Tilganga's cornea donation campaign bears fruit

PRATIBHA RAWAL
KATHMANDU, March 7: Two weeks ago, Yugeen Thapa, 18, died of cardiac arrest soon after he was admitted to Bir Hospital.

While still grieving the untimely death of his son, Rajendra Thapa, Yugeen´s father, contacted Tilganga Institute of Ophthalmology (TIO), which runs Nepal´s only eye bank, and asked them to collect the corneas of his dead son.

Thapa, who lives in Gatthaghar of Bhaktapur district, said he is proud that the corneas removed from his departed son´s eyes have helped at least two blind people see the world.

“My son wanted to donate all of his organs,” shared Thapa. “As per his own wish, we wanted to donate not only his eyes but all of his body parts for the benefit of those who needed them. However, due to lack of time, only his eyes could be donated.”

Thapa is more of an exception than norm when it comes to donating body organs of a dead family member.


Yugeen Thapa

Many people are still hesitant to donate even the corneas of their departed relatives. Even the otherwise charitable people shy away from donating their or their family members´ eyes which could help blind people see the world.

There is a huge gap between the demand and the supply of corneas. The rate of cornea extraction is far less compared to the people awaiting cornea transplants. In many cases, even the corneas of people who would have agreed to donate them are lost in lack of proper communication at the time of their death.

To reduce this gap between the demand and the availability of corneas, the TIO launched a cornea-collection campaign two months ago. As part of the campaign, five well-trained counselors have been deployed at two major public hospitals of Kathmandu. After the death of a patient, counselors try to persuade the family of the deceased into allowing them to extract corneas of the dead.

The TIO has currently stationed counselors at Bir Hospital and Tribhuvan University Teaching Hospital (TUTH) as part of the cornea-collection campaign. Shankar Narayan Twayana, Manager at the Tilganga eye bank, says they chose Bir and TUTH for the campaign as they are two of the most-visited and less expensive hospitals in the Kathmandu Valley. "Hundreds of people come for treatment at these two hospitals and it is natural that more people would die at the hospitals than elsewhere," explains Twayana. “That is why we have deployed counselors at the two hospitals."



According to Twayana, in the first two months of the campaign its counselors have collected as many as 87 corneas. “It´s a great success," said Twayana. "Had we not organized the campaign, we could not have collected so many corneas in such a short period.”

At the end of 2012, the Tilganga Eye Bank had around 300 blind people in the waiting list for corneal transplantation.

“One third of the people in that list have already got eyesight,” says Twayana. "More people will get corneal transplants in the days to come."

Counselors deployed by the Tilganga Eye Bank said their aim is not just to collect corneas but also to raise awareness about eye donation. “This campaign is dedicated not only to decrease the number of people in need of cornea but also to clear the misconception about eye donation,” shares Suraj Gautam, a counselor.

“Many people still think that eye donation involves pulling out the eyeballs, which is not true,” says Gautam. "We do not remove the eyes from the dead people. In fact, we just peel off the layer of corneas from the eyes."

If the counselors are able to persuade the family of the dead to donate eyes, they contact the experts at the Tilganga Eye Bank, who then reach Pashupati cremation site to extract the corneas.

According to Gautam, they have so far collected 34 corneas from Bir Hospital and 44 corneas from TUTH as part of the campaign. "Doctors, nurses and all hospital staff have been supportive,” he said. "Without them our campaign would not have been so successful. They instantly inform us if anyone dies at the hospital.”


Ram Pyari Karki and Suraj Gautam persuade families of dead for eye donation.

Rama Silwal, in charge of nurses at Bir Hospital, said the campaign is very important because it tries to utilize the corneas which ultimately get burnt along with dead bodies. “This campaign should have been launched years ago," she said. “Patients die almost every day at the hospital. Had the campaign been launched earlier, a lot of people would have benefited by now.”

Persuading the families to donate the eyes of their dead relative is certainly not an easy task. “We meet different kinds of people," said Ram Pyari Karki, another counselor, "Sometimes it´s very difficult to convince them."

