OCT 2012

EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.

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98 EWINTERNATIONAL October 2012 Into Indonesia by Matt Young EyeWorld Contributing Writer One charitable frontier for humanitarian ophthalmolo- gist and one big cataract backlogged country collide S anduk Ruit, M.D., ventures into places that most ophthalmologists never see to liberate the blind, like North Korea, for example. "We were constantly watched," said Dr. Ruit, medical director, Tilganga Institute of Ophthalmol- ogy, Kathmandu, Nepal, recalling his trip to North Korea some years ago. "But North Koreans would feel less threatened by us, coming from a developing country. Every [cataract] case was totally blind. There was a lot of difference we could make for them." Indeed, perhaps it's because Dr. Ruit is from Nepal—certainly not a monetarily rich country—that he can identify with what it means to be poor no matter the place and to crave healing. His sister died unnec- essarily from tuberculosis. "She died because of the lack of very simple medicine," Dr. Ruit said. "I tried my best to pursue a career in medicine after that." After attending medical school in India on scholarship, and subse- quently working there, new medical ideas began develop. "I spent about a year in [the late Professor Fred Hollows'] house," Dr. Ruit said. "We had no resources, nothing, just wild dreams—thinking of how we could make IOLs afford- able to the marginalized population. How could we bring surgical tech- niques acceptable to many surgeons of the world [to the developing world]?" In the 1980s, the two set to work. The cost of an IOL was more than $100 at that time and still out of reach for many of the world's poor. The Fred Hollows Intraocular Lens Laboratory in Nepal was set up to produce low-cost, quality lenses. "The first batch price went down to $20," Dr. Ruit said. "Then it went to $7 and to $5. People started doing this in many other places. Then I started taking this technol- ogy into the bush." Five years later, there were not only affordable IOLs but also a cost- effective surgical technique that could give good results and was easy to teach. The technique has evolved into what is known as manual small inci- sion cataract surgery (SICS), and has been through clinical testing and published in peer-reviewed litera- ture. Phacoemulsification versus the technique found comparable results, Dr. Ruit said. "These were important for us to advocate our work," Dr. Ruit said. "Otherwise people wouldn't believe it. Low cost doesn't mean bad qual- ity. Most importantly, it is accessible to the people." The technique has been taught in China, Vietnam, and many other developing locales. Recently, Dr. Ruit has brought his labor of love to Indonesia. Off the beaten track, again "I wanted to really get into Indone- sia," Dr. Ruit said. "The cataract surgical rate there is so low, but it's a big country." As luck would have it, Effi Jono, an Indonesian who is living in Singapore, was thinking of ways to help underprivileged Indonesians. At a business luncheon, she met a like-minded Singaporean who happened to be Dr. Ruit's friend. A meeting with Dr. Ruit in Nepal cemented their partnership, and Dr. Ruit was off to Medan, Indonesia for a 5-day period, target- ing to operate on 500 cataract patients in December 2010. He Naferati Nasution and his wife (left) together with Manggala, waiting for their turn to be checked by the doctors Mangala Hutabarat, suffering from very complicated cataracts A long day waiting for surgery. There are several steps a patient has to go through before entering the operating theater: registration, visual acuity test, blood test (pressure and sugar level), biometry, eye lash trimming, cleaning, diluting eye, anesthesia, surgery Trimming eyelashes, in preparation for surgery

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