"The Bright Journey" – A Chinese Funded Cataract Outreach in Fiji

At the onset of this commentary, I would like to note my connections to Fiji, both personal and professional. I write this commentary as a New Zealand-based academic with Fijian roots whose research focuses on the Fijian health system. Though I do not currently reside in Fiji, I am connected to this land by birth, through both paternal and maternal ties, regular visits, and sustained research ties. I am also an Adjunct Professor at the University of Fiji's Umanand School of Medicine and Health Sciences and have worked at the College of Medicine, Nursing and Health Sciences at Fiji National University, developing key health leadership and management programmes and courses. With a background in Public Health, my work examines how health systems are led, managed and organised to deliver effective, efficient and equitable people-centred care, particularly within Pacific Island contexts.

This commentary was not planned, nor did it emanate from research that I am engaged in. It comes from my lived experience and observations accompanying my mother, who lives in Fiji, as she underwent cataract surgery during the Bright Eye Cataract Surgery Mission by the Chinese medical team from Guangdong Province. My mother was added to the list of patients at the last minute, and it so happened that I was visiting her at that time. As we went through the process, I was no longer observing a system at work; I was experiencing it for myself and through the 'eyes' of my mother. This dual positioning as both an academic and a family member, and as an observer and a participant, sheds light on the strengths and weaknesses of the health system. It also reinforced a core belief that underpins my work: health systems are ultimately judged not by how they perform on paper, but by how they treat our parents, our elders, our most vulnerable, and by the outcomes they achieve.   "The Bright Journey"

Aptly named the "Bright Journey", this Chinese-funded bilateral mission brings a team of Chinese ophthalmological experts to Fiji to perform vision- and life-changing and often dignity- and independence-restoring cataract surgeries. It is a coordinated effort by the Ministry of Health and Medical Services, Fiji, and Guangdong Province, China, bringing a team of experts to Fiji to perform the surgeries, along with all medications, supplies and consumables needed to support them. The team were present at the Pacific Eye Institute from 3^rd November to 7^th November 2025 and, as reported by the Fiji Sun, performed 108 cataract surgeries. 2025 also marked a decade of the Bright Journey providing cataract surgery in Fiji, and 50 years of diplomatic relations between China and Fiji. In addition to Fiji, Bright Journey has several missions across the Pacific and around the world. The collaboration also aims to share knowledge and expertise and to enhance local surgeons' skills in performing cataract surgeries using advanced techniques, particularly phacoemulsification.

Details of the Bright Journey Chinese Funded Outreach in Fiji

Source: Jalal Mohammed, 4^th November 2025

The Chinese Ophthalmology Team with the Fijian Minister for Health Source: Fiji Sun 7^th Nov 2025 https://fijisun.com.fj/news/nation/bright-journey-restores-sight-hope-for-fijians 

Service Delivery and Patient Experience

From my observations, most patients were elderly. For each patient, the cataract surgery was a three-day process from 9.00 am to 5.00 pm, though patients usually began arriving from 6.30 am onwards and left by 5.30 pm. The first day entailed slightly over half a day of process; the second day was between half and a full day for the patients; and the final day was another half day.

The first day was the pre-operative consultation. Generally, this entailed patients spending half a day at the Pacific Eye Institute undergoing eye examinations and signing consent forms. Interestingly, Dr Weirong, who led the Chinese mission, examined my mum's eyes. Within 5 seconds of looking at her eyes, she said to my mum that this time her healing will be quicker as they are using 'modern' surgical procedures. My mum had cataract surgery on her other eye about a year earlier, and her healing was protracted due to surgical complications. Dr Weirong's ability to assess the previous surgery so quickly gave my mum significant confidence in the Chinese team's expertise and knowledge. The consent process was less organised. A medical intern was assigned to take consent. This involved having the patients sign the consent form and going through basic questions, such as medication allergies and blood pressure. However, the procedure and any risks were not explained during this process. Before patients left, their eye to be operated on was marked, and a medical band was placed on their wrist. Patients were told to arrive in the morning; most were told to arrive by 7.30 am, 8.00 am and 8.30 am. While patients waited, the Chinese team would enter the waiting area to speak with them. Sitting alongside the waiting patients, I could hear how much they appreciated this. The human touch makes a significant difference in the delivery of health services, particularly in Pacific cultures, where respect and relationships are vital, especially with elderly patients.

