Diary: Helping people tohelp themselves – the“Phaco Project”Cataracts are the leading cause of blindnessworldwide. If left untreated they lead inevitably tothe loss of sight. During cataract surgery the eyeis opened by a single incision, the clouded lens isremoved, and an artificial lens inserted. In ThirdWorld countries, more basic but risky operatingmethods are used. In industrial countries,phacoemulsification (“phaco”) has become thestandard type of operation. It is a minimally invasiveand gentler method: Because the nucleus of thelens is broken up (“emulsified”) by ultrasound andat the same time extracted by suction, the incisionin the eyeball is considerably smaller.An ideaOctober 2005 saw the birth of a project that morethan lives up to the Association’s goal – “Helpingpeople to help themselves”.Together with Prof. Om K. Malla, Head of theOphthalmology Department at KMC, KatmanduMedical College, an idea came to maturity: Thephaco method should be established at the KMCfor treating cataracts.First stepsThe first step was the purchase of a suitable phacodevice together with the corresponding accessories.In November 2005, the Association’s Chairs, MaxReindl and Susanne Grethlein, won the support ofOertli Instrumente AG (Switzerland) for the project.Not only were the device and its accessoriesprovided at a special price, Oertli also provided forinstallation and maintenance required at regularintervals. Contact was made with Oertli’s Delhibased(India) cooperation partner.
The art of persuasionProf. Klaus Ludwig, a prominent German professorof ophthalmology, was “inducted” into our project.The experienced ophthalmologist had alreadyworked in Kenya and other Third World countries,and brought with him the know-how necessaryfor such projects, as well as a great deal ofcommitment.Prof. Ludwig was, and is, convinced by our idea,and he offered us even more support than expected:He won the support of Josefa Eschenlohr for theproject. She is an experienced operating roomnurse who had worked with Prof. Ludwig for manyyears. She also had a lot of experience with projectsabroad – her commitment had already led her toHaiti.Phase oneIn January 2006, in close cooperation with Prof.Ludwig and Josefa Eschenlohr, a list of all materials,utensils and drugs required was made; thespecifications for the phaco device and accessorieswere defined in detail, and the device was ordered.Because we had to allow for difficult conditions inKathmandu regarding electricity and availablepremises, the phaco device was first delivered toGermany where it was tested thoroughly.To be even better prepared for the project in Nepal,it was decided to invite the physician from Nepalto learn the new operating in Germany. ProfessorMalla recommended Dr. Suprada, a member of histeam.In the meantime, transportation and import of thephaco device to Nepal were organized. A wellknownforwarding agent in Nuremberg offered usthe shipment at special conditions.
Even more helpNurse Josefa Eschenlohr approached suppliers ofconsumables and drugs, asking for their supportof our project and received a very positive response.She also collected donations of about ¤'db1,400for the project from friends and acquaintances.WaveLight’s Indian business partner, MonishBhachoo, had already supported “Vision for theWorld e.V.” during a number of other projects.He stated that also this time he would provide uswith the necessary intraocular lenses free of charge.A slight setback withpositive effectsIn May 2006, the political situation in Nepaldeteriorated. Instead of setting off in June, asoriginally planned, October 2006 was set as thenew date.Nevertheless, all activities were running at fullspeed. And it was becoming clear that thepreparations would require more time thanexpected.We approached Deutsche Lufthansa and asked fortheir support regarding air transportation expenses.It took a while until the right contact person forour request could be found, however, the effortwas worthwhile: Lufthansa sponsored the flightsfor Prof. Ludwig and Josefa Eschenlohr for theroute Germany – India – Germany. It was evenpromised to look favorably at future requests forflights. We would like to say a big thank you toLufthansa.In the meantime, Josefa Eschenlohr did a greatjob. She collected operating room materials anddrugs worth thousands of euros. These also includedsome instruments which would make it considerablyeasier for Prof. Ludwig to instruct Dr. Suprada inthe new operating technique in Kathmandu, aswell as many useful materials to ensure a sterileoperating procedure.After several efforts, the Nepalese authorities gavepermission for duty-free import of the additionalmaterials.
A visit from NepalDr. Suprada arrived in Germany on September 19,2006. Prof. Ludwig taught her the necessarytheoretical and practical basic knowledge aboutphacoemulsification. Observing operations gaveher an initial impression of the operating technique,and she practiced it on artificial tissue.Josefa Eschenlohr explained to her the proceduresneeded to ensure sterile conditions during theoperation.To enable Dr. Suprada to review and enhance whatshe had learned when she got home, Prof. Ludwigrecorded the operating techniques on DVD, andwe provided Dr. Suprada with a DVD recorder thatshe could take with her to Kathmandu MedicalCollege.Taking shape – at last!The political situation in Nepal stabilized and wedecided to stick to the initially planned start datein Nepal in October. Prof. Ludwig and JosefaEschenlohr would fly to Kathmandu on October21, 2006, and stay there for two weeks.The phaco device and all materials collected byJosefa Eschenlohr would be sent to Nepal. Inaddition, we approached another good friend, RinjiSherpa, in Kathmandu. He would help us duringthe preparations and look after Prof. Ludwig andJosefa Eschenlohr in Nepal.A big problemWe found out that distributor Monish Bhachoowould not be able to provide us with the type ofintraocular lenses we asked for.A big problem was looming: The operations couldnot be performed without them and buying themwould be way beyond our budget.
