girl: a young Afghan outside her family’s home in
the interlocking network of caves and grottos in the
sandstone hills that line the city of Bamiyan, home
to the famous statues of Buddha destroyed by the Taliban
Benevolent Life, and a Violent Death
Saturday (Aug. 7), the world received news of the deaths
of 10 people, including six Americans, who were slain on
a medical mission in Afghanistan. Among them was
Dr. Tom Little, a Delmar optician who spent decades in the
country, leading the National Organization for Ophthalmic
Rehabilitation, an eye-care mission serving patients in
the remote and impoverished reaches of embattled Afganistan.
Little raised three daughters in the country with his wife
Libby. He survived the turmoil of the Soviet invasion and
civil war, and provided care to countless patients.
Although their claims have not been verified, the Taliban
immediately took credit for the murders. Taliban spokesman
Zabiullah Mujahid told the Associated Press they killed
the medical team because they were “spying for the Americans”
and “preaching Christianity,” claims that have been widely
denounced and do not fit with any known information about
NOOR and its work.
Little rarely spoke of the details of his work and experiences,
but six years ago, Metroland staff writer Travis
Durfee traveled to Afghanistan with freelance photographer
Connie Frisbee Houde to document life in the war-torn country.
One of the many stories he brought back was that of Little’s
work with NOOR.
On April 29, 2004, Metroland ran Durfee’s story “Sight
for Sore Eyes,” an in-depth account of Little’s experiences
in Afghanistan and the day-to-day work of NOOR, an insight
into the impact of that work on both patients and doctors.
This week, as news of Little’s untimely death ignites interest
in his life’s work, we are reprinting the article in full.
We hope it serves as a fitting tribute to Little, and offers
our readers an opportunity to understand the man behind
the story and the work he gave his life to advance.
marshalled peace: a German soldier from the International
Security Assistance Force, the 34-nation, 6,500-troop
military peacekeeping force, in Kabul patrolling the
deteriorating Shrine of Nadir Shah, the father of
Afghanistan’s former king, Zahir Shah.
For Sore Eyes
eye-care mission run by Delmar optician Tom Little restores
vision to people in some of Afghanistan’s poorest and most
brilliance of the morning’s crisp sunshine lingers in the
canopies of the budding poplar and locust trees that line
the streets of Kunduz, a small city in northeastern Afghanistan
roughly the size of Albany. Pink, yellow and red rose bushes
are starting to bud at the edge and center of carefully
irrigated dirt plots, the work of determined gardeners willing
to give it another go despite the drought that has crippled
agriculture throughout much of the country for the past
six years. Swallows, warblers and magpies dive and flicker
and flit about, chirping a soundtrack to the beautiful spring
morning. Despite their number, you have to strain to hear
their symphony. It’s difficult to make out the birds’ tunes
above the clamor of men.
A sea of bodies six deep, probably 30 in all, undulates
around the window of the 1970s-era Russian bus, maneuvering
for the attention of the man inside. The pushing, pulling,
reaching and shouting are intense. Head wraps are dislodged,
fingers are twisted and beards are pulled. Spit flies and
shoving matches ensue as the men reach for the freshly scribbled-upon
pieces of paper. Another two dozen men wait patiently just
beyond the scrum. Some, arms folded, will wait till the
crowd disperses. Others on the periphery plot their entrances
and wait for an opening, an exiting body, an opportunity
to drop a shoulder and barrel into the crowd. There is no
stated limit on the number of people who will be seen, but
there is a rush. The crush lasts for over an hour. And then
the women get their chance.
