Restoring vision in the Himalayas

Russian astronaut Vladimir Djanibekov once told me that from space the Himalayas stretch across earth like a pearl necklace. Indeed, Nepal is the home of Mount Everest - the tallest mountain in the world. "The country is surrounded by brilliant white mountains," he said. However, the warmth, hospitality and humbleness of the Nepalese are the essence of this country.

It is these values that enchant its visitors. The temptation to help this countrty sandwiched between the mighty countries of India and China is often irresistible. Despite priceless beauty, Nepal is amongst the least developed countries in the world. The country needs a lot of help especially in the area of health.

The mission of Kae Walls, a resident of Melbourne, to raise 200,000 Australian dollars to build the first glaucoma clinic in Nepal is a humble step to help Nepal. With a small team of support, she is determined to raise the money within a year. The money is being raise through the charity – Nepal Glaucoma Eye Clinic Association (NGEC) based in Melbourne. Walls, who herself, lost her sight for almost a year knows this clinic is vital to the Nepalese people.

The mission began when she befriended a Nepalese doctor. She became close friends with Dr Suman Thapa, an eye specialist, at the Tilganga Eye Centre in Kathmandu, Nepal. Thapa was in Melbourne with a fellowship in glaucoma at the Eye and Ear Hospital at that time. Thapa helped her regain the gift of vision. A friendship was formed. Kae was to help Suman build the eye clinic in Tilganga.

The friendship between an Australian and Nepalese is not new for Tilganga Eye Centre. In fact, it was a similar and strong friendship that formed the foundations of Tilganga. Dr Fred Hollows, a famous Australian Ophthalmologist while on a visit to Nepal as a consultant to the World Health Organisation met Dr Sandruik Ruit, a young Nepalese doctor from the western region trying to prevent blindness in the mid 1980s.

Ruit was then working as a medical officer with the Nepalese Prevention for Blindness Programme. This meeting seeded a friendship which grew strong. Ruit came to Australia for over a year at Sydney’s Prince of Wales Hospital. Hollows became Ruit’s mentor and an inspiration to him. The two men had the same core values. Both believed that people in developing countries deserved access to the same quality of care and technology as those in the developed world.

They shared a vision: elimination of avoidable blindness in the Himalayan region. It could be achieved but with the help of the local people.

When Ruit returned to Nepal, he worked hard to put this vision into reality. It is estimated that over 300,000 of the Nepalese population is blind. The work of Ruit was to be a tough one. But, he didn’t give up.

Ruit was the first Nepalese doctor to perform cataract surgery with intraocular lens (IOL) implants. The process involves the removal of the cataract and insertion of an IOL lens. The implantation of the lens takes around 10 minutes. And a patient can see within 24 hours. Dr. Ruit has in one day planted the lens in more than 100 patients. "It is the best thing a human can do in five minutes," says Ruit.

Fred Hollows during his years as a doctor saw a growing disparity between the haves and the have nots in eye health. He decided to do something about it. Hollows worked in the Aboriginal communities in Australia to provide eye care services. The Fred Hollows Foundation’s vision is of a world where no one is needlessly blind and where Indigenous Australians enjoy the same health outcomes as all Australians.

Fundraising efforts by the team of Hollows and Ruit helped to establish Tilganga Eye Centre in Kathmandu. The centre was officially opened in 1994; one year after Fred Hollows died.

The centre, which is of high quality and non-governmental, has become the leading centre for eye care in the Asian region. The centre boasts of the Fred Hollows Intraocular Lens Laboratory which has the capacity to manufacture 350,000 lenses a year at a very low cost. The centre exports IOLs mostly to developing countries of Latin America, South Asia, South-East Asia, Africa and South Africa. Tilganga has an Eye Bank and a Surgicentre that has since restored sight to tens of thousands of disadvantaged people in Nepal and surrounding countries.

