Battambang optometrist Ek Sarou says cost is a big factor.

S

porting a blue checked hat and a thick pair of spectacles, Tith Chhorn, 57, sits

on his motorbike at his usual post on a Phnom Penh street corner. He squints through

his right eye looking for potential customers; the left was irreparably damaged by

disease when he was a child.

For five decades everything was hazy. People were just indistinguishable shapes and

he couldn't see anything at a distance. Then two years ago, the world he had known

became much clearer: Chhorn had an eye test and got his first pair of spectacles.

"I did not wear any glasses and my eyes were blurry and foggy," Chhorn

says. "But now it is clear, I can recognize people. If I take off my glasses

it is a blur."

The dubious vision of many motodups is the visible side to a little-discussed problem

that affects more than one million Cambodians. The Ministry of Health (MoH) says

one in ten have 'refractive errors and low vision', with men worse off than women.

VISION 2020, a global initiative to eliminate avoidable blindness, says at least

45 million people around the globe are blind, and 135 million have poor vision. Most

importantly, it says, 80 percent of the world's blindnesses are avoidable and far

more common in developing countries such as Cambodia where people have little access

to affordable treatments.

Bespectacled Dr Yutho Uch heads the MoH's national sub-committee for the prevention

of blindness. She says Cambodia is worse off than its neighbors when it comes to

eye problems: 1.2 percent of the population is blind. The rate in Thailand is 0.4

percent, while that in Vietnam is 0.7 percent.

"Compared to other countries we have problems with eyesight - mostly cataracts

for older people," she says.

Dr Yutho's small team has an enormous task ahead of it before every visually impaired

Cambodian has access to treatment or corrective lenses. She explains that moto-dups

often suffer from genetic night blindness or pigmentosa retinitis.

"Cambodia has a culture of marrying close relatives, like cousin with cousin,

and this causes retina degeneration or night blindness," says Dr Yutho, adding

that there is a higher prevalence of this in rural areas where such social conditions

are more common.

"And it is true you should worry, because most of the motodup drivers come from

the provinces," Dr Yutho says with a grin. "Moto drivers should come and

have their eyes checked before they select this job."

Liz Cross, a co-worker with Christian Blind Mission International (CBM), wears large

frames that she "only recently admitted" she needed. Cross is on secondment

with Cambodia's Disability Action Council (DAC) and agrees with Dr Yutho that the

number of motodups with poor vision is "rather worrying".

Tith Chhorn can see where he is going.

Cross says many people don't realize they need glasses; instead they believe that

to correct their sight will require an operation or more serious treatment. Others

just accept they are getting older and things naturally start wearing down.

 

"Sometimes when we went out and screened people we would give them glasses

and it was like a thunderbolt had hit them," Cross says. "The difference

was quite extreme."

Apart from a lack of awareness, why is it that in a nation with so many vision problems,

the only people wearing specs are the experts themselves?

It is a question that puzzles the near-empty optometrists on Sihanouk Boulevard.

"I don't know why we are always empty," says Rith Pagna, manager of Eye

Care. "I want to do my own research on why there are no customers."

Pagna says his shop averages five to ten customers per day. Down the road at the

Modern Optical Center, manager Sok Sehya admits that although they have the same

number of customers, only one person a day actually buys a new pair of glasses.

Sehya, who wears a fine pair of corrective lenses, points out that all his lenses

and frames are imported. The high cost deters many customers: his frames range in

price from $5 to $100 while lenses start from $7.

"It is very easy to explain [the lack of customers] if you look at living standards

in Cambodia," he says. "It is very poor, and some people think if they

wear glasses their eyesight will decrease."

Far from the bustle of Phnom Penh, long-sighted optometrist Ek Sarou agrees that

cost is a major deterrent to his customers in Battambang.

"It is a big problem for poor people in the community - they do not have money

for glasses," he says. "The people in the provinces are poorer than in

the town."

As the only optometrist for hundreds of kilometers, Sarou's Battambang Optical Center

serves patients from across Cambodia's northwest. He says the prevalence of eye problems

is much higher in rural areas.

Sarou provides free eye tests for the poor, and bases his highest priced glasses

on the monthly salary of government staff: 70,000 riel. None of his customers can

afford more than that.