These Afghans aren’t reaching for the autograph of a famous
Bollywood star on a bus-stop tour to promote the release
of an upcoming film. Nor is this a line for free food from
the World Food Program. The man in the bus is an ophthalmic
technician—an eye-doctor’s assistant—and the little pieces
of paper the Afghans fight for are appointment cards. Today
is the first day of a two-week eye camp run by the National
Organization for Ophthalmic Rehabilitation, or NOOR for
Roughly 70 percent of Afghanistan’s population, which the
best guesses put at 25 million, lives in remote regions
of the country’s rugged landscape. Few medical facilities
exist in these rural areas and the idea of a doctor in rural
Afghanistan specializing in eye care makes about as much
sense as a Rolls Royce repairman setting up shop in Schoharie
County. Despite the shortage of facilities and adequately
trained ophthalmologists and opticians, the need for eye
care is pervasive. Infections like trachoma and conjunctivitis,
and visual impairments like low vision and cataracts—matters
that could be easily corrected if diagnosed and treated
in the United States—often lead to blindness in Afghanistan,
placing further strain on already stressed families. The
World Health Organization estimates that 2 percent of Afghanistan’s
population is blind, one of the highest rates in the world.
It is thought, however, that 80 percent of that blindness
is preventable or correctable through cataract surgeries
or other treatments. But since most of the country’s population
is too poor to travel, Afghanistan’s blind often stay needlessly
sightless for years.
at a time, please: a crush of patients seeking eye
care in Kunduz, Afghanistan.
of the many programs run by NOOR (which means “light” in
Persian) brings eye care to Afghans in these remote areas
through eye camps. Small buses or Range Rovers loaded up
with medical equipment trek out to areas of need for two
or three weeks at a time to provide a range of basic eye-care
services like vision testing, providing drops and ointments,
and filling eyeglass prescriptions. NOOR-trained doctors
also perform basic surgical procedures, like cataract removal
and lens replacement.
As with much of the country, there are no trained eye doctors
in Kunduz province, a 500,000-person rural area bordering
Tajikistan. For the next two weeks, Afghans who’ve traveled
to the only hospital in the province’s capital will be examined
by trained ophthalmologists and technicians. For many it
will be the first time in their lives.
As the eye camp’s first morning stretches on, a teenager
wiggles away from the chaos in front of the bus with an
appointment card. Later that afternoon he will lead his
sightless, elderly grandfather to a simple surgery to remove
the cloudy, opaque cataracts that left him blind two years
ago. Three women, who traveled two hours from a neighboring
village, leave with the satisfaction of new eyeglasses to
cure the nearsightedness that finds them squinting from
beneath their burqas. A 55-year-old government employee
will have his vision tested for the first time and receive
a replacement for the pair of reading eyeglasses he picked
up in the bazaar a few years ago: a beat-up pair of tortoise-shell
frames with only one arm remaining and a rubber-band-and-string
headband to hold them in place.
Mohammed Guma, a 45-year-old rice farmer from a neighboring
village, also fought his way through the crowd this morning,
but so far has received little more than a promise. Guma’s
7-year-old daughter, Qandygul, has been blind since she
was 7 months old. When they visit with a doctor later in
the day, Guma is told that his daughter’s blindness is the
result of something called congenital cataracts. As is often
the case in Afghanistan, Guma married within his family.
He fathered eight children with his second cousin, and Qandygul’s
blindness is a result of their shallow gene pool.
But this Guma does not understand. He contends it was chicken
pox, after a case of which his daughter slowly began losing
her sight. Guma realized his daughter was going blind when
as a toddler she began walking around with her arms outstretched,
often tripping and falling. He hopes the doctors will be
able to fix this, but he will have to wait. Guma is one
of some 400 patients registered during the early hours of
the eye camp’s first day.
NOOR, a program of the Kabul-based International Assistance
Mission, has operated almost continually in Af ghanistan
since 1966. And although it receives no government funding,
NOOR provides the majority of eye-care services in Afghanistan.
Tom Little, 56, originally from Kinderhook, is NOOR’s program
director. Little and his wife, Libby, maintain a home in
Delmar for their annual visits to the States, but the couple
has lived in Afghanistan for the past 26 years, where they
have raised three daughters. A well-built man of average
height, Little has a full head of graying, sandy hair, wears
NOOR-manufactured glasses, and bears a slight resemblance
to David Letterman.
