SIGHTLINES Episode 6: Women changing the world transcript | Orbis

SIGHTLINES Episode 6: Women changing the world transcript

Hosted by Dr. Hunter Cherwek and guest host Bulgan Orgilsaikhan, with guests Julia Anderson and Dr. Suzannah Bell.

Dr. Hunter Cherwek: Welcome to Sightlines! I’m Dr. Hunter Cherwek, Vice President of Clinical Services at Orbis International.

Orbis is working to fight avoidable blindness and vision loss around the world. There are millions of people living without eyesight simply because they were born in places where they can’t get the care they need for their eyes.

And a striking thing about the vast numbers of people affected by global blindness is that most of them are woman and girls. In fact, there are 139 million women and girls living with blindness around the world – that’s 25 million more women than men.

We are on a mission to eliminate avoidable blindness, and if we’re going to do that, it’s clear that we must address this gender disparity head-on. That’s what we’ll explore together on this episode of Sightlines: the gender disparity in global eye health; how to address it; the essential roles women play in this work; and how COVID is impacting – and even leaving a legacy on – all of it.

I’m very happy to say that Bulgan Orgilsaikhan is back as my Sightlines co-host today and we’re looking forward to taking a deep dive into this important topic. We started by sitting down – virtually, as always – with Julia Anderson, the CEO of CanWaCH. CanWaCH stands for the Canadian Partnership for Women and Children’s Health. Here’s our conversation with Julia.

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Bulgan Orgilsaikhan: Julia, thank you so much for joining this episode for Sightlines. We are very excited to have you with us. Can you tell us a little bit about more what CanWaCH does and the mission and the collaborations you have?

Julia Anderson: Yeah, happy to and thanks so much for having me. So, CanWaCH is a membership-based organisation. We've got over 100 members: they can be research institutions, they can be civil society organisations, like yourself or NGOs, and they can also be healthcare practitioner associations. So, The Canadian Association of Midwives, for example, is one of our members – the nurses and the gynaecologist and obstetricians – they all come together under this collective banner to improve the health rights of women and children and adolescents around the world. They're all actively working in that space, so they're Canadian organisations largely, but work overseas on development projects as well as often within Canada.

Really, our focus as CanWaCH is to increase their capacity to do that work to make sure that we're focusing in on--- I always say, it's like we're standing there and there's a streetlight and it's our job to, like, pull the streetlight over and focus in on the issues that are going to have the most impact. And where we think the most impact is, is our focus on women and girls, because they're often the most neglected, they're often the most left behind. The COVID has uncovered that this is true in so many deep ways and so we try to pull – with all of our might, with the collective will of our members – that spotlight onto that issue. And really excited to talk to you about it today.

Bulgan Orgilsaikhan: COVID has been affecting every area and, especially, it's been disrupting global health system. And, specifically, how do you think the implications on the woman and the girls, what we need to focus on in these days?

Julia Anderson: You know, there're so many entry points. CanWaCH, we focus on health, so we focus on health, right. There's so many entry points to think about when we're thinking about the COVID crisis and how it's disproportionately impacting women. So, we see that women are the frontline healthcare workers, so they are globally the most impacted by contact with the disease – they are engaging in their communities with the sick, with folks who need help, who need support, they're out and about from the going to market, going to the grocery store, doing the childcare – have the most points of contact.

