In their hundreds they sit in near-silence on rude wooden benches outside Honiara's National Referral Hospital. They endure 35-degree heat, 90 per cent humidity, the roughly 50-50 chance of being treated, and even a preacher who delivers an impromptu sermon ("Yout', you got to go your local church. Let me tell you why: the Devil is after you, to do bad things in your life"). The eye doctors are in town, and in a country where the national characteristic seems to be stoicism, the people of the Solomon Islands are prepared to wait.

Kiwi opthamologist and inspirational social activist Fred Hollows established his foundation in 1992, five months before his death. "I believe the basic attribute of mankind is to look after each other," he said. Its aim was straightforward: helping people in the developing world help themselves secure first-world standards of eye care. In the Pacific, it funds an eye institute in Fiji to train local doctors. The institute runs "outreaches" - when staff and students travel together for a week, delivering as many sight-saving cataract operations as possible; surgery that is routine in New Zealand but even at a cost of $25, a luxury in places like Honiara, capital of the Pacific's second-poorest nation.

The locals travel up to a week to see the eye doctors. At the village of Visale, an hour east of Honiara, the soothing sounds of choral singing from the Sacred Heart Catholic Church drift down to the pebble beach where we await a group arriving by speedboat. Fifteen patients - including three blind grandmothers - wade ashore and clamber aboard a ute for the trip to town.

Sixty-two-year-old Aloisia moved from her home village three months ago to another nearer the boat to ensure she would make the trip. With two milky cataracts swimming across her eyes, Angella Ngaovava, who lost her sight two years ago, relies on her grandchildren to eat. Mostly, they give her rice. If she doesn't want rice, she goes hungry.

Once he oversees the ute's departure for Honiara, local eye doctor Mundi Qalo takes directions from villagers so he can visit nine-year-old cataract sufferer Hilda Pipina, who lives in a primitive wooden hut 20 minutes' drive down a rough track amid dense bush. This isn't an unusual way to recruit patients in this rural nation: the next day a nurse takes me in the other direction, to a clearing deep in a palm plantation where we find 27-year-old Augustine Sanau wearing a haunting look of absolute resignation.

Augustine, his wife Mary and two-year-old son James share a stilted hut with his mother-in-law. Both Augustine, the mother-in-law and a grandson are blind. Beside their house is a second, incomplete hut, which Augustine tried to complete before his sight faded completely. That happened last June, costing him his job as a deliveryman. Now his wife makes an uncertain living selling palm-frond broomsticks at the central market for $S10 (about $NZ2) apiece. Augustine tells me he's nervous, depressed, cannot go anywhere alone, and wants to see his son's face again. "Life is hard, everything is hard," says his wife. "I hope we can be happy again." Augustine and his mother-in-law are loaded on the ute.

A second outreach team led by Australian doctor Roger Dethlefs treats patients even farther-flung, travelling to the island of Malaita, third time lucky after two abortive attempts on faulty boats. Dethlefs is as sanguine about this as you'd expect from someone who spent four years working in Afghanistan (and saw a friend kidnapped, rescued by the CIA, then kidnapped again and killed) and 18 months establishing an eye clinic in a converted shipping container in Timor-Leste. Fifteen months and 500 surgeries later, he was relocated to Suva to teach - appropriate, given that early in his career he was taught by Hollows. "He certainly made an impression on me," he says.

Before the week's outreach had even begun, Dr Qalo had signed up 348 putative patients, so once at the hospital, Augustine and the grannies join a steady stream: a toothless nun who went blind a year ago; 19-year-old Richard, whose cataract was caused by his "very angry" dad throwing a wooden chopping block at him; elderly William, clad in blue beanie, boardshorts and a filthy blue polo, who spent two days on rough seas to see an eye doctor because his daughter, a nurse, "implored me".

Retired government officer Dudley Wate has already had one cataract removed last year and is back for his other eye. "People fear it, but I explained to a few of them how good it was," he says. "I told them you go in and they give you a new one, and they say, ‘As easy as that?' People lost their fear and were smiling."

