Tuesday, 3 September 2013

The Spirit of Eye Donation



Following is a narrative written by Toni Cervantes, a volunteer photographer who has worked closely with SightLife, LV Prasad and Ramayamma international Eye Bank. She has traveled extensively throughout India, photographing the noble work done by eye banks across the country. ln her travels, she has also spent considerable time with donor families, capturing their stories and the stories of their loved ones. Read through this story ("Bright Spirit") and spend a few minutes discussing how the work  carried out by eye donation counselors can not only allow others to see but can also help donor families through the grieving process.

Every parent's worst nightmare is to have to bury one of his or her own children. Beautiful 11-year old Gwonjan was on her way to a Pujah at the Hindu temple to receive a blessing from the Goddess Durga. On her way back home, she stopped at a friend's house before heading to her father's small shop in the neighborhood. She never made it.

A few hundred meters from the safe haven of her father's arms, Gwonjan cherry red bicycle with a pink floral basket hanging in front was hit from behind by an unknown driver who never stopped to claim responsibility for the crime. An upbeat and happy soul like her was well known in the neighborhood. Someone recognized her lifeless body and went running to get the father.

Satish accompanied his daughter to the emergency hospital hoping there was a chance for revival, but Gwonjan had died on the spot. His only wish was that she would speak just once - call out "Papa" – but she could not. She was already gone. His biggest regret is not hearing her voice one more time. After informing the family of the accident, Gwonjan's father went completely numb. From this moment on, he was on automatic pilot with only one thought in mind: against strong family and bureaucratic opposition, he was determined to donate the corneas of his beloved daughter.

It was around 8:00 in the evening when Gwonjan passed away, long past closing time for the legal and technical infrastructure and personnel to approve and endorse the cornea recovery. The father had no idea there was a time limit for donating healthy corneas. When he was informed that the integrity of the tissue is no longer viable for transplant after a few hours, he worked with more urgency. For a little girl who always wanted to do good in the world, her father would not be deterred from making sure that his daughter’s death would not be in vain.

First he had to convince the grieving mother, Rehke, and his other two daughters that this is what Gwonjan would have wanted. The mother, t4-year-old Ayushi and 8-year-old Twinkle were so overcome with grief they said, "No!" Eventually Satish was able to convince them that her death could be of some value; after all Gwonjan was always a god-fearing little girl and wanted so much to do something good in the world - please let this be it.

In the meantime, the manager at the local eye bank was startled awake by an urgent midnight phone call. The wheels were in motion and the clock was ticking. The police were reluctant to proceed, but Gwonjan's father was a self-motivated donor. He had seen the ad campaigns around town and remembered them well. He told the authorities Gwonjan was his daughter and they were in no position to tell him, "No!" He would not be denied. She was his and he had made the decision. lt was final.

The police reluctantly agreed. The next step was for the eye bank manager to coordinate with her staff in order to carry out the recovery. She needed to find a technician who was willing to crawl out of bed in the middle of the night to perform the recovery - and she needed to find one fast. With a blessing from the Goddess Durga, a technician was found. But Gwonjon's neck was so badly broken; the technician could not do the recovery and hold her head correctly at the same time. The father heroically stepped in and gently cradled his daughter's head in his hands one last time as he steadied her for the procedure.

The corneas were tested and they were superb. ln the morning two families were woken up by a life changing phone call. Two young children who had been waiting months for a suitable match were going to be the recipient of Gwonjan's corneas. By 3:00 of that afternoon (in April of 2O11), two successful PK surgeries were performed. Because of the tenacious mission waged by Gwonjan's father, these two kids would have a fighting chance at a normal life.

Satish still thinks of his darling daughter 24 hours a day. He cannot believe she is no more. The house is empty without her. Of the three daughters, Gwonjan was the naughty mischievous one who delighted everyone she met. Twinkle misses her favorite playmate. Ayushi misses the pranks Gwonjan used to play on her. When she entered the Horne she came in dancing, alerting everyone like a signal that she had arrived - her energy was that vibrant.

As the family related the story and their memories of their luminous sister and daughter, tears welled up in their eyes. Throats swelled and tightened from the overwhelming sorrow and disbelief that she is truly gone. That she passed so unexpectedly into the next world was impossible for the family to accept. Three days later, they went to the eye bank begging for the opportunity to meet the recipients, but the eye bank manager refused this request. She was able to convince the family of the legal and emotional ramifications if such a meeting were to take place. lt wasn't easy, but in time they understood the wisdom of maintaining the privacy of both families.

ln conclusion, Gwojan's family urges all people to be brave and courageous when they are faced with the difficult decision of whether or not to donate the corneas of their loved ones. That person is gone and cannot come back, but if his or her corneas are donated, then someone else will have the prospect of a new life. Her mother says, 'A donation is the gift of sight which can help light up the world," one person at a time.

