No More Cataracts in the Negev

Aware that in 1992 and 1993 Isralowitz had spent time in Eritrea on a mission for MASHAV (the Centre for International Cooperation of the Israeli Foreign Ministry), USAID and NIRP (The Netherlands-Israel Research Program), a mission which aimed to explore possible avenues of cooperation between Israel and Eritrea, I already had a fair notion what this might be all about. Isralowitz's purpose was to search out areas in which Israel might facilitate the establishment of small-scale enterprises in Eritrea's relatively new economy or in its agricultural sector, where Israeli technical expertise might be brought to bear (see Shalom 1996-2 and 1997-3 for related articles).

While there he noticed what seemed an excessively large number of elderly blind people. When he later mentioned his observation to Dr. Gideon Rosenthal, ophthalmologist at Beersheba's Soroka Medical Centre, Isralowitz was stunned to learn that at least 65% of all Black Africans over 60 are afflicted by cataracts, and the problem in old age was considered the norm. Although advanced techniques in laser surgery inexpensively and safely remove cataracts and restore partially or totally lost vision, it seemed that in sub-Sahara Africa, what was standard procedure in the developed nations of North America, Western Europe, Israel and the Far East, remained painfully out of reach.

Since the 1970s and particularly over the course of the preceding six years, Israel's population of Ethiopian Jewish immigrants has more than doubled to 60,000. Although this community as a whole is undergoing considerable difficulties associated with immigrating to another country, young people are slipping into their newly chosen places with a minimum of fuss. The elderly, though, are less flexible and some tend to avoid the health and other services of modern Israeli society, leading to certain problems. Richard Isralowitz noted that these elderly newcomers to Israel from East Africa might well experience the same percentage of eye trouble.

Resolved that Israel's elderly Ethiopian population, uprooted at an advanced age to undergo a hazardous journey, might actually see Jerusalem, which for generations had been kept alive in the hearts of their people, Isralowitz was determined that they not suffer from unnecessary blindness. He spent the next half year intensively networking. Probably his most curious encounter was with the National Health Service. Was he not aware, the administrators told him, that the usual waiting period for cataract surgery was at least one year? More to the point, there had been very few ophthalmological referrals of Ethiopian new immigrants to the Health Service. Very few!

"Yes," the Ben-Gurion University social scentist persisted, "but everyone dealing with the problem knows that cataracts among this population is widespread. Why not devise an outreach program?"

"Professor Isralowitz, we are very busy people. If they don't come forward with complaints, there's a message in that. As far as we're concerned, there is no problem."

Fortunately, Isralowitz is not one to get easily discouraged. Over the next months a planning grant led to liason with the Association for the Advancement of Ethiopian Family and Child in Israel (AEFCI), the only absorption program managed by the new immigrant Ethiopians themselves. The Municipality of Beersheba also agreed to help by providing subsidies that would cover the cost of eyeglasses and Ben-Gurion University's Department of Social Work selected some of its promising Ethiopian students to go into the community to survey the potential beneficiaries in Amharic, their mother language.

At 5pm that afternoon our two-car convoy pulled up outside of an apartment building in a modest neighbourhood on the western fringe of Beersheba. Out of the vehicles emerged the team that Isralowitz had painstakingly recruited in the preceding months: three ophthalmologists, an optician and a nurse - all volunteers - carrying portable cots, eye charts and assorted equipment.

One flight up we came upon a group of 40 elderly people waiting patiently in the hall, sitting on folding chairs or standing near a table laden with bottles of soft drinks and crackers. The women wore typical flowing white gowns; the men were attired formally in suits or traditional robes. The majority appeared frail. A few were completely blind.

Manoeuvring among them, explaining, interpreting, comforting in Amharic, young women student interpreters exuded agility and competence. The gap between the generations was simply spectacular and yet the atmosphere was warm, intimate, trusting.

Led by Dr. Rosenthal, the medical crew somehow threaded through the packed outer room to set up their equipment in the interior rooms of the apartment. Among the most enthusiastic was Dr. Valentina Assa, an ophthalmologist originally from Bulgaria, who had arrived in Israel four years ago. Her mission was to check vision, retina and eye pressure with an ophthalmoscope. Why had she come here at the end of a long day at the hospital?

"I love to work with people, all kinds of people. That's the simple truth." Less then ten minutes after arriving, she was examining her first patient.

Another patient's name was announced, and a woman of 60 was escorted into a cubicle. With the aid of a student interpreter, she answered questions about her vision and general health, then reclined on a table while the ophthalmologist closely examined her eyes under high illumination.

In an adjoining room Ofer Averni, 33, an air force optometrist who had driven down from Tel Aviv, was checking the vision of a 62-year-old man who was staring fixedly at a chart displaying capital E's of varying sizes and configurations. Anyone could tell the man desperately needed reading glasses. Various lenses were tried until one was found which enabled him to discern the next-to-bottom line. Averni commented after. "It just seems only right that I help these newcomers."

Shmuel Yilma, Assistant Director of the AEFCI, was aglow with quiet satisfaction. He had made his way to Israel from Ethiopia 15 years earlier. "How wonderful to give these old people a chance to see again. Sighted, they will be far more capable of transmitting a heritage that would otherwise likely disappear in this fast-paced society. You know, when we approached them, we talked at length, explaining what all this was for, and we encouraged them to come to the clinic on the appointed day."

Without warning a relatively stocky man in his mid-50s, hemmed in by a woman student and veteran activist Shmuel Yilma, started shouting in the hallway. Something had gone awry. Dr. Assa, emerging from another door, authoritatively intervened. Leading the man by the shoulders, she escorted him inside his room for an immediate examination. No one objected. No one complained. The day was too much of a triumph of good will to permit a momentary disturbance to cast a cloud.

A month later, after another screening session for a second group of Ethiopians, community workers visited each visually impaired person to explain the medical procedure to allay his or her fear. Getting with the spirit of this venture, Israel's National Health Service expedited procedures so that appointments for surgery materialized in a matter of weeks! Today, over a year later, not only are scores of Beersheba's elderly newcomers wearing glasses but dozens more who would otherwise now be suffering limited vision, after successful laser surgery and the implantation of corrective inter-ocular lenses, are enjoying the sight of their grandchildren and great-grandchildren at play with their own eyes.

A final note on the effort is that Richard Isralowitz, with the support of Ms Susi Smetana of the United States and the international organization Project Vision, lead by Dr. Stephen Kutner, has established a model mobile eye care outreach unit that is serving elderly people throughout the Negev region. Isralowitz's project now involves the head of the Department of Ophthalmology at Soroka Hospital, Dr. Tova Lifshitz, and the Deputy Director of Medical Services for the Negev, Kupat Holim Klalit, Dr. Tzvika Liss.

The realization of one man's "simple idea" in Israel's Negev region is giving many elderly, long-robed immigrants, who once had been relegated to darkness, a second chance to see. And, what no one had thought at the start of this project is that the effort is becoming an important foundation for communication and cooperation between Palestinians and Israelis who share the need to help others in need of better vision. A few months ago, representatives from Palestinian health agencies including the Red Crescent Society traveled long distances to discuss their needs, and how Richard Isralowitz and his team could be of assistance. With the involvement of the organizers of the Oslo Accord (the Economic Cooperation Foundation), Project Negev Vision has not lost sight of those most in need - the elderly - but is broadening its sights on making the region a better place to live. Perhaps the mere retelling may help restore the jaded vision of some others.