Garth Rattray
KINGSTON REGIONAL Hospital's Head of Ophthalmology, Dr. Albert Lue, incurred the wrath of people in certain quarters when he voiced the concerns of several senior public-sector ophthalmologists who observed higher than usual numbers of corneal damage (including blindness) from cataract surgery done on Jamaicans in Cuba.
As part of the PetroCaribe deal, Cuba performs cataract surgery and other straightforward procedures for conditions like ptosis (droopy lids), pterygia (fleshy growths on the cornea) and strabismus (crossed eyes) at no cost to needy Jamaicans. Cuba denies earning U$5,000 for each procedure but admits to "some help" from Venezuela.
Candidates initially came from major public hospitals but I hear that screening now takes place in unorthodox centres and that the programme is so oversubscribed that vetting has been temporarily halted to allow for catch-up surgeries.
DISCREDITING THE PROGRAMME
Cuban Ambassador Gisela García Rivera claimed that ophthalmologists who criticised the programme were attempting to discredit it because they had a 'hidden agenda'.
However, her utterances were absolutely baseless because: (1) our ophthalmologists are frustrated, overburdened and welcome assistance, (2) in those unusual circumstances where relatives find the cash (locally or by remittances) to bypass the public system, those patients often go to 'outside' ophthalmologists for treatment.
When the programme was launched, local ophthalmologists expected to travel to Cuba to see firsthand and beforehand the facilities where operations were to be performed but the Ministry of Health (MoH) ran low on funds. Twice, after subsequent batches of patients were shipped overseas, ophthalmologists travelled there to view the operating centres but were blocked in their efforts (one for as long as two weeks).
Post-op patients from the programme often ended up being reviewed by our ophthalmologists and they noticed that although the first batch of surgeries (performed in Havana) went well, after two months, higher than expected rates of complications (like cloudy corneas and blindness due to corneal decompensation - which should be rare), began emerging in patients who were operated on (outside of Havana). Questions of substandard clinical skills and inferior (aftercare) drugs arose.
Ambassador Rivera presented favourable (but unsubstantiated) data on post-op outcomes. Our worried ophthalmologists complained that the MoH greeted their observations, queries and misgivings with scepticism, snide remarks and a call for hard scientific evidence. So, in spite of their busy schedules and external resistance, they executed some impromptu research. However, after five weeks of noticing more frequent and severe complications than they observed in their own clinics, they did the ethical thing and raised the proverbial red flag.
Out of 60 patients, 19 had serious complications, of this number an astonishing 14 had cloudy corneas and three were completely blind. My ophthalmology colleagues explained that members of the 'miracle operation' eye surgery team already reviewed those patients and although their notes did not reflect serious complications, they contributed to the ambassador's propitious data.
OUR POOR BLINDED BY POLITICS
Our senior ophthalmologists were ignored and, instead of immediately auditing the system, the MoH and Cuba were dismissive and impugned the integrity of our hard-working and genuinely concerned ophthalmologists. They were blinded by politics and, perhaps, so too were some of our innocent poor.
I'm gratified to see that the ethicality and bravery of our ophthalmologists got Health Minister Horace Dalley to request a full investigation into the complication rate and make plans to lead a delegation, including local ophthalmologists, to view the Cuban facilities.
We are grateful to Cuba for her unremitting magnanimity and charity but, in this matter, we must seek clarity and a thorough examination of the well-intentioned but (apparently) flawed programme. The vision of our poor and elderly is at stake. Visual loss from cataracts is easily corrected but visual loss from the complications of cataract surgery is a different matter altogether.
Garth Rattray is a medical doctor with a family practice.
