‘I REALLY WANT TO SEE AGAIN’
Giving the gift of sight A Herald and Fred Hollows Foundation campaign
Clerence lives in a small village in Vanuatu, where 21 per cent of the population have diabetes.
Her father had two legs amputated and later died aged 48 of kidney failure. Clerence has lost all her toes and her eyesight is failing rapidly, yet the risk of infection has so far made an operation too dangerous.
But she still has hope.
In February a modern eye clinic will open in Port Vila, which could make the difference between seeing and blindness for Clerence and many patients like her.
Today the Herald and the Fred Hollows Foundation join forces to fight diabetes-driven blindness in the Pacific.
Clerence’s story Diabetes a ‘tsunami’ for Pacific How to donate
This Christmas, the Herald and The Fred Hollows Foundation NZ are working together to bring the Gift of Sight to the Pacific, where four out of five people who are blind don’t need to be. Alarmingly, an increasing number of these are young people, suffering from diabetes-related eye disease. This week, we bring you stories of just a handful of these people and invite you to help us raise money for a sight-saving machine that can improve the lives of people like them
Ask Clerence Natnaur what makes her happy and the young woman with bandages on her feet answers softly, “I love listening to music, playing guitar and singing”.
Later she will sing a hymn for her visitors, at her home in Vanuatu, tapping time with feet that are missing their toes. What’s more, diabetes is also making Clerence, 22, blind.
During the past 20 years there has been an explosion of this disease, particularly in the Pacific Islands where the incidence is among the world’s highest.
Clerence gets around her earthfloor family home in Erakor Village near Port Vila using a walking stick.
To venture further, there is the wheelchair her father used after his legs were amputated because of diabetes complications. He died last year, aged 48, from kidney failure.
Amputations are complications that are in plain sight. Eye damage is the hidden curse of diabetes.
Clerence has dense cataracts and diabetic retinopathy, whereby the disease causes bleeding at the back of the eye (the retina).
High blood sugar can lead to cataracts, glaucoma, and diabetic retinopathy which is the most common cause of vision loss for diabetics and is a leading cause of blindness among working-age adults.
Removing Clerence’s cataracts should improve her sight but it must also be done so the back of her eye can be seen to assess her retinopathy. Then laser surgery can stop the bleeding and preserve her sight.
The trouble is, cataract operations have twice been cancelled because of skin infections near Clerence’s eyes. If infection got into her eyes it could cause total blindness.
The operations are done by doctors visiting with twice-yearly diabetic outreach teams, part of the Fred Hollows Foundation’s diabetic eye programme.
Clerence hoped she would be third-time lucky when the outreach team returned in October.
Her story is about missed opportunity, misunderstanding, superstition and a health system struggling to cope. She knew her eyesight was poor at school when she couldn’t see the blackboard. Much later, Clerence learned diabetes was diagnosed back then but nothing was done.
“My father was upset,” she said. “He couldn’t accept that I would need lifelong treatment with insulin.”
Clerence learned she had diabetes when infection landed her in hospital years later. In 2014, the toes on her right foot were amputated after infection spread from a cut on her big toe.
Last year, poor sight led to the loss of the toes on her other foot. She
stood on an insulin needle, causing a small puncture on her little toe.
Her family first tried traditional treatments. Clerence even stopped taking insulin on the advice of a witchdoctor.
Often when doctors see patients for the first time damage was advanced, Vila Central Hospital general surgeon Samuel Kemuel said.
“Most start with just a tiny injury and present late to the hospital, sometimes because they seek an alternative source of medicine, traditional medicine and wait until that doesn’t work. So by the time we see them it can be extreme.”
About half the general surgeries at the hospital relate to diabetes. Twothirds of patients seen by the outreach eye team are diabetic.
Clerence said she now knew better how to live with diabetes.
“Take your insulin, do more exercise, move and sweat. Eat the right food and eat enough, not a lot.”
That means less white rice, tinned fish, juices and soft drinks and more vegetables. But that diet is expensive and sometimes she has to eat what the family eats. No one in the family is in paid employment since her mother stopped work to nurse her
husband a few years ago.
Her mother, Jeaneth, is in Samoa on a tourism course she hopes will lead to a job and a better life for the family.
The day before Clerence’s cataract operation, Outreach team ophthalmologist Johnson Kasso finds cellulitis, a bacterial skin infection, on her face.
Kasso says the operation must wait. He will prescribe antibiotics and see her after an eye clinic funded by the Fred Hollows Foundation opens at the hospital in February.
Clerence is close to tears. She says later, “I really wanted it this year but it is not possible”.
But the new clinic improves her prospects. It will be headed by Kasso, a native of Vanuatu, who will become his country’s first resident ophthalmologist.
Kasso says, “Hopefully we will save enough of her vision for her to move around the house and have a reasonably normal life.”
The Herald visited Vanuatu courtesy of the Fred Hollows Foundation NZ.
Most start with just a tiny injury and present late to the hospital.
Samuel Kemuel, Vila Central Hospital general surgeon My father was upset He couldn’t accept that I would need lifelong treatment with insulin. — Clerence Natnaur