Region Staff

The Pacific's key eye surgeon, Dr John Szetu, holds court in the eye clinic, his eyes dancing around the room. A fine surgeon, a methodical teacher and a tireless advocate for eye health in the region, right now he also turns his considerable charm to the task of recruiting nurses and doctors to study under him at the Pacific Eye Institute, The Fred Hollows Foundation NZ's ground breaking eye health training centre in Suva, Fiji.

"You need patience and tolerance to be an eye nurse or doctor, many patients are old people, and the conditions can be challenging. You need to be a good and loving person, with steady hands and good dexterity."

"And being pretty helps," says Dr Szetu, winking to cue the coming joke; "Pretty like me. Although perhaps you need an eye test if you think I'm pretty."

He says he hasn't had any trouble attracting students for the Institute, the new central training ground for eye doctors and eye care nurses from around the region.

A natural leader, Dr Szetu is a patient and attentive teacher and a brilliant eye surgeon who works skillfully in very basic rural conditions that Western ophthalmologists would find challenging.

A Solomon Islander from Gizo in the Western Province, Dr Szetu was one of the first indigenous doctors to help build the National Eye Health Program for the Solomon Islands in the late 1980s after studying ophthalmology and training under Dr Richard Le Mesurier, who initiated the program in 1987.

"John is an enormous talent and was easy to teach; great fun. He expects high standards of himself and others, and he gets high standards because he expects them," says Dr Le Mesurier, who is now VISION 2020's regional coordinator for the Western Pacific.

Dr Szetu fled his homeland in 2000 when civil unrest became a threat, as it did for many people from the Western province and Guadalcanal, where the capital of the Solomon Islands, Honiara, is situated.

"I felt guilty to leave my country but I didn't have a better option. I was practically forced to leave. I abandoned my clinic, my nurses, but they were not normal times," says Dr Szetu.

At the height of the troubles he took refuge in Australia with his family, and while there he was offered a position by The Fred Hollows Foundation to develop a national eye health program in Vanuatu.

Before moving to The Pacific Eye Institute in Suva, John spent five years in Vanuatu where he trained a local eye doctor, Dr Johnson Kasso, and a fleet of eye care practitioners, including eye nurses for every province. The success of the program enabled it to be taken on by the local Ministry of Health.

Throughout his posting in Vanuatu, Dr Szetu also made half-yearly trips back to the Solomons to conduct surgical outreach tours.  

It's a daunting job but what keeps Dr Szetu going is that every single cataract operation he performs changes a person's life.

"Some of my patients look up and say, 'I don't know what to give you in return'. I say that the reward is seeing them see again. Some start shouting and kissing your hand. Some are shocked because the colours are almost too much for them."

"In the early stages of cataracts you can only see black and white so the colours have been gone for a long time," says Dr Szetu.

The Vanuatu team is committed to upholding John's legacy and the small and dedicated team now conducts about 400 cataract operations a year in rough terrain.

"Learning is easy and enjoyable with John and you want to work with him all the time. He teaches in such a way that you don't have fear of asking questions. You feel he is your friend and he is always there," says Dr Kasso, who studied under Dr Szetu in 2004.

And now Dr Szetu leads a new team in Fiji to establish a regional training centre that will provide eye doctors and nurses for all countries in the region.

If his students learn anything from Dr Szetu during their studies with him, they'll learn to conduct themselves with a smile. If they feel their strength faltering under stress they can call on the image of Dr Szetu sliding into a tense situation and lightening the mood with a characteristic mixture of self depreciation, flattery and warmth that leaves people feeling good and capable.

It's this same mix that has enabled Dr Szetu to lead The Pacific Eye Institute and drive through a successful eye health program in Vanuatu and continue to provide surgical trips to his native Solomon Islands in testing times.

Beneath the smiling, good-natured exterior is a determined man on a mission; a man who simply doesn't give up until he has achieved the unachievable.

• Download article written about Dr John Szetu, The Sydney Morning Herald, 2002

Training nurses to give eye injections for cataract surgery is the best part of the job for Sister Wanta Aluta, FHFNZ's Pacific Nurse Coordinator.  She throws her head back and laughs as she confesses to this secret pleasure. Giving pre-operative anaesthetic injections isn't something that nurses in New Zealand would usually be required or allowed to do, but it's a skill that Wanta has acquired through necessity. It is also a vital skill for other nurses throughout the Pacific who are managing clinics without full-time doctors. 

 "I tell our nurses that they start their relationship with the patients when they first visit the clinic at their hospitals. Nurses have to relax the patients, making jokes so they don't feel scared, but at the same time, watching all the clinical signs. The nurses must explain everything that's going to happen in the surgery, about the injections and the operation. Nurses are preparing the patients from the beginning."

There's a natural compassion and warmth about this experienced nurse, who was the backbone of the eye clinic at the National Referral Hospital in Honiara since the inception of the national eye health program in 1987.

"Wanta was a natural," says Dr Richard Le Mesurier, a medical advisor to The Fred Hollows Foundation NZ, and Western Pacific Vision 2020 representative.

"Wanta anticipates what you want during surgery; she is organised and always knows what is needed. We never arrived at our destination only to realise the sutures or some other vital piece of equipment had been left behind. And she was an enormous pleasure to teach," says Dr Le Mesurier, referring to his days in the Solomon Islands at the start of their National Eye Care Program in the late 1980s.

Now Wanta is passing on her skills to others, training other eye nurses at the Pacific's only regional eye health training centre, The Pacific Eye Institute.

Wanta is entrusted with teaching some of the modules of the eye care curriculum to nurses each year, both at the Institute and other campuses where the FHFNZ Diploma of Eye Care is delivered.  As much as possible, eye nurses are trained alongside doctors in a ‘team training' approach.  This maximises their efficiency with each knowing what the other can do, and each helping the other achieve good clinical practice.  FHFNZ endorses the WHO assessment that about four eye nurses are needed for every one eye doctor.

The role of eye nurses throughout the Pacific is to treat all basic eye care conditions, find patients that require cataract or other surgery and have them ready for this surgery when an eye doctor is available to perform it, provide care after surgery, and test vision and dispense spectacles.  The training at the Pacific Eye Institute also includes management so that the eye nurse is able to run an eye clinic and keep it functioning well.  Throughout the Pacific, most eye nurses work on their own without eye doctors, often in remote and challenging locations.  Therefore, it is very important they can keep their services functioning, and this involves ordering medicines, organising community field visits, referring patients on to other services, and purchasing and selling spectacles.

"When I first started I didn't know anything about eyes; now I'm teaching at the Pacific Eye Institute. I like working with the eyes, it's adventurous. My goal for the Pacific Eye Institute is for everyone to have the same vision I have. To make sure everyone enjoys the view," Wanta says.