# Preventing blindness

Several people have recommended that we look at the Fred Hollows Foundation. We have been shown calculations implying that they are preventing or curing a person’s blindness for every $20-60 they spend. As we continue our research on developing-world aid, we checked them out a bit ourselves. The Fred Hollows Foundation’s programs include surgeries to cure blindness caused by cataracts and trachoma. These surgeries are relatively straightforward and can therefore be performed relatively inexpensively (at less than$10 per trachoma surgery, according to the Diseases Control Priorities Project). But the cost per surgery doesn’t tell the whole story – for example, we also want to know:

• How bad would patients’ vision be without surgery? While improving someone’s sight is always valuable, “curing blindness” means something very different to me from helping someone who previously had vision in one eye, or slightly impaired vision in both.
• How old the people are who receive the surgeries? Again, curing blindness always has some value, but it means more to me when it means giving someone a full life of healthy vision (or when it helps someone to care for their dependents).

The Fred Hollows Foundation conducted a 65-person post-operative survey in Cambodia that sheds light on the above questions. (You can see the full report here; this is the only survey of its kind that I found on their website.)

• 44% of those who received surgeries had been able to work before undergoing surgery, as they were “usually only blind in one eye or had some vision in both eyes” (Pg 11).
• 77% of those who received surgeries were over the age of 60 and another 21% were over the age of 41 (pg 10).

I’m excited by the idea of vision correction surgery; it’s cheap and tangible, even considering the above. But these sorts of details about who is being helped significantly change my idea of what you get for your donation with this kind of program, and I’m far from convinced that it ultimately represents a better “value” than our current top health-related charities.

• Brian Douglas Skinner on July 22, 2008 at 4:37 pm said:

I love the GiveWell blog posts. It’s great to be able to see what you’re working on, and it’s great to see examples like this of successfully digging up more specific information about outcomes.

In this particular case, would DALYs be a useful unit for talking about the results? The two main questions you focused on were “how bad was the disability”, and “how many years of disability were prevented”. Seems like this might be a good fit for talking in terms of DALYs.

• Elie on July 23, 2008 at 1:54 pm said:

Brian-

Those are the two questions we’re asking, but DALYs don’t directly serve our purpose. Inherent in the DALY metric is the position that a donor’s goal is maximizing years of life as opposed to maximizing full lives. For example, I’d far prefer to help one person live a full life (70 yrs) than help 25,550 (70*365) people live an extra day. That choice is philosophical, and therefore I believe, best left up to a donor.

The DALY metric doesn’t allow the donor to make that call for him/herself because it combines all information into one number in a way that obscures the underlying facts. I want to know the magnitude of the improvement AND the age of the person helped but not the combination of the two into one number.

We talked more about DALYs here.

• Gena Rotstein on July 27, 2008 at 12:25 pm said:

Another organization you might want to look at is the Colin Glassco Foundation. They are doing work in Zambia combating Tracoma (I believe that is the same thing as River Blindness) by providing medical care and potable water. In a two year evaluative study, they have taken a population almost have of whom had Tracoma and have reduced it to less than 10% of the total population. The ripple effect has been that they now have kids who can attend school (before the kids were too sick and/or blind) so the communities are building schools. The other effect that they have seen is that now people can tend their land better and so this year their crops/gardens have increased their yields allowing for improved nutrition amongst the villagers. Of course this has happened over several years. He has posted his findings on his website – http://www.glasscofoundation.org/.

Just another resource. Colin might be willing to share with you how he conducted his measurements and evaluations.

Gena