We also know that there's been this dramatic rise in Canada and around the globe in gender-based violence, so we've known for a long time the place that is least safe for a woman to be is not out, you know, in the community or on the streets, it's in her home, and that has been true for a long time. So, what happens when you send people into isolation? Well, that reality is very stark for a lot of women and that's true to countries like Canada, the United States, and it's true to the developing countries. So, we have this shared challenge that we need to find new ways and think about when we're designing any types of healthcare interventions. When we're talking about addressing COVID from newborn to childhood to young children not being in school, through dramatic healthcare implications of a child not being in school. We see in my community here in Peterborough, Ontario, in Canada, the children who are not going to school, at my school, are not accessing food because that's where they had their solid meal, their only solid meal of the day. So that's true globally, too, right? Where – food, things like, for women and girls, sanitary napkins, you know, period products – these things where all the school was a hub for health care. So, we think of hospitals are hub for healthcare, but the school was really often a hub for healthcare. So, at that stage and phase in life, you know, women are being disproportionately impacted and then, as you move into adolescence and girls, who chose to become pregnant, we're seeing this as global trend, where with an economic downturn, we know that girls enter into marriage at younger ages and that's been true at different points of economic decline, which is happening again. So, there's all these different kind of vantage points and entry points to where women and girls show up in this space and you can see that the progress made prior to COVID is going to take, if we're not careful, it's going to take these dramatic steps back.

Bulgan Orgilsaikhan: We've been presented with the statistics that, you know, 25 million woman or girls suffer more than the boys when it comes to blindness or eye related diseases. I think this is a massive, massive statistic and because they don't get the help, they're the last ones to go and get those help in the areas that we work and there's, certainly as you mentioned, the disruptions in terms of not being able to go to school and they’re missing out. What do you think that the learning lesson from, you know, after the pandemic is over, that we were able to focus on this area or have solution on some of these issues.

Julia Anderson: Really, it's just this dogged commitment to a focus on how our interventions create or perpetuate inequality. So, I think that the easiest story to wrap our mind around is that idea of isolation as a necessary tool, social distancing as a necessary tool, to fight the pandemic, and a woman being forced into a home that's unsafe. It’s really easy for women and girls all around the world and humans all around the world to wrap their heads around what that would mean. To feel like, in order to not get sick, I have to do this and I am afraid to do this because the consequence of me being at home. And so, I think, what success would look like is that we're actually paying attention to this and watching for this and thinking about our interventions with those lenses. And I'm very interested to hear from you how your access has been impacted by COVID when it comes to interventions around blindness and seeing.

Dr. Hunter Cherwek: That's a great question, Julia. I think you hit on it before where the school has really been an area where we can provide all children, with a specific focus in young girls, annual eye exams, spectacle distribution, and one of the things that I think you're also hitting on during these discussions is how everything's connected to everything else. How eyesight is connected to education, how that's related to economics, how that's related to equity, and those are metrics that we have in all of our programs. And certainly, as we're ramping up and restoring services, those are vulnerable populations that we're targeting and making sure that we're addressing first – that is in schools, that is with the remote vision centers – that we're having. I think job creation – and that's something I'd love to hear your thoughts. Obviously, you're a subject matter expert in this, how we can use innovation and the restart in this new normal to do job creation and social enterprise, specifically geared towards women in the vision space. That's something I'm personally very interested in and would love to hear your thoughts on.

Julia Anderson: You know, when I travel, when I used to travel, there's a tremendous number of critical healthcare workers. I am not talking about, you know, informal healthcare work is also critical, but I'm actually talking about formal healthcare workers who have a role in the community. I was in Rwanda and I met these four women, they all volunteered between, I would say, eight and 16 hours a week, going from home to home every time babies were born, every time there was young children. Doing the nutritional test, doing checkups on things related to diarrhoea, things related to, you know, these basic newborn interventions. These healthcare workers were the front line. They were giving out medicine, they were they were well trained. Then, I asked, "Well, what do you pay?” Answer: “Nothing.” They're volunteers. It is an honour to play this role within their community. They did it because it needed to be done, and they wanted to see their neighbours and their neighbours' children survive and thrive. The countries who have made and, from an International Development Assistance perspective, if we could prioritise this, when we know that the majority of frontline healthcare workers, these women that I am talking about, are women and all we did was say, “Okay, rather than just being volunteer hours, we're going to pay you.” And that would be around sight, all kinds of health care interventions are taken care of in a community level by volunteers. Half a step back to say "Let’s pay them" would be a game changer, a global game changer, so that would be my recommendation.

