Dr Sanduk Ruit and corneal transplantation in Nepal.

Abstract

In Kathmandu, Nepal, capital of one of the world's poorest countries, a patient with a blind eye from a corneal scar can have sight-restoring corneal transplantation as easily as in San Francisco — for free if the person is too poor to pay. The corneal tissue is fresh and of high quality, often better than what is available to patients in the United States. The central figure in creating this remarkable situation is Dr Sanduk Ruit, who was born in a small village not far from the Tibetan border. His family were mountain people — caravan traders. His father stretched the family funds to send him to primary and secondary school in Darjeeling, a rugged 9-day journey on foot across the high pass at the Indian border. He trained at the All India Institute of Medical Sciences in Delhi, completed ophthalmology residency, and learned corneal transplantation surgery in Australia and Amsterdam. In 1996, he established the Nepal Eye Bank, which, as in western countries, was set up in the hospital. Initially, things were slow. So Ruit and his associates thought about how most of the deaths in Kathmandu occurred at home and not in a hospital. They realized that 40% of people who passed away were brought immediately to the Pashupati Temple on the banks of the holy Bagmati River for cremation at the ghats. They thought about the fears among the Hindus and Buddhists who believe in reincarnation and often believe that if the corneas are donated they will be reborn blind. After a dialogue with prominent Buddhist monks and Hindu priests, word went out that the body left behind after death is unimportant and that giving sight to someone blind would increase good karma for the family. In 1997, Ruit moved tissue procurement for the eye bank out of the hospital and onto the grounds of the Pashupati Temple. Two years later, the number of corneas collected by the Nepal Eye Bank had increased almost fivefold, the number of corneas distributed in Nepal had tripled, and the number of corneal transplantations performed at Tilganga Eye Hospital had more than doubled.1