High-tech Nepali lab manufacturing IOL

Suvecha Pant & Perina Pathak

In Nepal 0.84 percent of the total population are found to be blind and cataracts account for two-thirds of blindness. Cataracts are treated by implantation of the Intraocular Lens (IOL) through surgery.

Every year at the Tilganga Eye Centre around 100,000 patients with cataract problems are implanted with IOL. However, very few might know that the IOL used for cataract surgery is in fact made in Nepal at the Fred Hollows Foundation IOL Lab in the Tilganga Eye Centre. Recently, we reporters had the chance to catch a glimpse of the making of the lenses at the Laboratory of the Centre. When one at first visits the Tilganga Eye Centre, it is hard to believe that inside the building lies a state of the art, high-tech lab – the best in the country and in South Asia. Certified by a handful of quality control agencies like ISO 9002 across the globe, it is clearly one of the prize scientific laboratories in Nepal.

Mainly established for service purposes the laboratory is capable to produce around 1500 lenses everyday. At first, Tilganga manufactured only 33,000 lenses a year but now the lab has a capability of to produce up to 350,000 each year. Furthermore, all the technicians involved in the manufacturing process are Nepalese. According to Rabindra Kumar Shrestha, Engineer of the lab, the lenses produced by our technicians are not just used within the country for cataract surgery but are also exported to more than fifty countries. "And the demand is increasing," adds Shrestha.

Recently an agreement has been made with Australia to export the lens. Prior to this the centre had been exporting IOLs mostly to developing countries of Latin America, South Asia, South-East Asia, Africa and South Africa. Pleased with the development of the Centre Dr. Sanduk Ruit, Medical Director of Tilganga said, "In the beginning we suffered a lot while establishing this high-tech manufacturing laboritory because it was a new technology and there was no way to compromise in quality."

Around a decade ago a lens used to cost about 4 to 5 thousand, which has now been lowered to Rs 350 in the Nepalese market, however, the exporting rate is around 7 US dollars. Before this the lens was limited only among the rich and high-class families and poor and lower class families used to manage with thick power glasses. But now over 99 percent of the cataract patients are implanted with the IOL lens in Nepal.

The implantation of the lens takes around 10 minutes. And a patient can see within 24 hours. Dr. Ruit has in one day planted the lens in more than 100 patients, while at various eye camps in different districts. But the doctors grieve that still people don’t trust in the quality lens. "From the very beginning we focused on low cost high quality production," said Dr Ruit, "However, the public still does not believe that IOL lenses of high quality can be manufactured in Nepal."

Other than eye services within the valley Tilganga also organises eye camps in various remote hilly districts from time to time. Similarly, the centre donates around 4000 lens to various eye centres of remote villages each year.

IT for good governance

Sudan Jha

Imagine a situation in which all interaction with the government can be done through one counter 24 hours a day, 7 days a week, without waiting in lines at government offices. In the near future this is possible if governments are willing to decentralise responsibilities and processes and they start to use electronic means such as the Internet. Each citizen can then make contact with the government through a website where all forms, legislation, news and other information will be available.

E-governance has started gaining its importance around the world nowadays. Internationally, most countries are in the early stages of e-governance. Moreover, a good start has been made in Europe, USA and in other westernised countries such as Australia and Singapore. The implementation will obviously require the major front office infrastructures such as several communication channels like physical counters, telephone, email and Internet to serve everyone properly. At present, commercial banks have already started working on the ground of this concept. Nowadays, only in a few very special situations one has to go to a physical counter as most transactions can be done at either an ATM, by mail or through the Internet.

Governments like that of Nepal, which in several arenas act as a collector and source of information, may also follow this trend, in order to serve its customers (citizens, businesses, and other interest groups) better and to save costs by making internal operations more efficient.

What actually is meant by e-governance? The relation of e-democracy and e-government can explain the meaning. E-democracy refers to the processes and structures that encompass all forms of electronic interaction between the Government and the citizen. E-government is a form of e-business in governance and refers to the processes and structures needed to deliver electronic services to the public (citizens and businesses), collaborate with business partners and to conduct electronic transactions within an organisational entity. Examples of government branches are Administration, Civil Service, Parliament and Judiciary functions. E-governance supports and simplifies governance for all parties’ - government, citizens and businesses. The use of IT can connect all these three parties and support processes and activities. In other words, e-governance uses electronic means to support and stimulate good governance. Therefore the objectives of e-governance are similar to the objectives of good governance.