Dr. Hunter Cherwek: No, I love that. That's something definitely we're looking at and how we can make sure that we empower those who are on the front line, whether it's school teachers doing eye exams or people going into villages identifying cataracts and doing community education and community mobilisation work. One of the big things that we've seen during this pandemic, we have a telemedicine distance learning program called Cybersight. It's in 199 countries. We've had 30,000 registered users, who are learners on a, you know, weekly and daily basis, as well as 30,000 tele-consults. One of the biggest things, I'd love to hear your thoughts, is how we get all people across the digital divide so that-- how do we democratise education through technology, how do we democratise access, so that we don't have a barrier by trying to introduce technology? How do you see that as something that we, as Orbis, should have a responsibility as we look to deploy new technologies? That we don't worsen that divide or disparities, but actually close the gap with the technologies were deploying?

Julia Anderson: Yeah, this is a challenge that I've heard every time we have a technology conversation and, again, it's one of those challenges that is true in Canada as it is globally. So, it's a shared challenge that there is a technological and digital divide. That means the most marginalised communities, if you think about rural and northern communities in our context, have the least access, and the most marginalised people within those communities have the least access to the technology that they need. I would say you've already-- identifying it as a problem is the first step and it's the first critical step that I think a lot of organisations, when they're thinking about their interventions, miss.

Dr. Hunter Cherwek: No, thank you for that. And that's something where, you know, obviously, we look at gender and those metrics on every Orbis project and that is built in at the beginning before a program or project is rolled out or even started, so that is baked into the design and the construct of a program before we start field implementation or working with partners. And certainly, I think, you started this webinar talking about some of the social issues that are coming to surface during a COVID crisis. On the different or a flip side of the coin, what are some innovations and some things that you see being created during this crisis that give you optimism and already are bringing utility to this very important field?

Julia Anderson: One of the things that I'm most excited about is, what we call it in the development community, the localisation agenda. The localisation agenda is a fancy way of saying having local people drive solutions for their communities and, intuitively, we all know that this is best because in our own communities, I'm in Peterborough, I'm in a small town, I don't really want someone in a big city making decisions about, and we've seen this during COVID for sure, about what happens at my local school. I want that decision to be delegated to my local school authority, so that I can have influence. And I think when it comes to organisations like ours, who are working overseas, we've, you know, in order to kind of protect donor dollars and demonstrate impact, we've often had the flip side impact of taking an agency away from local actors. So, rather than spending the resources to train and to, which I know you guys actually do a great job at this and so this is doesn't apply to you in the same way, but a lot of organisations, rather than train that doctor, train that nurse, train that educator in the whatever healthcare intervention, you know, they, traditionally, would send people over from the global north.

COVID, with its travel restrictions and inability to move about in the same way, will force a bit of a reckoning on this, right. Where we need to pass on, which we should have done a long time ago - through innovative technologies, like the work that you're doing online with educating people online, through that kind of thing - that capacity gets built into communities and allows them to continue to work, whether you're there or not. And I think, to me, we need to continue to get the resources to communities, they can do the work they need to do, and buy the equipment they need, but the more that localisation process happens, and I think COVID is forcing a little bit, the better. So, I think that's an exciting flip side.

In Canada, we've also seen and, I feel like globally to an extent, are major healthcare leaders are predominantly women. So, they reflect the fact that, in Canada it's 84% of frontline healthcare workers are also women, but at the top, the people that we're seeing on the local media on TV, are tending to be women and I think you're seeing that in a lot of different jurisdictions, we're talking about politically how countries with women as leaders are doing [feeling] better and the UN just put out a study on that they're [feeling] better when it comes to COVID. So, I'm taking a bit of a side view to that to say "What's the long term impact?", I've seen these powerful expert women driving some of this conversation around how to address COVID and, historically, we just haven't had the pipeline to have those people on the TV screen. So, I'm excited about that and definitely seeing that trend in Canada and globally as well. You see with the World Health Organisation and with others, you see just a lot of women taking predominant roles as experts and what does that mean when it trickles all the way down to our young girls and children and their aspirations for what they want to do. So, those are the two big opportunities I see.

