Himalayan Cataract Project
Encyclopedia
The Himalayan Cataract Project (HCP) was created in 1994 by Dr. Geoffrey Tabin and Dr. Sanduk Ruit
with a goal of establishing a sustainable eye care infrastructure in the Himalaya. HCP empowers local doctors to provide ophthalmic care through skills-transfer and education. From its beginning, HCP responds to a pressing need for eye care in the Himalayan region. With programs in Nepal
, Tibet
, China
, Bhutan
, India
, Sikkim
, and Pakistan
they have been able to restore sight to tens of thousands of blind people every year since 1994.
In addition, HCP's assistance has been requested for a pilot study on eye care services in twelve Millenium Research Villages in Sub-Saharan Africa
. The Millennium Villages Project was established in part to prove that successful implementation of the UN Millennium Development Goals is possible in the poorest, most underserved areas of the developing world. HCP has agreed to provide comprehensive eye care in each of the Villages (5,000 per village) and to demonstrate that the costs of these services will fit within the complex U.N. Health Budget for the Millennium Villages Project. So far, interventions have taken place in Uganda
, Ethiopia
, and Ghana
with effective delivery of interventions such as cataract surgeries, refraction and distribution of glasses.
estimates, the most common causes of blindness around the world in 2002 were:
Suffering from blindness affects not only the blind person but also members of his/her family. Where there are few paved roads and where terrain is rugged and mountainous, a blind person has incredible difficulty moving around and depends on a caretaker. There are no social services available to the blind, and individuals who are blind cannot contribute to family income. A blind person, unable to care for themselves in such a harsh environment requires a help of a family member, which essentially takes two people out of being able to contribute to family income, or community life. With sight restored, many patients would be able to return to work and to traditional roles in their families and societies.
In 1993, there were 15,000 cataract surgeries performed in Nepal, only 1000 of which utilized intraocular lenses. Most of these 1000 modern surgeries were performed by HCP's Co-Director, Dr. Sanduk Ruit, who brought microsurgery with intraocular lens technology to the region. Before this technology, cataract surgery consisted of intracapsular cataract extraction, in which the entire lens and capsule are removed from the eye and the patient is given cumbersome thick eyeglasses that provide no peripheral vision and distorted direct vision. At that time, the second and third leading etiologies of blindness after cataracts were aphakia due to the loss of these thick glasses, and failed cataract surgery.
In contrast, in 2003, over 118,000 cataract surgeries were performed in Nepal and over 98 percent were done with microsurgery and lens implants. Nepal is the only country in the Himalayan region performing more cataract surgery than the annual rate of new cataract blindness.
The cost of one sight restoring surgery, including the intraocular lenses, is $12 US, the most cost-effective intervention in all of medicine. The Himalayan Cataract Project teams are able to run remote eye camps for an average of $4,000 USD . Donors such John and Cecily Leach, who donated the HCP cataract camp bus provide a mobile clinic that gets medical teams to remote locations. Since 1994, Tilganga eye camps have examined nearly 150,000 patients and performed 25,000 eye camp cataract surgeries.
These programs also reach to Tibet, China, Bhutan, Sikkim, India, West Bengal, and Pakistan and are also rapidly improving eye care by establishing a sustainable eye care infrastructure. Through performing remote cataract camps, HCP has directly restored sight to tens of thousands of blind people in those regions. But the project’s impact goes much further because the HCP’s focus has been on training indigenous surgeons to perform modern cataract surgery.
One third of the patients pay the full USD $100 for a complete work-up, modern cataract surgery, and all post-operative care. Twenty percent of the patients pay a smaller amount based on what they are able to pay. The remaining third of the patients receive the cataract surgical care entirely free. With this model, the facilities are able to cover all costs.
grew up in a remote village in Eastern Nepal. He attended school in India and completed his three-year ophthalmology residency at the prestigious All India Institute of Medical Sciences in Delhi, India. He also completed fellowships in microsurgery in the Netherlands and Australia as well as additional ophthalmic training at the Wilmer Eye Institute of the Johns Hopkins University School of Medicine and the University of Michigan. In 1986 Dr. Ruit met Professor Fred Hollows from Sydney, Australia while Hollows visited Nepal as a World Health Organization consultant. He went on to study with him for 14 months at Sydney’s Prince of Wales Hospital. Hollows was Ruit’s mentor and inspiration in the work that he does. The two men believed in the right of people with treatable blindness to have their sight restored, and that people in developing countries deserved access to the same quality of care and technology as those in the Developed World. They shared an ambitious vision: the elimination of avoidable blindness in the Himalayan region, a process they believed needed to be driven by local people.
