Cambodia: Lifted from the burden of blindness

Before Bun Chem, 65, began losing his sight he farmed rice and vegetables. At first the loss was gradual but by last year he had gone completely blind.

Fortunately Chem's wife and two children were able to care for him most of the time. They had to prepare his food, shower him and lead him to the well for drinking water.

"It was very difficult relying on my family and it really hurt me to do so. It was a very sad time; I felt like I was disturbing the children," says Chem.

In a country where a day without work may mean a day without food, Chem's family were often forced to leave him at home alone so they could go to the fields to cultivate rice. On these occasions Chem would guide himself around using a walking cane fashioned out of a piece of bamboo.

Getting to the water and the toilet was always the most difficult, he says, and it was not uncommon for him to stumble on the rough ground.

Occasionally he would try to reclaim a sense of independence and visit friends in the village, only to get lost on the way.

"I felt there was no help; that they could not treat my blindness," says Chem.

But when two people in his village returned from the Kampong Chhnang Eye Unit with their sight restored he felt some hope that one day he too may be able to see again.

Five months ago he travelled with his son on a truck to the Eye Unit for his first operation.

Chem spent five days in the hospital and then returned shortly after with his cousin to have his second eye operated on. Thanks to The Fred Hollows Foundation's supporters both operations were performed free of charge, with transport (approximately $1.80) and post operative medicine (approximately $8) being his only expenses.

Chem explains how the nurses bandaged up his eye but accidentally left a very small hole. His face lights up when he remembers realising he could see the other patients in the room through the gap.

"When they removed the bandage I was so happy that everything was clear again," says Chem. He returned to the village in a mototrailer (a trailer attached to a motorcycle) and was soon surrounded by friends.

"I can see, I can see!" he exclaimed repeatedly. Regaining his independence has had a profound effect on Chem and he bustles around demonstrating all of the new things he can do.

He chops firewood, tends to the cows, collects drinking water, visits the local pagoda and is currently working on a wooden door for his daughter's house.

There is plenty to keep him busy, including spending time with the newest additions to his family.

"During my blindness, I could not see my cousin's small grandchildren. When I finally saw again they were very beautiful," says Chem.

In the thick humidity of Cambodia, 37 year old Cheum Sarath works as a stone-breaker. She and her husband, Pheng, work from early in the morning until nightfall every day breaking rocks and loading them into a waiting truck. Cheum's family depends upon this work for their survival. It is hard work but they now earn enough to feed their family.

Two years ago Cheum was blind because of cataracts in both of her eyes. Unable to work, she and her family faced hunger and poverty. Luckily The Fred Hollows Foundation's program in Cambodia was able to offer hope in the form of a simple cataract operation which cost only $33.

Cheum can work again, now that her sight has been restored in one eye. She is being encouraged to have surgery on the other eye but is afraid that she will lose her job and the money to feed her family.

"My five family members will have no rice to eat. The good vision I have in one eye is helping very much," says Cheum.

The eldest of Cheum's children helps care for her younger brother and sister. Now that Cheum is able to provide for her children again she feels that in time they will begin to make their own contributions to the family. Extra income may finally allow Cheum the chance to have sight restored in both eyes.

"When I first had problems with my eyesight I went to a local drug store and received one pill which did not make a difference and the drug store told me that surgery was very expensive in Cambodia - up to USD$50," Keo Hor said.

"When the outreach eye screening service visited my village they told me that I could be cured and that the operation was free due to the support that the eye unit received from an organization known as Fred Hollows."

Accompanied by her 28 year old son Keo Thourm, The Fred Hollows Foundation organized for a boat to take Keo Hun and 12 other patients from the village to Kampong Chhnang Eye Unit.

Like many elderly patients in the developing world Keo Hor didn't know what to expect:

"At first I was afraid as I thought that they would have to take my eye out, but then the doctor explained the procedure to me and he made me feel safer."

The operation, bilateral cataract extraction and intra ocular lens implants, was performed by Cambodian eye surgeon, Dr Chhun Mengchrea and judged a complete success. Keo Hor can now get on with her life - freed from the tyranny of bilateral cataract blindness.

"I will be able to see my family again and cook for them as I did in the past. I will be able to work growing rice and vegetables again and earn money to feed my children"

Khim Rath, a 33 year old mother of three, was once the proud owner of a paddy rice field in the Kompong Chhnang province of Cambodia where she lives. She worked there every day to provide for her family.

Cambodia, one of the least developed countries in the world, has a population of more than 13 million. More than 80% of people live in rural areas and poverty is widespread. Just like Khim Rath, most Cambodians rely on subsistence agriculture for their livelihood.

