Eye Clinics – An Unfulfilled Dream

As an optometry student in Joburg I loved our clinic work. Especially the outlying clinics in Alexandra and Riverlea. I have never forgotten the man who ran Riverlea clinic, a jovial man who introduced himself with a huge smile as, “Gerald Durrell! You know, like the author who wrote My Family and Other Animals?” That was ca.1975. After I qualified the army sent me to work at Addington hospital in 1980, and I loved working under ophthalmology Prof Anne Peters, who sent us to all three of her outpatient clinics: Addington on the Durban beachfront (strictly white people only), King Edward in industrial Umbilo (less strictly black people only) and RK Khan in suburban Chatsworth (less strictly Indian people only).

I enjoyed the work, so stayed on for years as a volunteer at nearby Addington even after I entered private practice.

At Natal SAOA meetings I met a wonderful man Abdul Motala, who was quietly running a clinic in Umlazi, south of Durban – as well as doing some pro deo work in his practice in town. I joined his efforts and with my propensity to nod instead of shaking my head, got involved in running it and encouraging others to join us. ‘The more of us do it, the less often we’ll have to do it,’ was my recruitment schtick. We got a number of volunteers and that helped a lot. We could see more people. The main reasons for people dropping out were 1. Some were not happy using unfamiliar (and usually inferior to their own practice’s) equipment; and 2. Some were uneasy with driving to Umlazi.

We tried a number of approaches and after a few years of running Abdul’s clinic in Umlazi, we settled on one: Centralisation. Instead of trying to establish a clinic in each township, we moved the Umlazi clinic to near the main transport hub in the city centre. That way 1. People from all the townships had a better chance of getting to us; 2. Our volunteer optoms were closer to it, greatly reducing their traveling time; 3. We solved the problem of some colleagues feeling they could not drive into the townships for security reasons, so we got more volunteers; 4. We could hire permanent staff at the clinic; 5. We could buy better equipment as we were actually making money and only needed one set of equipment; 6. Our volunteers could see more people as our trained staff did pre-screening for them on the automated equipment;

At its smoothest the Durban clinic ran like a well-oiled machine with minimal input from us. The two ladies Marian Glenn and Margaret Radebe managed it really well. We would arrive and be handed a card, introduced to our first patient and we’d get going with a record card that already had on it: 1. The patient’s main reason for visiting the clinic (translated from isiZulu where necessary by Margaret); 2. An autorefraction result; 3. Non-contact tonometry pressures; 4. Half-PDs measured. All we had to was examine, refract and suggest a course of action. All post-examination work – referral, frame selection, dispensing, paying, ordering, etc was done by Marian and Margaret.

At the end of the session our optometrists were handed the exact cash to pay for their secure parking, so that was not a hassle or an expense. Marian even arranged with volunteers how many people they were comfortable seeing. Some optoms saw painfully few, but at least we knew beforehand to book them less people so we didn’t turn people away after they had waited and expected to be seen. Our peak volunteer numbers were when we managed to get Continued Professional Development CPD points allocated for indigent clinical volunteer work. That ended when people wanting to make money out of CPD got the HPCSA to end it, even though we allocated a meagre ONE point for a morning session helping the poor, for goodness’ sake! Over the years our HPCSA has been pretty consistent in doing the wrong thing. We had a drop in volunteers then, but kept going.

Later, as President of SAOA I was keen to expand the clinic work done in Durban to the rest of the country. I thought our model could work all over. Progress was slow, but we did open a number of “clinics.” Some though, were just in-practice, which our experience showed were not at all productive. No paying patient was going to be kept waiting for an indigent person, and they were often kept waiting way too long. I felt we had to do it properly, not “as a favour when we felt like it.” I was told a few times, ‘You don’t understand, our people are not like Natal people.’ (meaning no volunteers)!

– most are no more –

Later came a new president – of a wannabe medical bent – derisive of refraction: “I could teach my dog to refract.” He was putting drops in people’s eyes and that excited him. Putting specs on their noses didn’t, even though it paid his bills. Later, when I asked him his views in front of other colleagues who I wanted to assess his approach, he dismissively said, “I could teach my wife to refract.” Interesting little fella. I can confidently say his years in practice did way less good than Abdul Motala’s! Over time our clinics dwindled. Some were usurped in seedy for-profit takeovers. Theft, really. Volunteer efforts need a champion to keep up momentum. Allan Marais’ Pinetown clinic sure had one, and he and Lily continued running it up to COVID, when I declined to go for the first time.

