The Impact of Cataract on Poverty in Tonga

Abstract

Background: Cataracts are the leading cause of blindness worldwide, especially in low income countries and it continues to be a growing public health issue. The impact of cataract on poverty, daily activities and time use and health related quality of life has been widely researched in major low income countries such as Kenya, the Philippines and Bangladesh, South India and Pakistan. However, there is a paucity of evidence on the impact of cataract on poverty in South Pacific countries such as the Kingdom of Tonga. To fill this gap this study gathers meaningful information from cataract patients and government agency staff to examine the meaning and indicators of poverty in Tonga. Aim: This study aimed to - 1. Explore experiences of poverty associated with cataract among pre- and post-operative patients in the Kingdom of Tonga. 2. Examine the concept of poverty as related to cataract among government officials in the Kingdom of Tonga Objectives: To develop a culturally relevant and appropriate questionnaire to measure the impact of poverty in Tonga. Method: In-depth interviews with key informants were conducted with three sample groups: pre- and postoperative cataract patients and key government officials from the Ministry of Health and the Ministry of Finance and National Planning. Participants were invited to discuss several issues relating to their understanding of poverty, indicators of poverty in Tonga and strategies to reduce poverty. Importantly, for pre- and post-operative cataract participants the questions relayed centred on having a cataract and the impact this has on their quality of life as well as what factors hindered their economic improvement. Interviews were conducted in both English and Tongan languages, to enable full and nuanced responses from all participants. Results: In total 20 individual interviews were conducted within three weeks in the Kingdom of Tonga. Five pre- and five post-operative cataract patients, five Ministry of Health and five Ministry of Finance and National Planning staff members participated in an hour long interview each. Pre- and post-operative cataract participants described in detail the importance of eyesight to their physical, mental, social and spiritual wellbeing. For some participants, having a cataract/s hindered their economic performance. However, once a cataract was removed, they were able to provide for their families financially. Poverty is multidimensional, incorporating both materialistic indicators such as owning a house, land, tapa and fulfilling traditional obligations such as fua kavenga/financial burdens. Government Agency workers were more likely to view poverty in relation to official quantitative measures such as the World Bank, $1.25/day definition. However, they also explored the use of the term hardship, to appropriately define the condition of Tonga. Conclusion: This study provides current, nuanced information on what poverty means to pre- and postoperative cataract patients as well as government agency workers and its significance to improving responsiveness to the impact of poor eye health. The relationship between experiencing poor vision as a result of cataract and broader experiences of poverty and hardship were evident within the sample interviewed. Most cataracts are related to ageing and cannot be prevented, but cataract surgery is highly effective. Although the benefits of providing free cataract surgery are widely recognised and beneficial for the individual, the relationship and dependence of countries such as the Kingdom of Tonga, on donor funding for procedures such as cataract surgery, becomes a double-edged sword - this issue is ripe for further research as it has huge benefits economically for the individual and their household as well as the economic productivity of the country. However it also causes strain on the relationship between donor and receiver countries, especially when donors provide services when it is convenient for them to do so. There is a need to promote and strengthen primary healthcare in Tonga to relieve the reliance on donors and develop the capacity of primary healthcare workers. This would enable them to take the lead in working with the government and communities to prevent the onset of cataract early, before it becomes blinding.