An odd title, I agree. Yet three gentlemen make up a small history of an institution that is fascinating on so many levels. The Tilganga Institute of Ophthalmology is itself quite a feat, founded by Nepali doctor Sanduk Ruit and supported to an extent by USAID, Australia’s Fred Hollows Foundation, and the Himalayan Cataract Project (US). The Nepal Eye Bank manager, Sankha Twyana and later the technician Bhola Khitri, were trained both in Nepal and in the Czech Republic, thanks to extra help by the international tissue non-profit, Tissue Banks International (Maryland, USA). These two gentleman spent years working on both an individual level and a larger social level in Nepal (accompanied by Ruit and corneal surgeons such as Dr. Reeta Gurung) to overcome the barriers of tissue donation in Nepal.

Shankha Twyana is the Nepal Eye Bank’s manager and first technician by Joel Addams
While it has been an uphill battle, many Nepalis now believe that donating one’s corneas (the thin, clear front portion of the eye) can be much more beneficial to them in the next life, an idea that was not always in vogue in Nepal. With a country that is 80% Hindu and about 20% Buddhist, many in previous generations were not interested in donating their corneas, believing that they would be blind in the next life. This has changed somewhat as corneal extractions by these eye bank technicians have moved from the hospitals to the sites where families bring their loved ones for cremation: the Buddhist Temples and the Hindu Temples. There is the intersection of medicine and religion, when families are met by these three men to discuss — in the middle of the funeral — if they would consider making the donation of their loved one’s corneas. It can be a tense and intense time, where some families are willing and understanding, others can be rude and quite angry.

Bhola Khitri was the second technician at the Nepal Eye Bank (and still loves his green tea) by Joel Addams
It doesn’t help, either, if you look too young when approaching families about such a major donation. The young Bala, the newest of the technicians, is in his mid-twenties and as most Nepalis do, he looks a bit younger. There’s no scorekeeping when it comes to successful approaches to families, but Bala and I were turned down many, many times when approaching families. The authority of the more elderly and therefore wiser (?) individual may be what is preventing a higher success rate for the technician, but he pushes ahead, knowing that he is doing a good thing. So many people are waiting for corneal transplants in Nepal and the tissue is never enough to meet the demand currently.

The Nepal Eye Bank technician Bala by Joel Addams
I’ve provided a few images of these three gentlemen. May they continue well on their way!
If you’d like to support any of these great institutions, I can think of none better who run more efficiently and effectively as they do:
TBI (Tissue Banks International, Baltimore, Maryland)
Himalayan Cataract Project (Burlington, Vermont)
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