Dr. Hunter Cherwek: No, I love that and, Bulgan, obviously you're a global citizen, you know, living in Canada, having been raised in Mongolia and that's how you came to find out about Orbis. What are you hearing today that really resonates and as we specifically look at, you know Mongolia, where I was supposed to be right now, I'm supposed to be in Mongolia, if we didn't have the pandemic. What kind of things that Julia has described and do you think really resonate with your home country, but also the Orbis's work that we're doing there?

Bulgan Orgilsaikhan: Orbis has a very specific mission in the global health, which is blindness and eye care, and I mean it's not in the highest priority for global health these days, right, but it's one of the crucial and one of the most important, and that also goes to the educational part where, you know, the kids, specially girls, if they can see they're not gonna be better student and it just leads to different results after that. A really, really serious issue when like small kids, like babies, when they're, you know, just born if they just, you know, miss that window they are permanently blind. You know, they have a whole life ahead of them and it's just these things when you think about it, it's just so difficult, but I think that organisations, like Orbis, they're doing everything they can to train these doctors in the rural communities where these doctors can go and help their communities.

Julia Anderson: You've raised something so interesting to me because even if I think about, I just went for an eye exam for the first time in forever, and even in our healthcare, it's often thought of as a "I'd love to have", so it's not a basic expectation of healthcare, at least in Canada and certainly globally. It's like, well, you know, we, you know, vaccine or this thing or food or but this is the thing about health care interventions, like you can't prioritise in some way, because, like you're saying, as a young child if you can't see, that's it, your education prospects are reduced, as you know, all the points you made.

Bulgan Orgilsaikhan: It's even in these difficult times, it's important to keep in providing those care for those people who need those emergency care because the windows [to get help] is so short, and the help needs to be, you know, provided as quickly as possible.

Dr. Hunter Cherwek: I want to ask, Julia, a one question: if there's one thing you would like either for me or the audience that is listening and watching, if there is one takeaway that you'd like people to think about, you know, before you, you know, design a program or invest in an organization with time, money, or expertise, what is one thing you'd have the or challenge the group to think about when addressing issues of gender, in especially the healthcare sector which we work in at Orbis?

Julia Anderson: One takeaway that I'd like to promote, whether you're designing a program or whether you're investing in organisation, is just put on that gender lens glasses.

Pay attention to how these projects and interventions could disproportionately affect women and girls and boys and men, just think about it and just asking yourself that question can change the world and I really believe in that. I have a lot of hope in the possibility of women to change the world and, you know, to play those leadership roles. But yeah, I think, the one takeaway is just put on those glasses, think about it, make it a lens that you always look through, that alone will shift what you do, where you invest, and how you support the great work that Orbis and other organisations do.

Bulgan Orgilsaikhan: Thank you, Julia, for joining this episode of Sightlines. The discussions we had is just very important and thank you for sharing those. Thank you so much!

Julia Anderson: Thanks for having me. It was a pleasure!

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Dr. Hunter Cherwek: That was Julia Anderson. Our next guest is Dr. Suzannah Bell, a Clinical Research Fellow at the Moorfields Eye Hospital NHS Foundation Trust in the UK.

Dr. Hunter Cherwek: Suzannah, thank you so much for being with us today, and certainly you're doing incredible work in paediatric ophthalmology and you've really focused on pediatric cataracts, both from a global perspective and also from a genetic perspective.

Dr. Suzannah Bell: Thank you so much for having me. I'm very happy to be here and lovely to meet you both.

Dr. Hunter Cherwek: Yes, and tell us a little bit about the work you're leading, what you've done so far in the field, and also what you're finding both in genetics and in global ophthalmology with access and gender issues.

