Blindness is a global concern particularly for developing countries. There are 12 million corneal blind in the world and 5 million in Bangladesh. The four key blinding diseases have been identified as priorities: Cataract, childhood blindness, refractive errors and low vision. The other blinding diseases include: corneal diseases, glaucoma, ocular trauma and diabetic retinopathy.
The problem is avoidable through proper treatment and due care. One of the major treatments is replacement of tissue. Due to lack of availability of corneal tissue, in 2014, only 54 and in 2015, less than 50 cornea transplants were performed in Bangladesh from locally procured corneas. At the current rate of corneal transplants in the country, it will take about 10,000 years to address the backlog alone assuming there are no additional cases added.
These 5 million people in Bangladesh in need of corneal transplantation and with only 55 to 60 corneas being collected a year. The figure paints a complicated situation for those who lost their sight because of cornea injury and related diseases.
Cornea transplantation began as early as 1974. The Sandhani, an organization of students of Dhaka medical College, first organized volunteer blood donation program in Bangladesh and began on 5 February 1977 with a view to donate blood among patients but it has since broadened its scope of postmortem voluntary eye donation and donation of money among the poor patients. Lateron students of other medical colleges also form similar Sandhani. Sandhanis are presently involved in campaign for donation of cornea, public health initiatives, primary care, blood donation drives etc.
In the year 1984, the Rangpur Unit of Sandhani encountered an approach for cornea for an 18 years adolescent girl named Tuntuni. The girl was blind from her early childhood. Sandhani also look into donor of other countries and contacted Dr. Hudson Silva of Srilanka for a pair of corneas for poor patient Tuntuni of Ranpur. At that time on November 25, 1984, Sandhani International eye Bank was launched. They also formed Sandhani National Eye Donation Society (SNEDS) was established on the same day.
The poor girl Tuntuni regained her vision from the eyes that Dr. Hudson Silva brought with him from Srilanka. The incident moved the whole nation and the existing media of that time highlighted the incident. Despite massive public awareness campaign extending over 3 decades about cornea donation countering the false perceptions in the society, to-date only about 150-175 cornea transplants are done every year in four centres at Dhaka.
Sandhani, a nationwide, about 4000 members' strong network of medical student-volunteers and their alumni to exponentially increase the number of corneas recovered and available for transplant. But the commitment of donation from the citizen is very insignificant and replacement of cornea is far below then requirement. There are social and religious inhibitions that stop people from after-death-donating corneas and also, in some cases, from accepting them.
According to the 2014 official statistics published in a daily newspaper, is estimated at 5.2 per 1,000 people and about 2,000 people have been enlisted themselves with Sandhani National Eye Donation Society, which is the only accredited eye bank and which transplants corneas free - waiting for corneal grafting.
The other issue that comes up as a big obstacle is that even when people have registered to be cornea donors, families do not inform the eye bank of the donor's death. The donation of eye brought under legal framework with The Blind Relief (Donation of Eye) Act, 1975 made donation or promise to donate eye for any individual or for society in general. According to The law, any citizen can voluntarily donate eyes to patient with a instruments signed with two witness. Donor's eyes will be taken after death as per medical science within certain period of his death. The clause 4(1) permitted enucleation by removal or extraction of such organ , tissue, or other part of the body which necessary for utilization of the eye.
The next kins or the person whom devolves the by the right to control the disposition of the remains of the deceased donor shall, if he has the information of the donation, forthwith inform the donee of the fact of the death of the donor. The failure will be an offence and punishable with fine worth Tk1,000. But due to lack of awareness and emotional sentiments the responsible person hardly takes initiative to arrange donation as per commitment of the deceased.
Moreover, early information of the death is important as cornea needs to be collected in six to 10 hours after death. This points out that the government needs to work on a few fronts apart from running an awareness campaign of the prime need for cornea donation and the process involved in it.
