The angels arrived after breakfast.
They were wearing fetching pink T-shirts complete with their hospital logo.
They had driven 5 hours from Bihar’s Muzaffarpur city to pick us up.
They refused chai and naashta – they had already enjoyed coconuts and ice cream on the way, they said. And there were still miles to go before we slept – at a remote farmhouse in the village of Sarkhauli in Bihar’s Madhubani district, a kind of rural outpost for Laxman Eye Hospital.

The country road meandered through fish farms and village ponds sprouting water lilies.
‘They eat a lot of fish here” said Angel Babul.
Then we joined National Highway 27A, an inconsistent road which, miraculously, became a glistening, newly tarmacked surface when its identity changed to NH 27B.
I remarked that I had never seen such an exponential expansion of the road network in Bihar as during the six months since my last visit.
“This is development’ remarked Angel Pompom. With a touch of angel-irony in his voice.

We arrived at Sarkhauli at sunset, with spreading, pink-tinged wing-shaped clouds hovering over the rooftop of our farmhouse. We were guests of Rita, who had been a mukhiya (village head) for 10 years and her husband Ramsagar Yadav. I got the idea that they were a team and even in their post-mukhyia days ran the village together, from their sprawling multi-coloured bungalow, surrounded by their extended family, a few water buffaloe and their own pond teeming with fish.

We met two more angels – this time in sky blue T-shirts – who vacated the bedroom that had been their base for three months so that we (the Second Sight three) would not have to share one small bed.
They preferred to sleep under the stars anyway, they said.

The next day the Laxman Eye Hospital lads took on a more specific role – they became Vitamin Angels.
Vitamin Angels (VA) is actually the real name of a US-based organisation that provides Vitamin A supplements.
Vitamin A deficiency can cause a spectrum of damage to the developing eye. It remains the leading cause of childhood blindness. It can also be a killer. The deficiency weakens the immune system making young children more vulnerable to illnesses like measles or diarrhoea which can be fatal.
In the UK most children get enough Vitamin A in their daily diet.
Bihar has one of the highest level of malnutrition and Vitamin A deficiency in the world. In most cases, families are simply too poor to be able to include the leafy green, yellow, orange or red vegetables in the daily diet of their under 5s.

Hence the importance of supplements.
VA provide these - the full required dosage of 200,000IU (international units) for those over 12 months, half that dose for younger children. And in a form that is easy to administer. Cut off the tip of a capsule and pour the liquid into a small, open mouth. Repeat every six months until the age of 5.

The organisation have always been canny about their choice of partner organisation.
In Bihar at least. Years ago, their then Indian Head – Dr Shilpa Bhatte - realised that our local eye hospital teams were the ideal administering angels.
They carry out hut to hut village screening as part of their routine work; ophthalmic staff are trained to recognise eye problems resulting from Vitamin A deficiency; in many a Bihari village half the population can be under the age of five.
Until last year two of our hospitals with the most extensive outreach teams were recipients of Vitamin Angels supplements, couriered with great efficiency to their doorstep.

Then VA supplies in India ground to a halt. The organisation had a manufacturing problem. It was a heart-sink moment.

The good news, for Laxman Eye Hospital at least, is that supplies are back on tap. The new Indian head is a nice man called Gaurav who has worked for VA for many years.
He resumed supplies to LEH and went out with its angels.
When we met in Mumbai he was as happy as I was to have witnessed them in full flight. Popping liquid supplements into little mouths is only part of what any successful Vitamin A programme must do. As was amply demonstrated in Sharkhauli village.

We started work at 6am in temperatures already soaring to 100 degrees. The angels who had lived in the village for the past three months knew that its population was around 3000 and that there were almost 400 children under the age of 5. All these must be registered and given Vitamin A supplements.
Most of the grannies and older siblings who were the childrens’ carers were eager and willing for this to happen. They were inquisitive about what the liquid in the capsule actually was, why it was important. These ‘guardians’ as they are called were also the best source of information as to whether or not a child had received measles vaccination.

