Film | The End of Blindness – Focusing on Healing in Ethiopia

How Restoring Sight is Saving a Country

Ethiopia is struggling immensely right now. Competing political forces are tearing at the fabric of society while people throughout the country wrestle with issues of poverty, famine, and sporadic access to healthcare. Nevertheless, there are slivers of hope scattered across the shattered landscape of a nation fighting to maintain its integrity. One such light-bringer is Dr. Samuel Bora, who has dedicated his medical practice to providing sight to those who have lost their vision due to cataracts and similar maladies.

A new documentary film called The End of Blindness from Section 3 Films follows Dr. Samuel’s journey as he fights to conduct hundreds of eye surgeries in some of the most isolated parts of the country. This extraordinary film chronicles the life of an amazing ophthalmologist who has completed more than 24,000 cataract surgeries over the past nine years. Independently produced, The End of Blindness has already received awards and entry into multiple film festivals around the country, including:

Culture Honey was able to catch up with Dr. Samuel recently to ask him about the current status of his efforts to reduce blindness due to cataracts in Ethiopia. The following is a transcript of that interview which has been edited slightly for clarity.

Interview with Dr. Samuel Bora

Your work is designed to give sight back to those with impaired vision and few resources. Why did you embark upon this philanthropic journey?  What compelled you to dedicate your life to this purpose?

Thank God I studied ophthalmology. It happened that I enjoy and love doing cataract surgery and the Lord blessed my hand. So doing surgery is not a burden for me. I was born to a poor family and got the rarest chance (I believe it was a divine arrangement) to be a medical doctor and an eye surgeon. Raimo and Pirkko (Tuppurainen) played great roles in this aspect. Their support helped to score the necessary points for me to be admitted to medical school. So I feel I am the right person to do all I can to be of some help to this poor community (from where I came) in whatever way I can. The work that I am good at is doing cataract surgery and giving back sight to those who are blind from cataracts. To do this effortlessly, I am well supported by THAF (Tropical Health Alliance Foundation) and GS (Gifting the Gift of Sight).

How did you become an ophthalmologist? Why did you select that particular field to dedicate your energies to?  What was the role of Raimo Tuppurainen in that process?

After completing my undergraduate study I became a General Physician and started my work at Aira hospital where I was born. During that time from 2001 to 2004 I had a chance to work with one of the health assistants who was taking care of ophthalmology cases, including cataract surgery. I saw patients who came in led by relatives and then the day after surgery they were smiling and walking out of the hospital on their own. He even went on to tell me that the type of surgery done in Addis Ababa is far superior to what he did. So I asked him what it takes to do that kind of training. He said an MD (was required), so I felt very happy since I was able to fulfill that criteria. Since that moment the idea to remove cataracts grew continuously in my heart, so I decided to go for ophthalmology. I thank my Lord as he helped me make that decision regardless of the challenges. So I sat for the entrance exam and, ultimately, I was able to join the ophthalmology field.

What could be done to increase the number of ophthalmologists (and doctors overall) in Ethiopia?

To increase the number of ophthalmologists, there should be greater admittance of students to universities in this field. Creating awareness about the huge need for ophthalmologists, i.e. explaining the magnitude of the problem to medical students, might help in this regard.

In places where medical care is scare sometimes there is hesitancy, and possibly even fear, to undergo medical procedures. How do you convince rural communities to trust your methodology and then participate in these technical surgeries?

It is true people need to trust your intervention. From our experience a thorough preoperative evaluation (patient selection) and good quality surgery helps in this regard. In completely new places we commonly get less crowds on the first day. Once they see the outcome on those who are operated upon, things change. I think in our case this is not a major problem (due to our positive outcomes).

To conduct 60 eye surgeries in one day is incredible! How do you manage to keep your enthusiasm and energy for this work even under such grueling circumstances?

We commonly conduct outreach at zonal towns (populations of over half a million). People travel for a day or multiple days to come to the outreach. So, as much as possible, we need to do as many surgeries as we can per day to reach everyone without much delay. The fuel is the joy and the smile you will see on these people’s faces the day after surgery. Thanks to my hardworking team as they encourage me to do more; they are amazing people! It is unusual to get these kind of people in our situation. I am extremely grateful to them.

What is the impact of assigning children the duty of care-giving for elders who are visually impaired or blind? What other options might there to care for these elders rather than tasking children with these responsibilities?

The impact is far-reaching. A child will not go to school. The best approach in our situation is to increase cataract surgery service so that people are given sight before they reach that stage of dependency and blindness.

How has your program evolved over the past few years? What new systems or technologies are you using now in your work that improve health outcomes and potentially serve more patients?

In 2009 I started working at Aira Hospital as an ophthalmic surgeon. We had to start everything from scratch to buy equipment and train staff. The first year we did 500 surgeries, the second year close to 1000 even with our limited resources. Things have changed dramatically after 2011 when Dr. James Guzek visited us and introduced me to Dr. Larry Thomas, which was the start of cataract surgery project. The support from Gift of Sight and Tropical Health Alliance Foundation multiplied our efforts to complete 3,000 cataract surgeries a year.  With generous support from THAF and GS we were able to build a team of 10 people which can do 300 cataract surgeries in a week with high quality surgical outcomes. This was impossible to think about without the huge contribution of the late Dr. Thomas. He gave his life for the project. He always said to give the best to the poor and reach out to as many people as possible who need the help. His legacy will continue through our work.

How did the pandemic affect the project? How are you adjusting your efforts to still be able to serve patients and yet deal with the effects of COVID-19?

COVID-19 markedly affected our project. For almost one year it was not possible to conduct outreach efforts. After that, with routine preventive measures we are now back to almost the usual number of cases.

How has the current political situation affected your work? What are the future implications of continued political and economic instability?

More than the COVID crisis, the political instability was and is the most imminent danger. For almost two years it was impossible to travel to most of the places where we work and only recently were we able to do so under extremely risky conditions. If no peaceful political solution is obtained, it is going to be a very difficult time for the blind. Already the impact is visible and we see numerous blind people in many localities not being able to access medical care.

According to Sir Eldryd Parry, the founder of the Tropical Health and Education Trust, one of the significant causes of the high incidence of cataract development in Ethiopia is a pervasive lack of clean water which leads to severe dehydration and a drying of the lens in the eye.  Another contributing factor per the Liverpool School of Tropical Medicine is the burning of organic matter such as wood, dung or charcoal for home cooking, heating and lighting.

This form of energy production is associated with high levels of indoor air pollution. These contaminants cause cataracts and blindness due to smoke that induces oxidative stress on the eye and also depletes numerous antioxidants that protect against cataract formation. Both of these contributing factors are found in countries like Ethiopia with extremely high rates of poverty where access to clean drinking water and clean sources of fuel are limited. Also, Ethiopia is close to the equator and the amount of UV exposure is thought to also be a cause. As a result, Ethiopia has one of the highest rates of cataract incidence in the world.
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