Seeing is believing

Published on Thursday 27 November 2008 12:07

FOR many Indians, blindness or poor vision will condemn them to a life of desperate poverty in overcrowded city slums. But it does not have to be this way – a £17 operation can give many back their sight and their future. You can help UK charity Sightsavers achieve this goal

• Watch a slideshow of pictures from Delhi by Phil Wilkinson

WE ARE entering Delhi's sprawling Tigri slum. To the left is an open field of rubbish in which knots of raggedy-clothed children attempt to play cricket while chickens and goats root for food scraps around their feet. To the right, a lorry tips a load of stinking household refuse from a more prosperous area at the feet of a group of "ragpickers", who seize on it eagerly in search of metal and plastic they can recover and sell for a few rupees. A herd of pigs trots over to share in the noxious bonanza with a pack of stray dogs.

Up ahead are the narrow, twisting alleyways of the slum proper, where the only sanitation – for humans and animals alike – is provided by open drains that flow past the ramshackle houses. But it's the smell in the fetid air that really tells you where you are. In the 32C heat, the stench makes you gag and your senses reel.

Entering the cool shade of the Kalyanam wellbeing clinic comes as a welcome relief. Here, Rakesh Baghal, his three-year-old daughter cradled in his arms, wife Ritu and their two other children by his side, is waiting to tell his story. They are a happy family unit, eager to share the transformation in their fortunes.

The first time Rakesh came to the clinic, he stumbled and fell down the stairs, suffering from cataracts that had blinded him three years earlier, at the age of 32. As a make-up artist for a TV news channel, his loss of vision had meant the loss of his monthly income of around 5,000 rupees – 60. Ritu had to take a job cooking and cleaning for other families. Possessions had to be sold off. In the slums, where the able-bodied need all their faculties to engage in a daily battle for survival, loss of vision can be a catastrophe.

For Rakesh, it was a time of despair, fearing he would never recover. "I couldn't do my job, couldn't even see my family," he says. Although he had sought medical help, the message was bleak. "All I was hearing," he says, "was that even if I paid for the operation I was not guaranteed the return of my sight. I began to lose hope."

Eventually, after contact with a volunteer worker, he attended an eye-screening clinic at the Kalyanam. Simple and quick operations – at a low price, subsidised by British charity Sightsavers International – restored his sight and he is now back at work. Rakesh's future is now much more secure, and his is a success story in one of the most deprived areas on Earth. India's capital city contains some of the worst examples of urban poverty in the world with vast and growing slums.

Squalid living conditions combined with overcrowding and a lack of adequate healthcare, means that the diseases and malnutrition that can lead to sight loss are rampant in some areas of Delhi. While Rakesh received the help he needed – in an operation subsidised by donations from Sightsavers International – many more cases remain untreated, unable to afford health care services or simply afraid of seeking treatment.

Rakesh and his family know how lucky he has been. Before leaving, Ritu proudly pulls out a sheet of paper and hands it around for inspection. It's a pledge that, after her death, her eyes can be used for corneal transplants to help others regain their sight. "My husband was given his sight back in both his eyes," she says. "To say thanks, I want to give sight to two more people when I die." She smiles, gathers her children, and the family heads back to a life rediscovered.

INDIA REMAINS AN astonishing country of stark contrasts, where the richest get ever-richer and the poorest struggle in conditions unfathomable to Western observers. Despite the much-vaunted decade of 7% economic growth and the rise of a salaried middle class, the dark side of the second-most-populous country in the world remains its infamous city slums.

In India as a whole, 63 infants die per 1,000 live births, compared with 45 in war-torn Eritrea. Around 400 out of 100,000 women die in childbirth, compared with 100 in Botswana. Despite the economic boom to which scores of high-rise buildings on the edges of the main cities testify, almost half of India's under-threes remain malnourished.

It is this kind of poverty that forces millions of Indians every year to uproot from their rural villages and make their way to the slums. Their aim is to join in the economic miracle; often they simply compound the problems.

Despite the squalor, the slums have a vibrant pulse that outsiders find hard to understand. Late afternoon, high on a factory rooftop above Delhi's Okla slum, all you can hear is a swelling buzz. It's the sound of more than 20,000 people crammed into a jumble of rundown brick houses spread out in the bowl of ground below. It's the hour before sunset, and women and children are – literally – coming up for air from the maze of dark rooms below. In family groups, those lucky enough to have roofspace ascend to escape the stifling heat, the noise, the dirt, the pollution and the menagerie of animals that share their lives. As the day cools, it's a few brief moments of respite.

