Sight Life, a non-profit global health organisation is working on a mission to eliminate corneal blindness by 2040. Claire Bonilla, Chief Global Officer, Sight Life, in an interaction with Prathiba Raju, speaks more on their ambitious goals and emphasises on the need for a well-rounded strategy in India to eliminate corneal blindness
After 20 years of managing various global functions for software giant Microsoft, how do you perceive this switch to SightLife?
For me, the transition personally was success to significance. I worked for 15 years with Microsoft and raised up to various ranks. I was successful in getting international market development, global business and PPPs. Though I have come this far, I learnt so much and have been successful, I was wondering how to lead a life with significance. I wanted to deploy the skills I acquired and make an impact, that is the reason I chose SightLife, which has taken up a mission to eliminate corneal blindness by 2040. It is an opportunity where I’m actually working to eliminate a disease in my lifetime. As a quote goes, ‘if you love your job, you will never work a day in your life’ and that is truly how I feel about my work here. It is incredibly meaningful and all of us working in SightLife think of making a difference.
Can you tell us more about SightLife and its mission to eliminate corneal blindness?
SightLife is world’s leading eye bank, and the only non-profit global health organisation, which is focussed solely on eliminating corneal blindness around the world. We have set a goal to eliminate corneal blindness by 2040. Corneal blindness is a condition caused by an injured or diseased cornea, the layer of tissue that covers the front of the eye. Primarily, we focus on having excellent eye banks, which we have already achieved in the US. In 2015, the US had performed 50,000 transplants and 65,000 corneas were collected. In the US, no one waits for a cornea transplant; if one needs a transplant, it is done the next day. It is seen nowhere else in the world. During May 2015 and April 2016, 22,858 transplants were done. Armed with the learnings on how to maintain world-class international standard eye banking, SightLife is now on a mission to eliminate corneal blindness globally.
Where does India rate in the list of corneal blindness?
There are about 10 million blind corneal cases in the world, with 98 per cent of those in the developing countries. Out of it, 5.6 million cases are in India. So, the country stands the tallest in corneal blindness. There is a massive gap between supply and demand of corneas. SightLife started its operations in India in 2009. We started with 3900 transplants and by 2016, we have done 13,500 transplants, with our partners. Though India has talent and an amazing capacity of eye surgeons as well as eye hospitals, the country lacks best practices, training and tools. There is a dire need of right policies and each state should create a favourable ecosystem. For example, right from a donor registry to educating the community to encourage donation is needed. SightLife is trying to partner with high-mortality hospitals and eye banks, to teach them efficient eye-banking operations along with achieving high-quality standards, during retrieving corneas and accessing them to ensure better patient care and follow up care.
Tell us about your partners and your engagements with various state governments?
SightLife has partners across eight states. At the national level, we work with National Program on Control of Blindness which is a part of the MoH&FW and with Eye Bank Association of India, where SightLife helps them to streamline their eye banking system. For example, we provide them with technical support and conduct capacity-building certification programme, which helps them increase cornea transplants. Our partnership with the ministry and eye association is not just to create those programmes, but to effectively roll them out.
SightLife is also looking at the minimum quality standards that need to be in place for eye banks to operate and how to build financial sustainability for the eye banks. Currently, the eye banks in the country are reimbursed with fraction of cost which is 12 percent. So, a better reimbursement and compensation for eye banks is what we are asking from the state governments. At the state level, we are trying to build one or two large eye banks in a state which would work as a hub, with quality and precision. The Government of Andhra Pradesh has shown interest in creating hub-and-spoke model. SightLife has proposed to have three eye banks in Visakhapatnam, Vijayawada and Tirupati instead of 13 districts having 13 eye banks.
What kind of policies should be in place at the central level to help the state governments engage better?
