Strong family ties and a sense of family responsibility are common in developing countries although. in recent years, the system has been breaking down. Married sons and daughters-in-law with grand children live in one house. with one kitchen. sharing all the jobs whether it is cooking, farming or raising cattle or sheep. Money may be with the head of the family. the father and his wife. The married sons or their children get the money they need from the heads of the family, Women may have small accounts of money but it is not common for them to have bank accounts. Cash is usually kept in the house or some jewels are bought as an investment. In his old age, when the head of the family gradually stops working. the responsibility of handling money is handed over to the sons or the sons-in-law. Then the older couple get money for their needs from the newly appointed head. Lending and borrowing take place between families and the banks are scarcely used. Money lenders make business in villages and their interest rates are high. They may give interest only against mortgage by jewels or copper and brass pots. The poor live at subsistence level and they may have hard cash for perhaps a week's needs. There is no social security or old age pension. There are no health insurance or medicare programmes. When there is illness the family may have some remedies or go to a village traditional medicine man or to a government dispensary nearby. Very rarely does a villager go to a doctor unless there is a serious accident or an acute problem sets in. Most of them use herbal remedies either from a qualified ayurvedic practitioner or a village medical man who has learnt the art from either a relative or through a correspondence course. Most people (90%) in villages do not go to allopathic doctors. Even in larger towns and cities ayurvedic and homeopathic practitioners are more familiar to people than allopathic doctors.

Cataract blindness
There is a high incidence of cataract blindness in countries like India. Younger people get cataract and the rate of maturation appears faster. So there is a higher pem:ntage of people in the community with cataract hlindness than in western Countries.

After Cataract surgery in India

1. Husband and wife relationship:
   A few years ago a woman of 38 years old was brought to an eye camp 15 miles from Madurai. She had bilateral mature cataract with light perception only in both eyes. She haa been blind like this for 2 years. Her husband was a village.:school teacher. Neither the husband nor the wife knew the cause of her blindness and they did not get proper advice from their relatives or neighbours. It was difficult for the teacher to look' after his wife. So he married another woman who could cook and help him. The first wife went to her sister's house where she was given shelter. food and care. At the eye camp the lady with cataract learnt that she could get her sight back by an operation. We operated on both her eyes and gave her sight but she had already lost her husband and his support. She had to start working in the fields to earn her food.
2. Elderly mother with her children:
   In another village there lived a widow of 55 years with her two grown-up sons and a daughter. The sons were 22 and 20 years of age and the daughter was 17. They were landless labourers and made their living by working on farms. The widowed mother had worked hard to provide for her children ever since her husband had died 10 years previously. She was slowly going blind because of cataract. She was not able to cook and look after the family. The daughter had to do the cooking and go for part time work. After some time the widowed mother's blindness worsened and she needed somebody to take care of her. The sons and daughter found it hard to earn enough to take care of her and feed her. When the children began to neglect her she sought the help of her sister who lived in the neighbouring village. This sister fortunately knew of free cataract operations that were being done at camps and at hospitals. She was thus able to take her sister to a hospital and after surgery her sight was restored. Since her relationship with her children was strained she decided to stay with her sister and work there. We met this woman at an eye camp that was held in her village. By then she had mature cataract in hcr other eye and so we performed surgery and provilkd her with spectades. It was then that she broke down and told us her story ahout how the children she raised failed to support her when she became hlind.
3. Young mother with small children:
   A woman who was about 39 years of age was brought to us with bilateral mature cataracts and with only perception of light in both her eyes. She had been blind for nearly two years. Her husband was a palm toddy tapper. He had to climb palm trees every day and tap toddy or a sweet juice called neera. They had three children, the eldest a girl who was 10years old, then a 6 year old boy and an IS month old girl. When the mother lost here sight the eldest girl had to work with the blind mother's guidance. The father. who also had to help around the house. could not climb trees any more and had to take a different job which did not pay him enough to feed his family. There was nobody to inform them of surgery that could restore sight. While the mother worried about the baby's health the older daughter had to shoulder more responsibilities and take care of her brother and sister. They were also forced to sell their belongings. such as pots and pans. to feed themselves. Finally when she was brought to us we were able to restore her eyesight and the association which helped us organise the camp in that village also helped her buy some cooking pots that she needed.
4. Problems of going to a hospital and getting relief:
   To a villager in a developing country allopathic hospital doctors and nurses are still alien. This is the reason why a villager does not feel comfortable in hospital surroundings. Also, staff in the hospitals have not made the effurt to make the villager feel more at home. So the poor villager is intimidated at the thought of going to the hospital. When they have to go to hospital they try to find out if any of their distant relatives are working at the hospital, believing they will be able to get more attention from the doctors and nurses through their help. They also believe that they will get better care if they pay the doctors with money or kind. Some rich people do pay money or give presents to the staff and get their favour. Poor patients do not get any help unless they tip the staff. This situation prevents villagers from seeking advice for their problem. They go only when there is an accident or an emergency.