A hand held in time of need: Inside Lions Club of Kuching Metro’s 12-year cataract mission

THE corridor was quiet, with a sense of nervous waiting.

An elderly woman stood outside the operating theatre, unsure whether or not to go through with the cataract surgery that could help her see again.

Her fear was not of blindness – it was of what was waiting behind the sterile doors of the operating room.

She had already started to back away when another elderly woman noticed her distress.

Fresh out of surgery, the latter walked over and gently took her hand, telling her that she had been just as scared before.

There was no pain, she said.

“Everything has gone well.”

The frightened woman stayed, and the surgery went ahead.

“After the operation, she said with relief: ‘It’s true, there was no pain. I could have more of this surgery’,” recalled Andrew Chioh – the coordinator behind the Lions Club of Kuching Metro’s ‘Cataract Mission’ for more than a decade.

“We never forgot her; it’s a heartbreaking lesson that curing physical blindness also required addressing the fear in the mind.

“She would have walked out had that moment not happened.

“It showed us that our work wasn’t only about surgery – it was also about trust, courage and human connection.”

The surgery went ahead. The woman’s sight returned after the bandage came off, but what stayed with the team was not the procedure – it was ‘the hand held in the hallway’.

“There had been another patient who had felt the same terror, but could not be consoled, and left before surgery began,” said Chioh.

The team never forgot that loss. It made them realise that restoring sight also meant helping people overcome fear.

From trial run to long-term commitment

Over time, moments like these became part of a mission that had spanned 12 years and 20 free eye-surgery programmes in Betong and the nearby areas.

Chioh said the journey went back to 2013, when Lions Club of Kuching Metro set up a formal partnership with Klinik Katarak Kesihatan Kementerian Malaysia (4KM), working alongside the Ophthalmology Department of Sarawak General Hospital (SGH).

What began as a trial run meant to help restore the sight of 31 people, later proved that a structured and sustainable rural eye-care system was possible.

Before Betong became the centre of the programme, the club had already been working deep into rural Sarawak.

Since 1998, volunteers had travelled beyond Kuching to places such as Siburan, Kampung Anah Rais, Serian, Lundu and the interior pockets of Lubok Antu, carrying out health screening expeditions that included dental checks, diabetes and blood pressure screening, glaucoma and cataract detection, and also body mass index (BMI) assessments.

Those trips exposed a stark truth – many villagers were living with untreated eye conditions simply because specialist care was out of reach.

The Betong project grew as a direct response to that need.

‘Surgery to those needing it most’

This programme was made possible through the dedicated sponsorship of Deputy Premier of Sarawak Datuk Amar Douglas Uggah Embas, and later sustained by Dato Dr Richard Rapu.

“The aim was to provide free, high-quality cataract and pterygium surgery to vulnerable rural communities,” said Chioh.

He added that the 4KM model ran on a disciplined, rotating system.

Over the past decade, surgical teams visited the rural hospitals in Lundu, Bau, Serian, Sri Aman, Betong, Saratok and Simunjan twice a year.

Last year, the preliminary screening and surgical teams were cut back to just once.

“The screenings identified patients who required surgery and detected other eye diseases that needed different forms of care.

“And then about a week to a month later, the surgical team arrived – fully equipped.

“That seamless screening-to-surgery pathway became the backbone of the programme,” said Chioh.

Major milestone

The 20th mission undertaken last November marked a major milestone.

Screenings, held from Nov 3 to 7, registered 233 people, of whom 115 had cataracts and 28 had pterygium.

From these numbers, 104 cataract and 28 pterygium patients were scheduled for surgery.

When the team was at Betong Hospital on Nov 20 and 21, surgery was successful for 93 cataract patients, and all the pterygium cases.

Over 12 years, at least 1,030 patients had undergone 1,036 procedures.

The surgeries followed a precise clinical process. The eye was numbed, small incisions were made in the cornea and the cloudy natural lens was broken up and removed through ultrasound – a procedure known as ‘phacoemulsification’.

A clear artificial intraocular lens would then be inserted into the lens capsule, and in many cases, the tiny incisions would be sealed without stitches.

Most surgeries took between 15 and 30 minutes.

Patients were awake but relaxed, and their eyes were protected with a shield afterward.

Elderly farmers, homemakers, breadwinners

Chioh said many who came for treatment were elderly farmers and homemakers, whose vision loss had gradually forced them into dependence.

Most were between the ages of 60 and 80, but there were those who were much younger – as young as in their 30s.