There are some core policies that need to be put in place. A simple mandatory notification of death will help the cause in a big way. For example, to get 100,000 corneas, you will need only one per cent of all mortalities in India. But when death happens, the number of opportunity for consent and recovery of the tissue is less in India. So, mandatory notification of death will be one important policy, followed by honoring the first consent of eye donation. Many a times, after the death of the person, even if the deceased was willing to donate his/her eyes, the relatives do not honor the person’s wish. To overcome this, we need a proper donor registry. Apart from it, hospitals here should have mandatory cornea recovery programmes, which allows eye banks to conduct and train eye-donation camps within hospitals, so that they can meet the family and get their consent for donating eyes of the deceased.
Which developing country has made remarkable progress in eliminating corneal blindness?
Taiwan and Sri Lanka to follow are progressive in formulating favourable policies on corneal blindness. Taiwan will now have a trained technician to recover the tissue to get quality retrieval of tissues. They are also working on bringing two national eye banks which will fund and reimburse the other smaller eye banks, and also look after quality standards.
Do you have any India-specific targets to eliminate corneal blindness?
In 2002, the Government of India took on a very aggressive target of performing 100,000 transplants by 2020 to end the corneal blindness. However, by 2016, the government completed 22,858 transplants and in the remaining four years, a four-fold growth is required to achieve the expected target for 2020. As a whole, the country has 750 eye banks but most of them exist only on papers. There are 160 operational eye banks, out of which close to 125 are functional where 22,858 transplants have been conducted.
Meanwhile, SightLife, with its partners in eight states, is actually growing much higher in percentage in corneal eye transplants than the government with 11,947 transplants, which is more than 50 per cent. Now, we are working to create high-performing large eye banks. If we have large eye banks partnering with hospitals in nearby localities, there is no need to travel long distances for the recovery of the tissues. SightLife is setting up a state-of-the-art eye bank through PPP with King George Medical University (KGMU), Uttar Pradesh, the largest hospital in the state, which has a record of 4,000 mortality rate. The trained dedicated staff at eye banks will get access to hospitals, ICUs, trauma wards. Besides, each death would be notified and counsellors would try to convince the relative of the deceased for a cornea transplantation.
The new eye bank will also create linkages with other hospitals in Lucknow and surrounding districts within a radius of 100 kms, to retrieve corneas and make them available for transplantation. Sightlife is also looking at a state-wide programme to link up hospitals with eye banks at the state level and to bring in policy changes.
Our idea is to focus on 10 key states and putting in effective systems like right policies, high – processing eye banks and central distribution systems. We will pick 10 states which have high mortality rates, so that we have access to more corneas. Our mission is to create high-volume eye banks, an effective distribution system, get more quality tissues that the local surgeons can use and build a robust corneal distribution system. Projections for 2020 – 2024 is 42,000 transplants.
Where does the money come from for SightLife?
SightLife has a myriad of donors. We don’t charge for our services. In many cases, we provide grants to eye banks to bring down the rates and making it easy for the initial investments. We get funds from major donors and The Hans Foundation is one of them. We also look for domestic and international funds. Apart from it, we have SightLife staff-giving where everyone contributes some fund and participate in the noble goal. We have private companies like Alcon, Orbis who associate with us in our training programmes.
How different would be the first eye bank in UP?
The world class state-of-the-art eye bank in UP will have the best practices and over a time we would like to make it a centre of excellence, so that people from Asia can come and get trained. The new facility will conduct about 1,000 transplants by the end of 2018. Besides, SightLife will also keep looking for opportunities to partner and open up more eye banks.
Is there a possibility to eliminate corneal blindness globally by 2040?
I truly believe it is possible. We need to take innovative and strategic steps and we are doing that. I have learned a lot from India and also opened an office in China. In 2018, we will start working in Ethiopia, which will mark our presence in Africa. We will also launch an online community and get three eye banks in the US, Vietnam and Thailand, so they can exchange ideas and also get access to the Standard Operating Procedures (SOP).
The recovery technicians will also get online training of the best practices to retrieve cornea. They can watch recovery videos and self teach to increase the quality levels. This online forum will help in dissemination of information. Using technology will be one of the areas we will have a robust growth by setting up webinars with our state partners like LV Prasad Eye Institute’s eye bank manager. Apart from it, we will be creating centres of excellence in KGMU in UP (India), Taiwan and Sri Lanka.