An eye for an eye(less)

-BIBEK BHANDARI Last year, 60-year-old Geeta Chhetri started feeling as if her eyes were “filled with sand.” The Janakpur native, upon being checked, found that she had corneal ulcer, an open sore on the cornea, for which she underwent a therapeutic corneal transplantation in January 2010. “I didn’t know what exactly eye donation and transplantation was,” she said, as she waited for her follow-up treatment at the Tilganga Institute of Ophthalmology. “But now I can tell.” And Chhetri is only a number who has benefited from corneal transplantation. In Nepal, eye donation was a new concept until 1994 when the Nepal Eye Bank at Tilganga was established as a center for harvesting, processing, preserving and distribution of corneas. Since its inception, the center has received 3,824 corneas as of 2009 with an average of 200 to 300 corneas every year since 2003. However, patients in need of corneas have outnumbered the Eye Bank’s stock, said Bal Bahadur Khhetri, a technician at the Eye Bank who has been associated with the Tilganga Institute of Ophthalmology since 2003. “People seem to be aware of eye donation,” he said, “but most of them tend to ignore it or it’s not the first thing that comes to their mind when they are emotionally distressed during the death of a family member.” And in between the counseling and making people aware, the corneas may just be worthless. In order to maintain a cornea’s quality, it is important to extract it as soon a person dies since the temperature affects its quality. With reference to Kathmandu, Khhetri said, it is best to extract corneas within eight hours of death in winter and four to six hours during summer. The cornea can thus be preserved for up to 14 days between 2 to 10 degrees Celsius. But not all corneas can be useful and not everyone can receive it. In case of deaths related with diseases like HIV/AIDS, hepatitis, leukemia, brain tumor, or rabies, the corneas cannot be used. Also, in cases the cornea gets exposed to direct sunlight or foreign objects like flowers and rice, which are used before cremation, the cornea goes wasted. On the other hand, patients with corneal opacity, age-related degeneration, corneal ulcer or damage of cornea during surgical procedures can undergo corneal transplantation. It is not functional for people with congenital blindness. So in order to make people more aware and give counseling, the Eye Bank has established a center at the crematory site at the Pashupatinath Temple, which is considered to be the center of cornea harvesting for the Eye Bank. At the Shri Pashupatinath Aryaghat Sewa Kendra, a hospice center in the periphery of the crematory site, Padma Raj Bharati is stationed as a counselor. When dead bodies are brought, he said he tries to talk to family members and explain to them the importance of eye donation. “This can be the best gift you can give to a person after death,” he said. “You can give someone’s vision back.” On a regular day, Bharati said, he is able to counsel and collect two corneas. But there are days when the number is a mere zero. At the Eye Bank, Khhetri said that in the past three weeks, the center has only been able to collect four corneas, while patients have been piling. Thuli Maya Rai from Okhaldhunga came to the hospital on November 18 with corneal ulcer. But she has not been able to find a cornea donor, and within a week her case might worsen, making her entire eyeball pop out. Currently at Tilganga, some 15 patients are on the priority list waiting for cornea transplantation. “In total, there are around 300 patients waiting,” Khhetri said, showing a stack of applications on his desk. But the Eye Bank is gearing up with strategies that will help resolve its shortage of corneas. By January 2011, two additional counselors will be stationed at Pashupatinath for a 24-hour shift, and by July 2011 and 2012, a counselor each at the Teaching Hospital and Bir Hospital respectively so that they can give direct counseling. “However, families should be very much convinced and willing to donate,” Khhetri said. And Geeta Chhetri, who now knows what difference eye donation can make after she has received her own transplant, is ready to spread the message. “Now I tell all my family members and neighbors,” she said, looking at her son-in-law who accompanied her to the hospital. He himself said, “My wife and I are thinking of donating our eyes after death.”