Assisting: Morotai in North Maluku has a mobile cataract clinic. Courtesy of John Fawcett Foundation

Around 3.8 million Indonesians can’t read this or any other newspaper because they suffer from curable eye conditions.  At least half are cataracts. The goal is to clear the problem by 2020. Yet just 11,000 free cataract operations for the poor were performed last year, mostly funded by overseas and local donors. Duncan Graham reports on an opaque problem.

Foreign doctors are not allowed to work in Indonesia.  Permission is sometimes given for overseas specialists to make short training visits to the Republic, but that’s all.

There are only 1,179 members of Perdami, the Indonesian Ophthalmologists’ Association. That’s a ratio of one eye surgeon to every 203,000 citizens. The World Health Organization recommends one to 20,000.

Blurring the problem is that most eye doctors work in the big cities, and not all are active. Few practice in the regions where the need is greatest.

Cataracts can strike anyone, but the rural poor who toil outside without using sunglasses are most vulnerable.

To get a cataract operation in Indonesia you need to be rich — or very poor and in the right place, like Bali, Medan or Malang. Here your surgery might be conducted by an Indonesian doctor paid by an aid agency or benevolent business. The system seems hit or miss, and that includes the subsidies.

The Indonesian Red Cross has allocated Rp 1 billion (US$104,000) for eye surgery for the poor through hospitals treating 500 patients.

Close encounters: Pak Nero’s cataract operation in Malang went smoothly. Duncan Graham

However the Singapore-based A New Vision managed to get 625 operations and training programs run in Sumatra for $75,000. Effi Jono, the founder of the charity, raised the money from family and friends.  

“We were greeted with protests and petitions [from local medical professionals] when we first tried to work in Medan,” said the Indonesian-born accountant.

“Thankfully we were allowed to go in and now have a much better relationship with the ophthalmologists of North Sumatra.

“Not allowing foreign doctors to work is a huge problem. Unless something changes it will take almost 40 years to clear the backlog of cataracts — provided no new cases are detected.”

In 1990 Australian potter-turned- aid activist John Fawcett raised funds to pioneer lens implant surgery in Bali. Since then his foundation has screened 750,000 people and treated more than 34,000 cataracts.

Malang’s largest private eye clinic employs eight ophthalmologists who also work in the public sector. Klinik Mata Malang charges upward of Rp 7 million per cataract for private patients, but discounts this to Rp 1.5 million when altruistic companies sponsor operations for the poor.

“They must have a letter from their local community leader confirming they have no money,” said clinic spokeswoman Seskoati.  

“Personally I think we need overseas doctors to enhance our skills because the techniques and technology are changing so fast.”

The clinic’s two operation rooms look more like dentists’ surgeries than hospital theaters. The patient sits in a chair that tilts flat. Local anesthetic is used and music to sooth. Seskoati prefers the voice of Italian tenor Andrea Bocelli. He’s blind.

The Jakarta Post watched an operation on closed circuit TV conducted by four doctors, including two trainees. Using a powerful microscope the eye was sliced, probed, vacuumed and fitted with a new lens before three stitches were inserted. It took about 30 minutes.

Recovery: Pak Nero rests with his wife Luluk Hasana after his cataract surgery. His cataract had been growing for 20 years following a poke with a piece of wood. Duncan Graham

Starting as a bright orange globe, the jelly eye wept a little blood before turning black, like a solar eclipse.  

Moments later the patient, second-hand goods dealer Nero, 64, was slumped on a sofa surrounded by family and friends, his right eye bandaged. His cataract had been growing for 20 years following a poke with a piece of wood.

He felt groggy, but said he was not in pain. The cost was met by a company that makes herbal remedies.

Nero should see clearly soon, but for a few days he won’t be able to pray by kneeling and pressing his head to the ground.