Shedding light on vision impairment

Izah Azahari

Sight is one of the most important senses as 80 per cent of what a person perceives comes through the sense of sight.

Statistics well known in the world of ophthalmology note that between 70 to 80 per cent of the world’s population suffer from vision impairment and blindness, and from this, about 70 to 80 per cent are actually reversible or treatable.

This was shared by Paediatric Ophthalmologist at Raja Isteri Pengiran Anak Saleha (RIPAS) Hospital Dr Helena Hurairah.

Dr Helena, who is also known as @islandeyedoc on social media, strongly believes that everyone around the world should have access to good eye care, and began volunteering her services with Orbis International – an international non-government organisation (NGO) that brings people together to fight avoidable blindness, after joining the Ministry of Health (MoH).

“I’m very passionate about international ophthalmology – that’s bringing eye care to places that don’t have so much access to it,” she said.

In October 2018, Dr Helena went to Mongolia through one of the Orbis International programmes where the mission focussed more on her field of paediatrics ophthalmology, while her second trip in 2019 was to Chile in South America to teach residents how to perform squint surgery.

Paediatric ophthalmologist at Raja Isteri Pengiran Anak Saleha (RIPAS) Hospital Dr Helena Hurairah. PHOTO: BAHYIAH BAKIR

She was scheduled to go to Zambia in Africa this year, but due to the current COVID-19 situation, she will have to wait until next year for her next mission.

“Orbis International is one of the bigger NGOs so anyone who goes through ophthalmology training generally knows about it,” she said. “It was always one of my aims that after I finished my training that I would join an NGO, and they have a good programme for people who are kind of young.”

“A lot of NGOs won’t let you go out until you’ve had five years of training, but Orbis International is different because they have a programme where you can join in and it’s for people like myself who are still early on in their career but want to join this programme.”

Dr Helena said that her calling in becoming a paediatric ophthalmologist didn’t come until the first year after she graduated.

She added that she didn’t get accepted the first time around as ophthalmology is fairly competitive and people usually know early on and gear up their CVs towards it, and as she was a bit late into this field, she had to do an extra year in neurology and neuro-surgery to build up her CV, before eventually managing to get in with her second application. As eyesight is important, the world also celebrates World Sight Day annually on the first Thursday in October, and Dr Helena explained that the event is a collaboration between the International Agency of the Prevention of Blindness and the World Health Organisation (WHO) to highlight the inequality in terms of eye care not being equally accessible all around the world.

She added that in Brunei itself, the people are lucky that the healthcare is free for Bruneians and permanent residents, but education and awareness still needs to be done as one of the most common causes of vision impairment in the sultanate is cataracts.

With a lot of the older patients she’s noticed in Brunei, she shared, “because we’re such a small community, a lot of it is based on hearsay, so when you didn’t have a good experience with your surgery you would tell your friends about it and those friends won’t want to go to the clinic and when they do come to the clinic, the cataracts are already matured and it makes the surgery even more difficult and the recovery a little slower.”

She explained that diabetes is also rampant in the country and can cause really bad visual consequences when the uncontrolled diabetes causes blood vessels in the back of the eye to grow abnormally becoming more fragile and bleed.

The doctor added that glaucoma is also a common cause of vision impairment in the country, while children here also suffer from strabismus or “cross-eyes”.

“The trouble with that is if you don’t correct it in time, you are disadvantaging that child because they don’t have that ability to perceive 3D vision and studies have shown that if you don’t correct the squint earlier on, they are more likely to be bullied in school and I think we all know at least one child who’s been bullied,” said Dr Helena.

She has also seen some adults who have had strabismus their whole life and she has corrected them, resulting in a life-changing experience for her patients as they are much happier after treatment.

Dr Helena also said that children get cataracts as well, and even though it isn’t as much as adults, they still need to be treated. Some of the causes of cataracts in children, she explained, could be a result of infections during pregnancy, genetic disorders, metabolic disorders and chemical imbalances within the system among others.

“We just did a case in the last two weeks of a child who had really bad cataracts. When they came in, the child couldn’t see and the eyes were wobbling around, because that’s what happens when the eyes can’t see,” she explained.

After cataract surgery, Dr Helena said that the child began high-fiving everyone and running around, which was very rewarding for her to see as they had given the child the best start in life without being visually disadvantaged.

“I love paediatrics because I never know what’s going to happen. I see them, and I wonder who this child’s going to be when they grow up, what change in the world this child will bring after we’ve given them the best sight. That’s why it’s so important to me – children’s vision,” she said.

In light of the COVID-19 situation in the country that began in early March, Dr Helena remembered having just finished carrying out a surgery on the day of the announcement, and then having been deployed the next day to carry out the first night shift in the test centre where she was tasked for three months before re-joining her department at the beginning of June.

“It all feels like a blur, I think that a lot of people are wondering where the last three months have gone,” she said. “So since I came back in June, I’ve literally just been catching up on all the surgeries and appointments.”

On the decision to make her social media account public, Dr Helena said that it was because she realised there isn’t really much awareness in ophthalmology in Brunei. Although she initially felt uncomfortable about putting her account on public as Brunei is a small community where people know each other and she knew she would be opening herself up for criticism, the decision came after having been approached by a lot of youth, as she has seen certain anxieties and depression particularly in young girls. This brought to mind the need for these youth to be able to see that they can do things.

“I feel that in Brunei and with every country, there’s so much that you want to do, but you almost feel that you need that permission to do it, and I think because now that I’m older, I just don’t really care, and I’ve gone through enough life experiences now that I can take the criticism,” added the doctor.

On one of her most recent experiences since receiving the Commonwealth Award after being nominated for her collaboration with Jerudong International School during the height of the COVID-19 situation in the sultanate, Dr Helena said that among the hundreds of congratulations she received, there were a few comments that still critiqued her.

“I knew I would be opening myself up for helping to motivate some people, but I knew that would also be opening myself up for that,” she said. “I had to mentally toughen up for that.”

Always looking towards viewing life positively, she often tells her residents or young doctors that they gain so much more learning from their patients. As she is always curious about people, she finds that whenever she encounters someone new, there is always something to learn from them.

Referring to a well-known quote, “everyone you meet is a lesson or a blessing”, Dr Helena explained that she is very much of that mind-set that everything happens for a reason, and that there’s always a reason why you’re supposed to meet the people that you do.

She noted that many people have a lack of awareness when it comes to self-belief. “I recognise it because I used to be like that. Obviously I still have my on and off days, but you know it is that thing where you have to believe that you’re worthy of having the things that you want, and it’s difficult here because a lot of things that we want can be a little bit traditionally or culturally questionable, but there are ways to work around that.”

“I think it’s difficult for this new generation because the way we think and the way our parents think are so different, but it’s about being mindful of their expectations, but not letting their expectations stop you from achieving what you want to achieve.”

Dr Helena encourages medical students or youth interested in the health field to visit her department to come and see what ophthalmology is all about as the country always needs more ophthalmologists.

“It’s a good specialty, but you do need to experience it. In terms of ophthalmology, I love what I do here, and in my leave time I get to do what I love in terms of NGO work,” she added.