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Dressed in his hospital scrubs, Sanduk Ruit looks
into the eyes of a patient through a microscope hanging over an
operating table.
He makes two tiny holes in one eye, takes out a jelly-like mass of
natural lens and replaces it with an artificial one that fits snugly
into the patient's eye, all in about five minutes, deftly moving his
fingers clad in thin white gloves.
The patient is then moved away swiftly, without any stitches, and Ruit
repeats the process to remove cataracts - a leading cause of blindness
in Nepal - from the eyes of another person.
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The simple operation pioneered by Ruit, a Nepali national, at the
Tilganga Eye Centre in Kathmandu has benefited tens of thousands of
people in Nepal and other countries in Asia and Africa, where surgical
teams from the centre provide much needed care in field camps.
"We are trying to set up a model of how you can conduct a very high
quality prevention of blindness programme at low cost and make it
sustainable," said Ruit, the centre's founder and medical director. "If
you can do it in Nepal it can be done anywhere in the world."
Ruit said an estimated 20 million people were blind from cataracts
globally. Another 60 million are at various stages of blindness, many of
them in developing countries and unable to afford expensive surgery to
restore their sight.
Ruit and his team of doctors at the centre have developed a simple
surgical technique involving little equipment and instruments that can
be used manually. No stitches are needed, and the technique can be used
on a simple table in field camps.
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Low cost acrylic lenses - called intraocular lenses - are produced at
the centre's laboratory by workers wearing bio-safe masks, helping bring
the cost down to $4 per lens from more than $100 apiece for the imported
kind used previously.
The centre produces about 350,000 lenses annually, selling them in other
nations, with the income helping pay its costs.
WITHIN REACH OF ALL
One operation, which could cost up to $3,000 in the West, costs less
than $300 even for the richest person in Nepal. The average cost is
$115, and those who cannot pay get the same service for free.
"The beauty of this is that it allows us leverage to cover the costs for
the poor, a sort of cross subsidy," said Ruit, 56, who studied in India.
"I am trying to duplicate what we are doing here in other countries."
Doctors at the centre train foreign surgeons who, in turn, replicate the
technique in their own countries.
"Getting such training in developed countries is both expensive and
difficult. But it is easy and nice here," said Ethiopian doctor Fikru
Melka, 49.
Australia's Fred Hollows Foundation, which helped set up the lens
production facility, and the Himalaya Cataract Project based in Salt
Lake City, Utah, also support the centre.
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Ruit has personally conducted nearly 125,000 operations including in
free field camps in Nepal and other countries like North Korea, China,
Indonesia, India, Ghana and Nigeria.
"Like a magician, he has given back my sight," said Krishna Kant Paudel,
81. It was the first time in four years that he could see.
"I will come back to get my second cataract removed soon," he said.
About 150,000 of Nepal's 26.6 million people are estimated to be blind
in both eyes, most of them with cataracts. But treating them is often a
challenge given the country's poverty and people's superstitions.
Nearly one quarter of the Nepalis live on a daily income of less than
$1.25 and the cost of the surgery - even as low as it is - can still be
a burden.
Moreover, some people are also loathe to seek treatment, thinking that
blindness is a punishment for something wrong they might have done in
their previous lives.
Still, headway is being made and the results can be awe inspiring. Ruit
recalled how he was moved by a woman who had given birth to a baby boy
when she was blind but saw her son for the first time when he was
4-years-old after surgery in a field camp in eastern Nepal.
She looked at the child for a few moments, then jumped to grab him, wept
tears of joy and began kissing him, Ruit said, eyes glinting with
emotion.
"I was totally moved by the expression of her face. This is the power of
such a simple surgical intervention," he said.
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