Impact of technology : Websites consist of information. Governments will have to collect (buy), produce and update the information daily. As the government moves its core processes (information, communication and transactions) to the Internet, security should be considered the most important. The government should enforce effective cyber laws and security measures as the internet increases the number of entry points exponentially. Protection is possible with anti-virus software, firewall at gateways, encryption technology, and authentic identification tools.

The government also contains detailed information about citizens and businesses, which is often held in multiple offices on many different computer systems or in paper files. This availability of data can result in situations where the privacy of individual citizens is in danger. It is the responsibility of the government to restrict the utilisation of private information, and secure such information from access by unintended parties.

The hardware for e-governance can be as follows: more than one server should be kept so that even if one is faulted the public can utilise the other for uninterrupted access. The amount of memory needed and various hardware requirements is dependent on the service needed by the public. For instance the number of user terminals needed in a city office is more than that of a village.

Similarly, the software used should be such that even a layman should be able to access the services without any help. It should be effective, efficient and user friendly and secured. Technological aspects involve software, hardware, infrastructure, telecom, IT skilled people, and maintenance, safety and security issues. When successful, e-Government initiatives optimise government operations and service delivery. However, if not successful, these initiatives can cost governments millions of dollars and enormous amounts of wasted time. Therefore, a complete study needs to be carried out before the implementation of e-governance.

Ozone hole

N P CHAPAGAIN

The ozone is formed in the atmosphere by absorption of certain radiations by the oxygen. Out of each 10 million-air molecules, about 2 million are normal oxygen, but 3 are ozone. Breathing ozone is lethal at dosage levels of a few molecules per million air molecules. This is why ozone at the surface is referred to as a pollutant. Most of the earth’s atmospheric ozone (about 90 percent) is found to be in the stratosphere, a region of atmosphere between 15 km and 50 km. It absorbs all harmful radiations coming from the space. Hence, it acts as a protective umbrella for the living organisms on the earth. If there were no ozonosphere in the atmosphere, all harmful ultraviolet radiations and high energetic particles coming from the space would enter into the troposphere and cause damage to the living organism. Such ultraviolet radiation is destructive of genetic cellular material in plants, animals and human. Without the "ozone layer" high up in the atmosphere, life on the surface of the Earth would not be possible.

Chlorofluorocarbons (CFCs) are a family of chemical compounds developed back in the 1920’s as safe, non-toxic, non-flammable alternative to dangerous substances like ammonia for purposes of refrigeration and spray can propellants. Their usage grew enormously over the years. One of the elements that make up CFCs is chlorine. Very little chlorine exists naturally in the atmosphere. But it turns out that CFCs are an excellent way of introducing chlorine into the ozone layer. The ultraviolet radiation at this altitude breaks down CFCs, freeing the chlorine. Under the proper conditions, this chlorine has the potential to destroy large amounts of ozone. As a consequence, levels of genetically harmful ultraviolet radiation have increased.

The ozone layer in the stratosphere is gradually being depleted due to anthropogenic activities i.e. due to production of CFCs, Oxide of Nitrogen etc. These gases are released into the lower atmosphere by many ways. The CFCs are released by spray cans, refrigerators, air conditions, various industries and burning of foam products etc. The CFCs when reach the stratosphere they destroy the ozone and the ozonosphere is depleted by the cyclic reactions. The region of space in the stratosphere where the amount of ozone content has been reduced drastically is called ozone hole.

The ozone column varies from place to place over the globe with time. Every year for the past several decades, the return of sunlight to the high latitudes of southern hemisphere has produced massive depletion of ozone over Antarctica in the polar spring. Satellite data showed that the affected area was over the Antarctica. The hole has steadily grown in size up to 27 million square km and it existed from August through early December over the past two decades. During some years in September-October months over a large part of Antarctica subcontinent, total ozone decreased to values closed to 100 DU from a normal level of about 300 DU. Similarly weaker ‘mini ozone holes’ in the Arctic region have been observed in some recent winters.

The ozone is being depleted over the Indian Subcontinent too. A spectrophotometer at Kirtipur, Kathmandu has been measuring total ozone since February 2001. However, it has been observed that the total ozone values over Kathmandu in the most of the days are less than the global average values. The minimum value of total ozone is found to be 220 DU which shows the large depletion of total ozone in this region.

