"I believe that my view of what a redeemed 'social condition' is has been consistent - equity between people - and I've tried always to work to that end."
Not long after he moved to Australia in 1965, Fred visited a number of Aboriginal communities and was shocked by the deplorable standards of eye health. He was especially concerned with the high number of Aborigines who had trachoma, an infectious eye disease that is normally only found in developing countries.
Speaking out and taking action
At a press conference arranged for when they got back, Fred said the discrepancy between medical services in the city and the outback, and between the eye health of Indigenous and non-Indigenous Australians, was “a scandal”.
Determined to make a difference, Fred was instrumental in establishing the National Trachoma and Eye Health Program. Between 1976 and 1978, he and his team visited 465 Indigenous communities where they screened 100,000 people for eye disease, treated 27,000 cases of trachoma, and performed 1000 eye operations. He also helped establish the first Aboriginal-run medical centre in Australia.
According to Fred, “the important thing about the trachoma program was Aboriginal liaison. And the reason we succeeded was we got a good lot of Aborigines working with us who would go ahead of us, tell the people what we were on about, what benefits they would gain and get the people on our side."
The developing world
In the mind 1980s, working as a consultant for the World Health Organisation, Fred visited a number of developing countries including Burma, Sri Lanka, India, Bangladesh, Eritrea and Nepal. He was appalled by the lack of medical resources and the prevalence of cataract blindness. In line with his basic belief in “equity between people,” he started working towards reducing the cost of eye care in developing countries.
On his first visit to Nepal, Fred met Dr Sanduk Ruit, a medical officer with the Nepalese Prevention of Blindness Program. “He was a first-rate diagnostician,” said Fred, “totally absorbed in the craft of ophthalmology.”
In 1988, Dr Ruit went to Australia, where he studied with Fred at the Prince of Wales Hospital in Sydney. When Fred visited Nepal for the second time, he discovered that Dr Ruit had refined and improved some of the methods of cataract surgery he had learnt in Australia.
“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.”
Fred and Dr Ruit had a shared vision of bringing modern eye health services to Nepal. They both knew that cataract blindness could be reversed with a relatively simple operation. The fundamental problem was that the tiny plastic lens (known as an IOL) needed to replace the cataract-damaged lens of the eye cost around $200 each, making cataract surgery much too expensive for people in the developing world.
Fred lobbied the multi-national manufacturers to drop the price of IOLs but had no success. So 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 passed away, the Fred Hollows IOL Laboratory at the Tilganga Eye Centre in Kathmandu began producing high quality, low-cost IOLs. Today, an IOL costs around $5.
Since then, the laboratory has produced more than two million lenses and is one of six divisions within the Tilganga Institute of Ophthalmology (TIO) – a world class eye care hospital and one of The Foundation’s most valued partners. Dr Ruit is the Medical Director and is recognised worldwide as one of the giants of 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.
In 1986, Fred treated an Eritrean patient at the Prince of Wales Hospital in Sydney. He knew that Eritrea was at war and that it was a bad place for eye disease – but he didn’t know that there were only 21 doctors. He asked his patient how many eye doctors there were. The answer was just one. So 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. 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 first visited war-torn Eritrea in 1987, and saw doctors operating in hospitals dug into mountains as the war raged above. He was greatly impressed by their adaptability - and their humanity.
Cataract blindness is the most common form of blindness in Eritrea, and Fred knew that the high cost of intraocular lenses was preventing people from having the surgery they so desperately needed.
Dr Desbele remembers Fred’s 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'.”
Fred was diagnosed with cancer in 1988, but that didn’t stop him from raising money to build an IOL laboratory in Eritrea.
In 1991 he was given honorary Eritrean citizenship.
By 2010, the Fred Hollows laboratories in Nepal and Eritrea had manufactured over four million IOLs which have been used all over the world.
In April 1992, Fred visited Vietnam to investigate setting up a third IOL laboratory. While he was there, he made a promise to train 322 Vietnamese eye specialists in modern cataract surgery techniques.
In July that same year, he discharged himself from hospital and returned to Vietnam to help fulfil his promise.
According to Dr Dung, one of Fred’s students, “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.”
Fred’s visits led to a revolution in Vietnamese ophthalmology. In 1992, only 1,000 cataract operations using IOLs were performed each year in Vietnam. Today, that figure has grown to around 160,000.
Since then, The Foundation has helped train and equip hundreds of Vietnamese 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