Dr Yutho Uch, head of MoH's sub-committee for the prevention of blindness.

Others say historical and cultural reasons also explain the reluctance of older Cambodians

to be seen in spectacles.

"During the Pol Pot [era] if some people wore glasses, the Khmer Rouge considered

them as intelligent people and they were killed," says Dr Yutho.

Sarou agrees that the Khmer Rouge viewed those wearing lenses as teachers, doctors

and members of the elite and killed them, but says that times and attitudes have

changed.

"People are no longer afraid," he says. "Now the Khmer Rouge big boss

from Pailin comes to my shop to get glasses."

Ray Soeum Ny heads the Cambodian Optometry Association (COA), an NGO that runs a

clinic in Phnom Penh, trains optometry technicians and conducts free eye screening

in the provinces.

He agrees that cost is a major factor that limits people's use of eyewear, but says

community acceptance also plays a part.

"Our team always explains to people: 'You have an eye problem, your vision is

very low, if you don't wear glasses you cannot see,' but still people are shy to

wear glasses," Ny says. "Khmer custom is different. If they have something

new they feel strange."

The vision experts agree that the main reason for Cambodia's glass-free faces is

that eyesight is simply not viewed as a priority, either by the government or the

population. Sarou in Battambang says the government must do more to support eye care

services.

"Right now they are not interested in eyes. Services depend on NGOs and support

from overseas," he says. "[The government] says 'blind is not dead'."

Eye doctor Nouv Lakhena tests a patient's vision at a Phnom Penh clinic.

Dr Yutho from the MoH's subcommittee for the prevention of blindness agrees.

"The eye care program is not a priority of the Ministry of Health," she

says. "In the MoH they talk abut HIV, TB and maternal health but nobody is interested

in eyesight."

Dr Yutho uses the word "constrained" to describe her sub-committee's budget,

and says it keeps going only with the help of NGOs such as Caritas. The lack of resources

is clear: Cambodia has only 18 optometrists or optometry technicians and just three

eye surgeons.

In terms of people's needs, eye care is not rated as a priority in rural areas where

many deal with more pressing issues such as malaria or lack of food.

"People don't die of eye diseases, so when someone has an eye problem it is

not seen as a serious problem," says CBM's Cross. "Until it restricts what

they are doing they'll just carry on. And even if they can't see it isn't a matter

of life and death."

Yet eye conditions such as glaucoma and cataracts can be treated to prevent blindness,

say experts. The economic benefit alone is substantial: a patient who has been treated

is able to continue working, and that also frees another from looking after them.

But there has been some progress in restoring Cambodia's vision: two years ago the

MoH conducted eye camps in every province - it found that more than half of the attendees

needed glasses.

And NGOs continue to travel throughout the country offering free screenings, while

eye units have been set up at 18 provincial referral hospitals. The number of experts

is also rising: Dr Yutho plans to have nine eye surgeons, 28 junior eye surgeons

and 45 optometrists by 2005.

Back on the city's dusty streets the only specs that do seem culturally acceptable

are sunglasses, as a quick Post poll of motodups at Kandal market confirmed. Fifty-year-old

Sok Vang says his eyes are normal, but admits he has never had a test.

Tiv Sokhun Mealea, 19, has her eyes tested.

Instead of corrective lenses, Vang sports a very attractive pair of imitation wood

frames with a black eagle painted between the lenses. They cost him 5,000 riel from

O'Russey market and have helped keep the dust out of his eyes for more than three

years.

Fellow motodup Sin Vanna's black, sporty shades set him back just 1,500 riel at another

market outside the city. It has never occurred to him to get his eyes checked.

"I've never had any problems," he says. "I don't even know where to

get an eye test."

To help the likes of Vanna and Vang, the MoH's Dr Yutho has devised an enticing offer.

For World Sight Day on October 10 - "all people have the right to sight",

she says - every government eye unit across the country will do what they have done

for the past three years: rather than hold a party, the clinic will celebrate by

offering free eye tests and free surgery.

"It is the same as Labor Day, Children's Day or AIDS Day," she says. "We

want to reduce blindness. Our aim is that by 2020 all people will be able to see

well, and there will be no blind people in the world."