Fluent in Dari, one of two Persian-based languages
spoken in Afghanistan, Little, or Mr. Tom as he is called
by the Afghans who work under him, spends his days visiting
NOOR facilities in Kabul and throughout the rest of country
making sure that they are running up to speed.
Little oversees NOOR’s three 40- to 45-bed eye hospitals,
one in each of the country’s three major cities of Kabul,
Heart and Mazar-I-Sharif, as well as a number of smaller
eight- to 10-bed facilities in the smaller cities of Khost,
Nilli and Talaqon. The program also provides support and
pays the doctors and technicians at the Ministry of Health’s
main hospital in Kabul, an 80-bed facility. NOOR operates
roughly a dozen eye camps throughout the country each year,
as well as a number of day clinics just outside of the cities
containing major hospitals. All told, NOOR facilities saw
234,570 outpatients in 2003, and operated on more than 14,000
All of these hospitals are staffed and run by Afghans trained
and paid by NOOR, which employs more than 200 Afghans nationwide.
The doctors earn an average of $300 per month, an excellent
salary in a country where many families eke out an existence
on less than $30 per month. All of the doctors and technicians
were educated at the ophthalmic training program NOOR runs
at Kabul University, which graduates a handful of ophthalmologists
and technicians annually.
NOOR also runs a fully functional, and quite busy, eyeglasses
manufacturing shop in Kabul. Working with imported glass
from Pakistan and India, donated frames from across the
globe, and antiquated machines donated by a man in Pennsylvania,
NOOR produces and sells approximately 25,000 pairs of low-cost
eyeglasses per year. NOOR also employs a dozen women throughout
the country who produced more than 350,000 bottles of medical
eye drops in 2003.
Even the Taliban recognized NOOR’s singular role in providing
eye-care services in Afghanistan. Despite the repressive
regime’s viciously enforced rule that women were not allowed
to work outside the home, NOOR convinced the Taliban to
allow its all-female-staffed eyedrop manufacturing operation
to remain open in Kabul. Little fed the Taliban the white
lie that these women were the only people in the entire
program who knew how to produce the drops, and the half-dozen
women employed there were permitted to work throughout the
you see: Massoud Ahmedi, 20, an ophthalmic technician
with NOOR, explaining an eye chart requiring patients
to say which direction the prongs on the letter “E”
are pointing. The length of many Arabic letters are
such that they cannot be used for eye exams.
likes the program to run autonomously, with himself and
the few other expatriate managers providing as little oversight
as possible. “That way, if we’re ever kicked out of the
country again, the hospitals don’t have to shut down and
people can still get glasses,” Little says. And besides,
Little wasn’t supposed to be doing this anyway; one of his
reasons for coming to Afghanistan in the first place was
to avoid practicing eye care.
Little spent his summers and vacations throughout his undergraduate
and graduate studies working in his father’s successful
ophthalmology practice in Hudson. After Little received
his graduate degree in theology, his father was pressuring
him to apply for med school so he could one day take over
the family business. Not ready to make a decision, Little
decided to get as far away as possible.
He and his wife connected with a missionary group providing
social services to hard-up hippies who’d traveled from all
over the West to Afghanistan on quests for . . . well, you
name it. Whether it was part of the journey or not, many
of them found drugs, addiction and jail terms in less-than-civil
judicial systems. Little and his wife moved to Afghanistan
with their 5-year-old daughter in 1979 and settled in the
northeastern city of Heart. Within weeks, though, Little
had connected with NOOR people and was working as an optician.
Despite how matters unfolded, Little says his father never
razzed him nor leveled the big I-told-you-so.
think he understood and respected the work I was doing,”
Little says. “I think he would’ve liked to do it himself,”
he later adds, mentioning that his father once provided
similar services to families in remote areas of the Canadian
province of Saskatchewan before opening his own practice.