When Dr. Ruit returned to Nepal he was instrumental in the formation of the Nepal Eye Program and worked on a large epidemiological survey of blindness in Nepal. He was the first Nepali doctor to perform cataract surgery with intraocular lens implants and pioneered the use of microsurgical extra-capsular cataract extraction with posterior chamber lens implants in remote eye camps. Although other important international organizations sponsored eye camps in the region providing eye care and training local ophthalmologists, the camps established by Dr. Ruit were the first to introduce the use of intraocular lenses in cataract surgery. Put simply, this is the removal of the cataract and insertion of a plastic intraocular lens.
Dr. Tabin and Dr. Ruit vowed to add their own efforts to those of other existing eye care programs, with a goal of overcoming treatable and preventable blindness in the Himalayan region in their lifetime. Dr. Ruit established the Tilganga Eye Centre in 1994 as the first outpatient cataract surgery facility in the Himalayan region. In 1995 Dr. Ruit and Dr. Tabin formally began the Himalayan Cataract Project as a charitable foundation to support their work. From the start, the projects of the Tilganga Eye Centre have been a central focus of the Himalayan Cataract Project.
Dr. Tabin spends at least three months per year in Asia working with his Nepalese counterparts directing Tilganga Eye Centre’s efforts to provide an international standard of eye care and participating in the outreach programs. As the director of the Himalayan Cataract Project, he has over ten years experience administering an international charitable organization. He is a leader in both the local ophthalmologic community and the American Academy of Ophthalmology. Dr. Tabin is also the distinguished recipient of the 2008 Outstanding Humanitarian Service Award given by the American Academy of Ophthalmology
in recognition of his international humanitarian efforts.
Sanduk Ruit
Dr. Sanduk Ruit is a Nepali eye surgeon whose small-incision cataract surgery with the use of inexpensive intraocular lenses has enabled hundreds of thousands of poor cataract patients of Nepal and other countries to regain their sight. Dr...
with a goal of establishing a sustainable eye care infrastructure in the Himalaya. HCP empowers local doctors to provide ophthalmic care through skills-transfer and education. From its beginning, HCP responds to a pressing need for eye care in the Himalayan region. With programs in Nepal
Nepal
Nepal , officially the Federal Democratic Republic of Nepal, is a landlocked sovereign state located in South Asia. It is located in the Himalayas and bordered to the north by the People's Republic of China, and to the south, east, and west by the Republic of India...
, Tibet
Tibet
Tibet is a plateau region in Asia, north-east of the Himalayas. It is the traditional homeland of the Tibetan people as well as some other ethnic groups such as Monpas, Qiang, and Lhobas, and is now also inhabited by considerable numbers of Han and Hui people...
, China
China
Chinese civilization may refer to:* China for more general discussion of the country.* Chinese culture* Greater China, the transnational community of ethnic Chinese.* History of China* Sinosphere, the area historically affected by Chinese culture...
, Bhutan
Bhutan
Bhutan , officially the Kingdom of Bhutan, is a landlocked state in South Asia, located at the eastern end of the Himalayas and bordered to the south, east and west by the Republic of India and to the north by the People's Republic of China...
, India
India
India , officially the Republic of India , is a country in South Asia. It is the seventh-largest country by geographical area, the second-most populous country with over 1.2 billion people, and the most populous democracy in the world...
, Sikkim
Sikkim
Sikkim is a landlocked Indian state nestled in the Himalayan mountains...
, and Pakistan
Pakistan
Pakistan , officially the Islamic Republic of Pakistan is a sovereign state in South Asia. It has a coastline along the Arabian Sea and the Gulf of Oman in the south and is bordered by Afghanistan and Iran in the west, India in the east and China in the far northeast. In the north, Tajikistan...
they have been able to restore sight to tens of thousands of blind people every year since 1994.
In addition, HCP's assistance has been requested for a pilot study on eye care services in twelve Millenium Research Villages in Sub-Saharan Africa
Sub-Saharan Africa
Sub-Saharan Africa as a geographical term refers to the area of the African continent which lies south of the Sahara. A political definition of Sub-Saharan Africa, instead, covers all African countries which are fully or partially located south of the Sahara...
