Nepal's "magic" surgeon brings light back to poor

Dressed in his hospital scrubs, Sanduk Ruit looks into the eyes of a patient through a microscope hanging over an operating table.

He makes two tiny holes in one eye, takes out a jelly-like mass of natural lens and replaces it with an artificial one that fits snugly into the patient's eye, all in about five minutes, deftly moving his fingers clad in thin white gloves.

The patient is then moved away swiftly, without any stitches, and Ruit repeats the process to remove cataracts - a leading cause of blindness in Nepal - from the eyes of another person.

The simple operation pioneered by Ruit, a Nepali national, at the Tilganga Eye Centre in Kathmandu has benefited tens of thousands of people in Nepal and other countries in Asia and Africa, where surgical teams from the center provide much needed care in field camps.

"We are trying to set up a model of how you can conduct a very high quality prevention of blindness program at low cost and make it sustainable," said Ruit, the center's founder and medical director. "If you can do it in Nepal it can be done anywhere in the world."

Ruit said an estimated 20 million people were blind from cataracts globally. Another 60 million are at various stages of blindness, many of them in developing countries and unable to afford expensive surgery to restore their sight.

Ruit and his team of doctors at the center have developed a simple surgical technique involving little equipment and instruments that can be used manually. No stitches are needed, and the technique can be used on a simple table in field camps.

Low cost acrylic lenses - called intraocular lenses - are produced at the center's laboratory by workers wearing bio-safe masks, helping bring the cost down to $4 per lens from more than $100 apiece for the imported kind used previously.

The center produces about 350,000 lenses annually, selling them in other nations, with the income helping pay its costs.

WITHIN REACH OF ALL

One operation, which could cost up to $3,000 in the West, costs less than $300 even for the richest person in Nepal. The average cost is $115, and those who cannot pay get the same service for free.

"The beauty of this is that it allows us leverage to cover the costs for the poor, a sort of cross subsidy," said Ruit, 56, who studied in India. "I am trying to duplicate what we are doing here in other countries."

Doctors at the centre train foreign surgeons who, in turn, replicate the technique in their own countries.

"Getting such training in developed countries is both expensive and difficult. But it is easy and nice here," said Ethiopian doctor Fikru Melka, 49.

Australia's Fred Hollows Foundation, which helped set up the lens production facility, and the Himalaya Cataract Project based in Salt Lake City, Utah, also support the center.