Creating a World Where Everyone Can See

Dr James Muecke is an ophthalmologist and co-founder of eye health charity Sight For All. He is this week’s Changemaker.

Muecke has dedicated his life to helping people in developing nations regain their sight and has worked in multiple countries including Kenya, Cambodia and Myanmar.

His international focus on blindness prevention compelled him to establish Sight For All, a charity aiming to empower communities to deliver “comprehensive, evidence-based, high-quality eye health care through the provision of research, education and equipment”.

In addition to his charity role, Muecke is also working in private practice and as a visiting consultant at the Royal Adelaide Hospital and Adelaide’s Women’s and Children’s Hospital.

Muecke’s contributions to blindness prevention have seen him receive an Outstanding Service in Prevention of Blindness Award from the Asia-Pacific Academy of Ophthalmology in 2011 and the Ernst Young Social Entrepreneur of the Year Award in 2015.

He was also awarded a Member of the Order of Australia in 2012.

In this week’s Changemaker, Muecke describes how Sight For All came together, explains why he sees the charity as his “second full-time job”, and reveals how he finds time for himself despite his busy schedule.

What is your professional history working in eye health?       

I am a medical doctor who graduated from Adelaide University in 1987. I subsequently trained as an ophthalmologist at the Royal Adelaide Hospital. Between finishing my internship and starting ophthalmology training, I spent 12 months working in Africa in a little hospital in the mountains of Kenya – this extraordinary year inspired me to take up a career in developing country medicine.

Once I finished ophthalmology training, I worked in Jerusalem for a year, where the most interesting element was going on outreach eye clinics to the refugee camps of the West Bank and Gaza Strip. That really cemented in me a passion for continuing developing country medicine, but now with a blindness prevention focus.

After my time in Jerusalem, I undertook subspecialty training in eye cancer in London, before returning to Australia roughly 20 years ago. Since then I’ve been working in private practice and as a visiting consultant at the Royal Adelaide Hospital and the Women’s and Children’s Hospital in Adelaide.

After returning to Australia, I also wanted to continue working in the developing country space. I had a number of colleagues at the Royal Adelaide Hospital who also had a passion for this. Our department had a connection with Myanmar, so I built on this relationship and founded what we called the Vision Myanmar Program. The objective of this program was to improve the educational opportunities for ophthalmic colleagues in Myanmar through subspecialty teaching workshops, so they had a more comprehensive understanding of our profession. Ten years later, it evolved into Sight For All.

So how did Sight For All come together and what is the work that your charity does?

My own contribution to the program in Myanmar was to teach the management of various eye cancers. I loved sharing my knowledge and skills with my colleagues who’d often been denied these opportunities. The instrumental experience however, was back in 2005, when I was involved in a large adult blindness study in Myanmar. I was blown away by the level of blindness we encountered.

Still to this day, I believe it’s the highest published level of blindness in the world. About 8 per cent of adults over the age of 40 were blind and the majority of that blindness was due to cataracts. The really decisive moment for me was to see people who were my age and even younger, who were blind or significantly visually impaired from cataracts, something you do not see in developed countries such as Australia.

The ophthalmologist working in that area didn’t have the equipment to perform cataract surgery at the highest level. So, even people who’d had cataract surgery often remained poorly sighted and, in some cases, blind.

So, after I got back from that study, I felt strongly that we needed to do something to improve the situation. Our team from Adelaide was able to win a grant from the Australian government to come back to Myanmar with a solid project to reduce the huge level of blindness.

We placed specialised equipment in 32 regional eye centres so that cataracts could be diagnosed and subsequently treated at a high level. It also involved raising awareness amongst the health care workers to mobilise patients from villages in regional areas to come in to the eye centre for surgery. It was this high impact initiative, which resulted from the research that we were doing in Myanmar, that ultimately evolved into Sight For All.

Two years later, in 2007, we undertook the first childhood blindness study in Myanmar. We found that half of all children who were blind, had blindness that could have been treated or prevented. But more powerful than that, we discovered that the leading cause of blindness was measles. To see a child who is needlessly blind from measles is quite disturbing. In every school for the blind that we visited, the team was surrounded by children who were blind from measles. It is heartbreaking and incredibly confronting to have that experience. It also made me realise that there’s so much more to blindness in developing countries than simply cataracts.

At the time, there were no children’s eye specialists in this country of over 50 million people, so I met with the health minister of Myanmar and discussed the results of our study and through that we were able to advocate to train a children’s eye specialist, a paediatric ophthalmologist. So, we brought out a young Myanmar ophthalmologist to Australia to train as a paediatric ophthalmologist.

