The first day at school was quite literally a disaster for Saqib Mohammad. The six-year-old was holding his mother’s hand right until they arrived outside the classroom, but the moment she let go and coaxed him into his class in the small town near Lahore in Pakistan, he appeared to stumble and almost fall on his face. Struggling to reach his desk, he bumped into chairs and other children, and soon had tears streaming down his cheeks as his classmates snickered at his gawkiness.

It was his teacher who guessed something wasn’t right with his vision, and called his mother inside. ‘Please take him immediately to an ophthalmologist,’ she told Asma.

Although surprised, convinced ‘he was just being clumsy and playing the fool,’ Asma took the little boy to Dr Irfan Khan, who at the time practised at his family-run Chaudhry Ata Elahi Eye Trust Hospital in Haveli Lakha, a small town with a population of around 300,000 people, 175km from Lahore.

‘The child was unable to see beyond his nose,’ says Dr Irfan, 40, now a consultant ophthalmologist at the Moorfields Eye Hospital in Dubai. ‘Naturally, he would be very clumsy at home and school.’

Saqib required a very high prescription, but was happy to wear the thick glasses because it opened up a new world for him. He also stopped tripping over things, and consequently his classmates stopped laughing at him.

‘After prescribing glasses his behaviour improved at home and at school too,’ says Dr Irfan. ‘Children are different from adults; they can’t tell their symptoms. It is very frustrating to be a child with very poor vision, and their frustration of not seeing better comes out in the form of a change in their behaviour.’

It was precisely for such reasons that Dr Irfan’s father, Dr Mohammad Akram Khan, had launched the trust that would run the eye hospital in 1998.

‘My father was an ophthalmologist himself, and so is my mother Azra, who is now 71 and retired,’ says Dr Irfan. ‘My grandfather, after whom the trust is named, migrated here from India after Pakistan was formed, and my father grew up here. He moved to the UK when he started practising, but always wanted to build a hospital here for the villagers who otherwise had to travel more than 100km to a proper hospital.

‘The Chaudhry Ata Elahi Eye Trust Hospital was launched with a very small loan, even while he was practising in Lahore,’ says Dr Irfan. His father passed away in 2007.

Dr Irfan and his twin brother Dr Imran, also an ophthalmologist, used to pitch in at the hospital whenever they could take time off from their practices – Dr Irfan in Dubai and Dr Imran in Lahore. After their father passed away and their mother retired, Dr Imran visited every weekend, with Dr Irfan lending his expertise every three months – a schedule they keep up to this day.

Patients are charged nearly nothing for treatment and surgery – Rs25 (less than a dirham) for treatment, which also includes consultation and medicines. Follow-up visits are free. Eye surgeries cost patients Rs1,500, which is a pittance compared to the Rs50,000 a private hospital would charge.

‘Initially we worried about deciding to charge for treatment,’ says Dr Irfan. ‘We then decided to charge a nominal fee because otherwise people who are not educated do not attach any value to it. This way we get them to take us seriously, and it’s not a strain on their pockets either.’

The hospital stands on three hectares of land, donated by a patient of their father’s. The hospital building occupies around half-a-hectare of space, with an outpatient area, operating room, some inpatient rooms, and a mosque.

What makes the Chaudhry Ata Elahi Eye Trust Hospital so vital to Haveli Lakha is that the town has no other proper eye care facility. ‘Before that the only relief the villagers had was when doctors from larger cities came down to set up short-term medical camps,’ says Dr Irfan. ‘The quality of service at such camps is very poor. They usually conduct mass surgeries, after which the patients, more often than not, get serious infections. The staff is not properly trained and the quality of treatment poor. It is usually run by newly graduated doctors who want to gain some experience. That’s why we wanted to give them exactly the service they’d receive in a professionally run modern hospital.’

