Dr. Steve Miller still gets choked up at a photograph of a Tibetan boy and his mother.

"This boy is 3 years old, and it’s the first time that he’s ever seen his mother," he said. "He had congenital cataracts and we operated on both eyes. This is the day after the surgery, and it’s the first time he’s seen his mom."

The joy is evident in the faces of the son, even with thick eyeglasses, and in the beaming smile of his mother.

For the past 20 years, Miller, a retired eye surgeon at Kaiser Permanente Moanalua Medical Center, has been traveling to remote areas of Southeast Asia, Africa and the Middle East to teach cataract surgery and hospital administration. Through his work with the Seva Foundation, a Berkeley, Calif.-based organization, he’s played a key role in restoring and saving the sight of hundreds of thousands of people.

"The average productivity (for surgeons doing cataract surgery) in the United States might nowadays be 300 or 400 a year," said Miller, 69, who is now chairman of the Seva’s board of directors. "The productivity in a program that we have that is high-volume, high-quality — equivalent results to the U.S. — can be as high as 2,000 a year."

Early in his medical career, he had spent a couple of years working in the public health system in Alaska, which gave him inspiration for public service. As his daughter Alexandra got older, Miller decided she should "see something other than suburbia," and he looked for short-term medical postings overseas.

"I found most people were going and doing and then coming back and showing their slides," he said. "It’s kind of a habit and an attitude of Westerners, or at least it has been, where we will go do something nice to those little natives, and then we will come back and feel good about it."

Such trips often involve complicated medical procedures that require the latest technology and full medical staffing. Although it does a lot of good, it’s not really sustainable, Miller said.

"It does fill a need in certain areas, but it doesn’t completely cover the need because you can’t possibly do enough with a trip," he said.

The Seva Foundation took a different approach to public health. Founded in 1978 by Dr. Larry Brilliant, who was named one of Time Magazine’s 100 most influential people in 2008, and his wife, Girija, a public health specialist, and supported by people like the late Apple CEO Steve Jobs and self-help guru Ram Dass, Seva’s philosophy can most easily be encapsulated by the proverb "Give a man a fish and you feed him for a day; teach a man to fish and you feed him for a lifetime."

The foundation did a study in Nepal of the causes of blindness and found cataracts, a clouding of the lens, to be the main culprit. Rather than just bring doctors to Nepal, the foundation established a locally based system for eye care, including testing and corrective surgery.

"We want to have the country be responsible; we want to have local folks do it, from the surgery to the administration to the funding as much as possible," Miller said. "On the other hand, they needed some help."

Seva has an annual budget of about $5 million, which in part goes toward purchasing essential medical equipment and building clinics. But Miller said its chief role in developing the eye care system was finding the right people to help.

Surprisingly, technical ability does not rate as the most important quality the foundation seeks.

"You need to find some compassionate people — skilled or not doesn’t matter so much — but compassionate, active people who are respected and can work in their areas and be reasonable administrators," Miller said. "And then you can train them medically. … We’ve trained people in Tibet that had no medical background at all."

Cataracts frequently develop with age. Cataract surgery involves removing the lens of the eye, leaving the membrane that covers the lens in place, and replacing it with a plastic lens. The Seva Foundation helped set up a factory in India to manufacture the lenses inexpensively.

While surgeries in developed countries use advanced technology including lasers and vibrating syringes, Miller trains surgeons to do the procedure manually, obtaining results that are comparable.

"They use a simple knife — maybe a diamond knife, because it lasts longer. That lowers the instrument cost of $500 or $600 or more to essentially nothing, maybe $2," Miller said, adding that it usually takes a trainee about 50 cases to be "as good as at least the average American (medical) resident, and better than many."

One of his more prolific trainees include a woman who’s a sheepherder in the remote regions of western Tibet. "She goes out with her four-wheel-drive Jeep and rounds up the guys like she rounded up sheep," Miller said. "She says, ‘C’mon, guys, you’re getting your eyes fixed.’ She operates on them, fixes them and does a great job."

Miller has focused more on teaching hospital administration in recent years, but he’s helped develop eye surgery programs in India, Tibet, China and Cambodia as well as Tanzania and Egypt, initially using his vacation time to make a couple of trips a year and retiring early to work overseas.

He’s sometimes run up against politics and culture while trying to help people. In Cambodia, with its recent violent past, he found a generation that "had lost faith that you could cooperate with anybody and be safe." Many doctors there had both government and private practices and would steer patients from one to another to make the most money, which conflicts with Seva’s philosophy of high-volume, low-cost surgeries.

In Tibet he found that monks would have cataract surgery on one eye but not the other. "They’d say, ‘Buddha made it that I should be blind, so I’m kind of cheating a little bit by getting one fixed. I will die if I get my second eye fixed,’" Miller said.

But he’s has had many touching moments with patients, too. He remembers asking a blind beggar from Tibet why she wanted the surgery. "She said, ‘Because I can’t see what people put in my bowl.’ Now she can."

ON THE NET:
» seva.org