Editorial»
Dr Ruit: ‘I had a puzzle to solve’
DEC 29 - Dr Sanduk Ruit returned to Nepal in 1987 after spending many years in Australia. It was then he felt the need to take an initiative to set up a separate eye hospital in Nepal and founded Tilganaga Eye Hospital in 1992. Today, it is one of the most reputed eye hospitals in the region, which has revolutionised eye surgery. Tilgnaga Eye Centre exports high quality lens to over thirty developing countries, including
Latin America and Africa. Dr Ruit spoke to Puran P Bista of The Kathmandu Post,
shedding light on cataract surgery, cornea
transplantation, and challenges ahead.
Excerpts:
TKP: What was the state of eye surgery before you decided to set up Tilganga Eye Hospital?
Dr Sanduk Ruit: Things surrounding eye surgery were very much traditional. For example, lens was not used while performing the eye surgery. Which meant those who could afford used to go to either Bangkok or India for the treatment. The trend of going out has slowed down since the last 15 years. Today, we are known for high quality cataract surgery. Our main goal is to further revolutionise cataract surgery here. In fact, the main goal is to reach the poor people so that they, too, can benefit from technological wonders. I have, no doubt, played a major role. Meanwhile, we have graduated to new methods using new technology. The first step was to make the entire efforts cost effective and the technique appropriate for the rural masses.
Cataract surgery deals with vision impairment. Hence one cannot compromise. We made it a point that the poorest of the poor, too, get to fight vision impairment as the rich are able to. This was the greatest challenge. We obtained that technology and are now providing quality service to the people. In other words, we have converted the challenge into reality. What is important here is we have successfully adapted the technology to local conditions without compromising on the quality and outcome. Today, any one can go for it, given the low cost. However, it is also true that the service rendered should be sustainable. Yes it is, we have overcome that barrier too.
TKP: How do you sustain the high-tech service by maintaining quality?
Dr Ruit: Eye surgery in other parts of the world is an expensive affair, given the technology involved. People would have flayed our move as commercially motivated had we introduced that same expensive technique here too. Obviously, this would have restricted the service to mere 5 percent of the eye patients. Hence we simplified the surgery technique and introduced it in such a way that even poor people can avail of the service. In fact, it widened the reach, and reduced costs. At least this was the beginning.
Again, technology is dynamic. It keeps on changing and we have to keep a tab on every change. We want to make sure that patients of developing countries receive the same kind of treatment as in developed countries. For that we introduced non-foldable intra-ocular lens. Now we are planning to introduce foldable lens. Sustaining this technology has to be part of our work plan.
TKP:What were the hindrances you faced while delivering such high-tech services to the Nepali masses?
Dr Ruit: If we talk about the cost, eye lens here used to cost anything from 80 to 90 dollars ten years ago. We brought it down to seven dollars for the local people. In fact, the role played by this hospital is a pivotal one in the field of ophthalmology. We broke the “stone” that too without compromising on vision and quality. We have proved that our lenses are of extremely high quality. We have reached the level of developed countries in this area. Today, there are lenses in the market manufactured by other countries but we were the ones who broke the stone.
TKP: Did you initially have the confidence that it would be Tilganga Eye Centre, which would lead?
Dr. Ruit: No. We did not have such confidence. We took great pains. We did not have such technology. It was very difficult to adapt such a high technology. Every lens used by us caused inconvenience. It demanded sophistication and quality. It was difficult to perfect it. We could do it only after much effort. Secondly, it was an equally difficult task to introduce it to the world since the tag was “Made in Nepal”. Fortunately, we have overcome that too. Now people worldwide know Nepal by two things: Tilganga-made lens and our motto of “non-profitness”. We have been able to transmit that message very clearly to the world.
TKP: What inspired you to achieve such a revolutionary mission?
Dr. Ruit: My teacher, Fred Hollows, was a good friend of mine. I spent some years with him. Both of us used to discuss and think about making this surgical technique a perfect one. How could we make this technique available in developing countries was the puzzle we wanted to solve. I always wanted to make it a reality. I would not have got any opportunity to turn it into reality had I been in Australia. I had enough confidence in myself that I could solve the puzzle once back here. Today, I do not regret my return to Nepal.
TKP: Do eye patients from other parts visit Tilgnag Eye Centre?
Dr. Ruit: Of course, we have patients from India, Pakistan, Bangladesh and even China visiting us for cornea transplantation and cataract surgery.
TKP: How reliable is cornea transplantation at Tilganag Eye Centre?
Dr. Ruit: Cornea transplantation is next on our agenda after cataract surgery. The Most common cause of blindness is cataract. Over 200,000 people are blind because of cataract-related complications. Nepal is an agricultural country. People work in farms and rear cattle. They get hurt in their eyes which, in fact, is the second cause of blindness. They develop cornea opacity. Such patients need to undergo cornea transplantation, which you can do only when someone donates eyes. We did not have that service in the initial phase. We raised awareness of eye donation among the people. We encouraged local initiatives and organised public awareness programmes. Today, our eye bank is considered one of the most reliable in this part of the world. We still have not been able to meet the demand, however.
TKP: Could you elaborate the incidence of blindness in Nepal?
Dr. Ruit: A survey jointly conducted by the government and the WHO in 1980-81 states that little less than one percent of the total population in this country are blind. In that proportion, nearly 80 percent cases were avoidable. Which means they were either preventable or curable. And 70 percent of the cases were that of cataract. Again, 5.3 percent were blind due to complications developed after untimely treatment. We realized that fact and felt the need to bring radical qualitative changes. We did just that.
TKP: What is the current success rate in cataract surgery?
Dr Ruit: It is, after all, a surgery. Some patients have pre-existing complications, besides cataract. In such cases, there may not be complete improvement in vision. Similarly, in any surgery you have complications. Despite that, cataract surgery is much more reassuring. The success rate is over 90 percent, which is comparable to both mobile service and service provided at Tilganaga Eye Centre. Our mobile service is much better in terms of quality and seriousness than in any country in South East Asia. India, too, has not been able to offer mobile ocular service in a cost effective way as we do. In fact, 500 patients visit us every day. Of course, we cannot satisfy every patient. Overall, we have had critical feedback from our patients, which is good for us. Still the biggest challenge is the way we are trying to provide extremely high quality service, given the paying capacity. To some extent, we are still exploring ways and means to overcome that challenge.
TKP: What kinds of difficulties did you face while working to establish Tilganga Eye Centre?
Dr. Ruit: Initially, it was a difficult undertaking. To have a separate eye institution was not encouraged by both the state and the medical professionals. But what was essential was that we were trying to do something in a very different way. We wanted to have three units: eye bank, surgical department and hi-tech laboratory. Nepal had none of these units. For that we had to have extremely swift and effective management. It was not possible without that. Retrospectively, those challenges prompted us to work with added commitment.Posted on: 2003-12-30 05:15
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