Karki said the smile on the face of blind, who become able to see the world after corneal transplants, is what motivates them to go on. “Whenever we see the blind get the eyesight, our happiness knows no bounds," says she. "It is what keeps us going."

Five hindrances for eye-donation

-A significant number of people with corneal problems are in their seventies, which means that restoring their eyesight by transplanting functional corneas in their eyes is usually not possible. Technical experts at the Tilganga Eye Bank say corneal transplant is not useful for people below five years of age or above 75.

-Some people still believe that they would be blind in their next life if they give away their eyes in this life. Such people do not want to donate their eyes.

-Some people belonging to higher-caste don not want to donate their eyes to people belonging to the low-caste. They say they will donate their corneas only if the Tilganga Eye Bank ensures that they are not given to the low-caste people.

-Many deaths that take place at hospitals are police cases, in which it would be impossible for counselors to get corneas. Also, police do not allow the Tilganga Eye Bank to extract corneas from the eyes of dead people whose families cannot be contacted.

-Extracting corneas from those with HIV, cancer, hepatitis, kidney failure, burns and jaundice is fraught with risks.

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INTERVIEW

We are expanding cornea collection campaign
Shankar Narayan Twayana
Manager, Eye Bank
Tilganga Institute of Ophthalmology

How is cornea collection campaign going on?
It is going great. Our main goal is to give eyesight to as many blind people as possible and this campaign has been a success to a great extent. After we launched the campaign, many blind people have got eyesight. I hope people suffering from corneal problems will not have to wait for years go get eyesight in near future.

How difficult is it to get the families to donate the eyes of their dead relative?
In the early days of the campaign, our counselors faced multiple challenges. They have to maintain good relations with everyone at the hospital. By now they have already turned the situation in their favor. They have been getting full cooperation from doctors and nurses. We organize trainings for our counselors every 15 days, which refreshes their skills.

How long will this campaign continue?
The campaign has a long way to go. The outcomes have been impressive as we have collected more corneas through it. We are planning to expand the campaign to other hospitals. In near future, we will send our counselors to other hospitals like Kathmandu Medical College, Patan Hospital and Nepal Medical College Teaching Hospital.

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Scientists say baby born with HIV apparently cured

ASSOCIATED PRESS
WASHINGTON, March 3: A baby born with the virus that causes AIDS appears to have been cured, scientists announced Sunday, describing the case of a child from Mississippi who´s now 2½ and has been off medication for about a year with no signs of infection.

There´s no guarantee the child will remain healthy, although sophisticated testing uncovered just traces of the virus´ genetic material still lingering. If so, it would mark only the world´s second reported cure.

Specialists say Sunday´s announcement, at a major AIDS meeting in Atlanta, offers promising clues for efforts to eliminate HIV infection in children, especially in AIDS-plagued African countries where too many babies are born with the virus.

"You could call this about as close to a cure, if not a cure, that we´ve seen," Dr. Anthony Fauci of the National Institutes of Health, who is familiar with the findings, told The Associated Press.

A doctor gave this baby faster and stronger treatment than is usual, starting a three-drug infusion within 30 hours of birth. That was before tests confirmed the infant was infected and not just at risk from a mother whose HIV wasn´t diagnosed until she was in labor.

"I just felt like this baby was at higher-than-normal risk, and deserved our best shot," Dr. Hannah Gay, a pediatric HIV specialist at the University of Mississippi, said in an interview.

That fast action apparently knocked out HIV in the baby´s blood before it could form hideouts in the body. Those so-called reservoirs of dormant cells usually rapidly reinfect anyone who stops medication, said Dr. Deborah Persaud of Johns Hopkins Children´s Center. She led the investigation that deemed the child "functionally cured," meaning in long-term remission even if all traces of the virus haven´t been completely eradicated.