Dr. Suzannah Bell: Currently, I'm a clinical research fellow working at Moorfields Eye Hospital and a Lab team, led by Professor Mariya Moosajee, and I am actually a junior doctor, as you said, and I've taken some time out to do some eye related research because I'm very passionate about it. And, at Moorfields, it's a very exciting place to work and unique in that we have a partnership with the UCL Institute of Ophthalmology, which is right next door. My research at the moment is looking at the genetics of patients with congenital and juvenile cataracts and also a rare metabolic condition called Cerebrotendinous xanthomatosis, so sorry is a bit of a mouthful, which is a life-limiting but a very treatable disease, of which cataract is an early feature. So, really the overarching goal of the project is to improve the genetic investigation and management of children with cataracts, because, in over half of bilateral cases, a genetic cause can be found. And, previously, I've done some work, as part of my masters that I did at the London School of Hygiene, in Nepal and then, after that, I was helping with a National Eye Center in the Gambia.

Bulgan Orgilsaikhan: Very excited to have you here, Suzannah. Can you tell us more about your recent project in Nepal, where you were looking at gender inequity in accessing eye care.

Dr. Suzannah Bell: Actually this was a project looking at the reasons why carer might delay seeking treatment for their child with bilateral cataracts in both eyes.

Bulgan Orgilsaikhan: And you're saying "carer", Suzannah. In some countries the word is "caregiver.” I just wanted to clarify that for our listeners from all over the world.

Dr. Suzannah Bell: Yes, we know that there is a problem with carers delaying seeking treatment, but we don't really know why. So what we did was give 102 carers a questionnaire to fill in and then we held in-depth interviews and focus group discussions, and some of the key things that we found that are relevant to this discussion, and with the carers spend nearly two months of their household expenditure on accessing care for their child. So it was no surprise that 40% stated that cost was the main barrier to accessing surgery for them. And we also asked, "When did you first notice a problem with your child's vision?", and from that, we met at the time from when carers first noticing a problem to presenting at the hospital for surgery, we found that this time was statistically longer for female children that it was for male children, 182 days [longer]. And also, and this has already been found that this hospital in Eastern Nepal, it was only 34% of the children in our study were female, despite cataracts affecting the sexes equally. And so yes, some really interesting findings and, sort of, maybe suggesting some reasons why there is a gender disparity in that, you know, if you're having to spend two months of household expenditure to access care and, perhaps, you're living in an area where male children may be more economically valuable, and very poor families are going to be forced to make these very difficult gendered financial decisions.

Dr. Hunter Cherwek: Suzannah, you know, and I really appreciate, you know, the fact that you were in Nepal, working with these families, because we all know it takes a village for a child to get their eyesight. Could you just talk very briefly about how a pediatric cataract, a child's cataract, may be different than an adult.

Dr. Suzannah Bell: Paediatric cataract interventions are different from adult cataract surgery, because when children have cataract often it develops within a period where the vision is still developing, the visual pathway from the eye to the brain. And so, really you need a good unobstructed path of light entering the eye and reaching the back of the eye, the retina and consistently, during childhood, to get very good visual development. And so, if you have something blocking that in the way, so clouding of lens, which is what a cataract is, this isn't possible, so the visual development will be interrupted and, even after the cataract is removed many years later, this child may still have vision impairment or maybe blind, because their visual pathway has not developed properly.

Dr. Hunter Cherwek: Yes, and I think everyone probably heard in their life or may know a family member or someone during their school years, who had a patch over their eye, or lazy eye, and I think that's what you're talking about where those critical years, where the eye needs to get very focused light and pictures to the back of the eye, if that's interrupted that lazy eye or those pathways will never develop, even if you correct it years later. So, really the work you're doing is time sensitive and critical to the development of that child's eye as well as their educational development and their social development.

Bulgan Orgilsaikhan: Can you tell us a little bit more about the research on the economic factor. Why the reason for girls having, you know, less access to the eye care than, for example, boys.

Dr. Suzannah Bell: And yeah, so I should probably start with saying that, obviously I'm a British woman and from the UK talking about Nepali female experience, which, obviously, I'll never fully understand and so I'll stick to commenting on the findings of this study, which were in the rural and Eastern Nepal, and in a hospital called Sagarmatha Choudhary Eye Hospital, which is really, really busy hospital. They, I think in the year before we did the study, had done 700, over 700 pediatric cataract operations, a year so a very busy [hospital].

