We first heard of the Impact Foundation at the Oxford Ophthalmological Congress in 1999. The organization was about to launch its floating hospital, the Jibon Tari (Figure 1), which means boat of life, in Bangladesh. The purpose of this vessel, which houses medical wards, operating theaters, a training center, laboratories, and its own water purification plant in its 40 X 10 m area, is to take the hospital to the people. The Jibon Tari can be taken from the mouth of the Ganges to the foothills of the Himalayas, treating desperately poor people who are unable to afford cataract surgery and surgery for deafness, walking problems, and cleft palates. I (DM) offered my services as an eye surgeon, and my wife (LM), a general practitioner, also participated. We soon found ourselves en route to this interesting part of the Indian subcontinent.
Impact is an international program dedicated to preventing and alleviating needless disability. According to the World Health Organization, 7% to 10% of the world’s people are disabled, 80% of them live in developing countries, and 33% are children.
There are 17 Impact Foundations located around the world, run by local people who understand the particular needs within their countries and how to meet them in appropriate, cost-effective, and culturally sensitive ways. For 25 years, Impact volunteers have travelled to impoverished countries to restore sight and hearing, rehabilitate orthopedic walking problems, and repair cleft palates for 800,000 people. Impact’s priorities of action are: (1) the early identification and treatment of potentially disabling conditions; (2) making surgery accessible by taking the hospital to the people; (3) promoting safer motherhood and child survival to protect the lives of pregnant women, new mothers, and infants; (4) ensuring that everyone has access to immunizations to prevent the spread of disabling diseases such as polio; (5) ending malnutrition, which affects more than 1 billion people and causes mental impairment and physical disability; and (6) improving access to safe water and sanitation to stop the spread of deadly waterborne diseases.
In Bangladesh, more than 650,000 people in the past 11 years have benefited from the medical care provided aboard the floating hospital. Impact’s hospital train travels through India doing work similar to that undertaken on the Jibon Tari.
ABOARD THE JIBON TARI
Travelling to Bangladesh is always a thrill. When we arrive at Dhaka airport, smiling Impact staff welcome us with garlands and take us to the Medical Aviation Fellowship’s tiny seaplane. From there, we fly to wherever the floating hospital is docked. Each time, our experience in this fascinating place feels new.
As we land in the river, hundreds of people dash to see the rare sight of an airplane. By the time we have arrived, resident eye doctors have assessed hundreds of blind patients who are waiting for surgery (Figure 2). Because most eye operations can be done under local anesthesia, an anesthesiologist is usually not required. The Jibon Tari has three operating tables. Rayner Intraocular Lenses, Ltd. (East Sussex, United Kingdom), generously donates IOLs. As operations commence, a hive of activity breaks out in the operating theaters, wards, pharmacy, and kitchen, where the staff prepares and serves hundreds of meals. The coming together of the floating hospital community is striking and encouraging, and there is a tremendous feeling of goodwill and friendliness. For us, work on the floating hospital is like a busperson’s holiday—the air is warm, the scenery is lovely, and the people are vibrant and colorful.
The disease processes are much more advanced in Bangladesh compared with what we see in the United Kingdom. Patients in the United Kingdom complain that they cannot see a golf ball at 80 yards. In Bangladesh, many patients have been blind for 5 years by the time we see them and are destitute and unable to feed their families. Many patients’ lenses are black or hypermature. It is not uncommon for the posterior capsule to disintegrate during surgery due to protein deficiency. Anterior chamber implants are available to take the place of posterior chamber models.
Children often develop lamellar cataracts due to lack of calcium, demonstrating the gross deprivation the population faces (Figure 3). The good news for these children is that, unlike those with congenital cataracts, they will achieve good results after surgery. Other causes of pediatric cataract include trauma due to bird peck (cattle egrets) and date palm spines.
When we first started travelling with Impact to Bangladesh, I operated on adults and children as young as 5 years old with local anesthesia only. Today, a Bangladeshi eye surgeon, whose training was assisted by Impact, runs a pediatric eye unit and performs 40 cataract surgeries per day in children. One of the joys of doing humanitarian work in ophthalmology is seeing the development of an eye facility such as this one that functions at world-class standards. The skills one leaves behind in the developing world are vitally important and long-lasting.
Ophthalmology is well suited for humanitarian efforts in the developing world. Ophthalmologists can do a substantial amount of work in a short time with instruments that can be carried in the shape and weight of two laptops.
A note to colleagues considering getting involved or who are newly acquainted with The Impact Foundation or other volunteer organizations: Never assume that everything will be waiting for you at your destination. Circumstances in developing countries can be quite different from what you are used to at home or what you may anticipate. The absence of a particular surgical instrument can be frustrating. Also, computer-reliant equipment that is dependent on a continual stable electricity supply is inappropriate. Once you have volunteered for the first time, it is helpful to keep returning to the same country because you can build on your past experiences in surgery and with the local people. This makes progress easier.
We encourage ophthalmologists to get involved with humanitarian organizations in the developing world that seek to prevent and reduce unnecessary blindness due to cataracts. With more than 20 million blind people in need of cataract surgery, there is a significant demand for volunteers. Although you will live in fairly basic conditions, work hard, and may even question at times why you got involved in the first place, if you go with your eyes open you will have a unique and deeply enriching experience that will be unlike any other in your life. Nothing compares with it. The Impact Foundation has given us the time of our lives.
Editors’ Note: As might be expected, there is more than one humanitarian organization in the world named The Impact Foundation or something similar. To find out about the organization described in this article, start here: http://www.impact.org.uk.
David Moss, MA, MBBChir (Cantab), FRCSE, FRCOphth, is a retired Senior Consultant Ophthalmic Surgeon from the North Hampshire Hospital and the Hampshire Clinic, United Kingdom. Dr. Moss states that he has no financial interest in the material presented in this article. He may be reached at e-mail: email@example.com.
Lynette Moss, BM, MCh(Oxford), MA, is a retired Senior Partner from the Shakespeare House Medical Center, Basingstoke, United Kingdom. Dr. Moss states that she has no financial interest in the material presented in this article. She may be reached at e-mail: firstname.lastname@example.org.