Restoring eyesight: From Doramba to the world

DORAMBA, MARCH 26

Watching people dance, sing, laugh, even cry and hug their loved ones with joy after being able to see is a magical moment - and that is something you get to experience in every eye camp held by the Tilganga Institute of Ophthalmology (TIO).

The most recent experience was aft the Doramba Outreach Micro Surgical Eye Clinic (OMEC) - the eye camp at Shree Kakling Secondary School in Doramba of Ramechhap - organised by the TIO from March 17 to 20.

 The magical moment at the camp, especially on March 19, was something to seal in one's memory forever as the emotional patients expressed their jubilance after being able to see. A day after their operation the patients were made to sit on the rows of benches on the school's ground, and Dr Sanduk Ruit started taking off their bandages one by one. They were all smiles, experiencing light again, identifying people in front of them, naming the colours they would see or count the fingers the doctor would ask them.

Krishna Bahadur Majhi hugs his wife after being able to see as he looks at his doctor.
Photo Courtesy: Michael Amendolia

Amongst them was 38-year old Krishna Bahadur Majhi, a diabetic patient since the past three years, who had lost sight in both his eyes nearly a year ago "due to high blood sugar level".

A daily wage labourer from Sukute of Sindhupalchowk, Majhi had been dependent on his wife even for minor things. The Majhi couple was hopeful before the surgery that Krishna Bahadur would be able to see.

"When I had gone to the eye screening camp in my area, they told me that Dr Ruit would operate on my eyes," shared Krishna Bahadur, who did not know about the doctor and was sceptical if he'd be able to see as he had already made rounds of different hospitals and spent "around Rs 2.5 lakh that I had arranged as loan" with no significant improvement.

He was then told by someone to check a text book of Class X that has a biography of Dr Ruit.

He shared this with his neighbours who checked the book, found about this eye surgeon and read it aloud to him.

On March 18, the same doctor operated on both his eyes, and on March 19 he saw light again.

As the doctor pulled the bandage off this diabetic patient, his expression was unexplainable.

Dr Sanduk Ruit performing surgery at Doramba eye camp.
Photo Courtesy: Michael Amendolia

At first he just gazed at the doctor in front of him, and then was elated that he could see, and saw his wife, hugged her and expressed his happiness and gratefulness for being able to see the light of day again!

Everyone present had moist eyes, felt overwhelmed as the young man promised: "I will now take care of my wife".

Another touching moment was when Gyan Yonjan could not hold his tears upon seeing his 75-year-old mother Maichyang Tamang being able to see again with both her eyes. His mother had not been able to get cataract surgery of both eyes till then as she was unable to travel long distances.

Every patient present at the camp for the surgery had a story to share like that of Majhi and Tamang. Ninety-year-old Putali Basyal's sister expected her life to be easier as Putali would not need a caretaker now onwards as she was able to see with both her eyes again. Plus the free treatment at the camp was a relief for the elderly who would otherwise not be able to afford the treatment.

Meanwhile Min Bahadur Tamang, 76, now wishes to sleep inside his home, and not on the bed outside as he was confident, "I will be able to go to toilet comfortably opening the door on my own at night now that I can see with both my eyes".

A total of 333 surgeries of cataract patients were done by Dr Ruit and his son Dr Sagar at the camp that saw nine cases of bilateral cataracts (cataracts in both eyes of a person), informed Pankaj Thapa, Communications Manager at Tej Kohli & Ruit Foundation.

The surgery was worth watching - it looked very effortless and swift as the doctors made a tiny incision in the patients' eye, pulled out the cataract, and then inserted new lens in the eye. The next day as the bandage was pulled off, the patients were able to see the world again, and that too clearly. And they would be allowed to return home, all jubilant and hopeful to lead a happy and independent life.