Okla is just one of the slum clusters that more than 2.5 million of the city's 15 million population call home. Penetrate the alleyways and the over-riding impression is of an overpowering and overcrowded mass of humans and animals with no choice but to somehow rub along together. Families of up to ten routinely share one tiny room, separated from the alleyways only by a thick curtain. Electricity is available for those who can afford it, but it is a luxury for people surviving on around 50p a day. Sanitation is, at best, primitive – at worst, non-existent.

The waste ground to one side of the slum is basically an open toilet where thousands of residents make a daily trip to relieve themselves in sight of their neighbours. Here the cows and goats from which the residents draw some of their milk supplies graze contentedly, but the smell of human and animal faeces blown down across the tumbledown homes is overpowering.

With November temperatures of 30C and winter approaching, at least the swarms of flies are at a minimum. The summer months are a different story. "Imagine what it's like in 45C heat and torrential rain," says Prabhat Sinha, the regional programme manager for Sightsavers International. "All the dirt and sewage gets washed into the homes. The situation may be improving here in the slums, but there is still a long way to go."

We are talking on the roof of a factory, where, in the workshops below, slum-dwellers make clothes for the Western fashion industry. It is this ring of factories that gave birth to the slum, where numbers swell every day as jobless Indians and their families from rural areas arrive in the city to find precious work. To the visitor, it is the unacceptable side of the "new" India, which now likes to regard itself as an emerging global economic superpower with the resources to send a spacecraft to the moon. Just beyond Okla's mass toilet are concrete pillars erected to support the multi-million-pound Metro lines that will transport tourists around this teeming and overcrowded city during the 2010 Commonwealth Games.

In just over a decade, the proportion of Indians living in cities and wanting to share in an economic miracle has increased from 20% to 30%. The problems are caused by a mass migration of rural populations in search of employment as rickshaw drivers, textile workers, ragpickers or labourers. It's not that the government ignores the slums as an ineradicable stain – fresh drinking and cooking water is tankered in every day. But slums have the habit of growing at a faster pace than any government can cope with. Every evening, Delhi alone has 500 extra people on its streets. "The council plans water for 100 people and then finds 200 have move in," says Sinha. "All the planning collapses."

In such a melting pot of people and animals, where incomes are so low, the diseases of poverty are free to thrive. Up to 70% of Delhi's slum children are malnourished – almost every one of them looks two to three years younger than the average Western child of the same age – so the search for money for food becomes the over-riding priority.

Inevitably, some medical concerns – particularly those that are not life-threatening – are routinely ignored, for cultural as well as economic reasons. Among them is eye health, even though easily treatable conditions such as cataracts and glaucoma can lead to total blindness and loss of a livelihood on which a family depends. The scale of the problem across India is huge, with 11 million blind people – more than twice the population of Scotland. Yet most of these cases are preventable, and many lie hidden in the deepest recesses of the slums.

To alleviate this requires a physical presence by organisations such as the Venu Eye Institute, a 60-bed hospital in south Delhi that runs eye-screening camps in the slum areas, partially funded by charities such as Sightsavers International. It's an uphill battle against poverty, illiteracy and cultural taboos, as Venu eye specialist Dr Ankur Agarwal explains. "Accessibility and affordability is the problem. There may be eye-care centres like ours, but that may mean taking time off work which means they will lose money. Many of them would prefer to go to local doctors who are not eye specialists and may not even be qualified (there are 40,000 unqualified medical practitioners working in Delhi alone]. They go for alternative remedies, many of which don't work. But by the time the patient comes to see us, it can be too late.

"Then we see parents of children with eye problems, and we tell them to seek help but they don't. It's just not a priority for them. They think it will cost them money they can ill afford. But if anyone can genuinely afford not to pay, then they will get the treatment free. Even then, we do not always get to the poorest of the poor."

The free screening camps run by Venu and institutions such as the RP Centre for Ophthalmic Sciences have become a lifeline in some of Delhi's poorest areas. To get the message across that help is available, networks of volunteer health workers have been set up. They are drawn from the slum areas themselves, and are often young women who welcome the opportunity to help their own communities.

Preeti Dirit has lived in the Tigri slum all her life, and has managed to progress through school to university and a bachelor of arts degree. The 20-year-old now devotes much of her time to ensuring that slum residents attend the free screening camps. "There are still many people who have not heard of these programmes," she says. "I try to persuade them to come here to get checked. Even now, some people hide away from me because they are unsure what will happen and afraid how much it will cost. But I just go back time and time again, until I make contact. It's something I enjoy doing for my own community."

