KABUL, Afghanistan -- Had they treated Nasaratullah sooner, the doctors might have been able to save the Afghan baby's eye, which was riddled with cancer.
Instead, the doctors at Noor Eye Hospital, a rundown facility in the Afghan capital overrun with 400 patients a day, had to remove it.
"Unfortunately, people come to us very late," Dr. Najib Osmani said looking up from the operating table where his tiny six-month-old patient, still anesthetized, rested in purple pajamas. "In early stages, this is curable. You can save the eyes, the sight – everything. Not in Afghanistan."
Eye care is a casualty of Afghanistan's tortured history. Eye clinics exist in only a few major Afghan cities. There are only six ophthalmologists for every 1 million Afghans. The country's lack of roads, mountainous terrain, extreme poverty and three decades of civil unrest are immense roadblocks to getting care – and giving it.
Roughly 1.5 million Afghans are visually impaired, according to the Ministry of Public Health. Every year, around 25,000 Afghans lose vision in one of their eyes.
Nasaratullah, a round-faced boy from eastern Afghanistan, has retinoblastoma, a rare cancerous tumor in his retina. After removing it, Osmani embedded a whitish glass ball, which later can be replaced with an artificial eye.
The infant's other eye appears healthy now, but there is a 40 percent chance that cancer will develop in it as well, the doctor said.
"I pray the other eye is OK," Osmani said. "At least we can refer him to neighboring countries for better treatment, radiation or chemotherapy."
Simpler vision problems can be easily treated in Afghanistan – if patients can get access to care.
Sixty percent of all blindness in Afghanistan is blamed on cataracts, which are removed in simple operations common in the developed world. But in Afghanistan, only 15,000 cataract surgeries are performed each year, not even enough to keep up with new cases and causing the huge backlog of cases – 200,000 by some estimates – to grow even more.
Babi Dukther, a 45-year-old woman from Kabul, is one of the lucky ones. On a hot day in the dusty capital, she walked barefoot into one of the hospital's operating rooms where a man was still swabbing the floor with a dirty mop.
"My eyes have gotten weaker for five or six months, and in the last month, it got worse," the mother of seven said as she lay down on the operating table to have a cataract removed from her left eye. "When I look, it's like something is coming down from the sky – like it's raining or snowing."
Doctors perform 15 to 20 operations at the hospital each day. With more space, beds and equipment, they could do more.
"We have too many patients," Dr. Yosuf Mahboob said. "It's too crowded. We don't have enough rooms for checkups."
Patients start lining up outside the hospital at around 7:30 a.m. There's plenty of pushing and shoving to get to two tiny registration windows – one for men and the other for women.
Patients thrust their fists, clutching the entrance fee of 50 Afghanis, or about $1, inside the windows hoping to be the next person allowed inside.
After registering, the patients sit in stifling waiting areas. Somebody tries to turn on a window fan, but it doesn't work. Patients fan themselves with the green registration cards. There's a 4-year-old girl with infected eyes ringed in red and men with cataracts shuffling with canes. There's a woman who suffered a splinter in her eye while chopping wood.
Those called from the waiting rooms line up for an eye test, with the chart is painted on a glowing light box. Fewer than 30 percent of Afghans are literate, so the chart uses a symbol that resembles an "E." Patients are asked whether the symbol is facing left, right, up or down.
Watching everything was 9-year-old Safauddin, his right eye severely deformed by a type of neurofibromatosis, a genetic disorder that causes the growth of tumors. The boy was silent, but his mother was shouting .
"I don't know how his eye got this way. Something happened during the Taliban time," she said, referring the years from 1996 to 2001 when the hardline Taliban regime ruled Afghanistan.
She barked at a doctor through her blue burqa, saying she could not understand why her son could not be treated at the hospital, which has no facilities or expertise to treat the disease.
In an examination room next door, a toothless woman was nearly hysterical, saying her eyes were getting weaker. She complained that she had no medicine and nobody to help her. Mahboob jotted some notes on her registration card and quickly sent her to the next examining area.
"We have to work like this because of the rush of patients," he said. "If we try to tell the patients to come back tomorrow they'd hold a demonstration."
Upstairs, the baby boy's father, Hafizullah, was fighting back tears. The shopkeeper, who like his son uses only one name, was heartbroken that surgeons couldn't save the diseased eye. His wife sat on the edge of the baby's bed, straightening his pajama top over his belly. Nasaratullah's face was covered by a bandage, and no one had told his mother yet that the eye had been removed.
The surgery was life-changing, yet it gave the parents hope that their son born to war might someday see a more peaceful Afghanistan.
That's a long way off. Noor Eye Hospital is the last stop in Afghanistan for patients with serious eye conditions. If they can't be treated there, they must be referred outside the country.
Days later, Hafizullah and his wife bundled up Nasaratullah and drove for 16 hours, hoping of seeing an eye specialist in Lahore, Pakistan.