“Their cataracts worsened by long hours in the sun, diabetes or work-related exposure. For them, losing sight meant losing livelihood and dignity.

“What kept us going was the immediate, tangible result,” said Chioh.

“The bandages came off and a person who was previously dependent on others, had become independent.

“We had seen patients who walked in led by their grandchildren, walking out holding their hands,” he added.

Giving up weekends, family time

The mission, however, went far beyond the operating room – much of it happened quietly, and long before surgery day.

There were months of planning, arranging patient schedules, securing intraocular lenses (IOLs), transporting delicate equipment, and spending hours reassuring anxious families before the team had even arrived.

“What people see is only the surgery day,” Chioh said.

“They don’t see the months of work before that, or the time spent talking to families who are scared and unsure.”

The emotional and physical strain on the medical volunteers was heavy.

Chioh said many of them already worked full days at the hospital before giving up weekends and family time to join the mission.

Moreover, they were in rural conditions that were often uncomfortable and demanding – yet they continued to return.

“They still choose to come with us, even if it means sacrificing rest and family time.

“That commitment is what keeps the programme going,” he added.

‘A mission nearly halted’

There were moments when everything nearly fell apart, and in this regard, Chioh recalled one particular incident.

The team was transporting donated IOLs to Betong when, having just passed the Sri Aman junction, they received an urgent call from their equipment packer.

A crucial item had been left behind – the stand needed for the operating microscope used in pterygium surgery.

“We realised very quickly that without that stand, we could not do the surgery,” Chioh said.

“Time was running out.”

At that very crucial moment, Chioh remembered that Sri Aman Hospital had a suitable microscope, one that was much newer than the team’s own.

They diverted immediately and called ahead. The senior medical assistant agreed to lend the equipment.

“The paperwork was ready when we arrived.

“It was a huge relief,” Chioh said.

However, they faced another problem – their vehicles were already full, with hardly any space to safely transport such a delicate instrument.

“Help came from an unexpected place,” said Chioh.

“My brother contacted the District Officer of Sri Aman, who agreed to help.

“A phone call later, he made arrangements for his official vehicle to transport the microscope for us.

“That saved the mission.”

The team reached Betong Hospital at around 10am.

The surgeries started late that day, but they went ahead.

For Chioh, the incident summed up how things worked in the mission.

“It’s never just about planning or equipment.

“When something goes wrong, it’s the people around you who step in and make sure that the work continues.”

Convincing families

Some of the hardest decisions came when walk-in patients arrived on surgery day.

“Without prior screening, they could not be safely operated on.

“We had to refer them to the next camp.

“Still, saying no is emotionally heavy every time,” said Chioh.

For many families, the biggest surprise was finding out that the surgery was truly free.

Suspicion was common at first; many believed that there must be ‘some hidden fees’.

However, trust grew slowly through reassurance, word-of-mouth and the credibility of Betong Hospital staff.

Over time, things changed. Screening camps were no longer greeted with hesitation, but with anticipation.

Financial reality remained demanding, nevertheless.

IOLs were the single largest recurring cost, yet they were essential.

A two-day mission involving 100 patients could cost between RM100,000 and RM120,000, covering lenses, surgical consumables, medication, transportation, maintenance, meals and also accommodation.

“Much of the major contributions came in the form of pro-bono work by the SGH ophthalmology team,” said Chioh.

‘A fragile future’

The programme has been sustained since its inception in September 2013 by a number of key founding figures, including senior ophthalmologists Dr Mohamad Aziz Salowi and Dr Intan Gudom.

Their dedication extended far beyond their formal careers, with Dr Intan providing continued support well into his retirement.

Their foundational work was critical in developing the 4KM service delivery model, which was formally presented to the Health Ministry in 2012.

“The programme prevented far more than blindness. It restored independence, dignity and economic participation.

“Without this programme, many cataract patients would have slipped into preventable blindness, families would have shouldered the burden of long-term caregiving, and rural economies would have lost productive members,” said Chioh.

Yet, the future remains fragile.

The core instruments are more than 12 years old and eventually, they would require costly replacement.

The risk of burnout among the volunteers is real, and also more ophthalmologists are needed to be brought into the mission.

“Our worry is that the need would outlast our capacity to meet it,” Chioh said.

“The long-term goal is the establishment of a formal, state-supported ‘Prevention of Blindness and Visual Impairment Team’ for Sarawak.”

Nevertheless, Chioh said when the 20th mission ended, the volunteers were tired, but satisfied.

“There are still people waiting for surgery, and planning for the next mission has already begun,” he added.