A person born in rural Nepal faces numerous challenges, but few things can affect the quality of life as much as the quality of sight. Most people living in rural Nepal work on the land, and being blind not only means they are not able to work, they also become a significant burden to their family. They are, for all practical reasons, rendered a waste of space, a curse, an existence that should cease to be. That is, before they realise that their sight could be restored, that powers exist to redeem their lives, that they can come out from the dark and begin living again. This is a story about the work of Tilganga Institute of Opthamology, a social enterprise conceived by renowned eye surgeon Dr. Sanduk Ruit, and how they are restoring sight to Nepal’s no longer neglected people.

(Left) Dr. Carey Dozier does a preliminary examination of a patient at an eye camp supported by the Druk Amitaba Monastery in Sitapaila, Kathmandu. On average, the Tilganga Institute of Opthamology conducts 40-50 screening camps per year across the Asian region. A cost-efficient and suture-less method of cataract surgery designed and perfected by founding surgeon, Dr. Sanduk Ruit, attracts international doctors and medical students to Nepal to learn its technique. When the method was introduced to the medical community in 1994, it was denounced and could not source any funding. No one believed that a ramshackle state like Nepal could develop a first-class surgical method. Determined and unrelenting, Dr. Ruit forged ahead with his skills and beliefs, and revolutionized cataract surgery for the underprivileged but no less deserving groups of people on this planet. He says, “Blind people are blind everywhere. In five minutes, they can regain their future.”

Text and pictures by Debby Ng

With just two eye surgeons working on more than 260 patients in just two days, the waiting lines were long. Some patients had travelled for days by foot and bus to reach the outer rim of Kathmandu district. A 70-year-old patient, who waited at least 11 hours before he received his surgery, said, “Life without sight is hard. This journey, this waiting, is effortless.”

Text and pictures by Debby Ng

Nuns at the Druk Amitaba Monastery gather outside the makeshift operation theatre as they stand by to render help to patients. This is the first eye camp initiated by the Druk Amitaba Monastery. Mohan Serestha, one of the several coordinators of these eye camps, explains that the capacity of the Institute is extended by the concern and pro-activeness of hundreds of volunteers who initiate and facilitate these eye camps that gather hundreds of patients from tens of rural districts that surround Kathmandu. Much of these monumental facilitation efforts occur in the background and the volunteers who enable the Institute to carry out their work go unnoticed, but M. Serestha affirms that these facilitators are fundamental to their work and the aid that is given to the beneficiaries.

Text and pictures by Debby Ng

Krishna Bahadur Pahari, 46, looks at his father, 98-year-old Birbathu Bahadur Pahari, who had just received surgery in both his eyes. For patients who are completely blind, doctors will carry out surgery on both their eyes at the same time. For those who have partial vision, one eye will be operated on at a time just in case an infection surfaces and complications occur. Although 80% of blindness is curable, 150,000 people in Nepal remain blind due to a lack of financial resources, patient ignorance that they can be cured, or both. Birbathu Bahadur Pahari was the oldest patient at this particular eye camp. He shares that “blindness makes me worry about death. Sight gives me the motivation to live. Blindness equals death.” He added, “After regaining my sight, I want to contribute to activities in the home.”

Text and pictures by Debby Ng

Patients rest with weighted balances that keep a gentle pressure on the eye as they wait for a recently administered anesthetic to take effect. Some of these patients have never been to a doctor in their lives, and although the procedures are arduous and painful, patients approach without fear. Instead, they are brimming with anticipation and hopefulness.

Text and pictures by Debby Ng

Amidst the 260-odd patients at this eye camp, 18-year-old Timthi Chepang from Dhading District stood out as the youngest patient. Just over five-feet tall, T. Chepang is small for his age. He suffers from congenital cataracts, which means he was born with cataracts though the effects are not observed till early childhood. Dr. Ruit described, “His vision is likened to looking though a misty windshield.” T. Chepang dropped out of school at aged nine because he could no longer read. It is possible that his mother was malnourished when she was expecting him, that he was malnourished or contracted rubella when he was an infant, or a combination of these.