For, centenarian Bir Bahadur Tamang, of Chhatre Deurali Dhading, the work of Ruit has meant he can see his great great grandchildren - meaning his grandson’s grandson. A surgery was conducted on the 101-year-old man’s right eye last year, and he got the most beautiful and precious gift on earth - his nearly lost eyesight.

"Just seven months ago my great-great grandson was born," said Tamang emerging from the makeshift operation theater at Kapan hill on the outskirts of the capital Kathmandu, his right eye covered with a bandage. "But I could not quite recognise him. Now (that the doctors have operated my eye) I can see his face, and identify my others, too."

The elderly man, clad in the traditional Nepalese dress - the daura surwal, was among hundreds of basically elderly crowd that had converged at the picturesque Pullahari Monastery from the surrounding villages of Kathmandu Valley. The operation was conducted free of charge, and it is something he could have never afforded in this life.

This is just one of the hundreds of camps Ruit and his expert team from Tilganga have conducted over the past decade in the Himalayan region. Stories like that of centenarian Bir Bahadur Tamang of a remote district in Nepal can be heard from each camp that Ruit’s team has given the gift of vision to.

Not only has Ruit restored over 30,000 sights himself he has also trained local surgeons throughout Nepal, Vietnam, India and China. And – doctors and medical staff continue to come to the humble centre in Kathmandu from surrounding countries.

In just ten years of its existence, the blindness prevention programme of Tilganga has been recognised as one of the best in the world. "We promote the use of intra-ocular lenses manufactured in Nepal as they are of high quality and relatively cheaper," said Dr Rajesh Kishore Shrestha, an eye surgeon at Om Hospital and Research Centre, a well established private hospital in Kathmandu, Nepal.

However, there is still a long way to go. "Until we can attract all the paying patients in the captive market, we’ll not be able to provide quality services to the poor," says Dr Ruit. And so, the work continues.

For Pema Sherpa, a trekker in the Himalayan Mountains of Nepal, the loss of his eye sight due to glaucoma meant he had to leave his job. To live in the country of mountains and not be able to see their beauty cannot be imagined. He was unable to see the majestic peaks that towered over his home in Solukhumbu.

Despite boasting the world’s highest peaks including Mount Everest, Solukhumbu is a very remote place and only accessible by air. It was a team of doctors and technicians from Tilganga that bought the gift of sight to these humble people of the mountains. The first ever glaucoma screening was done in this area through efforts of Dr Suman Thapa.

Pema underwent free surgery at Tilganga through funds collected by the Glaucoma Support Group Nepal (GSGN). He has now resumed trekking.

The next generation of doctors follows the step laid out by Fred Hollows and Sandruik Ruit.

Thapa, currently the only glaucoma specialist in Nepal has begun an awareness campaign to prevent glaucoma. Together, Kae Walls and Suman Thapa organised a Glaucoma Awareness Week last April. Glaucoma is a condition where the pressure within the eyeball exceeds the level that can be normally tolerated by the eye. It can result in the loss of eyesight. “It is the second largest cause of blindness in Nepal,” said Dr Thapa.

Pema is grateful to the team at Tilganga. He is now able to earn a livelihood and support his family. Pema has regained the gift of sight.

Walls was touched by this very humbleness of the Nepalese people. Although she had traveled to many places in the world, the helplessness of the patients who could not afford treatment to cure glaucoma sparked the start of her mission. “I just knew I had to help,” she says. And- when Dr Thapa wanted to open a clinic for patients she said she would raise the money.

This new glaucoma clinic will be an addition to the services of Tilganga. The need for a glaucoma clinic is vital in Nepal. The funds collected will be directly used to build the clinic and to hold various eye camps around the country. “We believe it is an excellent opportunity to foster self-reliance instead of dependence in developing countries,” said Walls.

Indeed, to give the gift of vision is great. Nepal is lucky to have strong friendships working to restore sights.

And – on a clear day this means they will be able to see Everest.