Nepali Times
An eye for an eye


Sushma Limbu was only eight years old when she hurt her left eye while playing in the family maize field in the village of Imbung in Panchthar district. There was no health post and the nearest hospital was several days walk away.

Her family thought it was just a scratch and didn't pay much attention. Soon, Sushma couldn't see through her left eye. Her parents took Sushma from one hospital to the next all over eastern Nepal. They all had the same answer: there is no cure.

Earlier this year, a team of opthalmologists from Tilganga Eye Centre in Kathmandu had set up an eye camp in a village near Imbung. Sushma's parents decided to give it one last try to save their daughter's eyesight.

The Tilganga team brought 22-year old Sushma to Kathmandu for corneal surgery. Waiting in the lobby of the hospital for his sister to come out of the operating theatre, Santosh Limbu is anxious. But soon there is good news, Sushma can see.

"It's still like a dream," Santosh says exultantly. "It is a miracle." Santosh had brought the family's entire savings with him to pay the hospital, but Tilganga provided the surgery for free.

Every day, this eye centre near Pashupati in Kathmandu is giving back the gift of sight to hundreds of Nepalis. There is still a lot to be done, as Nepal has one of the world's highest incidences of curable blindness. Since its establishment in 1994, Tilganga has helped Nepal make remarkable progress in pioneering modern eye care.

Nepal's Sanduk Ruit and his team of opthalmologists have turned Tilganga from a local eye clinic into one of the world's best centres for cataract surgery and intraocular lens transplants.

This is one hospital that doesn't just wait for patients to come to it-it also goes out to the patients. Tilganga's regular microsurgical eye camps in remote areas have examined 80,000 patients and performed 17,500 cataract surgeries in the past five years.

Nepali doctors have even reached beyond Nepal to conduct 3,000 eye surgeries in Tibet and 2,000 in India. It has trained several surgeons and assistants in various ophthalmic institutions of India, China, Bhutan, Sikkim and Pakistan.

Tilganga's real challenge was to convince Nepalis to donate the corneas of dead relatives for transplants. The centre has performed over 840 corneal transplant operations since its establishment, thanks to the Nepali eye donors.

Bhola KC, an eye bank technologist, recalls how difficult it was to convince the people to donate eyes of their dead relatives. When the Nepal Eye Bank started in 1994, it had just one donor, Chini Maya Tuladhar. In 1995, it got two donors but in 1996 again there were none. In a desperate attempt to find donors, KC and his colleagues tried their luck at the Pasupati cremation ghats to convince the mourners that their dead relative's eyes could help someone to see again. "As you can imagine it was very difficult, but we had no choice," recalls KC.

The results were spectacular. In 1997, the number of cornea donors jumped to 97 and in 1998 the number had gone up to a staggering 547 donors. Today, the Eye Bank has enough corneas to supply Teaching Hospital, Pokhara Eye Hospital, Rana Ambika Eye Hospital in Bhairawa and BP Koirala Hospital in Dharan. Corneas of dead Nepalis have even been flown to recipients in Pakistan, Egypt, China, Thailand and South Africa.

KC's work has been so effective that Nepalis are now actually registering to donate their eyes when they die. "My sister got so carried away that she has decided to donate her eye after she dies," says Risiram Pokhrel, a campus student. He came to KC's office to register his 16-year-old sister Sadhana from Rupendehi at the Nepal Eye Bank. Her friends also registered their names.

Nepal Eye Bank now wants the government to introduce eye banking and donation in medical courses taught in Nepal, but there hasn't been much interest.

Cornea blindness is rampant among Nepal's rural poor. Children rub their eyes with dirty hands while working in the fields, there is no eye care and almost no awareness about infections. Blindness in Nepal is also caused by vitamin A deficiency or severe dehydration.

In the waiting room, Santosh says his family will now be busy finding a groom for Sushma. "Even a little disability is a blemish on girls in our society. She had no chance to get married," he says. "Tilganga has changed her life." He gets up, elated as his sister is wheeled out of the operation theatre.

What is the cornea?
The cornea is the clear transparent window at the front of the eye which allows light to enter. The cornea can be damaged by injury or infection.

How can a corneal donation help people?
Due to various factors, the transparent cornea becomes opaque like frosted glass and this may result in loss of sight. A damaged or cloudy cornea can be replaced surgically by a procedure known as corneal grafting or transplantation. During this operation, the cloudy, diseased cornea is replaced by a healthy, normal cornea donated from another individual.

Why should I consider corneal donation?
Donating your corneas is one of the most precious gifts you will ever bestow on another human being. This special gift will dramatically improve the quality of life for someone now living in darkness.

How can I become an eye or cornea donor?
Donating eye tissue does not entail any cost to the donor or the donor's family. If you wish to pledge your eyes, just fill out an Eye Donor Card (available at Nepal Eye Bank, Tilganga Eye Centre 4493684, mobile: 981020933). Carry the card with you at all times.

Eye exports

Tilganga Eye Centre has been making waves with its world-class production of intraocular eye lens (IOL), which are used to replace the patients' damaged natural lens. They are made of a clear plastic which requires no care and becomes a permanent part of the eye.

The Fred Hollows Foundation Intraocular Lens Factory in Kathmandu is run entirely by Nepalis at Tilganga Eye Centre and produces 1,000 IOLs everyday, which are exported to more than 50 countries. Proceeds help make the center self-sustaining so it doesn't have to depend on donors. The income from the sales also helps aid free corneal surgeries in Nepal and keep costs for cataract surgery low.

"We can easily compete with American manufacturers in quality," says Rabindra Shrestha, deputy general manager at the spotlessly clean floor of the lens factory. Nepal is competing with ALCON, an American company, to supply IOLs to China. The factory also caters to the local market and sells international quality lenses at a much lower price. The state-of-the-art manufacturing facility inside the Tilganga Eye Centre in Kathmandu employs 78 Nepali technicians with a Nepali supervisor. There are no foreigners involved.

(11 JAN 2013 - 17 JAN 2013)