We received our fair share of criticism over the years for the way we did our clinic work. Eg: My guideline was let’s do what we can do to help TODAY. ‘Let us try to NOT say, “Go away; Try somewhere else.” So sometimes we gave a person with cataracts a pair of glasses and caught flack for doing so. We did the right thing. If a person had no specs and couldn’t see well and we could improve their vision TODAY, we did it in addition to referring them for a hospital consultation. The criticism that those specs would be useless after the op assumed that the op would actually take place. We did not assume that. Getting to the hospital for the initial consultation was a challenge, having money for transport was a challenge, long waiting times was a challenge, getting back to the hospital for the actual op was a challenge. Even if the op took place within six months after our appointment those specs could be a life-changing help in the meantime. Poverty has many MANY challenges. We tried to understand them and help directly wherever we could. ‘Sorry, go away’ is an easy and convenient response, but to see the disappointment and resignation in people’s faces . . . We would sometimes see people again a year after we had referred them to a hospital, still wanting help having NOT got to the hospital. It amused me (OK, pissed me off) that the people making criticisms were sometimes people who would not do a cataract operation for under R10 000 and WE were “making money” on our cheap specs! Humans! Greed! Cognitive bias! Tell me about it! And anyway, for those who thought we unpaid volunteers were greedily after our five bucks profit (which went to the clinic anyway!), all who did have an op soon after and returned to us would get a free post-op lens change to their frame, fgdsake!


One of my memorable days at a hospital clinic (there were many!) was in 1984 after I had returned from a month-long canoeing trip to the USA. As I walked in to Addington OPDB Anne Peters took one look at me and walked me down to her car in the basement parking garage and whisked me off to ENT Mike du Toit’s rooms at St Augustine Hospital. He whisked me straight into surgery (much whisking) and drained my frontal sinuses of ‘gallons’ of brown Colorado River water. After the op I remember a nurse pulling ‘miles’ of snotty brown bandage out of my nostrils. Mike’s re-alignment of my sinus drainage was so successful I have not had a day’s sinus block or hassle since! Not many surgeons can give a forty year warranty!

While still in the army Neville Welsh was the ophthalmology professor. He insisted we do his ward rounds on Saturday mornings which was cruel and unusual punishment to inflict on hungover soldiers. But we loved the rounds and always learnt something. One fine Saturday we stared in wonder at a worm in a patient’s anterior chamber. Fascinating to watch how the worm would peep his head out from behind the iris and when you switched on the slitlamp would jerk back as if to hide behind a curtain!

At King Edward hospital staff nurse Anita Lekalakala ran ‘her patients’ and ‘her doctors’ like a sergeant major. Full of confidence, was ‘Sr Lekalakala.’ I watched her march out of her office into the crowded waiting room carrying the next record card one day. She glanced down and a small smile appeared. Looking up she announced in her usual authoritative tone, ‘Grace Kelly! Would Grace Kelly come through, please.’ An old gogo struggled to her feet off the wooden bench, picked up her kierie and shuffled to the exam room. She was Mrs Grace Cele.


gogo – granma

kierie – walking stick

Do an Eye Op

Was a time when surgeons would get someone to hold open the pages of a book and do their first-ever eye op, squinting at the pages through their monocle. And they’d get someone else to hold open the lids of the eye!

Often none of these assistants, and often not the surgeon, would wash their hands. What for?

In 1847, a young Hungarian obstetrician noticed the dramatically high maternal mortality following births assisted by doctors and medical students. However, those attended by midwives were relatively safe. Investigating further, he realized that these physicians had often come directly from autopsies. He decided that something was contagious, and that matter from autopsies was implicated. So he made doctors wash their hands with chlorinated lime water before examining pregnant women. He then documented a sudden reduction in the mortality rate in the next year from 18% to 2%.

So they thanked him, right? Never! Semmelweiss and his theories were rejected by most of the contemporary medical establishment. How dare a 29yr-old come up with new evidence when all the eminent old surgeons already KNEW everything!?

Fourteen years later, in 1861, he wrote about his theory and was ridiculed. Eminence triumphed over evidence. What caused those deaths was not cadaverous infection, for goodness sake! It was ‘conception and pregnancy, uremia, pressure exerted on adjacent organs by the shrinking uterus, emotional traumata, mistakes in diet, chilling, and atmospheric epidemic influences.’ Anything BUT what this unpopular man and his evidence suggested! We do NOT have to wash our hands, understand?

Semmelweis got depressed, started drinking and acting weirdly and was eventually tricked into visiting a mental institution where he was held captive. He tried to leave and was severely beaten by several guards, secured in a straitjacket, confined to a darkened cell, doused with cold water and administered laxatives. He died after two weeks, on August 13, 1865, aged 47.

We’re a whole lot luckier 144 years later!

But we still have to keep a wide-awake wary eye out for the ever-present danger of ’eminence over evidence!’


