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Helping The Blind See Again

Menzikhang Hospital, Lhasa's only traditional Tibetan hospital, is just steps away from Tibet's most sacred pilgrimage site at Jokhang Monastery, where hundreds of Buddhist pilgrims prostrate themselves every morning and afternoon.

At the Menzikhang Hospital entrance I am met by Seva Tibet Sight Program's Associate Manager, Dolma Chugi. She guides me through the patient recovery room and the theatre of cataract operations. I was stunned to see, that in one morning, twenty patients were operated on for cataracts. They entered the operating theatre blind and ten minutes later came out seeing. Afterwards, we talked with some of the recovering patients with Dolma translating:

Dorje was the first patient we met. He works in the telecommunications sector in Lhasa and is fifty-one years old. In August 2006 he suddenly lost vision in both eyes. His work was severely affected. Staff had to read documents to him. Last year under Seva's program his right eye was operated on. His left eye was operated on yesterday. To travel to Chengdu for cataract surgery, the cost would be prohibitive. So he sought treatment in Lhasa through Seva. Minutes before meeting Dorje, he had checked 6:6 on his vision test.

Chu Ghe, fifty-five years old, came from a very isolated country to Lhasa for treatment last year when he could no longer undertake any farm work, essential for survival in his village. Through Seva he was cured of cataract in one eye last year; he has a second follow-up operation for the other eye scheduled for this year. Beside him, Ciren Drolma, seventy-five years old, from rural Chamdo, could not see. She requested her two sons bring her to Seva's partner hospital Menzikhang as she “felt she had no life to live and no hope for the future.” Following the operation she told us chat morning, “Now I am so happy because I am able to see again. One year ago I didn't understand what was happening to me and could not go out or even watch TV. I am now so happy, I have hope for my life. I can watch TV!” Such human stories, of which there are many in Seva's operation, are the substance of changing people's lives for the better.

Seva, a charity organisation based in Berkley California is dedicated to providing eye care services for the marginalized and underprivileged who cannot afford them. It has branches throughout the Himalayan region in Asia and in Central-South America.

At Menzikhang in Lhasa, Seva has established an eye department with eight people, three ophthalmologists and five paramedics. During twelve years of community outreach Menzikhang has undertaken over 8,000 operations including its many rural eye-camps. Seva also supports training for operations, equipment and medical supplies, intraocular lenses, and eye-drops. The teachers are volunteer doctors, usually from Nepal or North America.

Tibet Seva undertakes 5,000 cataract surgeries per year throughout Tibet and Tibetan ethnic regions of western China. “Most support is for rural people,” explains Seva Tibet Sight Program Director, Kunga Tashi. “Ninety percent of Seva's patients are nomads or farmers who cannot afford eye care services,” adds Kunga, dressed in a dark green Tibetan tunic, as he surveys the theatre of operation. “Local doctors join our foreign specialists to go on eye-camp trips and to improve their surgical skills.”

Patients coming to Seva partner hospitals are offered subsidized cataract surgery. Seva focuses on building local capacity. Doctors from Canada, Europe, India and Nepal offer voluntary services to provide training, enhancing local skills in cataract surgery. Moreover, required medical supplies such as intraocular lenses and equipment are sourced from India where products are cheaper than in China and with higher ethical standards the quality assured.

Unfortunately, China's state-run medical system does not provide sufficient support to enable access to cataract surgery for the poor. China's once socialized medical system has, over the past decade, become commercialized and moreover corrupted. Cataract surgery in most hospitals will cost an average of RMB 4,000, an unaffordable proposition for most rural poor, and unimaginable for those in Tibet, where the per capita annual income may only reach RMB 2000. In China's hospitals, corruption – involving the inflating of costs for services, medicine and treatment is rampant. All too frequently danger arises because fake equipment and medicine is used as doctors take kickbacks.

“Seva can do this because supplies are subsidized." Explains Kunga. “Ethical educational standards are important in the Seva program. Moreover, we try to adopt local approaches, which involve a Tibetan outlook towards a more holistic treatment."

When Seva started working in Tibet, Kunga had the idea of training ethnic Tibetans working through a traditional Tibetan medicine hospital. So Menzikhang in central Lhasa, just minutes from sacred Jokhang Monastery, became Seva’s local partner. Seva set-up the eye department at Menzikhang which became the first modern eye hospital in Tibet established within a Tibetan hospital.

A wealth of ancient knowledge could be drawn upon by combining the two schools of western medical practice with traditional Tibetan. For instance, in traditional Tibetan medicine there are several herbal medicines for complications related to eye disease.

“Phala-a Tibetan medicine which cures cornea scar and ‘pterygiun’ is derived from the ‘Four Tantras’, a tradition which is centuries old,” explains Kunga on site at Menzikhang between operations. “Due to our current medical system we need to rely on clinical trial. So the use of Four Tantras may not be accepted or even understood in the western medical approach. Because we apply both western and local traditional practices, we can draw the best from both traditions.”

