iphone. With a little coaxing and slipping and sliding out comes Enanu’s cataract. It looks like an orange pastille. I take a picture of it on the open rubber-gloved palm of nurse Abeba Woldu and later post the picture on my Facebook page with the question, what do you think this is ? The answers include kidneystone, gallstone, precious stone, red caviar, Vitamin E capsule, fish oil pill, and lemon drop.
Enanu’s cataract :
A textbook case, in and out in seven minutes. next morning. Next morning I find Enanu on the post-op waiting to be seen. Geoff removes her bandage and peers into her eye with blue l.e.d. light of his climber’s headlamp and says “She’s good !” And Nurlin her new friend, sitting beside her, says to Geoff, “Long life to you !” And I tell Enanu, “This operation is going to add ten years to your life and with your positive outlook she will live to 93 like my mother-in-law whom you remind me of so much.”
That morning at breakfast he explained, “A cataract is a clouding of the crystalline lens in the eye. That’s why it’s called a cataract. You see everything as if you were standing behind a waterfall and looking through it.” Through a glass darkly, I think, recalling 1 Corinthians : 13. Some of the cataracts he has been removing are really dark, like this one, which has completely calcified the cortex of the lens :
Geoff says there are are number of books about how great painters’ perception changed over time as they lost their vision to eye disease, like Manet, who had cataracts. They will be of interest to my brother-in-law, an artist who has macular degeneration, like James Thurber, and is still painting— abstracts with powerful lines and intricate colour schemes. Geoff says the macular nerve cells are in the retina— another kettle of fish. There is a lot of ongoing research, but no cure yet for macular degeneration.
When the cornea, the front window, gets cloudy, from trachoma, say, or river blindness, you have to do a cornea transplant.
Watching the cataracts being removed and the IOC’s implanted gives me a new appreciation of the material world, which I am no longer going to think of as separate from nature. The lens is made up of crystalline proteins, the IOC is acryllic, it is all the material world. What are we and every living thing in the end but evanescent coalescences of nucleotides and neurotransmitters, and our most miraculous and astonishing organ, after our brains, is our eyes, which are more than just the things we see with. They are also windows of our souls. Russian icons, I learned in Russia last year, are alive to the devoutly orthodox. A person who prays to them with genuine faith and reverence receives a transmission answering his prayer through the eyes of the saint in the icon. In the fifth century B.C. In the fifth century BCE, Empedocles postulated that everything was composed of four elements; fire, air, earth, and water. He believed that Aphrodite made the human eye out of the four elements and that she lit the fire in the eye which shone out from the eye, making sight possible. The evil eye can cast spells in many cultures— the Amhara believed it is possessed by a special type of malevolent people called buda, who belong to another ethnic group like the Beta Israel and that those who have the evil eye can change into hyenas and attack you so you don’t know they are humans— and in Hinduism the third eye, invisible and located in the middle of the forehead is the higher consciousness that seers and clairvoyants have and is symbolized by the red dot. Expressive eyes are the primary attribute of beautiful Indian women. In Taoism the “mind’s eye” is located between the two eyes. At the same time, in many cultures, blind people are credited with special powers, the ability to read you from the tone of your voice or by holding your hands or touching your, whether you are a good person and whether you are telling the truth.
Geoff calls the intervention a rodeo. The rodeo has come to Waldiya. There is constant drama like the t.v. series E.R. An old man staggers out of the room where he has just gotten his anesthesia injection and collapses to the floor. He is in shock but is being ignored in the chaos. I bring over a nurse who gives him two phials of 40% glucose. Geoff is operating on a woman who keeps moving. He is doing what he can for her black capsular plaque. Suddenly there is a blackout and the o.r. goes dark, then outside is lit up by lightning followed by deafening peels of thunder, and after five minutes the electricity comes back on and the surgeries proceed.
The next patient I have been tracking, his name is Mengistu Tarela and he is from the woreda of Delanta, west of Woldiya and south of Lalibela. He is 82 or 3 and has been stone blind for three years, after his left eye went, two years after he lost the sight of his right eye, and is helpless without someone to take him around, completely fearful and not knowing where to put his feet, how to navigate in his darkness. Two of his children are picking him up on either arm and dragging him to the next stop on his journey to sight. “All he has is family support and prayer,” my translator relays. “He believes there is no alternative but to go to church.”
