The eye surgery that finally came to Monument Valley

At seventy, Sandra Fletcher had watched her sight dim for years. In June she lay down in a new surgical suite at the Monument Valley Community Health Center and stood up able to see — one of seven patients in the first round of surgery ever performed on the Utah portion of the Navajo Nation.

The suite was built inside a clinic that already knew these patients. The Utah Navajo Health System runs it as a federally qualified health centre rather than an Indian Health Service facility, which means it treats people regardless of what they can pay. Michael Jensen, its chief executive director, and Revina Talker, a physician assistant at the health centre, worked to bring the operating room online. The John A. Moran Eye Center in Salt Lake City supplied the surgical expertise through Craig J. Chaya's community outreach team, and the Seva Foundation — through Jennifer Leo's American Indian Sight Initiative — paid for the buildout.

Cataract surgery takes fifteen to thirty minutes. The clouded lens comes out, an artificial one goes in, the patient goes home the same day. What made it hard here was never the operation. It was the distance: the drive to Blanding, the arrangements for a ride, the day of work lost, the calculation a person makes about whether dimming sight is worth all that. Many decided it was not.

Moran has been screening eyes on the Utah Navajo Nation since 2012, and the numbers it gathered describe the shape of the loss. Among patients found blind in both eyes, 73 percent had conditions that were treatable or preventable. Sight that could have been kept was being lost to a road.

Monument Valley sits at about 5,200 feet, and the ultraviolet light at that elevation brings cataracts on earlier. Diabetes compounds it: American Indian and Alaska Native adults carry the highest diagnosed rate of any group the CDC tracks, and diabetic retinopathy follows. In chapter communities like Oljato and Navajo Mountain, some households have no piped water, which turns even the instruction to keep the eye clean after surgery into a logistical problem.

Seva began in 1978, when the epidemiologist Larry Brilliant, fresh from the smallpox eradication campaign in India, and Ram Dass started funding cataract work in Nepal. Nearly fifty years later the same organisation paid for a room in the Utah desert.

Seven people saw clearly again in June. The next ones will not have to drive.