Dr Aung spent a year at the Women’s and Children’s Hospital in Adelaide and returned home in 2010 as the very first paediatric ophthalmologist for his country. We not only trained him, but we set him up in the country’s first children’s eye unit in the capital city Yangon. From that day, he started hugely ramping up the number of children he was treating and the surgeries he was performing and now, about eight years later, he’s seeing around 20,000 children every year, which is quite extraordinary.

Even more powerful is that he is now training his own colleagues to become paediatric ophthalmologists. About three years ago he finished training the second in the country, who is now working at the eye hospital in Mandalay where we set him up in a children’s eye unit. He’s also finished training the third and is currently training the fourth.

This is one of many examples that shows you the huge scalability and sustainability of what we do. We’ve calculated the cost of our investment to train and equip Dr Aung and it amounts to about a dollar for every child he’s treated. So, it’s a hugely powerful investment in the future of children and in the future of the economy of a country, in a region that I feel is very important to Australia’s future.

We are also involved in training and equipping across all areas of blindness, not just cataract and childhood blindness, for example glaucoma, diabetic eye disease, corneal diseases, ophthalmic plastic surgery, ophthalmic oncology, neuro-ophthalmology, etc. In this respect, the comprehensive nature of our approach, is very different to most other organisations working in this space.

What are the main challenges Sight For All faces as a charity?

Funding is probably the number one challenge, however another is differentiating ourselves from the Fred Hollows Foundation, who are the big and very well-known charitable organisation working in this area. There are hundreds of eye diseases, many are blinding, and some are deadly. Quite simply, the comprehensive and sustainable nature of the work that we do, and the fact that we are ophthalmic-led, sets us apart from all other charitable organisations.

Raising awareness around Australia of the work that we’re doing is also a priority. We need to become better known in this space, so it’s not just the Fred Hollows Foundation that people think of when they want to donate to blindness prevention.

We have a fantastic volunteer ethos in the organisation, which is a powerful thing and not a challenge. We have in the order of 130 specialists involved in our projects, and they’re not just ophthalmologists like myself, there are also optometrists, ophthalmic nurses, scientists etc.

They collectively donate about 10,000 voluntary hours every year, which is quite staggering, with the amount of their contribution reducing our overheads close to the 10 per cent mark. The voluntary input drives what we do, however it’s the funding to harness and mobilise the expertise which remains the challenge.

Given that you juggle your role with Sight For All with clinical practice work, what does a typical working day look like for you?

I call Sight For All my second full-time job. I work as many hours in my clinical practice as I do in my volunteer humanitarian work. So, being a full-time clinician, how do I fit in my voluntary work? Well, I’m an early waker, so I normally get up an hour or two earlier each morning before the day starts. I often squeeze in emails and phone calls between patients, and I have always had a day off a week where pretty much all my energies will go into Sight For All.

I have a wife and two kids and so try not to let any work eat into family time. My wife runs all our events and is heavily involved in our marketing program, so she’s very much on side, which is fantastic, and the kids are also well-aware of our commitments.

We have a number of committees that I am also a part of. Today, for example, is a Sight For All day – we just had our finance committee meeting and we’re about to go into our operations meeting. I’ll also meet and greet potential sponsors on my day off, give presentations about our work to various groups, or be interviewed! So, it’s a busy life and kind of all-consuming I would say.

Despite this all-consuming work, how do you find time for yourself and your family and what do you like to do in your spare time?

Well, generally weekends and evening time is sacred for the family, so I don’t feel I’m short changing them too much, which is very important. I am a keen photographer and, when travelling, love to take photos and share them on social media.

I have had photographic exhibitions and created and self-published a photographic coffee table book, which helped fund the children’s eye unit in Myanmar that we set up a few years ago. And I am in the process of creating another book of my photographs to help fund Sight For All projects. I’m also a passionate traveller and have a keen interest in music, in fact I produced a CD of music which is available on iTunes.

I’ve sadly recently developed a neurological condition which has meant that I’ve had to give up surgery, so I now have another day off each week. Rather than let that day be filled up with Sight For All, I want to make it more about me, so at the ripe age of 54 I’ve taken up golf. It’s a sport that I’m starting to enjoy more and more as I get better at it. It’s a terribly frustrating game but hopefully will ultimately become more relaxing rather than a frustrating thing to do with my time off.

Is there any person or organisation that has inspired the work that you do?

Nothing springs to mind. I have spoken a little about how I came to have a passion in this charitable space. I think it’s these experiences that have been instrumental in the direction of my career and my life, but also in the evolution of Sight For All. Working with my staff and my colleagues, both the trainers and the trainees, has filled me with inspiration. We have a fabulous board of 10 directors, and lots of passionate, enthusiastic, innovative, creative people all working together to fight blindness.

I mentioned the pediatric ophthalmologist from Myanmar and the extraordinary work that he’s now doing, and that we’re duplicating in several developing countries in Asia. These are the wonderful outcomes that really drive me to continue doing this work.