. The Millennium Villages Project was established in part to prove that successful implementation of the UN Millennium Development Goals is possible in the poorest, most underserved areas of the developing world. HCP has agreed to provide comprehensive eye care in each of the Villages (5,000 per village) and to demonstrate that the costs of these services will fit within the complex U.N. Health Budget for the Millennium Villages Project. So far, interventions have taken place in Uganda
Uganda
Uganda , officially the Republic of Uganda, is a landlocked country in East Africa. Uganda is also known as the "Pearl of Africa". It is bordered on the east by Kenya, on the north by South Sudan, on the west by the Democratic Republic of the Congo, on the southwest by Rwanda, and on the south by...
, Ethiopia
Ethiopia
Ethiopia , officially known as the Federal Democratic Republic of Ethiopia, is a country located in the Horn of Africa. It is the second-most populous nation in Africa, with over 82 million inhabitants, and the tenth-largest by area, occupying 1,100,000 km2...
, and Ghana
Ghana
Ghana , officially the Republic of Ghana, is a country located in West Africa. It is bordered by Côte d'Ivoire to the west, Burkina Faso to the north, Togo to the east, and the Gulf of Guinea to the south...
with effective delivery of interventions such as cataract surgeries, refraction and distribution of glasses.
Background
According to WHOWorld Health Organization
The World Health Organization is a specialized agency of the United Nations that acts as a coordinating authority on international public health. Established on 7 April 1948, with headquarters in Geneva, Switzerland, the agency inherited the mandate and resources of its predecessor, the Health...
estimates, the most common causes of blindness around the world in 2002 were:
- cataractCataractA cataract is a clouding that develops in the crystalline lens of the eye or in its envelope, varying in degree from slight to complete opacity and obstructing the passage of light...
s (47.9%), - glaucomaGlaucomaGlaucoma is an eye disorder in which the optic nerve suffers damage, permanently damaging vision in the affected eye and progressing to complete blindness if untreated. It is often, but not always, associated with increased pressure of the fluid in the eye...
(12.3%), - age-related macular degenerationMacular degenerationAge-related macular degeneration is a medical condition which usually affects older adults and results in a loss of vision in the center of the visual field because of damage to the retina. It occurs in “dry” and “wet” forms. It is a major cause of blindness and visual impairment in older adults...
(8.7%), - corneaCorneaThe cornea is the transparent front part of the eye that covers the iris, pupil, and anterior chamber. Together with the lens, the cornea refracts light, with the cornea accounting for approximately two-thirds of the eye's total optical power. In humans, the refractive power of the cornea is...
l opacity (5.1%), and - diabetic retinopathyDiabetic retinopathyDiabetic retinopathy is retinopathy caused by complications of diabetes mellitus, which can eventually lead to blindness....
(4.8%), - childhood blindness (3.9%),
- trachomaTrachomaTrachoma is an infectious disease causing a characteristic roughening of the inner surface of the eyelids. Also called granular conjunctivitis and Egyptian ophthalmia, it is the leading cause of infectious blindness in the world...
(3.6%) - onchocerciasisOnchocerciasisOnchocerciasis , also known as river blindness and Robles' disease, is a parasitic disease caused by infection by Onchocerca volvulus, a nematode . Onchocerciasis is the world's second-leading infectious cause of blindness. It is not the nematode, but its endosymbiont, Wolbachia pipientis, that...
(0.8%).
Suffering from blindness affects not only the blind person but also members of his/her family. Where there are few paved roads and where terrain is rugged and mountainous, a blind person has incredible difficulty moving around and depends on a caretaker. There are no social services available to the blind, and individuals who are blind cannot contribute to family income. A blind person, unable to care for themselves in such a harsh environment requires a help of a family member, which essentially takes two people out of being able to contribute to family income, or community life. With sight restored, many patients would be able to return to work and to traditional roles in their families and societies.
Objectives
| 1) teach ophthalmic care at all levels 2) establish a first-rate eye care infrastructure through creating centers of excellence and mentoring facilities 3) making all facilities financially self-sustaining 4) addressing eye care from the public health level up to subspecialty care |
In 1993, there were 15,000 cataract surgeries performed in Nepal, only 1000 of which utilized intraocular lenses. Most of these 1000 modern surgeries were performed by HCP's Co-Director, Dr. Sanduk Ruit, who brought microsurgery with intraocular lens technology to the region. Before this technology, cataract surgery consisted of intracapsular cataract extraction, in which the entire lens and capsule are removed from the eye and the patient is given cumbersome thick eyeglasses that provide no peripheral vision and distorted direct vision. At that time, the second and third leading etiologies of blindness after cataracts were aphakia due to the loss of these thick glasses, and failed cataract surgery.
