An eye for an eye can let the whole world see

Changing Hindu beliefs has been the small task taken on by Nepal’s Tilganga Institute of Ophthalmology in their ground-breaking work building one of the most successful corneal donation programs in the world.

Seven-year-old Lekha Pun Magar has a small bag of belongings at her feet and a big smile on her face.

Tomorrow, Lekha and her mother are leaving Tilganga, The Fred Hollows Foundation’s partner hospital in Nepal.

They're going home, back to their small village 400 kilometres north west of Kathmandu.

For the first time in her life, Lekha will be going to school with her four sisters and all her friends.

It may be hard to imagine now, as we watch her riding a rocking horse in the playroom, her face lit up with joy, but just a few days previously, Lekha had been brought in to the hospital with both eyes completely shut.

She’d been blinded by corneal damage caused by typhoid and Vitamin A deficiency.

When she wasn’t clinging to her mother's skirt, Lekha would hunch up by herself in a corner, withdrawn from the world, unable to do anything for herself or play with other children.

There seemed little hope of leading a fulfilling life.

But under the skillful care of the hospital’s leading corneal surgeon, Dr Reeta Gurung, Lekha can see again.


Lekha’s future looks bright. Photograph: Sunita KC (Sonu)

After her bandages were removed and she took in her surroundings, she gazed at her mother in astonishment, and began exploring her surroundings.

One of her eyes still needs further treatment, but the transformation has already been dramatic.

“Like a plant unfurling towards the sun,” is how one of the doctors described Lekha after her surgery.

This little miracle is just one of thousands seen every year at the hospital, thanks to its trailblazing program which uses the donated corneas from Pashupati, the holy site 800 metres from the hospital where Hindus gather to grieve their recently departed relatives before cremating them on funeral pyres.

To an outsider, harnessing such a prodigious supply such a short distance away from the operating theatre may seem logical, but for many years, the corneas were so unreachable that they may have been on other side of the world. 
 

Like a plant unfurling towards the sun.

The Hindu community held firmly-entrenched beliefs that to remove any part of a corpse would mean the person would be without that body part in their next life.

Tilganga was forced instead to rely on donated tissue from Western hospitals even though corneal damage is the second most common form of blindness in Nepal, as a result of birth defects, farm accidents or untreated infections.

“We had to fight for scraps," describes Dr Sanduk Ruit, the hospital’s executive medical director.

Whenever visiting ophthalmologists flew in from the US or the UK, he would ask them to bring a Styrofoam box of corneas, leftovers from the large teaching hospitals.

But these 'boxes of new eyes' as they were called, made few inroads into tackling the backlog of corneal transplants needed every year.


Posters at the cremation site read: "It's good karma to donate your corneas. When you die, you can give people the gift of sight." Photograph: Michael Amendolia

Not to be deterred, Dr Ruit made his way to the funeral pyres, and embarked on a long, dogged campaign to persuade the cremator and the Hindu priests to consider asking families to donate their relatives’ corneas.

Gradually, he began explaining that by taking the small flaps of tissue from the eyes of the dead, they could give sight back to the living.

Surely that would be meritorious for the deceased, and also the families of the deceased?

When he invited them to the hospital to witness the spine-tingling moments when patients could see again, their rigid beliefs starting to dissolve.

That was more than 20 years ago, and the start of a long fruitful partnership between Pashupati and Tilganga which has resulted in the first eye bank in Nepal, and more than 11,000 people have now had their sight restored through its corneal donation program.

At first there were only a trickle of donations.

Calls would come to the eye bank director, Shankya Twyna, in the middle of the night or at two or three in the morning but, no matter how ungodly the hour, Shankya would always take it.

Within minutes he would swing into action, rushing over to the funeral pyres on his moped - corneas deteriorate quickly, so he had to move fast.

The 15-minute procedure is fairly straightforward, similar to removing the glass face of a watch.

Within hours, one of Tilganga’s surgeons would be suturing the graft into place on a patient. 
 

Their corneas are still here, helping
someone to see this great world of ours.
- Anil Subedi

In the first year of the program, only eight corneas were donated but the following year there were about 300. The increase prompted the eye bank to set up small office at the funeral pyres, enabling the excision to take place in private.

The program was then extended to the three major hospitals in the Kathmandu valley.

The hospital counsellors, as well as a complete shift in the Hindu attitude towards donation have resulted in more 60,000 people pledging to donate their corneas to the eye bank.

Today, Tilganga is not only self-sufficient, it sends donated corneas around the world, from Bhutan, China, Malaysia and Pakistan to Cambodia, Bangladesh, Indonesia, Thailand and East Timor.

The program is so big that a commemoration ceremony is held every year in the courtyard of the hospital.

The donors' names are inscribed on a shrine before which the families of the recipients lay wreaths, light candles, and give prayers of thanks to the donors and their families.

Anil Subedi, The Foundation’s former country manager in Nepal described the ceremony as "deeply moving."

“When the families speak, they are so proud that although their relative has passed away, their corneas are still here, helping someone to see this great world of ours,” Mr Subedi said.

"At the last ceremony, one boy got up to make a speech. He was 10 when he had a cornea transplant.

He's now in Year 11, and wants to become a policeman.

The boy said he regards the day his bandages came off at the hospital as his birthday, because that was the day his life began.”

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