K amal Karki, a 17 year-old native of Janakpur, has a lot to be grateful for. He can't thank the unknown good samaritan who helped restore his vision by donating his or her corneas before death, but last Sunday at a gathering of donor relatives, medical personnel, and social workers, Kamal paid tribute to the memory of a host of individuals who have made similar arrangements. Sporting dark glasses-protection against the strong morning light-Kamal, who underwent a corneal graft to his right eye two months ago, thanked god for his good fortune. "I've been given a new lease of life," he beamed. "I can resume my education."
The young resident of Katakuti VDC, Janakpur, Dolakha district, lost all vision in one eye after an insect bit him while he was out collecting fodder in the forest. "The bite developed into a cyst. Within a year, I lost the ability to see with my right eye." Kamal says he dropped out of class seven at 15 when it became near impossible for him to read. Desperate to regain his vision, Kamal found his way to the Nepal Netra Jyoti Sangh in the capital, where he'd heard there were doctors who could restore his vision. They directed him to the Nepal Eye Bank at Tilganga Eye Centre, a community-based non-profit that works to restore sight to the corneal blind. Kamal had to wait a year before a cornea was found for him and he was operated upon two months ago.
Kamal is one of nearly 2,000 Nepalis who have regained their vision through corneal grafts. That is not even one percent of the 240,000 blind Nepalis. It is difficult to say how many of these would be helped by cornea transplants, but it is significant that damage to the cornea is the second most common reason for blindness in Nepal, after cataract. In an agrarian society like Nepal, where most people work outdoors in the fields harvesting crops, looking after livestock, collecting fuel and fodder, agricultural trauma to the cornea, ocular diseases, and the lack of immediate medical treatment can easily lead to corneal opacity, leaving the person blind. "When this happens, the only solution is corneal transplantation," says Shankha Twyana, Nepal Eye Bank manager.
Kamal has been lucky, but many have to wait much longer, sometimes all their lives, for the gift of sight. The demand far outweighs supply, and despite a steady increase in donors and growing awareness about eye donation, there's still a long way to go. In 1994, the year it was established, the Nepal Eye Bank, which was set up with the help of the International Federation of Eye and Tissue Banks in Baltimore, USA, and the Indiana Lions Eye Bank, registered just one local donor. "The number of donors has grown since, and today we receive more than 400 corneas a year, locally," says Twyana.
"It's not enough for people to just fill in a donation form. An environment needs to be created where families, relatives, individuals, understand the need, and are receptive to the idea," says Sarita Mishra, a music teacher at Padma Kanya Campus. It's been 15 years since Mishra donated her eyes to the Nepal Netra Jyoti Sangh through a social workers' group. "Initially I was a bit nervous. I wasn't sure what exactly it entailed. I thought the entire eye was removed. And maybe while one was still alive. After orientation, I found the courage to donate my eyes. It's a bit like donating blood. After you die, you don't need your eyes. Why deprive someone else of sight." More and more Nepalis appear to be thinking like Mishra. Sixty-eight year-old Purushottam Das Timilsina came all the way from his village in Rautahat to register at Tilganga as a donor. "After death, the body rots away. At least I'll have gained some dharma by giving the gift of sight to someone who needs it."
Twyana is cautiously optimistic about this trend. "The concept of eye donation and eye banks is still very new, and people are scared to donate their body parts even after death," he explains. People are often dissuaded by misplaced religious beliefs-Hindus often believe that by donating their eyes, they will be reborn blind. The centre has three grief counsellors or motivators to actually discuss with relatives who bring their dead to Pashupati the possibility of donating the corneas of the deceased. Since an excision centre was built by the Pashupati ghat three years ago, there are always technicians on stand-by there to remove corneas in privacy and with respect.
"It is important to explain to people exactly what happens. Donating your corneas is just that-the whole eyeball is not taken out, your face is not disfigured," says Krishna Thapa, who cremates people at Pashupati. Thapa has volunteered his services as a motivator and takes on the difficult task of speaking with grieving families. "It's hard, but people are becoming more aware. Today, maybe some twenty of every hundred families at Pashupati donate the eyes of their dead."
Since 1998, when the import of corneas from the International Federation of Eye and Tissue Banks was stopped, the centre has been trying to encourage people here to donate. Apart from harvesting corneas at Tilganga, procuring them, storing and distributing them, the Tilganga Eye Centre and the Lions Club of Pashupatinath have also opened an eye donation and information centre that runs awareness programs and helps in collection of more corneas.
A cornea transplant costs Rs 10,000 on average, and since its inception in 1994, the Lions Club of Kathmandu Rajdhani has been paying Rs 1,000 towards each cornea transplant. It has also distributed 10,000 pledge cards to people to make it convenient for them to donate their eyes.