What does he think will happen here ? “He came here to be healed. He’s a priest and farmer he expects to free his attendants, his two offspring, to go back to their lives, and he goes back to his. He goes to church to pray to heal his blindness but it is not working?” Why ? I ask. “His faith is not diminished. He still believes. He is getting some information from his neighbours that this operation can heal him. His left eye is impossible to heal. It’s already damaged. He doesn’t know how he lost it. There was no trauma.”
In biometry Mengistu’s blood pressure is checked : 160/95— high but o.k. to do the operation. A notation on his patient slip is made that he should be injected with lidocaine without adrenaline.
Now he lies down on Geoff’s table, his yellow ball is removed, his right eye is clamped open and the clamp is kept open by some tweezers dangling on a string. “His
right eye has a little glaucoma,” Geoff says. “This is the first patient I have had today that I am worried about his prognosis. I have to concentrate on this one. There is also a cataract.” Geoff jimmies and gently coaxes it out. “This is one of the biggest, blackest ones I’ve seen on this trip,” he says. “The glaucoma is still there. I can’t tell how will he will be able to see now. We’ll only know tomorrow. His other eye has glaucoma and there could be corneal damage too or a bunch of other things. In any case, it’s gone. Everybody except for him should have perfect visual outcome and I’ve done 16 so far. I’ve been doing one every five minutes.”
Mengistu leaves and the next patient lies down on Geoff’s table. “Here’s a woman with a totally blind right eye from cataracts,” he says. “The cornea is perfect. No sign of glaucoma. Yesterday I did 95 cases and 50 were totally blind. We try to do both eyes , there is only so much time. This one will see perfectly tomorrow from her totally blind eye. Last year her left eye was done.”
The next case is very hard. Geoff asks Dr. Mihret, “What would you do? I know what I’d do in America. My partner and I do it all the time. I’d try to do an intercap with a big number 9 keyhole. Here I don’t have the instruments or equipment to do it so I’m trying to figure out how to manage this. It’s a dislocated lens— one case in 850. The key thing we are trying to do here is to give the same quality care you get in the best institutions in America. Her lens was dislocated by trauma or some preexisting condition. You must be careful not to remove whole iris,” he explains to Dr. Mihret, and when he has finished, he says, “If I hadn’t done it that way there wouldn’t have been any way to get in the IOL. That’s as good as I can do here. This will be a fine eye tomorrow and she’ll see. You say a desperate Hail Mary and try to save a little vision. Her other eye is blind too. This good as the work of S., a marquis cataract surgeon in the States, if I do say so myself, but there is some advantage to having very expensive toys.”
The next patient has been totally blind for three years but unlike Mengistu he has learned to touch and feel and to poke around with a stick. In the morning he can see again and is overjoyed. “I haven’t been able to see my granddaughter since she was born,” he tells me. “Now I’ll be able to.”
202 operations are performed today, May 12. Mengistu can see ! He is already stumbling around on his own, finding his footing.
The overwhelming majority of the patients have positive visual outcomes, but not
everybody. One afternoon I make friends with a lovely man who is the tallest of all the patients yet, maybe 6’3” and is wearing a blue blazer with gold buttons and a collared shirt and grey slacks but no shoes and has a distant look of contentment, a wonderful blissed-out expression, a zestfulness, that belies the fact that he can’t see at all out of his left eye, and barely with his right.
The square of white tape is over his right eye. I ask him if he dressed up special for the occasion, and he says, no I always dress this way. He’s a farmer. A really sweet man, with a positive outlook like Enanu, and not a mean bone in his body. He is 66, from Gran, a woreda to the north. His name is Kasage Musgan. He came with five friends who are also getting the operation. His family is home. One of the screening centres was in Gran. “I’m a happy person,” he tells me, “but I’m just worried that my right eye is going to get worse. It’s the last one I have.”
Maybe I’m being romantic, I tell my translator, but this man is practically blind and living on practically nothing I imagine like most of the people here, but he’s so happy. They all seem to be. Much happier than many rich people I know.