Will the ozone layer recover?: In 1987, an international convention was adopted to reduce the production of CFCs by half by 1998, is called the Montreal Protocol. If it is strictly followed by all nations, the ozone layer will be recovered.

Ozone molecules are constantly being produced and destroyed by different types of UV light from the sun. Normally, the production and destruction balances, so the amount of ozone at any time is pretty stable. The ozone hole is an area of severe depletion. Since we cannot make more ozone, the solution is to reduce the hole to its natural size. The only way to do that is to remove the excess chlorine and bromine from the stratosphere. The method to achieve it is to stop making CFCs and several other chemicals. This will provide the natural processes to remove excess chlorine and bromine that will heal the ozone layer in about 50 years.

(The author is a lecturer of Physics at the Tribhuvan University)

Fits in children

DR DIPAK DEVKOTA

While working in the emergency at Kanti Children’s Hospital in Kathmandu it is impossible not to come across at least 2 or 3 children per day coming in with fits. Fits (convulsions) is a technical term that implies fast involuntary movements of the muscles of the body, limbs and faces usually accompanied by a change in the consciousness of the child.

Many lives of young children have been lost because anxious parents do not know or are very late seeing a medical doctor. Superstitions and strong belief in dhamis (witch doctors) and jharkris (medicine men) make the parents in the villages of Nepal rush their children to them where a chicken is sacrificed, incense is burned, magic words uttered, patient tapped with stick and drums are beaten to drive demons away. Esoteric rituals may include keeping incense fumes right under the nose of the child further decreasing oxygen supply and increasing carbon dioxide inhalation. Some children were brought too late to the hospital after this unfortunate trip to the dhamis and jharkris.

What to do in case of fits: As in most emergency cases in the medical field remember to stick to the first letter of the alphabet: A (which stands for airway. The air has to get to the lungs). Usually the first thing to do is get the vomitus and saliva out of the throat so the child can breathe. It is simple thinking but we keep alive by breathing. Instead of carrying the child in your arms with head hanging limply or face up, it would be wiser to carry the child with the head supported face down or sideways so the saliva and vomitus could run out of the open mouth or even between clenched teeth. Do not try to force water down the child’s throat. This misconception occurs because unfortunately in Nepal the dying person is given a last drink of ganga jal (holy water). Some children having fits might die when ganga jal is poured down the airway as this would block the air reaching the lung and accelerate death. Rush the child to the nearest hospital and do look about for pills and empty bottles of chemicals the child may have used.

Most convulsing children observed dying in the emergency at Kanti Children’s Hospital had blue lips and were gasping for air. It could be epilepsy, meningitis, or simply very high fever. If a child has a high fever then cool him by taking off blankets and warm clothes and occasionally putting wet cloths on forehead, arms and legs. It takes longer to die from pneumonia than from 110 degrees Fahrenheit of fever wrapped up in a blanket. Foremost, let him breath!

At the hospital: The doctor, after securing an airway and sometimes giving oxygen, maybe after intubation if the child is moribund, sets up a drip, gives an anti-convulsant and blood is drawn for investigations. Anti-convulsants make the violent spasms of the muscles stop by acting on the brain centres where the electrical impulses are generated that make muscles contract. This also helps oxygen reach the brain by improving respiratory muscle function. The medicine Diazepam is the most often used as anti-convulsant. This medicine is given intravenously or by inserting a suppository into the rectum. When given intravenous it quickly stops the convulsion. Parents might think to give Diazepam to the convulsing children before bringing to the hospital. The problem is the child can suddenly stop breathing and Diazepam should be given where there are means of sustaining the breathing of the child if it stops i.e. at the hospital. Then the doctor has to determine if the child has a life threatening illness like meningitis and encephalitis. For further diagnosis, the doctor does the spinal tap for laboratory tests by taking out the water (cerebo spinal fluid) out of the back of the patient by inserting a needle between the lumber vertebrae (hip back bones). Suffice it to say that this is dangerous but necessary in most cases. If the child has a spinal tap done (also called a lumber puncture) the child will have to be under observation for some hours at least. Many parents feel nothing is being done when the child is being kept in observation. A subtle hostility runs under the object helplessness of parents who feel their child is dying if they detect cold clinical detachment in this changed emotional situation and insist on taking the child home after the convulsions stop.

(The author is a Senior Consultant at the Kanti Children’s Hospital)

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