The Littles’ lives in Afghanistan have mirrored the war
and civil strife that has plagued the Central Asian nation
for the past 25 years. With prodding after dinners and over
tea, Little and his wife recall story after story—some candidly,
others somberly—of what they’ve been subject to throughout
a quarter century in Afghanistan.
There are far-off glances and long silences between the
gruesome details the couple remembers from the 1979 Russian
massacre and subsequent Afghan uprising that claimed hundreds
of lives and ultimately led to the Russian invasion. The
uprising took place mere months after they’d arrived in
the country. It was so brutal that the U.S. Embassy told
their relatives back home that the family was assumed dead.
The Littles recall exchanging morning forecasts predicting
the number of shells that would drop during the years of
civil war that destroyed Kabul, the nation’s capital. “Well,
it feels like a 10-shell day today,” Little says, remembering
how he and his wife used to joke. As if their lives weren’t
in danger at the time, the Littles offer hilarious renditions
of being kidnapped by the Taliban on multiple family picnics;
the Littles’ eldest daughter has since sworn them off.
It’s midmorning on the eye camp’s third day, and Guma, his
wife and daughter idly pass the time under a budding locust
tree in the courtyard of Kunduz’s Spinzar hospital. They
have yet to visit the surgeon. A technician examined Qandygul
on the first day and she was scheduled for surgery yesterday,
but the hospital lost power for most of the afternoon and
the operation was put off. A power cord run from a generator
was fed to the operating room through a freshly broken window—in
the middle of a dust storm, no less—to allow the surgeon
to finish the day’s operations. Considering the circumstances,
the doctor thought Qandygul’s surgery should wait. Maybe
today will bring better news.
The Gumas have not seen home nor tended their fields since
setting out by bus four days ago. The four-hour ride into
Kunduz from the neighboring village of Imamsib cost the
three Gumas 100 Afghani (the equivalent of $2). Guma bristles
at the price; that could’ve bought a cut of meat, some rice
and beans, and a stack of naan—enough to feed the
family for a few days. But the trip will be well worth the
cost if his youngest daughter regains her sight.
A chubby-cheeked young girl, with ruddy, slightly pocked
skin, Qandygul hovers at her mother’s side in the hospital
garden. Wearing a heavy, kelly-green dress bearing a red
floral pattern, Qandygul playfully tugs on her mother’s
burqa as the two whisper and giggle to each other.
If she could look into a mirror, Qandygul would see wide
eyes in a rich, chocolate brown, the whites bright and clear.
Sitting in the courtyard, Qandygul’s head darts about quite
often, tracking down each passing sound. She smiles a lot.
Qandygul’s lenses, the part of the eye that allows humans
to focus on objects, have atrophied and clouded over. Not
only do her lenses not focus, but they do not allow light
to pass through them. Ordinarily, the opaque masses that
have become Qandygul’s lenses would be removed and replaced
with plastic ones. This is a relatively simple operation.
And when it occurs, Qandygul’s cataract surgery will in
all likelihood be one of 12 or 15 the doctor will perform
that day. But there are still questions as to whether the
operation will restore the little girl’s sight.
Qandygul has been sightless since she was an infant and
her doctor is uncertain whether or not the neural pathways
that should have developed during her early childhood will
know how to process the light that will soon pass through
her optic nerves. The doctor says there is a possibility
that the operation will only lead to a different blindness—an
all-white, incomprehensible blur, as opposed to the current
black cloud. It will be a matter of months after the operation
before the doctors will know if Qandygul has retained any
semblance of normal vision.
But that will now be several months plus one day. The surgery
will not happen this afternoon, either, the Gumas are informed
after lunch. The anesthesiologist and the head of the hospital
entered into a shouting match and the former has left the
hospital for the day. Local anesthetic is recommended for
a child receiving a cataract surgery, so Qandygul’s quest
for sight must wait.