Cataract is the most common eye affliction in these areas, he says. ‘But some of these camps even fleece the poor villagers for lens implants after the cataract operation. After operating upon the patient’s eyes they’d demand around Rs5,000, a huge sum for the villagers, to implant the lens. The poor people would then have to scramble to raise the money to complete the operation. They were exploited in many such ways. They are a poor farming community, so many of them would make do without the lens implant and it would render the operation null as they would still not be able to see properly.’

Dr Irfan’s hospital fulfils a real need in the area. ‘It’s not plush, but it is clean and has all the modern equipment and medication required,’ he says.

Every three months when Dr Irfan visits the hospital the brothers organise mass surgeries – between the two of them they manage up to 30 surgeries in a day. ‘However, we don’t focus on quantity, but on quality. Even so, from 1998, we’ve built up quite a number of patients.’

Dr Irfan, who specialises in paediatric ophthalmology holding a fellowship at The Hospital for Sick Children in Canada, now aims to set up a special ward for children. ‘There are millions of kids suffering from poor eyesight and other afflictions,’ he says. ‘If they are provided proper glasses it will change their lives.’

Paediatric cataract is said to occur in one in 10,000, which going by the population is still high. There are also many cases of cataract trauma, where an injury to a child’s eye can induce cataract. Even some severe infections may introduce cataract in children, the doctor says.

‘If you don’t treat children with eye afflictions before the age of seven, the brain locks the vision, and then it becomes difficult to correct it,’ says Dr Irfan. ‘That’s why now my aim is to start an exclusive paediatric wing in our hospital.

‘I see so many children with crossed eyes and cataract, which are afflictions you can treat and cure. If we can catch them at the right age and correct their vision, it will be life-changing for them, and transform the lives of their families, and eventually the society at large.’

Cataract in a newborn has to be operated upon within 10 weeks, if it occurs in both eyes. ‘We usually see these cases when they are around six months or so. A professional fully equipped hospital would be able to detect such cases and redress the problem on time. That is what we are aiming for at our hospital.’

But the brothers never turn anybody away. ‘We’ll still be able to do something for the child’s vision, even if detected late,’ says Dr Irfan. ‘Think of it: if the child is able to detect even shadows, instead of total darkness, it means he can move around. He’s not dependent on someone for everything. Otherwise a person would have to guide him 24/7.’

The doctor shows us photos of Mohammad, a 10-year-old with a white pupil in his right eye. ‘He was brought to me by his father as he was getting bullied at school because of the appearance of the eye. His parents were very concerned about his behaviour at school and felt he was becoming socially isolated.’

Cataract surgery was performed on his eye successfully and not only did he get his vision back, his eyes now appear normal. The bullying stopped, and so his confidence grew.

What constrains the brothers is funds, and a lack of trained staff. On weekdays three ophthalmic nurses run the show. Dr Imran visits on weekends.

‘All the staff at the hospital has been trained by us. They’ve been with us for more than 10 years. But we can’t afford to pay to have a qualified doctor to run the hospital when we are not there to consult,’ says Dr Irfan. ‘We’ve lost count of the money that we keep pouring in to keep the hospital running. It costs us around Rs70,000 every month, apart from staff salaries.’

The hospital is a registered one and its accounts are audited, he says.

Even now the brothers constantly wrestle with the idea of hiring doctors to run the place when they’re not around. ‘But we then decided that if you want to do quality work, you have to do it yourself,’ says Dr Irfan. ‘You can’t hire a person and expect to get the same kind of commitment.’

Dr Irfan’s dream is to first get the paediatric section up and running, ‘hopefully with a full-time doctor to attend to patients when we’re not around, for which we may have to build a house on the premises. We also need to build a school and some rooms for inpatients, which will allow us to take on more serious cases.’

He is looking forward to the day when he can devote all his time to the hospital. 
‘I plan to go back and work there full-time when I retire, and so will my brother. I’d like to find ways of communicating with the villagers, and educating them, so that afflictions are minimised.’

He pauses. ‘You need a passion to do it. You have to give your 100 per cent.’ With the brothers, it’s a 200 per cent.