DR Chan Tiang Ho
DR Chan Tiang Ho still speaks with a deep sense of awe of the unforgettable moment when the first cataract patient he had ever operated on realised she could see clearly again.
“My very first cataract operation when I was still working in Sarawak General Hospital some 40 years ago was on an 80-year-old woman. She had leprosy and was living in the leprosy camp after being abandoned by her family.
“It was just before Chinese New Year. I was concerned about her well-being but she said to me in Chinese – I am old. If die, I die la. I have no family to celebrate the New Year with.
“So I did the operation for her. The moment I took out the cataract, she saw me clearly for the first time and exclaimed ahh! You are short and fat! She expected to see a tall and handsome saviour but instead saw a short and fat doctor. She was laughing but I didn’t mind. It was a happy situation because she could finally see again.
“To help those who cannot see to see again, to be active again, to be useful and to be able to look after themselves – it’s a very rewarding thing to do. It makes you happy,” Dr Chan shared when met at his clinic at Main Bazaar, Kuching.
Dr Chan, currently a general practitioner, does not perform cataract operations now but is still actively helping hundreds of people regain their sight as the director of the Sight First Programme (SFP) under Lions Club of Kuching North (LCKN).
The SFP is an initiative under Lions Club International. Locally, LCKN has been providing free cataract operations and cornea transplants to the needy through the SFP since the club was chartered on March 11, 1990.
Dr Chan has been involved with the programme since the very beginning.
Since the SFP started in Kuching, it has helped to fund 138 cataract operations worth about RM110,000 and 135 cornea transplants with an estimated value of RM162,000.
The programme has been a valuable lifeline for those with impaired vision due to cataracts or cornea damage but who cannot afford costly surgical procedures to help them regain their sight.
In private hospitals, a cataract removal can cost around RM2,500 while a cornea transplant can cost as much as RM10,000 in KL. However, through the SFP, the sight-giving procedures are free.
“We do it at a very special price of RM800 for cataract operations while cornea transplants are at US$350, which works out to about RM1,400. For those who cannot afford it, the club takes care of the costs but to do all this, we need funds,” Dr Chan said.
The SFP would not be possible without the support and donations of club members, other Lions Clubs, the public as well medical personnel from the public and private sectors, Dr Chan emphasised.
The patient’s left eye is suffering from cornea damage and must be replaced with a cornea from a donor.
Operations for older patients
Dr Stephen Wong from Kuching has been helping with the cataract operations for 25 years while the cornea transplants are conducted by the ophthalmologists at Sarawak General Hospital (SGH), presently the only hospital in the state to offer this procedure and has done so for more than 30 years.
It’s mostly older patients who require cataract operations while the average age of those requiring cornea transplants because of eye injuries are younger.
“The patients for cornea transplants are usually referred to us by SGH. We will also assess them at our end. Sometimes, they can afford to pay for the corneas but most times, they cannot – which is why they delay treatment for so long,” Dr Chan said, adding that cataract patients were also referred to them through other doctors.
Many of the cornea transplant candidates he has seen tend to fall back on home remedies or delay visits to the doctor in hopes that the problem will cure itself.
This is especially true in rural areas where the services of a doctor or eye specialist are not so readily accessible due to logistics, patients’ inability to take time off work or high costs.
The situation is all the more tragic because most of the time, the blindness can be prevented.
“It’s very sad. Either they stay too far away or they think “never mind” and self-medicate. By the time they come to us, it’s too late to do anything. The only thing we can do is remove the eye,” he said.
This patient has a mature cataract.
Sight-giving procedures
For cataract sufferers, the benefits of the operation are almost instantaneous.
The surgical procedure to remove cataracts can be completed in less than an hour. The clouded lens is replaced with a clear, artificial lens.
After surgery, the patient is typically able to go home on the same day. Vision will usually show signs of improvement within hours although it may take up to a few weeks before the operated eye is fully healed.
For cornea transplants, the surgical procedure takes longer – usually one or two hours as the damaged cornea must be removed and replaced with a healthy cornea from a donor.
Post-op care must be monitored closely to reduce the risk of infections.
Most of those who have benefited from the SFP are locals – from across the state, including Miri, Sibu, and Bintulu – as well as a handful of Indonesians.