Mohammed Guma, whose daughter Qandygul visited the
eye camp seeking surgery to correct the cataracts
that have blinded her since infancy.
history in Afghanistan has been no walk in the park. Hospitals
have been looted, homes have been vandalized, co-workers
have been murdered. But despite these hardships, the group
always found a way to move ahead.
Ironically, Little says, it wasn’t until a relative calm
befell the country following the U.S.-led forces’ overthrow
of the Taliban in November 2001 that NOOR’s future became
truly uncertain. When the Transitional Islamic government
of Afghanistan named what it saw as the basic aspects of
the nation’s health-care system that most needed funding
in 2003, the Ministry of Health focused on a basic package
of health services: more and better maternal and prenatal
care, increased childhood immunization programs, public
nutrition, disease control, mental health and disability
services and steady pharmaceutical supply. Eye care was
That was all it took for a long-tapped donor community to
begin withdrawing support, and despite surviving years of
carnage and war, NOOR was faced with the possibility of
closing its doors for lack of funding. The group’s money
had already been appropriated for the year, but whether
NOOR would be able to operate in 2004 remained uncertain.
By the year’s end, NOOR was bailed out by a generous contribution
from the Germany-based Christoffel Blind Mission, but Little
knew his organization needed to find a new way to keep its
programs afloat. What he devised was a new way to present
fund-raising for NOOR projects: Pitch the program’s various
projects to smaller donors as investments. The return on
which, Little says, is knowing that a $2 donation can provide
a pair of eyeglasses for a poor patient, $10 can surgically
repair eyes damaged by a land mine, a $50 donation would
purchase an intraocular lens surgery for one patient, a
$1,000 donation provides an Afghan ophthalmologist with
a good salary for one year, and $2,000 pays for an eye camp.
people are more willing to donate if they feel like they
know exactly what their money is going to,” Little says.
“It is easier to think about people writing a check to pay
for a handful of cataract surgeries as opposed to just donating
money to an organization and not knowing what they’re going
to do with it.”
Little returned to the States last summer to present his
investment idea to a number of potential donors across the
country, but he found one investor before he left Afghanistan.
Connie Frisbee Houde, of 20 Grand St. in Albany, traveled
to Afghanistan for 10 days last February and was moved after
witnessing the nation’s many needs. Looking for a way to
help, Houde found a suitable charity after a dinner with
Little in Kabul.
was so taken by the way Tom described the NOOR project,
how it worked and the whole thing about $50 buying a cataract
surgery,” Houde remembers. “He said he was trying to interest
donors back home and right then the wheel started clicking
for me—maybe I could put together a little money for the
Houde, a freelance photographer who works for the New York
State Museum, spent the next year showing her photos and
speaking to different groups about her experiences in Afghanistan,
all the while collecting funds for an eye camp. Prior to
returning to Afghanistan last month, Houde hosted an Afghan-style
dinner at Albany’s Westminster Presbyterian Church on State
Street to raise even more money for the NOOR project. Houde
says that more than 150 people attended. All told, Houde
says she raised almost $7,000 for NOOR, or approximately
3.5 eye camps.
seeing how the operation works, I feel good about knowing
that that money is going to good use,” says Houde, back
home form her trip to Afghanistan. “I’m frustrated when
I donate money to organizations and so much of it goes into
administration and salaries. What struck me about this program
is, yes, the money you donate is going to people’s salaries
but it is going to salaries of Afghans who otherwise wouldn’t
have a salary, not just another bureaucrat sitting in an
might ask me why didn’t I raise money for some project here
in the States,” Houde continues, “but you know, we have
so much here. To raise $7,000 for Afghanistan, which does
so much, is really just a drop in the bucket. There is so
much that needs to be done there.”
The Guma family has been sitting on the floor outside of
the operating room since early this morning when the surgeon’s
assistant comes to inform them that Qandygul will have her
surgery a little before noon on the eye camp’s fourth day.
