Q&A: Eye health NGO chief on barriers to care and prioritizing sight

Ian Wishart (right), CEO of The Fred Hollows Foundation, with a cataract surgery patient at the Hai Duong Ophthalmology Hospital in Vietnam. Photo from: Facebook

CANBERRA — After almost two decades as CEO of Plan International Australia, Ian Wishart took his development career in a new direction by taking leadership of eye health NGO The Fred Hollows Foundation in March 2018. With the organizational change came a need to rapidly educate himself in an area he had no previous experience.

“In joining the foundation, the most daunting thing for me was learning everything there is to know about eyes,” Wishart told Devex. “I had never worked in the eye health sector so I thought I might be lacking in technical expertise.”

With the help of colleagues willing to explain even the most basic concepts, his first year provided Wishart with a new appreciation for development assistance and the impact restoring sight can have on people’s lives.

Devex caught up with Wishart to learn more about The Fred Hollows Foundation’s new five-year strategy and why he thinks the prevention of avoidable blindness needs to be supported by the wider development sector.

The conversation has been edited for length and clarity.

What has been your experience in your first year with the foundation? What have you learned, and what have been the highlights?

The way we go about our work and the results we achieve has been beyond my expectations. I had heard that the foundation’s work in restoring sight was pretty impressive. However, nothing can prepare you for standing in an eye camp in a monastery in Nepal and witnessing 300 people have their sight restored.

“We know that 4 out of 5 people who are blind don’t need to be, yet global action is still not a priority.”

— Ian Wishart, CEO, The Fred Hollows Foundation

I think there is a story in a holy text about one man having his sight restored and that is considered a miracle. So the restoration of sight to 300 people was spectacular to witness. How we all work together to make that happen in the last mile of our work is incredible.

Was it daunting or exciting to be expanding the legacy of Fred Hollows, a New Zealand-Australian ophthalmologist known for his work in restoring eyesight for thousands of people in Australia?

Definitely exciting. I think the foundation is in an enviable and fortunate position to have the guiding principles Fred set for us and we certainly keep his vision of a world where everyone had equal access to eye health at the heart of everything we do. It’s something that drives all of us. I have a large portrait of Fred on the wall opposite my desk so I do feel like he’s keeping an eye on what we do and probably saying “get on with it!”

Can you discuss the work of the foundation over the past 25 years and what has changed? What are the biggest achievements that you hope would make Fred Hollows proud?

Fred used to say that the greatest attribute of mankind is our ability to help one another. The ongoing commitment to carrying on his legacy is inspiring.

The foundation started as a small charity in 1992 and is now one of the biggest global eye health NGOs. Over the past 25 years, we’ve restored sight to more than 2.5 million people.

The raw numbers of the foundation’s achievements during our last five-year strategy are astounding. Since 2014, working with our partners, we have seen 20.5 million people screened; 3.6 million eye operations and treatments; 77 million people treated with antibiotics for trachoma; 303,000 people trained including surgeons, health workers, and teachers; 4,300 medical facilities built, renovated or equipped; AUD$16 million [$11 million] worth of equipment and infrastructure provided; and 9.9 million children and community members educated in eye health.

Working with the global community, we’ve made big inroads in trying to eliminate trachoma. Fred was particularly disturbed by the terrible effects this incredibly painful and blinding eye condition has on people and would be very proud of the work the foundation is doing and the leading role we have played globally on the issue.

And I think Fred would also be pleased to see some of the newer work we’ve been doing, for example in Bangladesh, where we were the first eye health organization to look at the needs of the Rohingya refugees and to conduct eye screening and surgery.

What are your plans for the foundation? How will it continue to improve services and impact more people?

Our new strategic plan for 2019-2023 is the roadmap which will take the foundation to where we want to be in 2024. Our vision is for a world in which no person is needlessly blind or vision impaired.

Our priority is to work with communities to improve their own eye health. We do this through life-changing surgeries and treatments, training doctors and health workers, generating new ideas, and pushing for change at all levels — from global to local.

We want to make a greater global impact in reducing avoidable blindness and vision impairment. Our strategic goals are to ensure cataract treatment is accessible to all; to eliminate trachoma; to ensure refractive error prevention and treatment is accessible to everyone; and to ensure diabetic retinopathy and other eye conditions are managed affordably.

We also want to set up the foundation for growth and longevity so we can continue to make a difference for the people we serve. The past four years have also seen strong strategic growth, with the foundation opening fundraising offices in Hong Kong, the United Arab Emirates, and the United States in a bid to diversify our funding base and ensure we can continue to expand.

What are the continued barriers in supporting vision impaired people in low- and middle-income countries? How are you working to overcome these?

The barriers vary across countries and regions. One of the consistent issues we see is the cost of accessing services. This is not just the medical costs, but of course the transport costs for people living in rural and remote areas to reach health services which continue to be concentrated in major cities.

So as well as supporting the cost of accessing services, we advocate to governments the importance of including cataract and other eye health in national health plans and making eye health a part of the overall health system.

There is also commonly a lack of education about eye health. Often we ask patients why they haven’t sought treatment for cataract for years after going blind and regularly we hear that people didn’t know the problem could be fixed. They think that when you get old your hair goes white, your eyes go white and you die! They don’t realize that cataract can be fixed with a relatively simple 20 minute operation.

So one of the key things here is educating people and providing services that are closer to home. Community health workers play a critical role here in reaching the poorest and most vulnerable people and letting them know help is available.

What new projects are you passionate about?

Vision impairment through a gender lens

Women and girls in low- and middle-income countries are disproportionately impacted by uncorrected vision impairment, untreated eye conditions, and blindness. What does this mean for gender imbalance?

I’m particularly passionate about our focus on gender equity. In every region of the world, women are more likely to be blind than men. Globally, 55% of the world’s blind are women. That means more than 20 million women in the world are blind and a further 120 million women are vision impaired. Four out of 5 of them don’t need to be.

That’s why The Fred Hollows Foundation is determined to do more to close the gender gap in eye health. We are placing women and girls firmly at the center of our programs, services, partnerships, and global advocacy work.

What message do you have to global development professionals on the need to continue focusing on work in this space?

We have low-cost, proven solutions to many eye conditions — yet too frequently they are not accessible to everyone. The world community can and must do better.

The challenge we face is significant. 36 million people are blind and 1.3 billion people live with some form of vision impairment. Almost 90% of people who are blind live in low- and middle-income countries and 55% are women.

By 2050, as many as 115 million people will be blind.

We know that 4 out of 5 people who are blind don’t need to be, yet global action is still not a priority. Cataract surgery is one of the most cost effective health interventions and we know that for every $1 invested the economic return is $4. So not only is it a health priority, it should also be an economic priority, because we know restoring sight can lift people out of poverty.

Devex, with financial support from our partner Essilor, is exploring challenges, solutions, and innovations in eye care and vision. Visit the Focus on: Vision page for more.

About the author

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    Lisa Cornish

    Lisa Cornish is a Devex Reporter based in Canberra, where she focuses on the Australian aid community. Lisa formerly worked with News Corp Australia as a data journalist for the national network and was published throughout Australia in major metropolitan and regional newspapers, including the Daily Telegraph in Melbourne, Herald Sun in Melbourne, Courier-Mail in Brisbane, and online through news.com.au. Lisa additionally consults with Australian government providing data analytics, reporting and visualization services. Lisa was awarded the 2014 Journalist of the Year by the New South Wales Institute of Surveyors.