On the second day, the cataract surgeries were performed. During the pre-operative consultation, patients were advised that the surgeries would take between five and seven minutes. On arrival, patients were advised that they would receive three to four eye drops to prepare their eyes for surgery. This was administered over 1.5 to 2 hours. All patients were called in the morning, resulting in disparate waiting times. Some waited less than an hour for their surgery, while others waited substantially longer. Most patients were seen after lunch. As patients were not advised when they would be seen, they were unprepared for the day. The majority brought no lunch or water, and nearby limited and expensive eateries were not a feasible option for most. My mother's surgery was performed at 4.30 pm. We had been told to come at 7.30 am. It was a long day of waiting, with little communication about when her surgery would be performed, which made the wait longer. For elderly patients, some with mobility issues or chronic conditions, this posed considerable physical, mental and emotional strain. Seating was limited, consisting of hard benches that offered little comfort while waiting. Even I, someone decades younger than most of the patients undergoing surgery, struggled sitting on the benches. I had to alternate between sitting, standing, leaning against the wall, and taking short walks in between. Most elderly patients, limited by mobility, did not have that option. Most patients passed the day in true Fijian style – a good old 'talanoa'.

The Waiting Area at the end of the Surgical Day (The last set of patients w,ere inside and the last few family members were waiting in the waiting area) Source: Jalal Mohammed, 4^th November 2025

On the third day, the post-operative checks were performed. These were done from 8.00 am, and most patients were seen by midday. Local doctors helped with the post-operative checks, which facilitated the process. Patients were provided additional medication on the day for post-operative care and eye management and were told to return if any issues arose. A subsequent appointment was scheduled on this day.

Organisation of the Service

The local team from the Pacific Eye Institute handled the administrative process, while the Chinese team focused on the consultations and surgical procedure. They were assisted by the local nurses, medical interns and surgeons. Clinically, this was a well-organised mission. The surgeons were highly skilled, the procedures were standardised, and a high volume of surgeries could be achieved in a short period. Each cataract procedure took between five and seven minutes. The Chinese team brought their own supplies and consumables. The local team had opportunities to observe pre- and post-operative consultations and to support the Chinese team during the surgical procedures. From a health systems perspective, this was a well-resourced mission. Appropriate medical supplies and consumables, along with modern techniques, supported the highly skilled surgical team. However, the organisation prioritised surgical throughput over patient flow and experience. Understandably, this was done to allow the team to see as many patients as possible. However, a cataract surgery is a predictable and standardised medical procedure. Eye dilation takes approximately two hours, with five patients called into the surgical area at any one time. The rest wait outside. The time for each surgery was about five to seven minutes. Erring on the generous side, this means the five patients would be seen within an hour, including any necessary preparations. A new patient would be called into the surgical area every 20 to 30 minutes. Simple adjustments could have improved patient flow and experience while maintaining surgical throughput. Taking the above into account, one approach would be to stagger the times when patients are called to the Fiji Eye Clinic.

Patients had uncertainty about when they would be seen. Communication about expected waiting times was limited. The nurses had placed patient folders on a table in the waiting area. Some restless patients kept going to look at the order to see their position in the queue. While this raises legitimate confidentiality concerns, it also reflects deeper health systems and cultural issues. Patients seek certainty about the process, their wait, and, more broadly, open communication. In the Fijian context, what I observed was that there was low tolerance for uncertainty, particularly among elderly patients with chronic conditions and navigating unfamiliar clinical processes, exacerbated by the fear of having a surgical procedure. For family members providing support, this uncertainty affected their ability to pick up children from school, support other family members, and manage their households. Uncertainty led to frustration and, in one case, towards the end of the day, to accusations that the nurse was not following the order of patient arrival.