Dr Ruit, popularly known as the God of Sight, along with his team has restored eyesight of hundreds of thousands of people across the globe, including in the most difficult terrains using high-quality microsurgical procedures. They have been carrying medical equipment needed for the cataract surgery, operating on the patients free of charge while ensuring they get quality treatment. The lenses used while doing so are the lowcost intraocular lenses that are manufactured at the TIO.

A unique model

Had this camp been not organised at Doramba, for most of the patients who were operated here, it meant living with the impaired vision forever, as per Tilak Karki, Project Coordinator of the Community Development Society (CDS), Ramechhap, who said that blindness due to cataract has indeed affected the social and economic life of the people here. But the cataract surgery technique pioneered by Dr Ruit delivered to this area free of charge has given a new lease of life to these people.

The TIO has been organising such camps regularly. Before the COVID-19 pandemic, they had been organising around 45 camps annually in Nepal where 7,000-8,000 cataract surgeries used to be conducted plus around 10-12 camps abroad, as per Namkhen Lama, Ophthalmic Officer at TIO. During the process, eye screening of 1.5 lakh to 2 lakh people would be done, while the number would increase if they would go abroad. Even after the COV- ID-19 hit the country, they held 20 camps last year, and 12 camps year before, as per Lama where they provide hospitalbased service and thus call them Outreach Microsurgical Eye Clinic (OMEC) rather than calling it just an eye camp.

As per Lama, this is their fifth eye camp at Doramba- "before organising the camp we did screenings in 18 places from where the patients arrived for the surgery - from Ramechhap (Doramba Rural Municipality, Khandadevi Rural Municipality, Sunapati Rural Municipality, and Manthali Municipality), Dolakha (Shailung Rural Municipality and Mailung Rural Municipality) along with a case from Sindhupalchowk".

"Our goal was to screen 2,200 people and operate on 300 cataracts, as per Lama. And they were successful with the target exceeding their expectation as they operated on 333 patients in one of the biggest camps in the hill district of Nepal.

In this particular OMEC, supported by the Tej Kohli & Ruit Foundation, the TIO had brought its team to do the surgery, informed Lama. However, they also mobilised local partners for other kinds of arrangements - respective local levels did the publicity of the eye camp and screening camps while also arranging transportation of people from their households to the campsite. The Doramba Rural Municipality arranged the space for the camp along with arranging mattress and blankets for the patients. The CDS did the publicity of the eye screening in Sunapati Rural Municipality along with arranging feeding of patients and visitors. Likewise, the hospital staff of the Doramba Rural Municipality did the Antigen test, blood sugar and pressure test of the patients. The collaboration with local partners aided in making management of the camp efficient - a difficult task to accomplish while doing so single-handedly.

And through this camp, the organisers wanted to prove something too. Dr Ruit elaborated, "Doramba is near the capital city of Kathmandu in terms of distance, but is remote in terms of transportation facilities, geographical terrain and other facilities. We want to showcase that if the camp can be done in such a place, we can do it anywhere in the world."

That's exactly what Dr Rebecca Getacheal, an Ethiopian doctor, felt after seeing the camp.

"What strikes me most is the topography - despite the difficult terrain where it takes hours for the patients to reach, people came for the surgery," said the cornea fellow at TIO, who is determined to organise similar camps back home. Along with that, the camp turned out to be a learning experience for these doctors including Dr Serey Seng (cornea fellow) and Dr Roma Eng (retina fellow) at TIO from Cambodia too where they got to watch and learn from Dr Ruit.

A bigger goal

While the eye camp at Doramba is just an example of what can be done despite the odds, Dr Ruit who has been putting lenses in the eyes of poor people free of charge for years has a bigger goal - to scale it up and take it to 10 other developing countries as part of South-to-South cooperation.

Helping Dr Ruit meet his desire is British philanthropist Tej Kohli, who visited the camp two days in a row (on March 18 and 19) to see how things worked here.

The Tej Kohli & Ruit Foundation, "funded entirely from the private capital of Tej Kohli and the Kohli family", has a plan to cure 300,000 to 500,000 cataract blindness in 10 countries that include Cambodia, Ethiopia, Tanzania, Ghana, Indonesia, Myanmar, Bhutan and India, among others.