For me, the most interesting finding was this mother who was expressing a real concern about her son's vision, who may perhaps potentially be the one that would have to work in the family as she couldn't work. In fact, she also had bilateral cataracts herself, she was led into the interview by her son, who also had bilateral cataracts and then obviously there, in that culture, the female child will grow up, get married and then leave the family. The male child will stay within the family and help support the family. If you're very, very poor family, you are going to struggle if your only son is visually impaired, because this will reduce access to work and education.

Dr. Hunter Cherwek: What is something you'd like our audience to know about the importance of, you know, gender and how Orbis can do more of this incorporation at the beginning of our program planning, whether it's in paediatrics, or even adult eye care.

Dr. Suzannah Bell: I think it's really hard to talk about gender inequality without talking about health inequity. In general, in eyecare, someone who does a lot of research on this is a women called Jacqueline Ramke from the London School of Hygiene and Tropical Medicine and she found that in populations with high cataract blindness are the more socially disadvantaged groups, including women in rural dwellers and those who are not literate, but also these groups aren’t independent of each other and the group that was really in most need were illiterate rural women. And so, I think, when we're talking about gender disparity in eye care, we really need to be keep this group of people in mind when we're planning services and projects.

Dr. Hunter Cherwek: Yes, and I think the other thing you've talked about like the vicious cycle of poverty and blindness and gender, can you talk about how cataract surgery can reverse that and what some of the best stories you have from your time in Nepal.

Dr. Suzannah Bell: And yes, so I mean, for example, if you are a female child, for example, where who is born with bilateral cataracts and you don't receive any treatment or you have a delay in treatment, and you are visually impaired or blind from this, obviously, is going to affect your access to education and we know that female education not only benefits the individual, but also benefits the community around them and future generations. For example, we know improving the education of girls reduces neonatal deaths and so, in that way, it benefits the whole community and then the next generation.

Dr. Hunter Cherwek: Absolutely and that's one of the things we have a project called REACH, Refractive Error Amongst Children, that works both in India and Nepal, so those are the two communities you're most familiar with from your research. We've screened millions of children and obviously we find that white pupil, the Leukocoria that could be a cataract or other serious disease, and that's something that we've found is that education and vision are incredibly intertwined and the earlier you get sight, the better your educational trajectory are. How do you think COVID is going to impact these referrals networks and paediatric care?

Dr. Suzannah Bell: The whole world has been adjusting to a new sort of way of working and living and I know many projects have been delayed and a lot of focus has shifted quite rightly on to tackling COVID-19. So, really what we need to do is just make sure that we are keeping the focus on issues of gender equality in eyecare, to make sure these aren't left unaddressed. Also, with the sort of shift towards more remote working in telemedicine and rather than face to face consultations and interventions in person, we may be able to access more rural populations and the populations that are in the most need through telemedicine and so, I think, we're going to see a big shift in that way.

Bulgan Orgilsaikhan: Yeah, just add on that, back home in Mongolia, the doctors who are in the rural areas, they, you know, when they need help, with the diagnosis, with the surgeries, they're using telemedicine, the Cybersight platform, to get the consultation from the doctors and I think this is unbelievable. There are certain advantages of COVID that, you know, really pushing to use the telemedicine to the fullest.

Dr. Hunter Cherwek: And, Bulgan, you'll be very happy to hear. On Cybersight, Mongolia has adopted the platform more than any other country, and after English, Mongolian is the second most common language, so it really makes me happy. We can join in and the Flying Eye Hospital team, while they're grounded during COVID, is actually partnering with the Ophthalmic Society in Mongolia to do the entire conference and do lectures and training on Cybersight.

Bulgan Orgilsaikhan: A few days ago I checked a lecture, it was about a tear duct surgery, and it was surreal to see a Mongolian doctor teaching other doctors about the case that was just not available when I had that the issue, so I was sharing this, you know, the link with everyone I know who knows my case and it was just a magical moment, so I thank you for bringing, talking about that Cybersight courses in Mongolian and I think it's also helps when they're teaching a native language and, I think, it's very important so that all the doctors have access to these courses, so thank you for doing this.

