In 1985, as a consultant to the World Health Organization, Fred visited Nepal, Burma, Sri Lanka, India and Bangladesh on short-term assignments. Two years later he visited war-torn Eritrea and saw doctors operating in hospitals dug into mountains as the war raged above.
These experiences had a huge effect on Fred and, in line with his basic belief in “equity between people”, he started to work towards reducing the cost of eye health care and treatment in developing countries.
On his first visit to Nepal Fred was interested to discover that “things were shaping up” in the fight against avoidable blindess. There was a team of very young eye surgeons “making headway” and Nepal had conducted the best survey of blindness prevention in the developing world.
Fred met Dr Sanduk Ruit, a medical officer with the Nepalese Prevention of Blindness Program who had worked on that survey. “He was a first-rate diagnostician,” said Fred, “totally absorbed in the craft of ophthalmology.”
Fred felt he’d found a soulmate and, in 1988, Dr Ruit came to Australia to study with Fred at the Prince of Wales Hospital, Sydney.
On Fred’s second visit to Nepal he found Dr Ruit had refined and improved some of the methods of cataract surgery he’d learnt, “and at the Prince of Wales we now use what I call the Nepal technique,” said Fred. “No one else does the operation quite like Ruit for speed, dexterity and precision and fortunate indeed is the Nepalese patient who comes under his care.”
Gabi Hollows says Fred and Dr Ruit shared a determination to bring modern eye health services to Nepal.
One of the obstacles to their vision was the high cost of the intraocular lenses (IOLs) used in modern cataract surgery, which put IOL implant surgery out of reach of most people in developing countries.
In the early 1990s, Fred and Dr Ruit began working together towards building a world-class IOL manufacturing facility in Nepal. “They both pushed boundaries and demanded results and their combination was always going to give us an enduring and powerful legacy,” says Gabi.*
In 1994, one year after Fred’s death, the Fred Hollows IOL Laboratory at the Tilganga Eye Centre in Kathmandu began making high quality low-cost IOLs.
Today the laboratory has produced well over 2 million IOLs and is one of six divisions within what is now the Tilganga Institute of Ophthalmology (TIO) – an international standard, tertiary-level eye care hospital and one of The Foundation’s most valued partners.
Dr Ruit is the Medical Director of the TIO and is recognised as one of the giants of world ophthalmology.
"Fred was always behind me all the time. He always thought that what I was doing was right. With Fred's values we were as one," says Dr Ruit.
When Fred treated an Eritrean patient at the Prince of Wales Hospital in Sydney in 1986, all he knew of Eritrea was there was a war going on and the Red Sea was a bad place for eye disease.
They got chatting and Fred commented that the doctors there must be busy, and his patient said, “Yes, we have twenty-one doctors and they are very busy”.
That didn’t seem like many doctors. Fred asked how many were eye doctors. One does eye surgery, said his patient, though he hasn’t been trained. At the time there were hundreds of eye surgeons in Australia.
It took a while to organise but Fred got that one doctor to Sydney for training.
“[Fred] was my friend, he was my teacher,” says Dr Desbele Ghebreghergis, who became Eritrea’s first ophthalmologist after training with Fred at Prince of Wales Hospital. Dr Desbele is now Medical Director of Birhan Hospital in Asmara.
“Fred's work is unforgettable. It is built like a statue in our heart.” - Dr Desbele Ghebreghergis
Fred made his first visit to war-torn Eritrea in 1987, travelling down from a conference in Egypt. The trip had a huge impact on him.
Fred admired the adaptability and humanity of the Eritreans as they performed their medical duties under fire, and was hugely impressed by their sophisticated manufacturing of chemicals and pharmaceuticals amidst the fighting.
Cataract blindness is the most common form of blindness in Eritrea and Fred knew that the high cost of intraocular lenses put modern cataract surgery out of reach of most people.
Dr Desbele remembers Fred’s determined vision for Eritrea. “Fred said, 'Hey Des, we are going to produce intraocular lenses here [in Eritrea]'. 'What are you saying, Fred?' I asked. 'Even if we are going to produce them, who is going to put them in?' Fred said, 'You are going to put them in. You and your colleagues'.”
Despite being diagnosed with cancer in 1988 and knowing he didn't have much longer to live, Fred started raising money to build an IOL factory in Eritrea.
In 1991, a year after his second trip to Eritrea, Fred was given honorary Eritrean citizenship.
By 2010, the Fred Hollows laboratories in Nepal and Eritrea had manufactured over four million IOLs for use in low cost cataract surgery around the world.
Fred visited Vietnam in April 1992 to investigate setting up an IOL factory for affordable cataract operations. On that same trip, he promised to train 322 Vietnamese eye specialists in modern surgery techniques.
In July he discharged himself from hospital and a week later returned to Vietnam to help fulfill his promise.
Two of Fred’s former students are Professor Do Nhu Hon, now the Director of the Vietnam National Institute of Ophthalmology (VNIO), and Dr Nguyen Chi Dung, now head of the VNIO’s Preventive Department.
According to Dr Dung, “Professor Fred Hollows was an active and frank man. He came to Vietnam even though he was sick, worked all the time, teaching us. When we did something wrong, he always told us to do it better.”
Professor Hon and Dr Dung say Fred’s visits in 1992 led to a revolution in Vietnamese ophthalmology.
At that time, only 1,000 cataract operations using IOLs were performed each year. The number is now around 160,000 per year.
Fred died on February 10, 1993. A few weeks later The Foundation initiated a training program for surgeons in collaboration with the Vietnam National Institute of Ophthalmology.
Fred’s son Cam was with Fred on his initial trip and, in December 2010, Cam received the Vietnam Friendship Medal on behalf of The Fred Hollows Foundation (Friendship Medals confer the highest recognition available for outstanding contributions to economic and social development in Vietnam).
Cam, on placement at Hanoi’s Viet Duc Surgical Hospital as a medical student said, “I am thrilled to be receiving medical training in a country so close to my father’s heart, where The Foundation’s work has been such a success story.”
Since Fred’s initial visit, The Foundation has helped train and equip hundreds of doctors to perform modern sight-restoring cataract surgery, and has expanded its support to cities and provinces throughout the country, in close partnership with local eye care service providers.
* Quote from Mivision magazine, From Big Ideas, Big Things Grow, August 2009
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