“There may not be a doctor who can operate on cataract independently in Altay.”

Altay means the “golden mountain” in Kazakh. Ten times the size of Hong Kong, Altay has a population of less than 700,000. Situated in the far north western corner of the autonomous territory of Xinjiang in China with Russia to the north, Kazakhstan on its west and Mongolia in the east, Altay is in the remotest part of China.

Dr. Hong-wei Zhang is probably the only eye surgeon who is learning to perform cataract surgery in Altay thanks to the support of The Fred Hollows Foundation.

Given the dominant Kazakh culture, eye care awareness is low in Altay.
- Dr. Zhang Hong-wei
Cataracts and pterygium are common in Altay as a result of the strong sun light and ultra violet exposure. Diabetic retinopathy is another issue, as meat, milk and cheese heavily feature in the dominant Kazakh-style diet. Summer is a short but important time for people in the area. The season is busy with collecting and drying grass to feed livestock in winter. The long winter starts in October and ends in May, and temperature can fall as low as -20 degrees Celsius.

The herdsmen are nomadic and it is difficult to approach them. In the long winter season, heavy snow makes transportation to and between the scattered villages challenging. Education levels in the district are generally low and language is a barrier to accessing health care: most people in the area speak Kazakh rather than the more widely-spoken Mandarin.

As a result of a lack of eye health education, many patients who access the health system in Altay do not recognise early signs of vision impairment. By the time they arrive at the hospital, their vision problems are sometimes beyond the point of repair.

The Altay region has a high demand for eye surgeons.

Dr. Zhang says it takes 8-10 years to train an eye surgeon in China and doctor retention is an ongoing issue in Altay. Well-trained doctors often choose to leave Altay to work in other parts of China for a higher salary. “We trained a doctor in The Altay People’s Hospital in the past, but he left in the end. There may not be a doctor who can operate on cataract independently in Altay.”

The training Dr Zhang received allowed him to accurately diagnosis and operate using current best practice models.

His “master”, Dr Pulat Abdiryim from Urumqi, also joined The Foundation’s train-the-trainer program before.

In the past, Dr Pulat enjoyed doing surgeries on his own but is now giving younger doctors a chance to improve their skills in the operating room.

Dr Pulat said the eye was a very special organ of the human body. It is small and fragile, and thus cannot be repeatedly cut open. “I don’t need them to do surgeries fast. Patients’ safety should be put in the first place. The happiest thing is to conduct a successful surgery, and I can sing when I leave the operating theatre.”
The 33-year-old Dr Zhang says being an ophthalmologist may not be financially rewarding, but he is rewarded by being able to create ample social impacts.

Investing in Vision, a 2014 PriceWaterHouseCooper report commissioned by the Fred Hollows Foundation, found that for every US$1 investment in eye care, US$4 of social benefit is created.

“Patients come to the hospital being carried by their families, and can walk out by themselves when discharged. It is definitely an achievement,” says Dr Zhang.