Let there be light

By  Zubeida Mustafa

For four years an eye hospital has been functioning quietly and unobtrusively at Nagan Chowrangi in New Karachi. Not much fanfare attended its opening in July 1993. No political dignitary was invited to grace the occasion. Even today not many people know about the existence of this hospital, except for those who benefit from the services it offers nearly free of cost.

This is the Eye Bank Society’s hospital which has come up entirely with public donations. A nominal registration fee of Rs 20 is all that a patient is required to pay for consultation and medication. If surgery is needed, say for cataract, he would have to pay Rs 5000 — but that too if he can afford it. (Private clinics are charging as much as Rs 35,000 for cataract surgery.) The majority of the patients are not charged the full amount because they come mainly from the low-income families and it is not in their means to spend fabulous sums on medical treatment. Over 25,000 patients have benefited from this eye hospital so far. Dr Hasnain, one of the two eye surgeons attached to the hospital says that he and his colleague examine about 70 to 80 patients every day.

The PEBS eye hospital, which is still under construction, is designed to provide eye care facilities to the indigent who need it and cannot pay for health care to private practitioners. When all its four floors are completed and it is fully operational the hospital building will also house a facility for research in eye diseases.

While the hospital is serving a noble cause, the key function of the eye bank has assumed a low profile. When it was launched, the eye bank was expected to maintain a register of patients whose sight can be restored by a corneal graft. Concurrently, it was also designed to motivate people to give a gift of sight by signing will cards to donate their corneas after death. But the last mentioned activity has been at a standstill for sometime now. After getting 40,000 cards filled but very few deaths reported for enucleation, Iftikhar Husain feels the exercise of mobilizing potential donors is proving to be quite a futile one-in the present conditions. “We need laws to recognize corneal donation and grafting. Relatives also have to be motivated so that they facilitate the fulfilment of the donor’s will. Without a law, many problems are being encountered. Thus resistance from even one next-of- kin can obstruct the enucleation of the eyes of a donor who wanted to gift his eyes to the blind,” he observes. Why do we need an eye bank in the first place? Rubina’s (not her real name) tale of pain and agony — and there are many others like her — underlines the urgent need of an eye bank and the underpinning of a law sanctioning corneal donation. Had corneas been available in plenty and grafting was as commonplace as cataract-surgery, Rubina would have got a new cornea much earlier and her pain and itching would have disappeared long ago.

Rubina had been suffering from corneal ulcers in her left eye for over six years. With the fluid of her eye having dried up and the blisters causing intense burning and pain, she was adviced a graft. After overcoming her initial reluctance she agreed to have one. The grafting procedure is simpler than cataract surgery. But where does one go to get a cornea? Sri Lanka is the only option. Since Rubina comes from a comfortably well off family she could afford to pay. She deposited a 200 US dollars bank draft with an eye surgeon in Karachi to book a cornea from the Sri Lanka Eye Donation Society. She was promised a cornea within three months. Mercifully, the wait was not a long one. Within a month the cornea arrived and Rubina got her graft. Since she also suffers from cataract in that eye she will have to wait for the implanted cornea to heal before she can go in for cataract surgery. It will be another few months before Rubina will be able to see with her left eye.

 Rubina’s case is a revealing one. She is one of the fortunate ones. She did not qualify as a Lions Club’s cornea recipient because she is not young and is not totally blind. With just a few corneas coming in, the Lions have to be extremely selective. Since a minuscule number of Pakistanis donate their eyes, there is a constant shortage of corneas for grafting. Then there is the fact that Rubina could pay 200 dollars for the cornea and Rs 20,000 for the surgery which will facilitate the restoration of her sight.

True this amounts to less than the charges for cataract surgery in the private sector (Rs 35,000). But cataract surgery is being done more or less free of charge by government hospitals and a number of charitable eye hospitals. Eye camps are also set up from time to time which take the miracles of cataract surgery to the doorstep of people in the most remote rural areas.

This cannot be done for corneal graft surgery — though the operation is simpler — because corneas are not available. They have to be paid for. If only a fraction of the 1.3 million or so people who die every year in Pakistan were to donate their corneas, the problem of non-availability of the organ at nominal cost would vanish. What we need to do is to launch a massive campaign to mobilize public opinion to make people aware of the problems of the corneal blinds and how easily they can be given the gift of sight provided those who die donate their eyes for corneal grafting. The eye bank plays a crucial role in mobilizing public opinion and coordinating the modality of enucleation and grafting.

For that, there is need for corneal donation to be given legal cover. Hence the importance of the bill. At the same time the campaign for motivating people must be re-launched.

Source: Dawn 4 Sept 1997