The Kingdom of Tonga is a tiny cluster of islands in the Pacific, near Fiji and Samoa, and the first country across the international date line. It is also a country where blindness, principally from cataracts, is so common that the word for blind, “cui,” is the same as the word for grandmother.
The Hawaiian Eye Foundation has been making annual charity surgery mission trips to Tonga for many years, with thousands of surgeries done over the course of decades. When presented with the option of joining the Hawaiian Eye Foundation for a trip to Tonga in September 2009, I jumped on the opportunity. I did not exactly know what to expect, but because it was a group trip with other ophthalmologists and support staff, I knew that we would enjoy working as a team.
Tonga is a country focused on a simpler life that is centered on the family. Most houses have multiple generations living under the same roof, with a division of labor that eases the burden on everyone. There is one job, however, that is rarely seen in the U.S.: the “seeing-eye child,” in which one of the young children is designated as the eyes for a blind elder, typically a grandmother, leading her to church and helping her around the home. Giving the gift of sight to the grandmother not only restores her vision, but it also gives a young child newfound freedom to go to school, play with friends and even be a bit mischievous, just like the other kids.
I truly enjoyed the surgical challenges: dense cataracts, old equipment, lack of modern phaco units, inability to speak the language, and the unfamiliarity of foreign operating room customs and conditions. The intraoperative challenges made me a better surgeon and tested my ability to handle difficult situations. But the true reward came after surgery, when the patients who were blind for years regained their vision. The gratitude expressed by the patients is amazing, with tears of joy from patients as well as their family members. And once the former “seeing-eye children” realized that their elders could see again, they quickly seized the opportunity to run around and play with other kids.
One thing that struck me as odd was the lack of Tongan programs to encourage their citizens to become involved in their own health care. While doing surgery for the Tongans was helpful, I wish that I could have instructed Tongan surgeons, too. I have taught cataract surgery to many ophthalmology residents in the U.S., and I would have enjoyed teaching Tongan surgeons. I would like to see Tonga invest in its youth by setting up programs that sponsor bright Tongan high school children who want to go to college and medical school, and once they have achieved proficiency in a field, bring them back to Tonga to establish health care programs locally. With the right nurturing and guidance, one of those former “seeing-eye children” could be a Tongan cataract surgeon superstar.