“When somebody gets what he expects, he is happy,” my translator tells me. “When somebody can appreciate the things he has, he is happy.”
I put in a special request to Geoff that he do Kasage. I really love this guy I tell him. He’s a really beautiful guy. Geoff puts him on the table and says. “He is not going to see that well because he has corneal scars. Not from trachoma. Could be measles or herpes simplex. I can’t see what’s going on. His pupil is all scarred.” Geoff works on him for eighteen minutes and does the best he can, and when Kasage has gone, he says, “I shouldn’t have operated on him. It took a long time, and he’s not going to see any better.”
Next morning in post op this is sadly confirmed. There is no improvement in his right eye, his last good orb. Kasage takes the news as well as he can, tries to put on the best face he can, but it is a huge disappointment. I am really distressed. Even if you have the right attitude and live a life of complete probity, you can be fucked. Who said life is fair, that virtue is rewarded ? I know this, and don’t need to be reminded of it here. Life is a lottery, from the moment our parents chromosomes are shuffled irreproductibly during the act that produces us.
“Why Kasage ? He’s such a great guy” I ask the translator, and he says, “God never makes mistakes. There’s a reason why you didn’t die of malaria in the Amazon when you were thirty (which I have been telling him I came within an inch of doing, in l976) : maybe so you can tell the world what is happening here. Sometimes God gives some people more of a test, a challenge. Maybe Kasage is like Job. God works in mysterious ways. But a lot of Ethiopians are not good with God, only mouth, and get indirectly punished through human beings. Nobody have ever seen God but they have seen Jesus and some of his messengers, like Dr. Tabin. Others like Mengistu [Mengistu Haile Mariam, the president who overthrew Haile Selassie and was responsible for death of hundreds of thousands of his countrymen and was himself overthrown by the Tigray Liberation Front in l991] cause suffering.”
Saddened by Kasage’s outcome I head over to the cantina behind the O.R.. This is where I go once or twice a day to decompress and rehydrate. The beverage choices are coffee, weak tea with cinnamon, coke, and Fanta orange soda, and the food choices are deep-fried dough balls and and injera. The cantina is doing a brisk business this week with the intervention in town. It is a different scene, a different part of the ecosystem. In the field below the cantina several dozen people men and women, all of them wrapped in white gauze robes, shawls, hoods and turbans, are sitting under a eucalyptus tree and a cedar. They are pilgrims of some kind. No one knows what they are doing here, who they are or where they are going. They don’t seem to be connected to the campaign. They look like they are waiting for the Rapture, the Second Coming. Such groups are so common in Ethiopia nobody gives them a second thought or glance.
A number of black kites are lazily but vigilantly slicing the air overhead, coasting over a grove of jacarandas and crying their name, krai. The music on the radio in the cantina sounds Malian, motoring forward to D minor and back to A minor to a duh DUH duh DUH beat.
Most of the people at the cantina are not the ones who were screened and bused down for the operation. Some are relatives, neighbors, and other caregivers of the patients, but most of them are blind people and their entourage who heard that there is this ferenji doctor who is giving this operation and have come in the hope that by some miracle he will restore their sight. Most of them have more serious eye problems than cataracts. You could say they have come on spec. None of them are being pushy. Several have been waiting at the cantina for days and have not even approached any of the nurses.
Testa Amara, for instance, heard about the intervention and has come with his mother from Lalibela. He is 33 and has been blind since the age of 17. Lalibela was not in the screening area, but he and his mother have come anyway. I bring him to Geoff, who says he says he has congenital glaucoma or Vitamin a deficiency. Testa’s eyes itch painfully under his his eyelids. Nothing can be done on this campaign.
A crowd gathers around us while I talk with Testa and his mother, Alemuh Abate, 55. One of the waitresses comes over and, why are you crowding around him [me] as if he was an eagle. Shoo ! Beat it !
Testa serves the church as a deacon. Most of the blind turn to the church. It’s their main support system and gives them a purpose and functions to perform, like reciting the parchments. Most of them don’t read braille and memorize the parchments from hearing others reciting them. Testa has hope. If don’t get the light this time, maybe I will next time, he tells me.
