How a Singapore team braved poor communications and equipment to provide free eye surgery for Laotians
The two countries are “building up the resilience of our public health systems together”, said Singapore's Prime Minister Lawrence Wong during a recent trip to Vientiane.
Ophthalmologists and nurses from the Singapore National Eye Centre working in the operating theatre with the surgical team at the National Ophthalmology Centre (NOC) in Vientiane, to perform cataract surgery on Laotian patients. (Photo: Singapore National Eye Centre)
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VIENTIANE: Frustration gripped eye doctor Yep Zhen Ting as she went about what would appear to be routine screening for cataract.
The language barrier between the Singaporean and her Laotian patients only seemed to get higher and higher; and outside their hospital room in capital Vientiane, the line was growing longer and longer.
“It was hard to understand their symptoms," she recalled. "We were afraid that we might miss crucial information from the patients regarding their medical history."
Still, the senior optometrist in the Singapore National Eye Centre (SNEC) remained undeterred in her mission: To provide free eye consultation for Laotian locals, the majority of whom work in agricultural jobs like rice farming and earn less than US$2 a day, making cataract surgery unaffordable.
Ms Yep was part of an SNEC team of 14 - including surgeons, allied health workers, nurses and technicians - who travelled to Laos in March. During a five-day visit, they screened a total of 518 patients and performed free cataract surgeries for about 150.
“We had a very high patient load (and were) faced with limited manpower and challenges with crowd control and moving patients from station to station,” she told CNA.
“We quickly learned key Lao vocabulary to improve communication during eye examinations, which significantly improved patient flow.”
These included basic terms such as asking patients to open and close their eyes, look straight or sideways, not move and most importantly, to ask if they were feeling any pain.
Senior surgical nurse Goh Hui Jin, who also went on the trip, said the team sought help from translators from an international school. They also organised English lessons for staff and doctors in Vientiane.
Some of the local students who helped with translating were even trained on the spot to help with logistics in the entire operation, said Ms Yep.
STRUCTURAL ISSUES
Prime Minister Lawrence Wong had said during a trip to Vientiane earlier in October that Singapore and Laos were “building up the resilience of our public health systems together”.
Clinical associate professor Anna Tan, SNEC’s director of global ophthalmology, said a separate team earlier visited Vientiane in January last year, to better understand the eye care needs of the local community.
It led to Laos being prioritised for the SNEC-Global Eye Health programme, which aims to improve eye care development in Southeast Asia.
“They have an estimated population of 7 million people with only 35 trained ophthalmologists, mostly sited in the capital city. In comparison, Singapore has about 400 ophthalmologists,” Dr Tan told CNA.
She said training for ophthalmologists and other eye care specialists in Laos needed to be improved, to go deeper and be more specialised.
Eye care was also fundamentally not a health priority for the government of Laos, and ophthalmology departments across the country were lacking funding and manpower, said Dr Tan.
She also pointed to infrastructure issues - in the main hospital in Vientiane, for instance, many pieces of equipment were in disrepair or not maintained at all.
Under the SNEC programme, ophthalmologist Dr Keovongkoth Nouanphanthakoun from the National Ophthalmology Center in Vientiane was in Singapore at the start of 2024.
There, the 34-year-old learnt more about issues such as glaucoma and cataract treatment.
Among his key takeaways were the detailed patient care and systematic work procedures at the SNEC, smooth coordination between doctors and nurses as well as modern technology being used.
The challenge is in replicating Singapore's system in Laos, where an improvement in overall technical knowledge of medical personnel is much needed, along with more advanced treatment techniques and equipment.
Meanwhile, through the SNEC’s project in Vientiane, many disadvantaged people who live far away from the capital have been able to get “proper and safe treatment, which makes them have a better quality of life”, said Dr Keovongkoth.
“They were very happy to be able to see clearly again."
MORE TO COME
Dr Tan pointed out that as a developed country, Singapore faces different issues when it comes to eye problems.
“For Singapore, ageing diseases such as glaucoma, macular degeneration and diabetes are more pressing eye conditions causing blindness,” she told CNA.
In Laos, most cases of visual impairment are caused by refractive error or cataracts, she noted.
Singapore can share expertise in the area, said Dr Tan, as it has better primary and secondary health care systems with resources to address those particular problems.
Moving forward, the SNEC is in the process of signing a memorandum of understanding with the National Ophthalmology Center in Vientiane.
It will facilitate specialised training in Laos, focusing on hospitals at district levels and equipping local trainers with knowledge and expertise.
“We plan to improve the skills of not only the medical eye health professionals, but also the support staff such as biomedical engineers and administrators,” said Dr Tan, adding that more exchange visits and training opportunities between both countries are also on the cards.