The tight schedule did not allow for anothershipment to Nepal – it was October 17, 2006 –and Prof. Ludwig and Josefa Eschenlohr wantedto set off on October 21, 2006.Our last hope: WaveLight GmbH in Berlin, aWaveLight subsidiary which had the intraocularlenses in its product program. We asked if theyhad the type (material and dioptre) and quantitywe needed, and struck lucky: everything was instock. The package was prepared in no time andwe reached agreement to receive the gods at costprice. In addition, WaveLight GmbH donatedinstruments needed for the implantation of thelenses.The package arrived in Erlangen on October 18,2006. In the meantime, Lufthansa allowed us totake excess luggage free of charge.On October 21, 2006, Prof. Ludwig and JosefaEschenlohr boarded the plane to Delhi with anadditional suitcase.Phase two:On site in KathmanduAfter a ten-hour flight and some problems whentransiting in Delhi, Prof. Ludwig and JosefaEschenlohr landed at Kathmandu InternationalAirport at 1.15 p.m. local time on October 22,2006.After a short settling-in period they started withpreparations for the operations at the KMC. Theymet not only Prof. Malla but also other physiciansfrom the Ophthalmology Department.The next day, Josefa Eschenlohr instructed localnurses in preparations for the operation andcompliance with the sterile procedures.
Of course – as Prof. Ludwig had already predicted– the conditions at the KMC were not comparablewith our own. The operating microscope posed abig problem. Its quality was so bad that Prof.Ludwig was only able to operate thanks to hismany years of experience. Consequently, thisnaturally meant that Dr. Suprada could learn onlyvery slowly under these difficult conditions.The arrangements were changed immediately: Prof.Ludwig operated on all patients himself and Dr.Suprada assisted – until late in the evening. NurseJosefa Eschenlohr was tireless in her job and,thanks to her expert instructions, the Nepaleseoperating room nurses learned the most importantpre- and post-operating procedures. She alsoensured that all the materials they had broughtwith them were properly cataloged and stored. Alockable cabinet was obtained. It helped to keepeverything tidy and to protect the material fromunauthorized access.After a week full of operations, Prof. Ludwig andJosefa Eschenlohr earned a short breather. Rinji,a local tour guide, was at their disposal and gavethem a tour that – although short – showed themthe beauties of Nepal. Wonderful themes presentedthemselves for Prof. Ludwig, a passionatephotographer.The final operating days started. In the meantime,word had spread about Prof. Ludwig’s presence:Many patients were waiting for him. He could havestayed for many more weeks.In a detailed wrap-up meeting with Prof. Mallaand the Medical Director of the KMC, there wasagreement that a new operating microscope wouldhave to be bought to allow the project to besuccessfully continued. Furthermore, Dr. Supradawould have to build on her initial experiences. AnIndian colleague who had already startedperforming operations in the southern part of Nepalusing the phaco technique might be able to helphere.
Moving on – we start phasethree!December 2006: Prof. Ludwig reported on hisimpressions gained during his first project in Nepal.Together, new goals were set. Top priority: Buyinga “new” operating microscope.And so it continues:Phase three: Purchase of the microscope, andanother trip by Prof. Ludwig and Josefa Eschenlohrto Nepal for follow-up seminars.Phase four: Practical training courses and followupseminarsThe “start-up” team from the KMC OphthalmologyDepartment gained their first experiences and skillsusing the phacoemulsification device by themselvesperforming operations on patients. In fall 2008,Vision will again send a partner physician fromGermany to Nepal. He will provide advice to thelocal Nepalese physicians and conduct follow-upseminars. Seminars will then take place at regularintervals.Phase five: Training and continuing developmentAfter gaining sufficient experience with the newdevice and operating method, the Nepalesephysicians from the “start-up” team themselvesnow handle training and continuing developmentfor their colleagues and students at the KMC.We would like to thank Prof. Klaus Ludwig for providing theimages for this newsletter.Vision for the World e.V.c/o Susanne GrethleinAm Wolfsmantel 591058 Erlangen, GermanyTel.: +49 (0) 9131/68 59180Fax: +49 (0) firstname.lastname@example.orgDonations account:Stadt- und Kreissparkasse ErlangenSort cod: 763 500 00Account no.: 29 005 000