Testa and his mother
Another man has one dead white eye and says he is not on the register and has been here for four days. Another has bulging eyes, some kind of proptosis or exothalmos, likely caused by hyperthyroidism or Grave’s disease, an autoimmune disorder. All of them heard about the campaign and have come to Woldiya. Everybody assumes that I am a doctor. David Relin had the same problem whenever he went out with Geoff or Sanduk Ruit. “I tried to explain that I couldn’t help them,” he writes, “that I was just a journalist. I tried to convince myself that my writing would raise awareness to make more work like this possible. In the face of overwhelming need, storytelling felt like a poor excuse for my presence.” He quotes a passage in Saul Bellow’s Henderson the Rain King in which Henderson is deep in the African interior and feels “singularly ashamed of not being a doctor.”
But being able to see, I remind myself, doesn’t mean your suffering is over, either. Relin, in fact, was a major depressive, and ended up throwing himself in front of a train in Portland, Oregon, in 2012.
Most of the people at the cantina are going to need complete new eyes, which there is not a big supply of in Ethiopia. The Menelik Institute in Addis has an eye bank, and another has established Quiha hospital by HCP in partnership with Orbis, another outfit that started out as a flying hospital and is doing great stuff in Ethiopia.
Most of the patients are geriatric, 50 years old up to 90. A few have beautiful daughters and granddaughters, some ofwhom are looking for husbands and are dressed to the
nines. It is not everyday they come to Woldiya, and if the operation is successful, they won’t have to be caregivers any more, they’re about to be free, God willing.
this girl is 18 and was a housemaid in Jedda, Saudi Arabia for two years.
There are not many paediatric cases, fewer than in previous interventions for some reason. Perhaps it is just a random artifacts of the screening process.
One morning I find half a dozen kids sitting inside the OPD building waiting to be examined. One is a ten-year-old girl from Afar, the searing desert area where the famine of 1983-4 was concentrated, and where the bones of our oldest ancestors have been found. She has come from afar, I say to Geoff. Afar is not in this year’s screening area, and the girl sees with both eyes. Her problem is not a cataract, but a big nasty tumour on her right eyelid. Her oldest sister heard about the intervention and brought her here. She is wearing a beautiful beaded head-band and necklace and is wearing a black amulet packet that probably containing scripture from the Koran. Her name is Alima Ahemed. She is Muslim, one of the few in this intervention. Some Muslims are reluctant to have their eyes operated on because they believe their bodies have to be completely intact when they die if they are going to have any chance of getting to heaven. The tumour could affect Alima’s vision, and also her marriageability and her whole social life and self-esteem, and she is a good-looking girl, very proud and headstrong, so Geoff has agreed to remove it. By the end of the day Alima has made it to the last bench and has her gornw on and is about to go into the O.R., but she and her sister quarrel, and the sister leaves. Alima rips off her gown and sits there fuming, and after a few minutes takes off after her. She’s supposed to come back tomorrow morning, but she never does.
“Afar people are from lowlands and are hot and aggressive,” my translator explains. “People in highlands are quiet.”
Another girl, twelve-year-old Jeneti Fanta, is from Gobiye, ten miles from here. She’s in Grade 3 and has the second-best grades of its 48 students. “They teach English in my school,” she tells me in English. When she was a kid she put a needle in her right eye, which is somewhat crossed. Jeneti has real strength and character and a great outlook. She is someone who could go far, a prime candidate for visual capacity-building. Geoff sees what he was can do and next morning, Jeneti can see with her right eye, although it is still crossed. She is given a pair of cool white-framed Nike sunglasses, which all the kids get.
in front of the O.R.
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Two plant geneticists from Milan who are staying at our hotel— they are working on new drought-resistant strains of maize in preparation for the next big drought which there are many indications could be right around the corner — have come down to see the intervention, and as they watch Geoff and Dr. Abreham and Dr. Mihret making their way down the benches and the joy in the faces they have given sight to, the growing pandemonium of joy on the porch, one of the geneticists says, “It’s a beautiful thing they are doing.”