From the age of 19 years, Khim Rath started to lose her vision because her eyes were affected by cataracts. By the time she was in her early thirties, Khim Rath was totally blind. At the time she didn't know she was blind because of the treatable cataracts in her eyes. Many people in her village thought she had lost her vision because she was pregnant.

Most of those affected by cataract in Cambodia are forced to live a life of dependence, relying on others to help with basic tasks like eating. Women and children in developing countries are particularly detrimentally affected by blindness, because they play the role of primary carers and carry out daily chores, along with often being the primary income earner for their family.

When Khim Rath's vision diminished she could do almost nothing for herself. She needed help to eat, walk and carry out basic daily tasks. She also had to stop working in her paddy field and her husband needed to care for her and their children. As their regular source of income dried up, the family became very poor.

Unable to work in the fields, Khim Rath tried to make baskets at home to sell at the local market. To make ten baskets it took her a month which she could only sell for 700 to 800 Riels each (which is approximately AUD40 cents). Khim Rath knew that she couldn't do this for the long term and would need to earn more money to help herself and her family.

Many people in Cambodia are prevented from having their sight restored because of the minimal facilities that are available. Often too, people can't even afford the bus fare to their nearest eye clinic.

Cambodia's lack of welfare and health infrastructure - partly due to a long history of war and genocide, poverty and under development - further exacerbates many people's situations. When Cambodians need assistance they have no where to go and generally mistrust the few government services that are available. Most rely on their family to care for them.

Four of Khim Rath's relatives were also affected by cataract blindness. Her brother had had his sight restored at a clinic nearby to their village, which is supported by The Fred Hollows Foundation. Khim Rath was determined to have her sight restored too so she went about raising 6000 Riels to get to the clinic, so she could be screened.

The clinic assessed Khim Rath and found that she had treatable cataract blindness. An operation could restore her sight, but unfortunately her family were so poor they could not afford the surgery.

Khim Rath was determined. Despite criticism from people in her own village, she borrowed money from some wealthier people in a nearby village. To do this she had to mortgage her paddy rice field. It was a risk she was willing to take to restore her sight and independence.

Soon after raising the money she needed, Khim Rath had her cataract surgery. Her vision was restored virtually overnight.

With her sight restored, Khim Rath is once more able to earn an income, making baskets and cultivating other paddy rice fields. Her family now survives on her income and is self-sufficient once again. Khim Rath hopes to own her own paddy field again in the future.

Moen Som is old but she doesn't know how old.

In early 2001, she was one of a group of nine people to be screened at the Thnor Chum But Clinic in Cambodia. She was told she had cataract blindness, which could be treated by having surgery.

Moen Som was fearful to travel to an unknown fate at her nearest hospital, Kampong Thom Provincial Hospital. When she did though, her cataract was replaced with an IOL and her sight restored.

When Moen Som's eye patch was removed she could see again! She then stood up and moved slowly and surely through the nearest doorway into a hallway. If she had tried before her cataract operation Moen Som would have walked into a wall.

Moen Som now has the confidence and ability to live an independent life with restored sight!

A year ago, Yieng Simuth realised the vision in both of her eyes was deteriorating when she looked outside the window of her house and found that everything she saw was filtered through a smoke like screen. After some time, Yieng could only see two to three meters in front of her and could not recognize the faces of her family members.

Despite having steady work as an administration staff member at the Provincial Health Department in Prey Veng Province, Yieng Simuth is supporting two cousins who are currently staying with her in a small wooden house located in the Kampong Leav district of Prey Veng Province. Yieng also sends a substantial part of her monthly income to her ageing father, who lives in a remote rural village.

At work, Yieng was not able to perform any computer related work, instead taking on tasks that required her to do hand written work. She increasingly found it difficult to write in a straight line and needed to increase the size of her writing for her to see what she had written. "There are difficulties, but I still came to the office, when I read the book, I take it much closer to my eye". It took an insensitive urge  from Yieng's supervisor before she decided to seek help: "Blind!!! Go to do operation, why you are not go?!"

Upon visiting Dr Im Tov at Neak Loeung Eye Unit, Yieng was told that she needed to wait 6 months for her cataracts to mature. In May 2006, Dr Im Tov operated on one of Yieng's eyes. Before surgery she said "I expect fully to see again because I trust with Dr Tov that thousand of blind he has operated". Yieng was amazed at her sight restoration. "I was much surprise with my vision, it was like I was young again" she said. Yieng's remaining eye will be operated on in three months time.

Free surgery was provided to Yieng due to the fact that her sole income needed to support 3 other people.

Upon returning to work, Yieng can now undertake tasks on the computer again. "I laugh myself when I look at my alphabet written during the time I was blind, the letters go big and bigger and the sentences go up and down!"

"It is great help from The Fred Hollows Foundation to help the poor, include myself" Yieng said.

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