Clear: Anny Sulistyowati is head of the Indonesian Ophthalmologists’ Association (Perdami) in the Malang region. Duncan Graham “The days of cataract surgery in hospitals need to pass,” said John Fawcett. “Provided proper sterilization procedures are followed operations don’t require the massive and costly resources of a sophisticated hospital.  

“Surgical day centers and mobile clinics are the way to go. A slow but acceptable rate for a surgeon is two cataract operations an hour.”  

“I’ve been advocating change but hitting brick walls trying to get an audience with the health policymakers in Jakarta,” said Jono. “The whole public health system is crumbling and it seems the bureaucrats aren’t interested.

“Sometimes I wonder whether we should be putting our money into countries where we’d be more welcome.”

If you blink your way off the street into a Singapore hospital seeking cataract surgery, you’ll walk out with clearer vision but a lighter purse. Prices vary, but S$4,000 (US$3,262) is average.

The costs are similar in Australasia where insurance companies often pick up the tab.

Yet overseas aid agencies appealing for donors claim just US$25 will restore an Indonesian’s sight.

“That’s the cost of materials, the surgery is extra,” said Fawcett. “If you look at the agencies’ ads closely they say donors can ‘help’ save an eye for $25. The patient pays nothing, but the real cost is around $50 for walk-in operations at a big city clinic like the one we have in Surabaya, or double that in isolated areas.”

These figures are skewed because the Fawcett rural clinics are supported by the Indonesian Air Force, which has been flying surgeons and equipment into remote areas at no cost.

It’s a similar situation in Medan where the hospital doesn’t charge for A New Vision’s theater use. Regencies have helped transport patients for free along with the Army, effectively using the military to subsidize treatments. Jono said a general justified his troops’ involvement “because the army had two duties — to defend the nation and to help the poor.”

Even after including all these factors, the gap between prices is enormous.

“Doctors like to drive Lexus,” said Jono dryly. “This is a business — charges depend on demand and what the market can bear.”  

“Not everyone thinks like that,” commented Anny Sulistyowati, head of Perdami in the Malang region.  

“We operate on the poor for very little.  We tour the islands of Eastern Indonesia seeking patients. “I drive a Toyota Alphard.

“I studied for nine years and I’ve been a surgeon for 12.  We never think in terms of getting a high return from our training — we’re not traders.”  

She rejected allegations that Perdami had a quota system for graduates. “The problem is that only 12 universities teach ophthalmology and each takes around six per semester,” she said. “There aren’t enough lecturers or facilities, and few graduates want to be ophthalmologists.” Those that do are often women, attracted by regular working hours.

Anny said she had no issues with foreign doctors, or local general practitioners doing eye operations provided they were properly trained and registered.

So how can the backlog be cleared and the 2020 goal achieved? Anny: “This is a very serious problem, and frankly speaking, I don’t know the answer.”

– Duncan Graham

WHO’s Vision 2020 goal:
A world in which no-one is needlessly blind

Ratio of ophthalmologists to citizens in Indonesia:
1 / 203,000

WHO recommendation:
1 / 20,000

Number of free cataract operations in 2012:
11,000

Backlog:  
Close to 2,000,000