Next, Persaud´s team is planning a study to try to prove that, with more aggressive treatment of other high-risk babies. "Maybe we´ll be able to block this reservoir seeding," Persaud said.

No one should stop anti-AIDS drugs as a result of this case, Fauci cautioned.

But "it opens up a lot of doors" to research if other children can be helped, he said. "It makes perfect sense what happened."

Better than treatment is to prevent babies from being born with HIV in the first place.

About 300,000 children were born with HIV in 2011, mostly in poor countries where only about 60 percent of infected pregnant women get treatment that can keep them from passing the virus to their babies. In the U.S., such births are very rare because HIV testing and treatment long have been part of prenatal care.

"We can´t promise to cure babies who are infected. We can promise to prevent the vast majority of transmissions if the moms are tested during every pregnancy," Gay stressed.

The only other person considered cured of the AIDS virus underwent a very different and risky kind of treatment — a bone marrow transplant from a special donor, one of the rare people who is naturally resistant to HIV. Timothy Ray Brown of San Francisco has not needed HIV medications in the five years since that transplant.

The Mississippi case shows "there may be different cures for different populations of HIV-infected people," said Dr. Rowena Johnston of amFAR, the Foundation for AIDS Research. That group funded Persaud´s team to explore possible cases of pediatric cures.

It also suggests that scientists should look back at other children who´ve been treated since shortly after birth, including some reports of possible cures in the late 1990s that were dismissed at the time, said Dr. Steven Deeks of the University of California, San Francisco, who also has seen the findings.

"This will likely inspire the field, make people more optimistic that this is possible," he said.

In the Mississippi case, the mother had had no prenatal care when she came to a rural emergency room in advanced labor. A rapid test detected HIV. In such cases, doctors typically give the newborn low-dose medication in hopes of preventing HIV from taking root. But the small hospital didn´t have the proper liquid kind, and sent the infant to Gay´s medical center. She gave the baby higher treatment-level doses.

The child responded well through age 18 months, when the family temporarily quit returning and stopped treatment, researchers said. When they returned several months later, remarkably, Gay´s standard tests detected no virus in the child´s blood.

Ten months after treatment stopped, a battery of super-sensitive tests at half a dozen laboratories found no sign of the virus´ return. There were only some remnants of genetic material that don´t appear able to replicate, Persaud said.

In Mississippi, Gay gives the child a check-up every few months: "I just check for the virus and keep praying that it stays gone."

The mother´s HIV is being controlled with medication and she is "quite excited for her child," Gay added.

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Dr Koirala breaks silence on sudden TUTH exit

KATHMANDU: After 108 days of taking charge of Tribhuvan University Teaching Hospital(TUTH), Dr Bhagwan Koirala has resigned from his post disillusioned over various external and internal pressures.

On Friday, Dr Koirala had tendered his resignation from the position of Executive Director of TUTH and after three days of silence, he clarified the reasons on Monday that led him to walk out from the prestigious post.

Issuing a statement this evening, Dr Koirala charged that the University Teachers Association and Unions constantly expressed resentment with tighter regulations.

“It became extremely painful when some of the leaders and clean professors started justifying patient referrals out of the hospital,” he said.

Expressing dissatisfaction over the failure of TU and the government to allocate funds for general expenditure, he blamed the central office of TU for dominating authority to make decisions on financial and administrative matters.

However, he has admitted that he has been doing two full time taxing jobs: running a busy cardiac surgical programme and a full time administrative job. “This also became a final tipping factor in my decision making process” Koirala said.

Recalling that the Dean of Institute of Medicine and he were appointed at a time of crisis in the IOM and Teaching Hospital, Koirala said that he was asked to help rescue Teaching Hospital by the Dean and TU Authorities and he did so albeit the various problems some three months ago.

He highlighted 13-point, in his own words, ‘important and positive changes’ during his over three-month stint at Teaching Hospital.

He listed the legal action against those involved in financial irregularities and those violating discipline, enforcement of electronic attendance and observation of timing, clearance of the previous dues including other changes as important positive changes made during his tenure.

