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THE exercise in philanthropy about which I write today began 34 years ago. Two successful businessmen who were close friends decided to launch a project in their post-retirement life to serve humanity. Being compassionate, they understood the burden of disease for the poor in terms of financial costs and loss of productivity. Hence they opted for healthcare, which is the most neglected of the services sector in Pakistan. As one of them had lost his vision in one eye, a hospital for eye diseases was their natural choice.
The two friends were Graham Layton (an Englishman) and Zaka Rahmatulla (from Pakistan) and that is how the Layton Rahmatulla Benevolent Trust (LRBT) was born in 1984. Graham acquired Pakistani nationality to enable himself legally to join hands with Zaka in this venture. They died several years ago — Zaka in 1989 and Graham in 1999 — but their legacy lives on, growing and developing and remaining true to the mission of its founders, “No man, woman or child should go blind just because s/he cannot afford the treatment”.
LRBT’s first eye care mobile clinic was set up in Tando Bago in Sindh in 1985 in a small trailer; 11,699 patients visited it in the course of the first year of its operation. Today LRBT has a network of 19 hospitals (two of them tertiary) and 56 primary eye care community centres (four of them being outreach clinics) all over the country. To make them accessible to the poor, they are located mostly in small towns and villages or low-income neighbourhoods of big cities.
In 2016-17, 2.9 million patients visited these 75 facilities. Recently LRBT treated its 38 millionth patient, a student of Grade 4 whose vision was restored much to his family’s joy. Last year, LRBT performed 315,502 surgeries/procedures and 281 corneal transplants. This accounts for a third of the patients who seek any kind of eye-related treatment in Pakistan.
Timely intervention can prevent blindness.
The treatment is free, being financed by generous donors. Thus last year, LRBT raised Rs1,186m, nearly two-thirds from individuals in Pakistan. The two major institutional benefactors have been the Graham Layton Trust UK and Sight Savers International. It is a perfect example of how non-medical professionals can run a healthcare facility with the expertise of surgeons and physicians.
What is significant about LRBT’s work is its strong preventive approach to medicine apart from the state-of-the-art treatment it offers. While talking to me about the main causes of vision impairment in Pakistan — trauma, glaucoma and cataracts — Dr Fawad Rizvi, the chief consultant ophthalmologist, said that in many cases blindness is preventable by timely intervention. All patients who are registered in the OPD have to undergo mandatory group counselling on eye care by a trained consultant. The idea is to create public awareness about eye health. Screening camps also help diagnose eye diseases in their early stages when blindness can be pre-empted. Eleven such camps were organised in 2016-17 by LRBT.
Has this helped lower the incidence of blindness in the country? A survey conducted just before LRBT’s clinic began functioning in 1985 recorded 1.78pc of the total population as suffering from blindness and another 18pc being afflicted with vision impairment. A recent survey shows only 0.9pc as being blind and 10pc with impaired vision. Quite a drop!
What interested me specifically was LRBT’s experience of corneal transplantation and deceased corneal donation. Since 2003, LRBT has performed 3,915 corneal transplants to give patients the gift of sight — the success rate being much higher than that required by WHO. Hence LRBT went on to set up a corneal bank in 2013. So far it has registered 129 potential donors. Three have actually gifted their corneas. Chairman Najmus Saquib Hameed attributes the discouraging response to cultural factors. He is spot on, for this trend is reflected in the drive to register deceased organ donation overall.
This is something for Pakistanis to reflect on. Most corneas used by LRBT are imported from North America and Sri Lanka, which are accepted gratefully by Pakistanis who need them. But few families sign up will cards to become donors — notwithstanding years of campaigning. Abdus Sattar Edhi, Chris Abbas and Aban Jamal, whose deceased corneal donations were well publicised, were exceptions. They were humanists in the true sense of the word.
It is time public opinion leaders began advocating the noble cause of deceased tissue and organ donation. It is sanctioned by Islam. The retrieval of corneas can be carried out up to three hours after death has occurred. It causes no disfigurement. It does not require the donor to have been on a ventilator. And what a beautiful idea it is to bequeath one’s corneas for transplantation after death so that someone blind can see again.
Published in Dawn, May 25th, 2018
