Oration for Dr John Sandford-Smith MBE

By Professor Gordon Campbell

John Sandford-Smith is an ophthalmologist who served for 21 years as Consultant Ophthalmologist at the Leicester Royal Infirmary, and as Honorary Clinical Tutor to the University of Leicester. Today we honour him both for his medical service in Leicester, to patients and to our students, and for his work in some of the world’s poorest and, in some cases, most dangerous places.

John read Medicine at Cambridge. After graduating in 1961 he hoped to find a job teaching at one of the new universities in sub-Saharan Africa, but no such post emerged. He therefore, at the suggestion of a friend, decided to serve for a year as a volunteer at the Christian Mission Hospital in Quetta, a Pakistani city close to the border with Afghanistan. He drove overland to Pakistan in a second-hand Land Rover, and soon immersed himself in the work of the Hospital. Among the features that engaged him were the so-called 'eye camps', which were pop-up surgical eye units in rural Balochistan, the poorest province in Pakistan. He also began to learn Urdu, the first of many languages in which he learned to say 'open your eyes'. Towards the end of his period in Quetta a job came up in the Nigerian city of Ibadan, and John was able to revive his plan to work in Africa. He returned to England, married his girl friend Sheila (who is with us today), and together they went to Ibadan, where John worked as a surgical registrar at University College Hospital, which was then the only teaching hospital in West Africa.

In 1966 John returned to England to begin postgraduate training in Bristol. In the interval between his Registrar and Senior Registrar posts at Bristol, John returned to Quetta for three years, this time as Specialist Ophthalmologist and Surgeon, and this time with Sheila. By the time he returned, he had become fluent in Urdu, a language that was in due course to be useful for his interactions with patients in Leicester. At the end of his postgraduate training John chose to return to Nigeria, this time to serve for four years as Consultant Ophthalmologist at Ahmadu Bello University Hospital in Kaduna. In Nigeria he also began to publish, notably on herpes simplex keratitis, a condition that damages the eyes of young children with measles.

After four years in Kaduna, John returned to England to take up a post as a consultant in Leicester. He had spent nine of the 18 years since he graduated in overseas work amongst the very poor. For all but the first of those years, Sheila was with John, and they were raising a family. One of their four children was born in Pakistan, and another in Nigeria; all four are with us today. Our purpose today is to honour John, but we cannot do so adequately without acknowledging the importance of Sheila. She has tirelessly supported John in his work for the disadvantaged, raising a young family overseas and continuing to support and understand the value of the journeys he makes in his late seventies.  John dedicated one of his books “To Sheila my wife, who has brought up a family in three different continents and 12 different homes and hardly ever complained”.

The move to Leicester did not involve any diminution of John's commitment to third-world medicine. He managed to spend at least a month a year overseas, not by applying for grants, but rather by paying his own expenses and accumulating the time off by consolidating two weeks of his annual leave and one week of study leave, and by being on call on all bank holidays and at Christmas.

After he retired in 2000, the time that John spent overseas quadrupled. Throughout the 16 years of his retirement, he has worked in a direct surgical role in many developing countries. For most of those years, he has made annual visits to Yemen, India and Burma.  In his retirement John's surgery and his development of ophthalmological training projects have also taken  him, sometimes repeatedly,  to Bangladesh, Benin, Cambodia, Ethiopia, Gambia, Ghana, Malawi, Nepal, Pakistan, Sierra Leone, Tanzania, and Uganda. In these countries  his expertise has been of huge benefit, not least in training others in the inestimably valuable technique of small incision cataract surgery.  John has carried out up to 50 cataract operations in a day, but he is also a dedicatedly patient teacher of all grades of ophthalmic worker (doctors, nurses and paramedics) and has played a particular role in training nurse-cataract surgeons, whose surgery is helping to remedy the shortage of doctors in rural areas of several African countries.

Beyond all of this, there are two more important contributions. First, there is a pair of textbooks, Eye Disease in Hot Climates and Eye Surgery in Hot Climates. Both are written in simple English, because their readers include many for whom English is a second language. Both have been translated into a similar register of French, the other important international language in sub-Saharan Africa. Both have been read in large numbers by health workers all over Africa.

The second contribution is technical -- not the ever more complex equipment used in the developed world, but rather the equipment that practitioners in developing countries can afford and maintain. Eye doctors need ophthalmoscopes, and they typically cost about £100, which is far beyond the resources of health workers in poor countries. In the Christmas 2000 issue of the British Medical Journal there was a light-hearted article about an ophthalmoscope made of silver paper and a rolled-up tube of cardboard. This article sparked a sequence of events that culminated in John tracking down a very able optometrist called William Williams, who as a result of John's briefing designed the ophthalmoscope now known as the Arclight. This is a robust and durable tool: it uses LED lights, so there are no filaments to blow; it can be charged with solar power, can double up as an instrument for examining ears, and costs just over £5. John and a colleague secured £100,000 from the Fred Hollows Foundation, an Australian NGO, to develop and produce the first 10,000 instruments.  The effect on eye health in developing countries promises to be transformational.

The qualities of the Arclight -- robust, durable and transformational --  might justly be said to characterise the life of John Sandford-Smith, which has been wholly dedicated to transforming lives, including those of the poorest people on earth. It would be difficult to think of a nobler way of living a life in medicine.

Delivered by Professor Gordon Campbell on 14 July 2016

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