Built with Taiwanese aid money barely 25 years ago, the hospital is already dilapidated, its general wards grim, but the standards of care and the staff's professionalism are impressive. Once the waiting hordes gain entry, they are first tested for vision in a cramped room where the standard alphabetical eye test has been adapted for the illiterate. A nurse with a big afro and severe specs inspects medical records all patients must carry (signs in the local pidgin warn: "Iu mas bringim kam longs klinik a hospital evri taem iu kam") and takes observations. Another completes the paperwork, a doctor compiles the surgery list. In every corner, patients sit, slouch, slump and wait.

One of the youngest is Platini Vekea, 9, a scrawny, fidgeting waif who can see barely a metre. He's deeply afraid of his looming double-cataract operation, a fear Qalo reckons was implanted by his dad Terry, who looks equally edgy and reveals he was scheduled for eye surgery - one of his eyes points permanently skywards - but fled on being told the news. That was in 2007, and this is the first time he's set foot here since.

Amid this sea of humanity, trauma cases still arrive, common because of the national tendency to walk everywhere with knives or machetes in hand, such as the 19-year-old spear fisherman whose homemade dart gun backfired, smashing his goggles into his eye. His pupil bulges through a cut in his cornea, and registrar Carole Poloso-Misi cuts and stitches it, Qalo casually leaning through the surgery door dispensing directions.

But the cataract surgeries are straightforward. To extract these hard brown or white discs about the size of an M and M chocolate, the surgeons cut a nick in the eyeball, and with a hooked instrument, ease the cataract out, then insert an artificial lens, which, in turn, hooks on to the iris. They stitch the eye, clean it, and cover it with a protective sheath and patch. They work fast and efficiently. The most complicated case we see takes an hour, but that's because senior doctor John Szetu has awful trouble cleaning mascara from the eye of an ex-pat American, Joyce Baykin, to ensure there's no infection.

Grandmother Angella is so relaxed she falls asleep. Szetu maintains a constant banter, hooking a big cataract and declaring to laughter: "It's a baby boy."

The final operation of our day in theatre is on Augustine. His mother-in-law has already gone home: she has corneal scarring, probably caused by a traditional but acidic herbal potion being used to treat an infection. Her vision is lost forever. Augustine's is the only other failure: about 90 per cent of patients will have what the surgeons call a "good outcome". Dr Claude Posala removes his cataract easily, but a dead, milky haze at the back of his eye instead of the usual red glow means toxoplasmosis has permanently damaged his eye. The best he can hope for now is "navigational vision" - enough sight to walk unaided.

"It feels sad. We hoped to give him at least some useful vision, but the chances are diminishing," says Szetu. "Some surgeons would say no, but some of us believe in miracles."

When the team finally returns to its hotel after an 11-hour day in theatre, the budget stretches only to two-minute noodles, not the overpriced hotel meals. "There's an adrenalin high, and when you go back to your room, you are wide awake for two hours," says Posala. "Towards the end of the day, you don't get to feel tired, but you know you actually are."

The final figure of would-be patients is 416. The team manage 165, more than expected. Eventually, the queue is told they won't be treated today, not, most likely, until October. The team says this caused a near riot on their trip to Samoa, but here it's met with silence.

By Wednesday morning, the first patients are being taken into a simple consulting room to have their patches peeled off. They offer a range of reactions, says Qalo, who has seen it so many hundreds of times, but still enjoys it: "Some are happy, some sob, some cannot believe what's happening and they just stare. It is a new world for them. That feeling is the rewarding part of it, for they are all smiling."

First comes Platini. As usual he's fidgeting, mining his nose for giant boogers, even after the patch comes off, until he suddenly realises he can see his mum clearly.

He freezes, then unfolds a tremendous smile; "Me look-look" ("I can see"). Entranced, he moves his hand back and forth.

Then the trio of grandmothers are guided in. When Angella's patch is removed, she blinks, then her eyes widen, and she raises her hands in a gesture of half-prayer, half-celebration.

Her friend Winnie, who wants to see her grandchildren "by face, not voice," is laughing. "Now we can walk alone," she says.

Steve Kilgallon travelled to the Solomon Islands as a guest of the Fred Hollows Foundation which works to restore sight and end avoidable blindness in the Pacific. To watch one man's journey back to sight visit seeingagain.org.nz

- © Fairfax NZ News