In contrast, in 2003, over 118,000 cataract surgeries were performed in Nepal and over 98 percent were done with microsurgery and lens implants. Nepal is the only country in the Himalayan region performing more cataract surgery than the annual rate of new cataract blindness.
Skills-Transfer Program
The Himalayan Cataract Project has trained well over thirty surgeons to perform modern sight-restoring cataract surgery through a unique skills-transfer program. HCP utilizes a team approach, where a doctor, a nurse, and an ophthalmic assistant trains for 4–8 weeks at Tilganga. The surgeon takes an intensive microsurgical course, gaining dexterity under the microscope, while the team develops into a finely-tuned unit. The team then returns to its remote clinic, where it prescreens several hundred patients who are blind from cataracts. The HCP teaching surgeons follow and set up a high-volume skills-transfer cataract camp. The teaching surgeons operate on the first eye of each patient, while the training surgeon assists. Then the training surgeon operates on the second eye of each patient while the HCP surgeon assists. In the course of a typical skills-transfer eye camp, more than five hundred blind people will have their sight restored and each local team and surgeon will perform over 100 cataract surgeries. This is more surgeries than an American ophthalmology resident usually does in a three-year residency program. At the conclusion of the session, the Himalayan Cataract Project donates the operating microscope, surgical instruments, intraocular lenses, and consumables needed to perform an additional 500 surgeries. The HCP then follows up with additional training at the local surgeon’s hospital every year for the next three years. Several of the surgeons we have trained are now performing more than 1000 sight-restoring cataract surgeries per year, and have gone on to train other ophthalmologists. The cost of a skills-transfer program, including all equipment and supplies, is usually around USD $25,000.High-volume Remote Cataract Surgery Camps
The Himalayan Cataract Project travels into remote areas where medicine has not yet reached, extending eye care to those who perhaps need it most. In these remote villages where the population is too small to warrant training a doctor, the HCP performs high-volume cataract surgery camps. These camps differ from skills-transfer camps in that the focus is not to train physicians, but to provide eye care to as many people as possible. The goal of these camps is to move patients from total blindness before surgery to having good ambulatory vision on the following day after their eye-patch is removed. Complete vision is typically recovered within one month.The cost of one sight restoring surgery, including the intraocular lenses, is $12 US, the most cost-effective intervention in all of medicine. The Himalayan Cataract Project teams are able to run remote eye camps for an average of $4,000 USD . Donors such John and Cecily Leach, who donated the HCP cataract camp bus provide a mobile clinic that gets medical teams to remote locations. Since 1994, Tilganga eye camps have examined nearly 150,000 patients and performed 25,000 eye camp cataract surgeries.
These programs also reach to Tibet, China, Bhutan, Sikkim, India, West Bengal, and Pakistan and are also rapidly improving eye care by establishing a sustainable eye care infrastructure. Through performing remote cataract camps, HCP has directly restored sight to tens of thousands of blind people in those regions. But the project’s impact goes much further because the HCP’s focus has been on training indigenous surgeons to perform modern cataract surgery.
Cost-Recovery
All of the Himalayan Cataract Project’s facilities strive to be completely financially self-sustaining through a unique cost-recovery program in which the wealthy patients subsidize the poor patients.One third of the patients pay the full USD $100 for a complete work-up, modern cataract surgery, and all post-operative care. Twenty percent of the patients pay a smaller amount based on what they are able to pay. The remaining third of the patients receive the cataract surgical care entirely free. With this model, the facilities are able to cover all costs.
Tilganga Institute of Ophthalmology
Tilganga Institute of Ophthalmology (TIOC) is the flagship of the Nepal Eye Program and the current facility was opened in 1994. It is a non profit, community based, non-government organization that is committed to providing eye care services and implementing the Vision 2020 concept of elimination of avoidable blindness. TEC's goal is to act as a model for treatment, research and training, in cooperation with all other eye care centres and organizations in Nepal.Dr. Sanduk Ruit
Dr. Sanduk RuitSanduk Ruit
Dr. Sanduk Ruit is a Nepali eye surgeon whose small-incision cataract surgery with the use of inexpensive intraocular lenses has enabled hundreds of thousands of poor cataract patients of Nepal and other countries to regain their sight. Dr...