A health worker like Preeti helped Marar Hussain, a 45-year-old tailor who recovered from TB only to discover that he was going blind through cataracts. Home for Hussain and his seven children is an abestos-roofed shack on the edge of a dusty, rubbish-strewn square where pigs, goats, chickens and the inevitable sacred cows criss-cross the only space the huge groups of children have to play in. With Hussain unable to work, his family had to survive on the meagre income his 13-year-old son could earn from selling balloons on the streets.

A month ago, the cataract was removed from his right eye, and he has regained some sight and, importantly, some confidence. Once his other eye is operated on, a return to work will be possible. Another family may have been saved from the downward spiral of crippling poverty.

Sometimes, surgery is not required. One of the main problems picked up by the screening camps is simply short sight, where the answer is a pair of spectacles costing around 1.50. But there are cultural barriers to wearing spectacles that permeate all levels of Indian society. Even those who have come to appreciate the power of specs are reluctant to wear them.

At the Tigri screening clinic, Murtza Ali has returned to have his glasses fixed. A 51-year-old decorator with five children, his eyes began to deteriorate six years ago and he became unable to work. Armed with a pair of spectacles at a subsidised price of 75 rupees, he is now back working and providing for his family again. He thanks "God" for returning his sight, but admits that when pitching for jobs, the spectacles stay firmly in his pocket. "There is a stigma," he says. "They suggest I will be slow and can't do the job very well. I get less jobs when I wear my spectacles than when I hide them away."

It's a serious problem that frustrates Selvi Roy, executive director of the Hope Project, a slum-based aid organisation. "Wearing spectacles is something you would prefer not to do," she explains. "For men, even though you know you cannot see without them, it suggests to an employer that you cannot perform your duties. At school, other children will laugh at you. And for women, marriage prospects will be damaged.

"For many women, the only real chance of advancement is marriage. But men will not marry women who wear spectacles. 'Why do you need them?' 'Only to read and write?' 'How will that help you with the cooking and cleaning?' There are many mindsets we have to change." r

Sightsavers International works with local partners in more than 30 countries to combat blindness and secure equal rights for people who are blind and visually impaired. Its vision is a world where nobody is needlessly blind. Donations to assist Sightsavers International in its life-changing work around the globe can be made by post, using the coupon below, by calling the 24-hour donation line (0800 089 2020) quoting ref SOS08, or by visiting www.sightsavers.org.

Please send donations to the Scotland on Sunday Christmas appeal to the following address.

Room SOS08, Sightsavers International, PO Box 17160, Edinburgh EH12 6WF. Donations will be used to fund Sightsavers' work wherever the need is greatest. Thank you!

eyes wide open

6.7m people in India are blind, 18% of the world's total blind population

1 is the price of screening an individual for eye problems.

2.8m eye examinations were carried out by Sightsavers in 2007

1.50 will pay for a new pair of specs for a person with low vision

113,704 cataract operations were performed by Sightsavers in India in 2007

400,000 children in India are blind in both eyes

154,496 people with poor eyesight received spectacles from Sightsavers in India last year

17 is the cost of an adult cataract operation, which can restore sight in just 20 minutes

Click here for more information.

Scotland on Sunday Christmas Appeal

Q&A

What does Sightsavers do?

Sightsavers works with local partners to combat blindness in developing countries, restoring sight through specialist treatment and eye care. We also support people who are irreversibly blind by providing education, counselling and training. We help the people who need it most - those living in poverty in some of the world's poorest countries – by supporting the development of long-term projects.

Where will donations from the appeal go?

Donations made to the Scotland on Sunday Christmas Appeal will be spent wherever the need is greatest. Sightsavers works in over 30 developing countries throughout Africa, Asia and the Caribbean.

How much of the money raised by Sightsavers goes towards the projects it supports?

In 2007, for every 1 raised 72p was spent on charitable activities. The balance of 26p goes on securing further funds and 2p on ensuring Sightsavers meets its legal obligations as a charity including reporting to the public and regulatory bodies. For more information please see our 2007 Annual Review on our website:

http://www.sightsavers.org/Who%20We%20Are/About%20Us/Annual%20Review/default.html

What governance does Sightsavers have in place to ensure that monies raised from the appeal actually reach the people they are meant to help?

Sightsavers works with local partner organisations who are as equally passionate about our mission and values as we are. They have strong links into the community and are committed to ensuring that the money is spent in the most effective way to support the poorest in the community.

All our partners are happy to engage in careful financial monitoring, with comprehensive measures in place to track expenditure. Sightsavers partners submit regular reports and accounts and are visited regularly by our country office staff as well as an independent audit team.

• Watch a slideshow of pictures from Delhi by Phil Wilkinson