In Nepal, Doctors Cure Blindness Among Poor

Brian Handwerk
for National Geographic Ultimate Explorer
September 26, 2003
This week on href=""
target="_new">National Geographic Ultimate Explorer, host Lisa
Ling visits Nepal with the eye specialists of the Himalayan Cataract
Project. These dedicated doctors, and those they have trained, are
restoring the gift of sight to tens of thousands who need it most.
Miracle Doctors premieres Sunday, September 28, 2003, at 8 and 11
p.m. ET, 5 and 8 p.m. PT.

The World Health Organization estimates that 45 million people worldwide are blind; 90 percent of them are in developing nations. Many of these cases may be easily preventable or treatable. Nearly half could be helped by a procedure that's become routine in many nations—cataract surgery.

In Nepal, a tiny mountain kingdom that is home to Earth's highest mountain, Everest, a dedicated team of doctors is making remarkable progress in treating one of the world's highest rates of occurrence of cataract—and setting the example for many other developing countries.

Enter the Himalayan Cataract Project (HCP), a group of dedicated physicians who have reopened the eyes of tens of thousands of Nepalis of all socioeconomic backgrounds.

Nepal, where the HCP was born, has one of the highest rates of curable blindness anywhere in the world. "It's just accepted that when you get old the hair turns white, the eye turns white (because of cataracts), and then you die," said HCP co-director Geoffrey Tabin.

The reasons for the high cataract incidence are unclear, but may include genetics, intense UV sunlight exposure, malnutrition, or other factors. The effects are more apparent. "Without a family to take care of you, you die right away," Tabin explained. "But even with them you become a huge burden. So cataract surgery in that part of the world not only restores sight but really restores life."

A Single Operation Changes Many Lives

Tabin, an accomplished mountaineer, was returning from a 1988 expedition that put him on the summit of Mount Everest when he witnessed an operation that changed his life—and ultimately those of many others.

"I had started a residency in orthopedic surgery and I took time off to climb and also work as a general practitioner in Nepal," Tabin recalled.

"A Dutch team came in and performed cataract surgery and it absolutely blew me away. It was like a miracle. I got so fired up that when I came back to the States I told my girlfriend that I really wanted to do ophthalmology."

Back in Nepal several years later as ophthalmology resident, Tabin met his future Nepali partner, HCP co-director Sanduk Ruit. Ruit was already making a name for himself in the region by pioneering modern microscopic cataract surgery in Nepal, including the utilization of intraocular lenses (implanted in the eyeball).

The two knew that it was necessary to promote the modern surgical style in Nepal, and to train others to perform it in order to tackle the nation's enormous backlog of treatable cases.

Since the 1994 founding of HCP, the landscape of eye care in Nepal has been drastically altered. A decade ago Ruit was nearly alone in performing modern cataract surgery, but by 2002 there were over 100,000 annual cataract surgeries and 97 percent of them used the modern methods.

It's been made possible by HCP's emphasis on teaching.

"The focus is not myself and Dr. Ruit going to the most remote area in Nepal and doing 50 surgeries," Tabin explained. "It's teaching local folks how to perform thousands of operations. Lots of people Ruit has taught are now teaching others, and even some of those students are now teaching as well."

"Dr. Ruit has changed eye care for the whole region," Tabin added. "He's the genius behind the technique that we teach. I liken myself to the fat boy who gets to play because I brought the ball in the form of fundraising."

A real key to the success of HCP is making the surgery available to huge groups of people in many locations, at an affordable price, in poor nations. It's not an easy task.

At Kathmandu's Tilganga Eye Center the lines sometimes form as early as 3 a.m. About a third of the patients at the facility will pay full price (U.S. $100), a third will pay between $1 and $100, and a third receive the operation at no cost. The system makes Tilganga economically self-sustaining and a model that's worked elsewhere—but not everywhere.

HCP doctors also take their trade to the country's rugged and remote regions, conducting eye camps and training local technicians to work in rural areas.

"We've started a program to train ophthalmology associates," Tabin explained. "They can give glasses and they prescreen patients for the traveling surgeon, find the people with cataracts, and identify those with other problems."

So Much More to Be Done

In Nepal, HCP-trained cataract technicians and doctors are making a dent in the nation's longstanding cataract problem. Tabin and HCP hope that the next step is a more comprehensive eye care system. "It's really amazing to see how much they have improved at the surgery," he said. "Our next challenge is to start training full ophthalmologists. We have doctors doing fellowships abroad, and they will be the teachers in our residency program to train full ophthalmologists."

Beginning this summer, HCP hopes to expand Tilganga Eye Center (Kathmandu) from a cataract outpatient surgery facility to a full-care eye hospital.

With programs in Tibet, China, Bhutan, India, Sikkim, West Bengal, and Pakistan, HCP is casting a broader net. But much more remains to be done worldwide.

"We've just started our first little forays into Africa," Tabin said, "in places like Niger there may be one ophthalmologist for every two million people. So much of the world really has substandard care."

Indeed, in much of the world modern eye care is unheard of.

"The first time we go somewhere people are extremely skeptical," Tabin admitted. "We'll expect several hundred people at an eye camp and we'll get 27. But then the next year we'll have 300 when the word gets out that people are able to see again."

Seeing the word get out, and watching the development of self-sustaining eye care facilities is enormously gratifying to all at HCP. But at the end of the day, it's individual human experience that may be most rewarding of all.

"It's an amazing thing seeing somebody's face when they've been blind for a long time and get their sight back," said Tabin. "It never, ever ceases to thrill me, it just really makes you smile."

To learn more about the Himalayan Cataract Project or to help give someone their sight by supporting the work of Dr. Ruit and Dr. Tabin, log on to their Web site.

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