So far, the patients have been mostly farmers or farm workers.
This patient’s eye was injured and became severely infected. The cornea was perforated and required an urgent transplant.
Logistical challenge
Corneas are sourced from the International Eye Bank (IEB) in Sri Lanka.
When a cornea transplant patient has been identified, Dr Chan will send a request to the IEB which will make arrangements to send the donor’s cornea as soon as it becomes available. It may take a matter of days or up to a few weeks.
According to Dr Chan, there is a much high probability of obtaining corneas from the IEB as Sri Lanka has a very high rate of organ donations compared with Malaysia where organ donation is very much a rarity.
Sri Lanka is predominantly Buddhist and many residents there have pledged their corneas as they consider donating organs after they have passed away to be a virtuous act, he shared.
Getting corneas from Sri Lanka to Kuching requires a lot of coordination and more than a little luck. If a donor has just passed away, the corneas can arrive within a day or two. More often than not, a patient may have to wait.
Time is of the essence as corneas have to collected within six hours of the donor’s passing and are only good for one week after harvest.
Getting patients to Kuching in time for their operations can also be a big challenge, especially when it involves those from rural areas, Dr Chan acknowledged.
“Sometimes they can’t make it at the last minute because of change of plans or miscommunication, so we have a list of back-up patients just in case,” he explained.
Preventive eyecare
Many cornea transplant cases referred to the SFP could be prevented if immediate medical attention had been sought.
However, many of them were staying very far away – sometimes a few hundred miles – from the nearest hospital and could not afford to take time off work. So they turned to self-medication.
“You’d be surprised at some of the home remedies.
“People use all kinds of funny stuff – like sirih for instance. Some people whose eyes are infected or already septic, even use belacan (pounded fresh prawn) and the infection gets worse and the eye goes blind,” Dr Chan said.
“Some people believe that putting breast milk on the eye will help but as the milk contains lactose, the eye gets worse.
“If the eyes are injured, patients should go to the nearest clinic to seek treatment. If the injury is bad, they need to go to the eye clinic in the hospital.
“The important thing is not to delay because if you delay, it can become so serious that it’s too late to treat. Some of the patients we see don’t use the right treatment or they leave until it’s too late – until it’s blind.”
So what are the symptoms which differentiate a non-serious eye injury from one serious enough to warrant immediate medical attention?
“A bad eye injury is usually when the person cannot open the eye. The eye is usually watery, painful and photophobic – which means cannot stand bright light. If they are experiencing these symptoms, that means something is serious there – like foreign bodies in the eyes or an ulcer in which case they need to get it checked out,” Dr Chan explained.
Dr Stephen Wong (left) performing a cataract removal.
He also advised people to use safety goggles to reduce risk of injury.
“This also applies to people working at farms, or anyone doing work where there is possibility of foreign objects like chemicals, dust or sand entering the eye during work like cutting grass or welding.
“If dust or sand gets into the eye, it is not advisable to rub the eye as it may scratch the cornea and injure it.
“Try to rinse out the foreign object with clean water. For chemicals like pesticides, the best thing is also to wash out the chemicals thoroughly with piped water and seek treatment as soon as possible.”
Charity appeal
This Nov 9, the LCKN will be hosting the Kuching Charity Run and Cycle for Sight – a non-competitive public event – to raise funds for the SFP.
The event is scheduled to flag off at 7am from the Sarawak State Library in Petra Jaya. Those interested may sign up for either the run/walk or cycling route and will receive a free t-shirt for their participation.
Fees are RM50 per adult and RM30 for participants aged 18 years and below.
Maps of the run and cycle routes may be viewed on the event’s Facebook page at http://tinyurl.com/mltpu29.
A copy of the registration form is also available for download there.
To register, visit Asiana Gallery Sdn Bhd at Padungan Street, Moh Tak Bicycle at Jalan Abell or Bike Care Shop at Jalan Rubber. Closing date for registration is Nov 1.
The t-shirt collection centre will be at Hills Shopping Mall on Saturday, Nov 8 from 12 noon to 8pm.
For more information, contact Mike Lim (019-819 9777), Poh Guan Huat (019-817 8070), Goh Seng Kee (012-887 0436), Derrick Chai (016-577 8933) or Wen (010 982 6210).