If Gwonjan’s' family has but one wish for the recipients it would be that they embrace life with a passionate vivacity. They pray the beneficiaries carry in their Heart the bright spirit their beloved Gwonjan radiated to all those who crossed her path

Monday, 2 September 2013

MCEH trainee from Zanzibar, Tanzania



Fatma is the firstborn in a family of five. She was born in 1969 in Pemba in Zanzibar Island, Republic of Tanzania. Both her parents are associated with healthcare; her mother is a retired gynecologist and her father a nurse. She too joined the medical profession is currently employed with the Ministry of Health as a national eye care coordinator for the Zanzibar Islands and mid level eye care worker. She has trained as a cataract surgeon in Malawi and has a post graduate diploma in community eye health from the University of Cape Town.

Fatma has collaborated and coordinated, both locally and nationally in her country, on several eye camps, outreach screening and surgical programs. She is keenly involved in planning, clinical teaching, management, supervising and conducting staff training at Primary Health Care Units Centers. She is married and has a son.
Despite all her commitments and engagements, Fatma seized the opportunity to fulfill her dream of obtaining a Masters’ in Community Eye Health (MCEH) when she chanced upon the LVPEI/UNSW program. She promptly applied for it and was selected.

At LVPEI, she soon felt so much at home that she didn’t miss Zanzibar much. The excitement of an impressive work environment and the sizeable exposure contributed immensely to her skills and knowledge. Thanks to the training, she has upgraded her capability in areas such as community assessment, planning, project management, epidemiology, biostatics and research. She is so enthused with the experience that she plans to continue with her studies and pursue a PhD. 

 

Inspired by the LVPEI model, she has plans to make suitable changes to the eye care program she works with back home in Tanzania. She is also eager to continue communicating with LVPEI in different ways in terms of sharing experiences, case studies, research, etc., and plans to send more students to the institute.

Tira, the eye bank trainee from Mizoram

 

T Lalhriattira or in short Tira is from Aizawl, Mizoram. Having completed his B SC in Physics, he found work as an ophthalmic assistant at the eye bank at the Civil Hospital in Aizawl. He has now been sent to LVPEI to train for 3 months as an eye bank technician at the Ramayamma International Eye Bank.

Now two months into his training at LVPEI, he is highly appreciative of the quality of training provided and is particularly impressed with the immense practical orientation he is getting. In his words, “Even after 10 years, I will not be able to forget what I learned here at LVPEI!” 

Thanks to the practical hands-on training imparted by eye banking staff, he says that he has gained so much knowledge and experience in two months that he is confident of applying it right away; if he were to return to Aizawl now, he thinks he could handle assignments with ease. What that would entail for an eye bank technician would be to screen the donor, retrieve the corneas from the deceased, processing of corneas, evaluation of the corneas and distribution of suitable corneas to the needy surgeons. This would also include ensuring quality until the cornea is transplanted along with taking care of laboratory and equipment maintenance, instrument cleaning and sterilization and proper documentation of the donor corneas.

He also had the opportunity to work with eye donation counselors trained by LVPEI. The counselors spend time at the multispecialty hospitals, approaches bereaved families and motivate them to make an eye donation. This forms part of the HCRP (Hospital Cornea Retrieval Program) which is the first of its kind started by LVPEI way back in 1990.

Tira looks forward to coming back again for the one week refresher training. After completing his training, he aspires to work for the people of Mizoram in particular, and India at large. He is a soccer enthusiast just like most of his other peers from the North East; but quite unlike many other digitally inclined, keypad-happy youngsters, he enjoys reading good old books and has even enrolled for a B.A to fulfill his passion!

Dr. Joseph Nezgoda completes short term clinical rotation


 


Dr Joseph Nezgoda says that with his fellowship training having completed, he will have two personal goals being very effectively fulfilled. Firstly, he will be able to understand and perform the nuances of Small Incisional Cataract Surgery (SICS) that he believes is the most cost-effective treatment for cataract extraction. Secondly, he will also be able to pursue his main area of interest of vitreoretinal disease thanks to the exposure to the retina service at LVPEI. 

He feels that LVPEI offers good learning opportunities in retina care. The diversity and numbers of India’s population provides a host of trauma and uveitis cases that can only further his education. He has seen many cases of Macular Telangiectasia (MacTel), VKH, Behcet’s disease, FEVR, Retinoblastoma, among other rare conditions, and found it exciting that LVPEI’s research includes Idiopathic Juxtafoveal Macular Telangiectasia (MacTel), a blinding condition of the retina. 

He also had the opportunity to work with eye donation counselors trained by LVPEI. The counselors spend time at the multispecialty hospitals, approach bereaved families and motivate them to make an eye donation. This forms part of the HCRP (Hospital Cornea Retrieval Program) which is the first of its kind started by LVPEI way back in 1990.