Though it was to her mother’s side that Qandygul has clung
over the past four days, it is in her father’s arms that
the little girl is delivered to the operating room and placed
on the cold, metal operating table draped with a thin cotton
sheet. Her body barely spans half of the operating table.
It is 11:05 AM and Qandygul begins to cry as the doctors
insert an IV into her arm. Minutes later the anesthesiologist
delivers a shot of Ketamine and within seconds Qandygul’s
eyes glaze over. Her lids shut a few seconds after that.
At 11:17 AM, the gloveless doctor swabs Qandygul’s face
and eyes with an iodine-drenched cotton swab and drops it
into a red plastic bowl on the floor below the operating
table. The bowl contains syringes, used blades, discarded
human lenses and other surgical waste from the half-dozen
cataract surgeries the doctor performed earlier this morning.
ain’t from around here are ya, boy: Tom Little, NOOR’s
program director, grew up in Kinderhook and maintains
a home in Delmar.
his forefingers pressed against Qandygul’s wrist, the anesthesiologist
pulls double duty as a heart-rate monitor since none exist.
The little girl’s dress has been lifted to expose the rising
and falling of her belly; it is the only means the doctors
have to tell whether their patient is still breathing.
The operating room’s light bulb has been flickering for
a few minutes when the doctor places a speculum in Qandygul’s
right eye and covers the rest of her face with a thick blue
cloth. With the sliver of razor that he broke off from a
larger blade, the doctor makes his first incision into Qandygul’s
cornea at 11:20 AM.
doctor slides a thin, crooked metal device the width of
a sewing needle into the slit in Qandygul’s cornea to detach
the lens from the rest of the eye. This procedure creates
debris in the eye that needs to be flushed prior to proceeding,
and the doctor assembles a surgical device to wash away
the detritus. It’s 11:22 AM.
As the doctor brings the hydrating device over to Qandygul’s
head, it’s apparent there is a problem. It usually shoots
a thin, steady stream of water, but now produces only a
steady drip, drip, drip. The doctor fiddles with the device
but can’t seem to correct the problem. The blue cloth covering
Qandygul’s face begins to show a puddle and the doctor lets
out a sigh. Qandygul’s stomach rises and falls and still
drip, drip, drip. Frustrated, the doctor disassembles the
electronic device and rigs a manual facsimile with the plunger
from a nearby syringe. The other doctors in the room crowd
around the table. It’s 11:26 AM. The rigged device does
the trick and the doctor proceeds. He removes the first
of the two deteriorated lenses at 11:30 AM.
A battery-operated radio is blaring and the doctor is stitching
Qandygul’s cornea when the operating room loses all power
at 11:35 AM. The doctor’s hands freeze and the anesthesiologist
leaves his post as a heart-rate monitor and assumes the
job of operating-room spotlight, for which he uses a nearby
flashlight. Qandygul’s stomach continues rising and falling.
Someone starts a diesel-powered generator outside. Power
is restored to the magnifying lamp at 11:37 AM and the operation
continues to the din of a two-stroke.
By 11:57 AM, the doctor has removed both lenses and is preparing
Qandygul’s eyes for recovery. Two gauze pads are placed
over each of her sockets and secured with tape. Before removing
the blue cloth from Qandygul’s face, the doctor wipes the
blood from his fingers with a cotton ball soaked in alcohol.
The little girls rests on the table, awaiting a move to
her family and one of the hospital’s many crowded recovery
Qandygul is one of more than 3,000 patients treated at the
two-week eye camp in Kunduz. Her doctor performed more than
100 cataract operations. From the dirt-floored examination
rooms at Kunduz’s Spinzar Hospital, NOOR provided hundreds
of eyeglasses and filled countless prescriptions for simple
medicine like eye drops and ointments.
In six weeks Qandygul will return to this hospital to have
her eyes examined and fitted for new lenses. The replacement
surgery will follow a few weeks later. Shortly after that
surgery, doctors will be able to tell if Qandygul’s brain
will be able to register the light that is now flooding