134yrs later it happened again. The so-called Semmelweis reflex—a metaphor for a certain type of human behaviour characterized by reflex-like rejection, ridicule, and rejection by contemporaries of new knowledge because it contradicts entrenched norms, beliefs, or paradigms—is named after Semmelweis. In 1981, in his third year of internal medicine training, Barry Marshal in Perth, Aussie realised bacteria caused ulcers. Well, he was ridiculed. Eminence over evidence again. Us important, established old bullets who haven’t done the research just KNOW you’re wrong. You’re 29yrs old, keep quiet! You’re threatening a $3bn industry! It took till 1993 before he was believed. At least this time, Barry Marshal eventually got recognised while he was still alive: Twenty four years later he got the Nobel Prize!


Yes, we could talk about germ theory denial and hand-washing avoidance in 2020 too . . .

COVID and Ordinary People

Trying to stay on top of COVID news? We have no choice but to do so, to best protect ourselves and our loved ones. It’s stressful and draining, but we have to do it.

This post is paraphrased and shortened from an article by Alanna Shaikh, a global public health expert and a TED Fellow, for tips on how to navigate this information overload while staying safe and sane (for full article, see here ).

1. Look for news that you can act on

When you’re trying to figure out what stories to stay on top of, ask yourself: “Will having this information benefit my life or my work? Will it allow me to make better-informed decisions?”

Accumulating masses of information that you can’t use isn’t so helpful.

For most people, the most critical information for you to follow is how the virus is transmitted. Scientists are still learning every day about how people get infected.

2. Turn to trusted sources

If something reaches you on your whatsapp or instagram in Blikkiesdorp, chances are people professionally covering the pandemic heard it before you did.

So go and see what they say about it. COVID-19 has been heavily politicized, and even some major news sources are basing their content more on opinion than on science.

You can generally trust the accuracy of top news sources like Nature, Wired and The New York Times — to name three examples. Why? Cos their reputations are at stake. And they have the kind of budget that lets them hire full-time journalists who will stand by the facts or who rely on fact-checkers to verify their information. Unfortunately, you also have to check your fact-checkers. Use reputable ones like these eight listed here. In Africa we have Africa Check.

3. Check where their information is coming from

No-one actually KNOWS, so be wary of articles or sources that claim to have a definite answer to a complex question. Be especially wary of forwarded stuff on your social media. The way posts go viral is by being controversial or scary, not by being true.

For example, Dr. Anthony Fauci is currently saying that there should be a vaccine for COVID-19 in early 2021;

the Gates Foundation has a longer estimate; and others are warning that we may never have a vaccine for it.

Right now, there is no consensus about a timeline — these people and organizations are simply offering their best guesses. Use fact-checking sites – find one here. Even when a vaccine “arrives” it will be a while before you or I get one; and a while before enough people get one to potentially be effective; and even then, only time will tell the actual outcome. The much-hyped ‘fastest’ vaccines are using RNA for the first time. Proven vaccines actually injected an antigen which your body responded to; RNA vaccines will inject instructions to your body cells to MAKE an antigen, which your body will THEN need to respond to. There’s an extra step. Let’s hope it works, lasts, etc.

4. Look for news that works for you

For ordinary people whose expertise lies outside global health — i.e. most people — look for trusted sources of information that you can read and digest without having to devote your whole day (or brain) to it. Like the Think Global Health website; it’s aimed at passionate non-experts. It’s not dumbed down, but it doesn’t assume you have a PhD.

Johns Hopkins University is publishing some great work on COVID — more technical, but not too technical.

So is Vox; they have some terrific explainers.

5. Be prepared to change your behavior based on new information

No source is perfect, but that doesn’t mean you should disbelieve all sources. Research constantly changes and informs and shapes our ideas.

Remember when wiping down surfaces was the MAIN thing? Now, reputable organizations and scientists basically agree on masks, contact tracing and the existence of transmission of COVID by people who aren’t showing symptoms. If you get sick you will probably never know who ‘gave it to you,’ as they would have felt as healthy as you did the day the virus was transmitted.

Some of this info may change again, but we need to keep going along with best practice AS FAR AS WE KNOW TODAY.

6. Refrain from arguing with people who ignore the facts

Save your breath. Yours and theirs might be contagious!

You WON’T change their minds.

You are not a law enforcer.

Like it or not, this situation isn’t going anywhere. This pandemic is awful and complicated and changing. Finding our way through it won’t be smooth, nor easy, nor emotionally comfortable. It’s a constant, dynamic process of learning new things and adapting as we learn.


That lovely pic is from the cover of Wits Review Oct 2020, magazine for University of the Witwatersrand alumni.