When at Mudd studying physics, Lewallen recalled talking to Bell about why he took a yearlong trip to Istanbul. “He said he had been feeling that his life was going to be thus: good college, good grad school, good research, good life, good bye—and he didn’t want to leave it at that.” Lewallen graduated from Mudd and returned to her home state to complete medical school at the University of Colorado Health Sciences Center in 1980. Bell’s words came back to her then, and she decided to get out of her comfort zone and take her first trip abroad to Europe with her friend Nancy Smith ’76. They traveled extensively, and were rewarded with eye-opening experiences.

The sojourn led to a medical internship in New Zealand then to travels and work in the South Pacific and Southeast Asia, during which she developed an interest in tropical medicine and health care problems in developing countries.

She returned to the United States in 1988 to do a fellowship in cornea and external eye disease at the Proctor Foundation for Research in Ophthalmology, University of California, San Francisco, and, there, met her future husband and collaborator Paul Courtright, a research associate completing his doctorate in public health. After marrying in 1989, they worked overseas, first with leprosy patients in Korea and China, then with ophthalmic assistant trainees in Ethiopia, and finally in Malawi, where Lewallen became the only ophthalmologist for 5 million people in the southern half of the country. “Our four years there were extremely rewarding but also frustrating,” she said. “I learned that without a good management system in place, a lot of time can be wasted.”

The couple returned to the States and called Bellingham, Wash., home for seven years while establishing, at the request of the University of British Columbia in Vancouver, the BC Centre for Epidemiologic and International Ophthalmology. “We continued a number of projects in developing countries—Vietnam, China, Mynamar, Egypt, Malawi and Ethiopia—but knew, in our hearts, that if we were going to make a difference we needed to base ourselves in these same countries,” she said.

So, in 2001 the couple moved to Tanzania with their sons Jim and Tom (now ages 15 and 13) and subsequently established the Tumaini University-based Kilimanjaro Centre for Community Ophthalmology (KCCO) of which they are co-directors. Lewallen said they “couldn’t resist the challenge.

“The needs are huge, and it is a challenge to figure out what are going to be the most practical, sustainable solutions to some very difficult, long-standing problems.”

The United Republic of Tanzania, among the poorest of developing countries in the world, has a population of 36.7 million. An estimated 350,000 people are blind, yet more than 80 percent of the causes of blindness are preventable or treatable.

“Reducing blindness on a large scale requires a paradigm shift in how we think and plan and implement,” said Lewallen. “Our past working practices, based upon single ophthalmologists with external support, were not meeting the needs of the population.  The paradigm shift in prevention of blindness was the shift to planning services and activities based on the population to be served. It requires bringing all potential partners together, creating common goals, and investing in management systems, and systems to reach people needing eye services.”

To that end Lewallen and Courtright are working with KCCO staff to test strategies, train professionals and provide support and supervision. “In the past three years in the two million population of the catchment area of the hospital in Moshi, our programs have led to a three-fold increase in the number of people getting cataract surgery and an almost three-fold increase in the number of children getting eye surgery. We have now trained people from three other areas (covering a population of about six million people) and they have made huge strides in providing high-quality, low cost services. Most important, they are very proud of their success and are looking for ways to improve upon it. We have helped plan for other countries in the region—Malawi, Ethiopia and Egypt—and next we will start working in Uganda.”

Eventually Lewallen and Courtright will return to the United States, and Tanzanians and others from eastern Africa will carry on the KCCO’s existing projects, design new ones and write the proposals to support them. Lewallen said that building the capacity of the eastern Africa faculty is one of their biggest challenges. They are hoping that their model, which focuses on local capacity, on practical cost-sharing by people, on evidence-based practices and on team building, will make for a sustainable program in the long run.