Death wasn’t part of the plan for Fred Hollows. Diagnosed in 1989 with the cancer that would take his life four years later, the legendary Australian ophthalmologist and humanitarian became a man on a mission to ensure his work would continue.
“At our family home in Sydney, friends and colleagues would come and go, sitting around a table to engage in conversations, discussions and arguments about how to continue Fred’s goal to end avoidable blindness,” says Fred’s widow, and the Fred Hollows Foundation’s founding director, Gabi Hollows.
He even discharged himself from hospital at one stage to go to Vietnam and deliver on a promise he had made to build that nation’s eye health workforce.
“Fred said we’d train 300 surgeons in three years,” Gabi says. “These days there are 1,000 eye surgeons doing cataract surgery in Vietnam.”
Gabi convinced the 1990 Australian of the Year to establish a foundation shortly before he died. She describes his work as “like dropping a stone in the lake and watching the ripples grow”.
Over the past 30 years, the foundation has restored sight to more than 3 million people across the world, and delivered more than 200 million doses of antibiotics for trachoma, the leading infectious cause of blindness. It has persuaded governments to integrate eye health into national health systems and tackled diverse local issues around vision.
Maternal health worker Nasrin Akter holds up The Fred Hollows Foundation’s eye chart and explains basic eye health to the 50 women and children in Jessore, Bangladesh. Photograph: Michael Amendolia.
In Bangladesh, where garment workers develop serious eye problems because of their intricate and repetitive work, the foundation has set up visual detection corners in factories so workers can access eye charts and be referred to hospitals for treatment. When 1 million refugees fled across the border from Myanmar in 2018, as many as 50,000 were blind. The foundation was there to deliver eye care services.
Fred’s early approach in Australia, and then Nepal, Eritrea and Vietnam, was to treat eye problems, train local eye health teams and make technology available and affordable. This “treat, train and equip” formula has been the blueprint for the foundation’s global expansion.
In 1985 he visited Nepal, a country where at the time almost 1% of the population was blind. Two-thirds of those cases were due to cataracts and potentially reversible with surgery. There was a lack of operative skills in the country, but a second obstacle was that the tiny pieces of plastic that replace the clouded lens in cataract surgery were prohibitively expensive for a developing nation.
Fred met a young eye doctor, Sanduk Ruit, and invited him to Sydney to learn more about modern cataract surgery. The partnership between the two resulted in the establishment of cataract surgery training in Nepal, and factories that were able to produce high-quality intraocular lenses for less than $5. The ones made in industrialised countries were closer to $150.
The foundation now works to end avoidable blindness in more than 25 countries, but for most Australians, Fred’s work in his own backyard is what they remember best.
Dr Kris Rallah-Baker operating at Sunrise Health Service Aboriginal Corporation. Photograph: Michael Amendolia.
In 1968 two Gurindji elders turned up at Fred’s Sydney clinic with eye problems he’d never seen before. He later visited them in their remote Wattie Creek camps in the Northern Territory and was shocked by the incidence of trachoma, a disease he hadn’t thought existed in modern-day Australia. A program that began in the 1970s with Fred and his team personally visiting hundreds of communities has grown into one that involves First Nations Peoples in its design and delivery, and that has more than halved blindness in Indigenous communities.
Associate Professor Kris Rallah-Baker, a Yuggera/Biri-Gubba-Juru man and Australia’s first and only First Nations ophthalmologist, says: “For me, there’s no better feeling than seeing the joy on a patient’s face when their patches are removed.”
When Fred was alive, First Nations Peoples were 10 times more likely to be blind than other Australians. Today, that number has reduced to three times more likely, a significant achievement but one that Rallah-Baker says shows there is still a way to go.
“We are entering a new era and in the not-too-distant future we will have more than one First Nations ophthalmologist in Australia, which is extremely exciting,” Rallah-Baker says. “I think Fred would be proud but pushing us to do more.”
The Fred Hollows Foundation Ethiopia, in partnership with the Government of Ethiopia and the Oromia Regional Health Bureau, celebrated its 100,000th trachomatous trichiasis surgery at Babile Woreda, East Hararge zone. Photograph: Mark Maina.
On the world stage plenty of challenges remain in the fight against avoidable blindness. Covid-19 has disrupted access to services, and in many countries, led to long waiting times for surgery. Climate change is causing an increase in cataracts and trachoma infections, due to a decline in water quality. And an international study published in 2017 estimated that by 2050 blindness would almost triple because of the world’s growing and ageing population, with the greatest burden occurring in developing countries in Asia and sub-Saharan Africa.
It was the sheer inequity of poor countries suffering from a condition easily fixed in rich countries that drove Fred Hollows’ outrage. “It’s obscene to let people go blind when they don’t have to,” he said.
After 30 years, his foundation has grown to be one of Australia’s best-known charities. Its appeal is still underlined by the spirit of the man who began it all.
Ray Martin, who first met Fred and Gabi at Wattie Creek when he was a journalist reporting on their work in the bush, and went on to become the foundation’s first chairman, says: “Fred was one of a kind – brash, gruff, no nonsense – and fiercely committed to fighting injustice and ending avoidable blindness.
“As I’ve often said to Gabi, I’m sure Fred would be sitting somewhere, sucking on his pipe, having a whisky and be forever grateful for what we’ve been able to achieve.”