Urging all to rise above party politics and help get a new leader to carry on with the agenda of clean deal, Dr Koirala assured that he will remain in public sector in the coming days.

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Free health camp in Gulmi

GULMI, Feb. 23: Thousands of service recipients have thronged a free health camp at Ranibas of Gulmi district.

The specialist health camp is being organized by the Civil Servant Women´s Association, Kathmandu. People from Baglung, Palpa and Arghakhanchi districts have also thronged the free health camp.

According to General Secretary of Association Urmila Bhusal, services on heart, maternity and gynecology, ENT, pediatrics, teeth, mental health, eye and others diseases have been provided for free.

Nephrologist Rishi Kumar Kafle, psychiatrist Mahendra Neupane, cardiologist Diwakar Sharma and Yadav Bhatta, among others are providing services in the three-day-long health camp.

Secretary at the National Planning Commission Yubraj Bhusal and Deputy Director at the Department of Health Service Dr Gunaraj Lohani had inaugurated the health camp.

Ministry of Health and Population, Sahid Gangalal National Heart Center, National Kidney Treatment Center, Universal College of Medical Sciences, Lumbini Medical College, National Academy of Medical Sciences, Bir Hospital and other organizations have extended supports to run the health camp

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Reduced health budget will hamper MDG efforts: Experts

KATHMANDU: Reduction in health budget could create obstructions in meeting the Millennium Development Goals’ (MDG) target, health experts warned today.

Babu Ram Marasini, chief of Health Sector Reform Unit at the Health Ministry said the budget cut will adversely affect efforts to meet the MDG target.

Although the country is showing progress in so far as child mortality rate and maternal mortality rate are concerned, the situation could reverse if the budgetary allocations are not forthcoming, said Marasini.

The Finance ministry has allocated Rs 16.58 billion to the health sector for this fiscal through interim arrangement of expenditure.

Of the total 24.92 billion budget earmarked for the health sector last fiscal, the ministry spent only 20.62 billion.

Though external development partners are interested in increasing financial assistance, the Finance Ministry and National Planning Commission have failed to draft the programme accordingly, said Marasini.

He said the Finance Ministry was not interested in increasing the health budget due to corruption in the health sector.

About 70 to 72 per cent of health budget is spent on salary, incentives, procurement of food and drugs, and transportation, he said.

According to MDG needs assessment for Nepal-2010 carried out by National Planning Commission and United Nations Development Programme, there is urgent need to identify groups that are excluded from access to child health services.

Moreover, neonatal mortality rate (NMR) has not gone down in comparison to under-five mortality rate (U5MR).

There is a need to decrease NMR to achieve the MDGs targets for U5MR and infant mortality rate (IMR).

There are three MDGs focused on health: MDG 4 to improve child health, MDG 5 to improve maternal health and MDG 6 to combat

HIV, AIDS, malaria and other diseases.

As per the report, the U5MR per 1,000 live births was 50 in 2010 which is expected to come down to 40 by 2013. The targeted MDG for U5MR by 2015 is 38 .

The IMR per 1,000 live births was 41 in 2010 and the goal is to bring it down to 36 by 2013. The MDG for IMR by 2015 has been set at 32.

NMR per 1,000 live births was 20 in 2010. The target for 2013 is 16.

The maternal mortality rate (MMR) per 100,000 live births was 229 in 2010. The target set for 2013 is 170. The MDG for MMR by 2015 is 134.

“Direct impact of reducing the health budget will be noticeable after some years,” said Marasini. The effect will be mostly seen in child health, maternal health and status of communicable diseases, nutrition and other preventive care programmes, he added.

Meanwhile, he said the health sector has been adversely affected with the government’s failure to introduce new programmes in the current fiscal.

Secretary at the ministry Praveen Mishra said the country has various challenges to address in child health, maternal health, and communicable and non-communicable diseases.

Human resource crisis in the health sector is another major challenge before the ministry, said Mishra.

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