grew up in a remote village in Eastern Nepal. He attended school in India and completed his three-year ophthalmology residency at the prestigious All India Institute of Medical Sciences in Delhi, India. He also completed fellowships in microsurgery in the Netherlands and Australia as well as additional ophthalmic training at the Wilmer Eye Institute of the Johns Hopkins University School of Medicine and the University of Michigan. In 1986 Dr. Ruit met Professor Fred Hollows from Sydney, Australia while Hollows visited Nepal as a World Health Organization consultant. He went on to study with him for 14 months at Sydney’s Prince of Wales Hospital. Hollows was Ruit’s mentor and inspiration in the work that he does. The two men believed in the right of people with treatable blindness to have their sight restored, and that people in developing countries deserved access to the same quality of care and technology as those in the Developed World. They shared an ambitious vision: the elimination of avoidable blindness in the Himalayan region, a process they believed needed to be driven by local people.
When Dr. Ruit returned to Nepal he was instrumental in the formation of the Nepal Eye Program and worked on a large epidemiological survey of blindness in Nepal. He was the first Nepali doctor to perform cataract surgery with intraocular lens implants and pioneered the use of microsurgical extra-capsular cataract extraction with posterior chamber lens implants in remote eye camps. Although other important international organizations sponsored eye camps in the region providing eye care and training local ophthalmologists, the camps established by Dr. Ruit were the first to introduce the use of intraocular lenses in cataract surgery. Put simply, this is the removal of the cataract and insertion of a plastic intraocular lens.
Dr. Geoffrey Tabin
Dr. Geoffrey Tabin is Professor of Ophthalmology & Visual Sciences and Director of the Division of International Ophthalmology at the John A Moran Eye Center at the University of Utah. He graduated from Yale University and earned a Masters in Philosophy at Oxford on a Marshall Scholarship. He received his MD from Harvard Medical School in 1985. His background in philosophy and ideas of improving health care delivery came together after a climbing trip to Nepal on which he became the first ophthalmologist to summit Mt. Everest.Dr. Tabin and Dr. Ruit vowed to add their own efforts to those of other existing eye care programs, with a goal of overcoming treatable and preventable blindness in the Himalayan region in their lifetime. Dr. Ruit established the Tilganga Eye Centre in 1994 as the first outpatient cataract surgery facility in the Himalayan region. In 1995 Dr. Ruit and Dr. Tabin formally began the Himalayan Cataract Project as a charitable foundation to support their work. From the start, the projects of the Tilganga Eye Centre have been a central focus of the Himalayan Cataract Project.
Dr. Tabin spends at least three months per year in Asia working with his Nepalese counterparts directing Tilganga Eye Centre’s efforts to provide an international standard of eye care and participating in the outreach programs. As the director of the Himalayan Cataract Project, he has over ten years experience administering an international charitable organization. He is a leader in both the local ophthalmologic community and the American Academy of Ophthalmology. Dr. Tabin is also the distinguished recipient of the 2008 Outstanding Humanitarian Service Award given by the American Academy of Ophthalmology
American Academy of Ophthalmology
The American Academy of Ophthalmology is the largest national membership medical association of ophthalmologists–medical doctors specializing in eye care and surgery including medical, surgical and optical care. More than 90 percent of practicing U.S. Eye M.D.s are Academy members, and the...
in recognition of his international humanitarian efforts.
In Film
- Light of the Himalaya (2006) is a 9 time Award-winning documentary film by Michael Brown, produced by David D'Angelo in collaboration with Rush HDRush HDRush HD was an adventure sport-oriented television channel that broadcasted exclusively in high definition television in Central Europe, Scandinavia and Latin America. Programming features coverage of Extreme Action Sports such as BASE jumping, snowboarding, windsurfing, bungee jumping, and cliff...
and The North FaceThe North FaceThe North Face, Inc. is an American outdoor product company specializing in outerwear, fleece, shirts, footwear, and equipment such as backpacks, tents, and sleeping bags....
. At the heart the most formidable mountain range on earth lives a gracious people who suffer from the highest rates of cataract blindness on the planet. The North FaceThe North FaceThe North Face, Inc. is an American outdoor product company specializing in outerwear, fleece, shirts, footwear, and equipment such as backpacks, tents, and sleeping bags....
athlete team joins eye surgeons from Nepal and America in hopes of making a difference. This film follows the doctors' work on the Himalayan Cataract Project all the way to the summit of a 21,000-foot Himalayan giant.