Over the course of the day, many patients directed their questions to the nurses, who dealt with them calmly and with care. That level of care was appreciated by many, including myself. While the nurses could not give certainty about waiting times, the intentional care and calm responses were appreciated by the patients. However, overall, the system relied heavily on the patient's endurance rather than intentional scheduling and operational design. What I observed were committed health professionals who were let down by operational systems and processes that were not intentionally designed to reduce patient wait times, improve comfort, and facilitate open communication. The Chinese team's approach to patient care did not go unnoticed. Throughout the three days, the team would come out into the waiting areas and talk to patients. While there were language barriers, their warmth, patience and respect were not lost in translation. Much of the engagement was quick, yet the patients nonetheless appreciated it. It gave patients a sense of being seen, rather than being considered as throughput units. Their visible efforts to engage patients and move them through the process underscored a commitment to both the quality and dignity of care. Both of which are essential components of any health system and must be kept at the forefront of service delivery. Final Thoughts

Chinese diplomacy is winning hearts and minds in the Pacific. While this blog is about health systems design, one cannot overlook that this outreach is part of a broader diplomacy effort. Often, the conversation about Chinese influence and impact in the Pacific focuses on large, highly visible infrastructure. And often this is where the conversation ends, overlooking soft diplomacy at work.

The goodwill generated from this outreach and the operations is not limited to the patient. In Fijian society, people share experiences (good or bad) not only with family but also with their wider communities. Several members of parliament, former ministers, and former Speakers of the House utilised the services of the Chinese team. This underscores the soft power of health interventions such as these and their ability to build trust, friendship, and ties between Fiji and China.

This is a Win-Win situation. Fiji's health system is fragile, prone to shocks, and its infrastructure is ageing. Bilateral/Multi-lateral aid can play a role, as long as it is coordinated by the Government and in line with national priorities. It can fill shortfalls in the health sector and, as such, should form part of the Government's strategy. Incorporating donor aid to address identified shortfalls can help the Ministry of Health achieve its mission, which broadly aims to deliver good health outcomes for all Fijians.  

Lessons from the Chinese Team for the Fijian Health System

1. Humanise health service delivery by keeping patients at the forefront. Engage with patients. Come out to the waiting areas to say hello. This takes a few minutes, but incorporating it into the routine throughout the day provides patients with comfort and helps them be seen as individuals rather than cogs in the wheel.

2. Strengthen communication and preparation by providing clear information about waiting times, food and water needs using language that patients and families can understand.

3. Introduce staggered patient calling systems. Dilation in preparation for the eye surgery takes two hours. Once the patient was called in for surgery, they were dressed and waited inside. Approximately five people were inside at any point, including the person being operated on. This way, the time was between 45 minutes and one hour. Calling a patient about three to four hours before surgery would have reduced the waiting time, increased comfort and reduced stress. The bilateral mission is not new. Chinese teams have done a number of these outreach missions in Fiji and the Pacific. There is data to support surgery times, including preparation times. Local teams need to utilise the data to improve service delivery and minimise patients' wait times.

4. Design waiting spaces with comfort and patient dignity in mind. Limited waiting spaces, hard benches, poorly managed toilet facilities, and a lack of water provisions were significant issues. These issues are not limited to the Pacific Eye Institute but are a broader issue within the Fijian health system and its ageing infrastructure. However, the Pacific Eye Institute is a much newer building compared to Fiji's ageing health infrastructure. Waiting spaces are not a prominent forethought in the building's design. Minor renovations can improve the waiting area and enhance patients' dignity and comfort.

5. Improve privacy and patient information governance. Patient files should never be left in public areas. Transparent, clear verbal updates about waiting times can help reduce anxiety and, in this case, reduce the number of patients seeking this information through their own devices, such as checking patient files to ascertain their place in the queue.

6. Ensure monitoring, evaluation and learning from these bilateral missions. Monitoring and evaluation of these missions should feed into strategy, planning, continuous improvement, support evidence-informed decision making and future programme development and design.

7. The Ministry of Health Fiji should establish and appoint a Donor and Partner Manager (beyond the current Administration Officer level appointment) to manage partnership and, importantly, identify shortfalls in the health system that could be filled through aid, ensure donor aid coordination, including planning, scheduling, monitoring and evaluating outreach and intervention missions. Donation of medical supplies and consumables, pharmaceuticals and biomedical equipment could be consolidated under this position, with appropriate links and coordination with the Fiji Pharmaceutical and Biomedical Services (FPBS).

   
   

Summary of my blog:

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https://www.youtube.com/watch?v=80rB6l-DCqI