A noble initiative of Rotary Club of Dhaka Central successfully brings some organizations to organize a National Eye Recovery Program in Bangladesh. The Tissue Bank International (TBI), USA Rotary International (RI), Rotary Club of Dhaka Central (RCDC) and Sandhani came into agreement to establish the unique program which can exponentially increase the number of transplantable corneas and mitigate reversible and curable corneal blindness in Bangladesh. Dr Mahmood Farazdhagi, an Iranian origin US national played the major role to organize the fund for Bangladesh.
The budget for this grant is $350,000 direct and about $150,000 additional contribution. RCDC members have contributed US$8,000. TBI / International Federation of Eye and Tissue Banks (IFETB), USA is contributing $160,000 towards the grant and additional contribution such as sponsoring this symposium, training of eye bank manager and technician in our international training center in Prague, assisting creation of training center in Dhaka, accreditation, certification etc. Rotary clubs and Rotary International are contributing through the global grant project. After initial six month period, when the training is completed and organization is in place, we begin to see the stark difference in number of tissues collected.
The program envisions in creating national awareness in alleviating corneal blindness in Bangladesh and subsequently ensure in collecting 3000 plus corneas over a 2 to 3 year project using hundreds of volunteers from various connected stakeholder. A dedicate team of medical/dental students and professionals shall work and/or supervise the collection of 3,000 plus cornea lens commitment from various corners of Bangladesh.
The program will organize effective communication campaigns and trainings for their newly recruited volunteers and staff for this project that will run at least 2-3 years in the first phase. SNEDS will be the implementing agency supervised by Rotary Club of Dhaka Central (RCDC) on financial and budgetary controls matters. The activities will include : Training of Sandhani National Eye Bank Managers, purchase of required equipment and instruments, recruitment of volunteer faculty from Medical Doctors and Professors of Sandhani alumni for training center in Dhaka, Bangladesh, training of above faculty and trainers of The Sandhani Eye Donation Society and the Sandhani National Eye Bank in Dhaka on eye banking, and training of Sandhani members by above faculty on obtaining consent and procurement of eyes, Dhaka, Bangladesh.
The volunteers will go extensive promotion of the noble cause and collect cornea. The forum will hand over 70% of the corneas to charity hospitals and 30 % to private hospitals where a processing fee will be levied for the cornea tissue to offset the cost of operations. All the service clubs, voluntary organizations and the nation as a whole may come forward to join the hand with the program to create awareness for participation in the program and donate cornea to serve the humanity.
The government might also consider amending laws that govern the process. The Blind Relief (Donation of Eye) Act 1975 may have provision of permission for the family members to donate eye of deceased and create a regulatory authority to organize the donation and collection of cornea. Government can create a regulatory authority to organize Champaign for voluntary donation, create awareness.
The authority may be given to get the donation agreement and organize collection of cornea with the co-operation of organization such as Sandhani and initiative of RCDC. The global voluntary organization like Tissue Bank International (TBI) and International Federation of Eye and Tissue Banks (IFETB) are seems ready to support national programs of Eye and tissue banks and collection of fund and cornea from other countries.
World Health Organization (WHO) and International Agency for Prevention of Blindness (IAPB) jointly launched Vision 2020, the global initiatives for elimination of avoidable blindness, in Beijing in the year 1999. Vision 2020 is the global programme to get rid of avoidable blindness by the year 2020.
Bangladesh National Council for the Blind (BNCB) has successfully adopted the 'Bangladesh National Eye Care plan' responding to the Vision 2020 - "The Right to Sight"- global campaign to eliminate avoidable blindness by the year 2020. Government has adopted the Vision 2020 as per the decision of the 56th General Assembly of WHO in 2003. It has been coincide with the national Vision 2020 of the present government. The vision of WHO and Bangladesh government of "right to sight" indecently coincides and given more importance. It should get due attention of all stakeholders.
The writer is a Legal Economist. He can be reached at: email@example.com
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