Every morning they make their way through the bustling, ancient city of Peshawar, Pakistan, towards the Hayatabad Medical Complex.
Men, women, young and old, locals and refugees who have crossed the border from nearby Afghanistan. All of them are making their way to queue at the new eye unit built by The Fred Hollows Foundation where they will be treated for diabetic retinopathy, one of the fastest-growing epidemics of the developing world.
Rashin Choudhry, The Foundation's program co-ordinator for Pakistan and Afghanistan, has come to know the streets of Peshawar well.
She loves the dusty chaos of people buying spicy meat and fresh fruit at roadside stalls, and the rickshaws and livestock that share the road with motorbikes, trucks, and cars.
Inside the eye unit, by contrast, a sense of order prevails. The men and women are separated into two different lines. Each will be examined to identify the early onset of diabetic retinopathy. This simple, quick procedure can halt the progression of the disease and prevent the person from becoming completely blind.
Choudhry says she is saddened by the dramatic increase in diabetes that is largely caused by easy access to a fattier, more Western style diet, and increasingly sedentary lifestyles.
As a result of diabetes, blood vessels in the retina begin to be damaged due to fluctuating high blood sugar levels. Although it can’t actually be treated, laser treatment and closely managing blood sugar levels will slow it down.
“A lot of people who have diabetic retinopathy are not aware they have it and its effect on the eyes,” Choudhry says. “Many of the women that come in are illiterate so they often have no idea they have it. More than half have not been diagnosed, so it is an unseen burden. It’s the hidden part of the iceberg.”
Choudhry says she is comforted by the sight of so many women receiving treatment at the Hayatabad Medical Complex.
“It amazes me to see people of all ages with this condition,” she says. “But when they come to the hospital they will receive high quality treatment. Women are so often not given priority in the developing world; often they look after the households; the animals and the children and they simply cannot get away from their duties to get to the hospitals.”
Part of the reason many people find it hard to exercise, she says, is that “Peshawar has been the target of many terrorist attacks including suicide bombers, and so as a result people feel insecure and are unable to even walk to the park.”
“It always lifts my heart to see so many people in the waiting room, knowing they are going to receive such high quality treatment.” - Rashin Choudhry, program co-ordinator
Diabetes has also become become prevalent in India, Bangledesh, Nepal, Pakistan and The Pacific. It is estimated to be responsible for 4.8 per cent of blindness among the 32.4 million cases worldwide, despite almost 90 per cent of its blinding complications being preventable.
At a recent screening camp in Kathmandu, for example, 56 per cent of attendees were diagnosed with diabetes; 26 per cent of those had diabetic retinopathy. Almost no one was aware that their eyesight was at risk.
“It really is a scourge of the developing world,” Choudhry said.