For the past 27 years, Grant McLaren has driven the long, straight road into Soweto to the St John Eye Hospital at Chris Hani-Baragwanath Hospital. The professor is the full-time head of the eye hospital and, together with his team, they attend to 250 to 300 eye patients a day.
With skills that would earn him a senior place in private practice, McLaren elected to work at St John as he regards his work in Soweto as a vocation. “I am wired to serve and I derive great pleasure out of helping people to improve or regain their eyesight,” says McLaren.
“We frequently operate on people, particularly elderly people with advanced cataracts, who thought they would never be able to see again as they have been blind for years. They are led in by their relatives for their operation, and the rejoicing and ululating when they come out of surgery and can see again is wonderful to experience.”
For his extraordinary commitment and service to eyesight in South Africa, he was knighted by the Order of St John in July last year. A royal order of chivalry, it recognises service to humanity, and dates back over 900 years to a hospital established by monks to care for the sick and poor in Jerusalem. The Order of St John today is an international non-profit organisation that provides first aid, health care and support services in 42 countries, including 13 African countries.
Queen Elizabeth has the final say as to who is honoured with the knighthood of the Order of St John. McLaren is one of a handful of South Africans, including Nelson Mandela, to have it bestowed on them.
The decision to award a knighthood is a lengthy process. “Nominations are discussed, sent to an awards council, then to the Lord Prior, Grand Prior (the Duke of Gloucester) and ultimately to Queen Elizabeth,” explains Major Ian Crowther, Prior of the Order of St John in South Africa, based in Joburg.
“The knight or dame is invested by being tapped with a sword. They receive a medal and robe bearing the order’s emblem, the Maltese cross.”
Humble and self-effacing about his knighthood, McLaren says if it can help to focus attention on the equipment and infrastructure needs of the St John Eye Hospital, that is all the publicity he desires.
“We do eye operations on about 20 people daily, most of whom are indigent. We want to do so much more, but our biggest challenge is that we are under-resourced,” McLaren explains.
Three new eye theatres have been built at the new Baragwanath outpatient complex, but they are still to be commissioned. “We are confident this will boost our cataract surgery output and are waiting for the necessary equipment, which has been promised for the new financial year. We desperately need this added capacity as we do a lot of cataract surgery here.”
The team at St John’s comprises six medical officers, 13 registrars (specialists in training), seven specialists and a dedicated nursing and support staff.
“We need to create a work environment that encourages newly trained specialists to stay on in service at St John,” continues McLaren. “With better resources we can tackle the lists of patients waiting for operations – from cataracts to corneal transplants.
“We would like to offer a walk-in cataract service, where patients who are severely visually impaired could come in and be operated on the next day. At the moment they are waiting from six months to two years, with
several visits to the hospital in-between, which is logistically and financially stressful.
“To achieve this and more, we need the procurement process to be streamlined. We would be far better off to have local procurement instead of the current centralised service, which tends to be slow and cumbersome.
“Another option which would streamline the process is to create a public-private partnership with the St John Opthalmic Foundation. This way the foundation would form a board of trustees who could appoint a full-time fundraiser to raise funds to equip us, while the government would continue to underwrite our salaries. This has worked well in countries like India. Closer to home, the Red Cross Children’s Hospital in Cape Town successfully operates on this model.”
Since 1951, the St John Eye Hospital has been helping patients who cannot afford eye care. Built with private money by the St John Opthalmic Foundation, it was opened in 1951 by Helen Keller and later donated to Baragwanath Hospital.
Cataracts are by far the most common affliction treated here. “Cataracts are the most common cause of reversible blindness in the world, affecting people over the age of 60. It is an age-related disease and the surgery is wonderfully successful,” says McLaren. Patients pay about R60 per eye at St John (pensioners and children under six do not pay), as opposed to R7 000 to R10 000 per eye at private clinics.
Other eye disorders they treat regularly include glaucomas, bacterial and viral eye infections, HIV/Aids-related eye infections, tumours, retinal detachment, squint eyes and corneal damage.
“We treat plenty of patients with glaucoma, which affects about 4.4 percent of our population over the age of 40. Too often we get patients coming to us who are already blind in one eye from this condition. Fortunately, we are generally able to stabilise the vision in their second eye. We urge people to pay attention to their eyes and have them examined on an annual or at least a biannual basis.
“Even allergies need to be treated without delay. We treat a lot of patients with allergic conjunctivitis. The symptoms are extremely itchy eyes, which, if left untreated, can in some cases cause severe damage to their corneas. Parents need to have their children attended to immediately if they see them vigorously rubbing their eyes,” advises McLaren. “What is very helpful to our patients is that we are situated close the Baragwanath taxi rank.”
The doctors at St John also participate in surgical eye tours of rural areas organised by the Bureau for Prevention of Blindness, an NGO. The surgery is performed in remote areas throughout South Africa. Those who can’t pay receive treatment or surgery free.
“Our aim is to help more of the thousands of people still out there who continue to live in darkness and whose vision could be improved or restored,” says McLaren.
“As a country we are well resourced and have plenty of donor goodwill. We need to draw on this to modernise and expand St John so that we can meet the escalating need for eye care. If I can help to improve our facility in the years I have left here, then my knighthood will have been well served.”