Just to go back to the Nepal project and ask about the people. Is there like any beneficiary story that left an impression on you?

Dr. Suzannah Bell: I mean those are so many and, to be honest, and I think the most inspiring one for me, and obviously, but also the biggest limitation of the study because it was based at an Eye Hospital. Obviously, we're not reaching those carers who had not access care at all. So I think the story that really was the most amazing was this woman who, I think, a member of her community had told her that something that this would go away on its own, or that it was something that her child was affected because something bad she'd done in the previous life or something, and then she'd managed to see a doctor, who correctly identified a cataract, but then she couldn't afford the surgery and then there were just all these barriers. And then finally, this bus and this cataract outreach service arrived and this really allowed her child have access [eye] care, and so really, for me, that was the sort of standout story for me. Yeah.

Bulgan Orgilsaikhan: Thank you for sharing that.

Dr. Hunter Cherwek: Maybe, I know you've talked about Moorfields. For those who don't know, can you tell us about this incredible eye center. It's been an academic partner for Orbis for years, some of our best volunteer faculty, including in paediatrics, comes from this hospital.

Dr. Suzannah Bell: It's a very exciting place to be because you do have such a mix of experts and in a very sort of close space. Really, it's just exciting to share information and knowledge with each other. I'm just very excited to be involved with organisations that are willing to discuss these really complex issues and also to be part of the solution. Both the London School of Hygiene and Tropical Medicine and the International Center of Eye Health there and Moorefields are very committed to reducing the health inequities globally and also willing to discuss gender inequality in ophthalmology, not just in patient access to care, but also within the workspace. And, the Women In Vision UK, which is a great resource for women in ophthalmology and, sorry if you're a woman in ophthalmology and would like to get involved, I'm sure you can Google them, but they also have Twitter and Instagram.

Dr. Hunter Cherwek: We really appreciate not only you spending time with us today, but really the work, the hours, you spent away from family and friends, doing this really critical field work. If there was one thing you would like for our audience to take away from your work, from your observations, from your experience with regards to gender and blindness and how women are changing the way the world sees, what would be that one takeaway that you want all of our viewers and listeners to know and follow?

Dr. Suzannah Bell: I think, really, being aware of the issue and not being afraid to discuss these issues and really thinking about them more and talking about them, because I think the more that we talk about them, the more we could [help]. That's sort of really the first step to making a change to addressing this issue.

Dr. Hunter Cherwek: Yeah, and I think that's something we're deeply committed to at Orbis. I think we know that this is a critical part of the problem and blindness is not just the eye, it's the person connected to the eye, how they fit into their family, the community, what cultural or government or other social influences are impacting that paediatric cataract or adult cataract.

So yes, I think that's the point of this Sightlines is educating people of the non-ophthalmic components of blindness and I just can't thank you enough for your field work, your time today, and I'm super excited to see where you go with your career, both geographically and clinically, because I can just tell you're going to do amazing things.

Dr. Suzannah Bell: Well, thank you very much. And thank you so much for having me. I'm completely honored and so lovely to meet you as well, Bulgan.

Bulgan Orgilsaikhan: Thank you. Same here. Thank you so much!

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Dr. Hunter Cherwek: That was Dr. Suzannah Bell. I want to thank all of our guests today on Sightlines. And, a special thanks to my friend and co-host, Bulgan Orgilsaikhan. We've been talking about women changing the world, predominantly from an eye care perspective, but it's about so much more. Women lift economies, empowering them - creating access to education and healthcare - that translates into richer leadership, stronger communities, healthier societies, and a changed world for the better. Orbis's commitment to ensuring that they can see their future remain one of our greatest priorities

Thank you for joining me for Sightlines today. I hope you’ll join us for the next episode and for the entire series. If you would like to learn more about Orbis and the Flying Eye Hospital, please visit us at orbis.org.

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Until next time!

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