Tran Minh Anh was born and brought up in Hanoi, the capital city of Vietnam. The opportune moment for her to be associated with the world of Optometry presented itself when the two organizations of Eye Care Foundation and Brien Holden Vision Institute in collaboration with the Vietnam National Institute of Ophthalmology were scouting for avenues to establish and develop Optometry in Vietnam. Tran Minh Anh seized the opportunity by enrolling for a course in optometry, securing a sponsorship for a 4 year program. This was how she came to L V Prasad Eye Institute and the Bausch and Lomb School of Optometry (BLSO).

With interests in travelling and reading books, Tran Minh was particularly fond of Chemistry and Biology right from her school days. Tran Minh had travelled to a few countries before coming to India, having chosen the country for its strength in imparting both theoretical and clinical skills. She says she is fond of Hyderabad for its beauty and feels that India, with its diversity of cultures, provides a very fascinating environment. Though she finds the food spicy and oily, she has come to cope with it. Being the fourth year of her stay at BLSO and LVPEI, she recalls how the past 4 years were memorable.

She found the classes held in BLSO very interesting and inspiring. She has a special word of praise for the BLSO principal and faculty who are always helpful and supportive. She also recalls how during her internship, she could herself clinically examine patients. She also recalls how she and her mates at BLSO had chanced upon 'Reflektionz', a two-day intercollegiate festival at the Sankara College of Optometry, Bangalore, on the occasion of World Optometry Day. The festival included more than 20 competitions; and there were 8-9 colleges from South India attending it.

  
 

Tran Minh Anh – fondly called Miao by her mates - won awards in various categories such as debate, pick and speak, art from waste and face painting categories. To top it all she even won a special prize for winning the highest number of prizes in the festival. This was something special both for Tran Minh and BLSO. She became noted on campus as the Vietnamese student who had come all the way to study Optometry in India and was now winning awards for BLSO, beating students from other institutes! Tran Minh Anh hopes to become an Optometry practitioner in Contact Lens and Pediatrics. She is also ambitious of becoming a good teacher to inspire the minds of aspiring Optometrists.

Penetrating Keratoplasty (PK) surgery for Kanakappa

This is the story of Kotha Kanakappa who hails from Avangapur in Narayanpet mandal of Mahabubnagar district of Andhra Pradesh. Unfortunately for him, at the age of 55, he developed vision problem in both his eyes and was confined to his house. He was even unable to attend to his daily chores.

As he was carrying on in this difficult condition, after about a year, his son came to know of an eye camp at Kaverammapeta. On being taken there, Dr. Mallikarjun referred him to L V Prasad Eye Institute. At LVPEI, Dr. Somasheila Murthy performed Penetrating Keratoplasty (PK) surgery on Kanakappa, once in the left eye, and two times in the right eye.

Penetrating Keratoplasty (PK) refers to the replacement of the host cornea with a donor cornea. It is used with success in patients with decreased visual acuity secondary to corneal opacity, in the treatment of corneal thinning or perforation, for the removal of non responding infectious foci and for the relief of pain. Penetrating Keratoplasty (PK) may be combined with cataract surgery, secondary intraocular lens implantation, glaucoma surgery and retinal surgery.


Post surgery, Kanakappa’s condition has improved significantly, and he is able to carry out his activities effectively. He says he goes to his field, goes to the nearby hotel for a cup of tea and is able to carry out his daily activities and is again self dependent. He is full of gratitude for Dr. Somasheila Murthy and LVPEI. He says LVPEI has brought back "light into his life".

Vitrectomy Restores Vision for Sai Keertana

The story is regarding a young girl Sai Keertana from Kakinada in East Godavari District of Andhra Pradesh. Doctors who saw her said that they had little hope in restoring her eyesight as she had developmental defects in both the eyes right from birth. The parents, both of whom were working people, were very distraught with this.

However, on the advise of well wishers and the medical fraternity in Kakinada, they came to LVPEI Hyderabad where Dr Raja Narayanan “created hope, gave assurance and showed the result” in the words of Sai Keertana’s happy mother Mrs Usha Rani. In February 2012, Vitrectomy was performed in the left eye. Vitrectomy is the surgical removal of the vitreous gel from the middle of the eye which is done in cases of retinal detachment. In March 2013, surgery was performed for cataract and an IOL (Intra ocular lens) was implanted. Post surgery, there was significant improvement.





Sai Keertana is now in the seventh standard and with the use of aids like the telescope and stand magnifier provided by the CSE (Centre for Sight Enhancement) at LVPEI, she is able to carry on with her studies. She has come out of the situation in which she had to depend on her mother to read out to her. Though she had a post operative problem of developing cataract, it was also attended to by Dr Pravin Krishna.

Sai Keertana, who is 14 years old, has been under treatment for the last one and a half years. With follow up treatment along with regular check-up every two months, her condition has improved significantly. Back to normal life she is now eagerly pursuing carnatic music apart from her regular studies. With this intervention, not only Sai Keertana, but the entire family has been helped out of the emotional trauma.