Opinion: Afghan eyesight, another casualty of war

BOSTON — This summer, the world was riveted by the murder of 10 medical workers on the banks of a river in northern Afghanistan. When I first read the news, I was saddened to see the name of a man I knew, Tom Little.

I had interviewed Tom via Skype at the end of 2008, when he and his wife were at home in Kabul. It was not a long conversation, but enough to glean some stories about his 30-plus years in Afghanistan, during which the Littles raised three daughters and provided eye care to the country’s poorest citizens. I intended to write a story about Tom Little’s work, and had been thinking of checking back in with him. His death struck me, as it did so many, as a pointless tragedy.

Over the last month, there have been many articles and tributes to the expedition members. Their deaths underline the deteriorating security situation in Afghanistan, particularly the growing penetration of Taliban in relatively quiet areas in the north. The loss also imperils an ambitious effort to rebuild Afghanistan’s medical infrastructure, particularly in eye care. And it deprives Afghans in cities and remote villages alike of the chance to be free of preventable blindness.

The medical workers were assassinated in August during their journey back from mountainous Nuristan Province, where they had been providing the locals with eye care, dental work and other medical services. This was an expanded version of the “eye camp,” a service that Tom Little’s organization, the International Assistance Mission, has provided rural Afghans since 1966. During an eye camp, a team of opticians, nurses and other medical workers set up shop in a remote province, dispensing eyeglasses, removing cataracts and performing other basic but critical procedures that allow people to regain their sight.

“The rural areas are a whole different world,” Little told me last year. “Some might call it primitive. Many people never leave their villages.”

Eye camps serve Afghans who live beyond the reach of urban hospitals or even rural clinics — some 70 to 80 percent of the population. The need in these regions is vast — preventable blindness affects up to 2 percent of the Afghan population, according to the World Health Organization. Cataracts are a common affliction, even among the young. So too is trachoma, a bacterial infection that causes painful scarring on the inner eyelid and eventually destroys the cornea. Small wonder that the eye camps were frequently mobbed with people seeking treatment.

Tom Little led many eye camps to Nuristan, and had been invited to return by tribal elders. The success of these expeditions, and the safety of their participants, rested on the strength of Little’s relationships with local Afghans. Connie Frisbee-Houde, a photographer and family friend who accompanied an eye camp in 2005, shared her thoughts on the Little family shortly after I interviewed Tom in 2008.

“They’ve formed incredible relationships with the Afghans,” she said. “If they had picked up and left when times got bad, what kind of example would that have been? The need hadn’t left, so they felt it was important for them to stay. Because of how they treated them and what they were doing for them, the Afghans saved their lives on many occasions.”

Yet Little was uncomfortable with the idea of a foreigner, even one as assimilated as he was, leading the eye camps indefinitely. He had seen foreign NGOs come and go, and knew that no program could last without the skills and talents of native Afghans. During the Soviet invasion and subsequent Taliban rule, Little told me, most of Afghanistan’s optometrists and ophthalmologists were killed or exiled. His vision was to help cultivate a new generation of leaders, to prepare Afghanistan for the day when foreigners like himself would no longer be around to provide critical care.

The eye camps were part of an ambitious project to rebuild an eye care system laid waste by three decades of violence. Afghans know this initiative as the National Organization for Ophthalmic Rehabilitation, or NOOR — also the Persian word for light. Unlike most other development programs in Afghanistan, NOOR has functioned through the past three decades of Soviet invasion, civil war, Taliban rule and American occupation. In addition to eye camps, NOOR encompasses three major eye hospitals in Kabul, Mazar-i-Sharif and Kandahar, as well as two smaller eye clinics in the provinces.

Recently I spoke with a nurse who worked with NOOR in Afghanistan and who has known the Little family for over 30 years. She asked that her name not be used, since she and her husband hope to return to Afghanistan in the future.

“NOOR has touched the lives of everyday people all over Afghanistan,” the nurse told me. “People know the name. If they weren’t treated there, then their mother or grandfather or cousin was.”

When he wasn’t at an eye camp, Little worked with NOOR to get the Afghan eye care system back on its feet. During our interview, I asked him how a typical day went. He replied that in Kabul no day was like another, but that he would usually start out teaching classes at the Eye Hospital, then arrive by midday in the NOOR office. He would visit the factory where NOOR technicians manufacture the country’s supply of eye drops, and the optical lab where they make eyeglass frames. Recently he had taken to varying his route to and from the office, he told me, in light of the increase in kidnappings.

Little hoped that NOOR could raise a new generation of optometrists, technicians, manufacturers and management staff — the human infrastructure for effective eye care. He went back to school so that he could be a better teacher — from 2006 to 2008 he studied at the New England College of Optometry, where my father was one of his professors. He worked with the Afghan Ministry of Health and with ophthalmologists and NGOs in Pakistan to bring new training programs to the country.

Now, like the murdered Afghan doctors and optometrists he knew decades ago, Tom Little is gone. He leaves behind an international network of churches and charities that have supported his efforts, as well as Afghan and expatriate colleagues who share his skills and dedication. His parent organization, the International Assistance Mission, has vowed to continue its work in Afghanistan. However, for the foreseeable future it is unlikely that anyone will risk an excursion to the remote mountains of Nuristan, or any of the other rural provinces where eye care is so desperately needed. Afghan villagers in these areas may feel his absence most acutely.

“Tom’s heart was in outreach,” the nurse told me. “He saw the eye camps as a way to reach in to communities that had been closed. Those camps were his baby.”

Lindsey McCormack is a writer based in Queens, N.Y.