It was not all plain sailing, however.
Said one suspicious man in the smarter end of the village: the government came during Covid and gave us medicine that made us all sick.
We are from Laxman Eye Hospital, explained Amit turning his back to show the white lettering of the hospital logo. (Other members of the LEH outreach team would come to the village at another time to identify adult patients requiring cataract surgery).
We know about Vitamin A deficiency because we can see the signs in children’s eyes.
Also, look at their hair, said Surjit gesticulating to the many blonde-haired toddlers. Why do you think it is light-coloured, not black? That’s a sign of malnutrition. Here, take a leaflet and read why we are doing this, he suggested to the sceptic. The man took the leaflet.

The angels have to tread sensitively when it comes to explaining the root of the problem – the lack of dietary Vitamin A in the children’s food. The last thing they wish to do is to make poor families with very few options feel inadequate or guilty that they can’t feed their children properly. It is very much a case of, if possible, if you have the means to buy or grow such vegetables, fruits, remember that it is the smallest children who need it more than others. A small amount each day will do. In the meantime, please allow us to give them these supplements until they are out of the danger period.
Believe me, this kind of detailed interchange demands enormous tact, listening and observational skills and empathy. A composure the angels had in abundance.

Occasionally they got a flat refusal. A naked three year-old squirmed his way out of the combined clutches of grandmother and older siblings and then ran like the wind through the village scattering startled goats and squalling hens. Angel Babul, serene in the scorching sun, made a note of his name for a second attempt on another day.

On the way back to the farmhouse we pass a young family returning from the fields where they have been working since sunrise. They carry hoes and spades. Two toddlers hold the adults’ hands. A smaller babe dangles from its mother’s hip.
‘That’s why we must go to the fields’ explains Babul. “They take the breast-feeding babies with them.’

The couple look exhausted. But by the time they reach home, their small children have been protected against Vitamin A deficiency for six months and they know that the LEH angels will return to top them up.

We left Sarkhauli at around 11am, luxuriating in the cool of our air-conditioned car. The angels napped, checked their messages. We agreed that the abundance of ripe mangoes available at this time of year made the heat bearable.

My phone pinged.
Someone, actually the third person to do this, had forwarded me a link to a YouTube video. It was called India’s Eye Care Revolution.
In the video, an Indian cardiac surgeon called Dr Devi Shetty, well-known for bringing the price of cardiac surgery down to affordable costs, talks over graphs with stats about cataract surgery worldwide.
3.5 million annually in the USA, 3.2 million in China and 8.5million in India.

How did India do it? he asks. The script goes on to explain that 30 years ago, Indian doctors “got fed up of big hospitals” and walked out, set up their own small clinics on the ground floor of their homes, where necessary got ‘“their wives to assist them” (!) and brought down the cost of cataract surgery so that “anyone can afford it.”
Unchallenged by an awestruck interviewer – cutaway shots of this man muttering “incredible” - the Dr Shetty on the video goes on to announce with triumph that “in India today you don’t find a single person who is blind due to cataract.”

I have since done some research and discovered that this video could be an AI-generated fake. It seems that Dr Shetty has been a victim of this in the past. However, what is important here is the response of the young men with me.

‘Look what people keep sending me’ I said, passing my phone over to them.
They watched, raised their eyes to heaven.
Handed me back my phone.
Obviously the video didn’t warrant discussion or comment.

And for good reason.
Having completed their morning’s Vitamin A programme, the team were returning to the base hospital in Muzaffarpur city. There the surgical team, under Lead Clinician Dr Razi Hassan, were preparing to operate on 20 patients that evening – all blind from cataract.
A day like any other at Laxman Eye Hospital which restores sight to around 20,000 people every year.

The angels are living an eye care revolution in Bihar. No need to comment on ludicrous assertions made on social media. They have too much common sense for that.

Lucy Mathen

#vitaminangels #commonsense #laxmaneyehospital #cataractblindness #childhoodblindness