While the only treatment in the west for a cornea scar is to transplant, here in Tibet it can be treated through traditional medicine. “Tibetan medicine has much to offer for cornea treatment,” explains Kunga. “But the bigger issue is that we need to reform our medical system.”

“Traditional medicine has little in the way of negative or side effects,” explains Kunga. “The problem is more sophisticated in terms of economics and professional institutional protectionism. So-called modern science simply refuses to accept traditional medicine.”

Kunga points out “So what we are really talking about is the issue of reforming western medicine and its non-humanitarian practices of refusal in opening up to other alternatives and holistic cure possibilities.”

Seva also seeks to enable its partner hospitals to become self-sustaining over time. One way of doing this is to provide glasses and frames, which can be sold for a small profit. Seva underwrites the costs in the beginning stage, so that in the next it will become self-sustainable.

“Eye care service CAN be self sustainable,” insists Kunga.

There are frequent exchanges between Seva’s Tibet and Nepal offices. Seva arranges for Tibetan ophthalmologists to visit Lumbini for training where Nepalese doctors conduct 250 operations each day. One Tibetan, Dr Yang Kyi, under Seva's program conducted 478 cataract operations within a forty-day work and training program at Lumbini Eye Hospital. Nepalese doctors provide their skills at Seva Tibet organized eye-camps in rural and nomad areas. In Nepal Seva has built a sophisticated eye hospital with extensive facilities, where Tibetan doctors are sent by Seva for technical training. The hospital is located in Lumbini, northern Nepal. Known for something other than eye care, Lumbini is the home and birthplace of Buddha.

Anatomy of a Seva Cataract Operation

Most hospitals in China charge RMB 4,000 for a cataract operation; this is unaffordable by most rural Tibetans. Seva is working within a budget of US$ 50 per operation. The cost breakdown of how this US$ 50 is used follows:

• US$ 25 goes toward intraocular lens and surgical drugs;
• US$ 25 covers logistical expenses such as doctor travel accommodation, food, medical team transport.

A program of voluntary training and subsidized doctor support help reduce costs. The cost will be subject to upward pressures from both inflation and currency appreciation.

Make a difference for US$ 50

Shambhala has undertaken an autumn 2008 fundraising drive to support 500 planned cataract operations in the Tibetan highland regions scheduled for summer 2009.

Donations by credit cards accepted.

Visit our websites at www.shambhala-action.org and www.seva.org

Tenzen's Story
Text by Dolma Chugi
Associate Manager, Seva Tibet sight Program

“My daughter's personality has changed since the blindness,” explained Tenzen Chudren's mother. “She barely talks to anybody and wants me to hold her every second. If I take her away from my lap she just cries and cries.”

Tenzen is the youngest child in her family. She has an older brother and sister. Two months before I met Tenzen, she became totally blind. She was only six years old. The cause was congenital bilateral cataract. Since her disease struck, she becomes panic-stricken and anxious when left alone. Soon her mother had to hold her all the time to keep her calm.

“Now, her father must do all the work to support our family because I am completely tied up with her,” explained Tenzen's distraught mother. The family comes from a poor area in Tibet Nagaze county of Lhoka prefecture, half a day's drive south of Lhasa.

I first met Tenzen and her mother at the Mensikang Hospital in Lhasa, where the Seva program sponsors ongoing eye clinics to assist and cure cataract patients. When her mother removed Tenzen from her lap, placing her on a separate chair, Tenzen immediately panicked. Searching for her mother in a desperate voice she asked “Where are you going? Mom, please don't leave me. Give me your hand... I need to hold your hand, please!”

After fumbling for a while, Tenzen found her mother's right hand, grabbed it and brought it close to her chest; holding onto her mother desperately. The moment touched me deeply. This child needed to have her sight back. With her whole life ahead of her, Tenzen's blindness is a needless tragedy. Tenzen made me realize, more than ever, the importance of our Seva programs, in changing lives for the better.

“I didn't know her blindness could be treated until recently,” explained her mother. “My relatives in Lhasa persuaded me to bring her to this hospital. I feel nervous about Tenzen's operation,” her mother explained in a soft voice. She held Tenzen tightly while both of them waited outside the operating room.

Three days after post-operative, I visited Tenzen and her mother again. They looked relaxed and happy. Her mother approached our Seva team and exclaimed, “Guess what? Tenzen doesn’t feel anxious anymore. She can be alone without my presence.” Tenzen, a shy and curious girl, without hesitation, grabbed my camera case and started playing with it.

A ten-minute cataract operation changed not only Tenzen's life, but also that of her whole family.

Twenty days later, Tenzen had her second cataract operation on the other blind eye. We space out operations so that one eye can recover before proceeding on the other; assuring safety for the patient. Just a few days afterwards, I had the pleasure of taking Tenzen and her mother to a restaurant in Lhasa. I bought her an ice cream topped with flavoring. She marveled at all the different colors held within it. When she finished, Tenzen picked up a piece of French fry and lovingly fed her mother.

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