Text and pictures by Debby Ng

An anesthesiologist administers a local anesthetic into the eye cavity of one of T. Chepang’s eye as one of the nuns from Druk Amithaba Monastery comforts him. Although he has cataracts in both eyes, doctors will work on only one of his eyes as he still has partial vision. Opthamological Supervisor, Radha Krishna Shah, who has worked with the Institute for 14 years, explains that younger patients require more anesthetic to relax the muscles that surround the eye. T. Chepang required two injections, and though his anxiety was evident, he braided his fingers and bared the pain quietly and hardly flinched during the procedure.

Text and pictures by Debby Ng

Dr. Ruit and his assistant carry out the cataract removal procedure in the make-shift operating theatre at the Druk Amithaba Monastery. After the cataract is removed, an artificial lens that is also manufactured within the Institute is inserted in its place. Dr. Ruit founded the Institute and developed his methods with the conviction that “the poor should not receive second-class medical care.” The clean room that manufacturers these lenses is based within the Institute and is the only such manufacturing facility in Nepal. Hence the methods and materials for this procedure are purely developed and designed in Nepal, which is an inspiring fact for many. Today, Nepal advances fast in terms of eye surgery.

Text and pictures by Debby Ng

After several hours of waiting for a procedure that takes less than 10 minutes, patients rest in rooms prepared by volunteers at the Druk Amitaba Monastery. T. Chepang rests among several older men who have just had their surgery. They will have to wait a few more days before their eyes heal and their vision stabilises, but for those who have been living in complete darkness, just a glimmer of light and the slightest improvement in sight thrills them.

Text and pictures by Debby Ng

On the morning of the second day of the eye camp, more patients arrive from the districts surrounding Kathmandu. Patients are eager to receive their personal cheat sheet that will allow them to begin preliminary tests to ascertain the condition of their cataracts. Though the patients were already screened at community eye clinics located outside Kathmandu or by mobile eye clinics rallied by volunteers from throughout the country, a second screening conducted at the eye camp affirms their condition and aids the staff from the Institute with administration procedures.

Text and pictures by Debby Ng

Dr. Sanduk Ruit inspects the eye of a patient who underwent surgery the day before. As this eye camp was conducted in Kathmandu, several members of the press from surrounding countries including India, Malaysia, Singapore and Hong Kong, arrived to report on the efforts and the almost-instant results of the eye camp. In less than 24 hours, patients who are cleared of complications are briefed about basic eye care that is necessary over the following two weeks, and discharged to be sent on the journey back to their villages. The suture-less technique allows the eye to heal within 24 hours, and costs between US$20-25. Yet this amount is not affordable to many.

Text and pictures by Debby Ng

Patients, including T. Chepang, and their chaperons, leave the eye camp with a bottle of antiseptic eye wash and a new life illuminated by sight. Their reactions are subtle, and they express few words, but their gratitude is apparent. Having followed a handful of patients closely during the two days, several patients and their family members offered me handshakes and hugs to share their joy.

Text and pictures by Debby Ng

Back in Singapore, patients would be encouraged to rest and stay at home after undergoing similar surgery. But patients who have regained if even the slightest sight, are ready to enter and experience a world, which for a while had been taken away from them. Here, a few patients exit the bus during a traffic jam in the city to buy grapes from a vendor on a bicycle.

Text and pictures by Debby Ng

The loss of sight affects individuals in different ways. Women, who play a massive role in the home and farming environment, are twice as likely as men to be impaired by blindness, and their incapacity has a severe impact on their dependents. For young persons such as T. Chepang, it means he can’t go to school, and life begins to deteriorate from an early age. He left home to work after he dropped out of school, and though the sight in one of his eyes has been restored, his vision is still not good enough to enable him to read. Here he rests in his “bedroom” – an open hay shack he shares with five other youth labourers in the district of Dhading. Complete sight restoration has the potential to renew his life on several levels. He says he wants to do social work when his sight is completely restored, so that “others like me can be saved”.

Text and pictures by Debby Ng