"Conducting 300,000 to 500,000 successful operations under Dr Ruit's command is not a joke. That itself is an achievement and I am sure we can achieve those marks,"

Kohli said at a press briefing held at the camp on March 19 and added, "To me it is almost life threatening to be a blind person. So, with Dr Ruit's leadership, we can eradicate any form of blindness and pave a path so that others can follow."

As they are diversifying the treatment to other countries, Kohli added, "Our contribution together is for those countries where people can't afford these types of treatment."

However, the support of the Tej Kohli & Ruit Foundation for TIO began last year as "with Mr Kohli's help we have been able to operate on about 12,000 cataract patients right across Nepal, particularly in indigenous and unprivileged communities, right from the eastern border of Nepal to the western border. And this has been a great help, especially this is such a timely help as because of COV- ID-19 some hospitals were about to be closed and this funding for cataract sponsorship kept the hospitals alive," informed Dr Ruit.

This is just the start as "we plan to do 20,000 to 25,000 surgeries every year to start with in Nepal, looking at the unprivileged and make sure we provide equitable services" as per him.

The confident doctor further claimed the quality of the outcome of the post-operations in situations like this is second to none: "If you take a round at the University of Massachusetts or Cambridge University or the Royal Victorian Eye Hospital, the post-op results will not be very different from what you saw at Doramba."

But in rich countries, such surgeries "will cost multiple times and so a lot of people can't afford it", Kohli said as he reiterated their objective: "So, I think it is one of our criteria to go to places where affordability is an issue." Dr Ruit added, "But we can't do it without Mr Tej Kohli's help and that's very clear."

So, what's the financial commitment that Kohli has made towards this project? "It will be in millions of dollars. My contribution is going to be whatever it takes to do whatever it takes.

And it has to be scaled up in a manner that is doable," assured Kohli, who has been contributing towards the treatment of cornea blindness for the last 12 to 15 years. Yet he was not very happy with cornea transplant because "I believe in scalable things and it is hard to scale cornea blindness as the model has limitations where it can grow."

He was looking around to see where he could to scale his desire of giving sight to people and then Kohli "met a friend who had heard about Dr Ruit". He added, "I heard his name twothree times, and when you hear the same name coming up two or three times, you know in one part of the world he has to be good. So, we reached out to him and convinced him to create this foundation together and see if you could help more people."

Now that they have joined hands, the collaboration is looking into the transfer of technology, as per Kohli who said, "Equipment will be a part of this thing, training and the lenses too. Dr Ruit added, "We have a fantastic group of surgeons in Tilganga who are looking forward to joining this mission. The good thing about Nepali cataract surgery is that we have been able to train others. What I think Mr Kohli sees is that this is a system that has been developed in a country like Nepal and it is very easy to export to another developing country.

It is a beautiful example of South-to-South cooperation."

Tilganga also manufactures intraocular lenses for use in cataract surgeries, keeping costs to less than $4 a lens compared to $250 in the West, as per Dr Ruit.

The lenses are exported to more than 70 countries at present and as of now six million lenses have been used for sight restoration purposes in Nepal and around the world - they are mostly used by the people who cannot otherwise afford it, he informed.

Now, the plan is to relocate the lense manufacturing setup and build state-of- the-art facility to create a model production facility in Nepal, as per Dr Ruit. "We want to take the manufacturing to a new setup to increase volume, and its reach has to be increased across the globe," he said as he informed that it will take around Rs 60 to Rs 70 crores to relocate the lense manufacturing setup, and increase the current production volume by four times. For that they have approached different organisations, including the Tej Kohli & Ruit Foundation though they are yet to commit, he said.

Dr Ruit also informed that they have approached the government for the same and are hopeful though nothing has been done yet.

A version of this article appears in the print on March 27, 2022, of The Himalayan Times.