SURVEY REPORT ON LOCAL ORGANIZATION

“Tilganga Institute of Ophthalmology”

Submitted By:

GROUP 5 (LOGIT)

Pranjal Raj Ghimire

Binayak Giri

Ramesh Nepal

Rajina Dangol

Prakash Majhi

Submitted To:

Apex SMART

FALL 2016

December 09

Kathmandu Nepal

Bachelors in Computer Information System (BCIS)

 DECLARATION
This Report on “Survey of Local Organization” which is submitted by us in partial fulfillment of
the requirement for the award of Apex SMART as well as BCIS degree of Apex College
comprises only our original work and due acknowledgement have been made to materials used in
the report.

Thank You,
Binaya Giri
Pranjal Raj Ghimire
Rajina Dangol
Prakash Majhi
Animesh Bhattarai
Ramesh Nepal

………………………
Authorized Signature

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 ACKNOWLEDGEMENT

SMART project provided by APEX College has indeed been a fruitful for all of the
students of the APEX College. For the topic given, survey of the local organization we
have been able to prepare this report. Beside our continual efforts, we got support from
different people and parties for which we are extremely grateful and by their support
while completing the report. Firstly, we would like to give special thanks to our Principal,
and my friends for their encouragement and support during our project study period and
at the time of preparation of this report. A special gratitude we give to our SMART
project mentors, Ms. Monica Gautam, Ms. Utsha Thapa, Ms. Manju Bhusal whose
contribution in stimulating right from the time of selection of the topic and throughout the
course of the research.We had tried our best to minimize errors to extent possible way by
consulting our supervisor, colleague, personnel, organization, books and the use of
internet.

We gratefully acknowledge the cooperation received in collecting necessary data,

information and research materials from Mr. Dinesh Khanal, Assistant Manager,
Tilganga Institute of Ophthalmology.

We would like to appreciate to all of those who had helped us in making this report
possible and guiding us in every step of the way. Furthermore we would also like to
acknowledge with much appreciation the crucial role of the staff of library, who gave the
permission to use all required equipment and the necessary materials to complete the
task. We appreciate the guidance given by other supervisor as well as the panels
especially in our project presentation that has improved our presentation skills thanks to
their comment and advices.

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 EXECUTIVE SUMMARY

Tilganga Institute of Ophthalmology (TIO) is the implementing body of the Nepal Eye
Program, a not-for-profit, community-based, non-government organization. This
organization is working for the better treatment of one of the most important sense organs
of our bodies: the eye.

With an aim to act as a model for treatment, research and training, independent yet
working in co-operation with all other eye care centers and organizations in Nepal, the
current TIO facility was opened in 1994.

TIO has crossed many milestones and has now grown into a centre for high quality
ophthalmic services, products, training and academia. However, the burden of blindness
in Nepal is still large, TIO and its staff feel there is still much more to do and many more
challenges to overcome.

We interviewed Mr. Dinesh Khanal of Tilganga Institute of Ophthalmology. He has been

working as an Assistant Manager for 2 years in this organization. According to TIO is a
Non Governmental organization which looks for the welfare of the people’s eyes. He
mentioned that the people from rural were targeted the most by various campaigns
organized by TIO. TIO main source of fund is from foreign organizations, which has
made their day to day jobs much easier. World class doctors and state of the art
technology is what Tilganga Institute of Ophthalmology is renowned for.

Regarding the competition, it is enjoying its monopoly to some extent due to lack of
competitors. The primary objective of this organization is to provide people with world
class service, so the competition is among every organization to do better and treat more
to cure their diseases. TIO believes that serving the people is more important than
anything else in this sector.

Regarding the average age group of patients in TIO, there were patients ranging from
kids to old people.

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Overall, TIO has crossed many milestones and has now grown into a centre for high
quality ophthalmic services, products, training and academia. However, the burden of
blindness in Nepal is still large, TIO and its staff feel there is still much more to do and
many more challenges to overcome. TIO might seem like a big and much managed
organization from the outside, but from the inside they are still broken because they are
still willing to help & support the whole country. TIO still needs a lot of help and support
from the government and other private organization to grow larger, so they can help the
all the civilian’s throughout the country.

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Contents
DECLARATION ............................................................................................................................ i
ACKNOWLEDGEMENT ............................................................................................................ iii
EXECUTIVE SUMMARY .......................................................................................................... iv
CHAPTER I - INTRODUCTION ................................................................................................ 1
1.1 BACKGROUND .................................................................................................................. 1
1.2 OBJECTIVES ...................................................................................................................... 1
1.3 LIMITATIONS OF THE STUDY...................................................................................... 2
1.4 NEED AND SCOPE OF THE STUDY .............................................................................. 2
1.5 LITERATURE REVIEW ................................................................................................... 3
1.5.1 A day in the life of an OPAL surgeon ......................................................................... 3
1.5.3 Outpatient Tilganga ...................................................................................................... 4
1.5.4 Operating Theatre ........................................................................................................ 5
1.5.5 Overall............................................................................................................................ 7
1.6 RESEARCH METHODOLOGY ADOPTED ................................................................... 7
CHAPTER II – DATA ANALYSIS ............................................................................................. 8
2.1 SWOT ANALYSIS ............................................................................................................ 10
Strengths ................................................................................................................................... 10
Weaknesses ............................................................................................................................... 10
Opportunities ........................................................................................................................... 10
Threats ...................................................................................................................................... 10
2.2 CHALLENGES OF THE ORGANIZATION ................................................................. 11
2.3 MAJOR FINDINGS .......................................................................................................... 12
CHAPTER III - CONCLUSION ................................................................................................ 14
 CHAPTER I - INTRODUCTION
1.1 BACKGROUND

Tilganga Institute of Ophthalmology (TIO) is the implementing body of the Nepal Eye
Program, a not-for-profit, community-based, non-government organization. This
organization is working for the better treatment of one of the most important sense organs
of our body, the eye.

With an aim to act as a model for treatment, research and training, independent yet
working in co-operation with all other eye care centers and organizations in Nepal, the
current TIO facility was opened in 1994.

In the early years, working with The Fred Hollows Foundation (FHF), Australia, TIO
played a key role to help refine and adapt a practical, safe, and affordable technique of
intraocular lens implant for cataract surgery in developing countries. Another key
achievement in the early days was the establishment of the country's first eye bank.

With the establishment of the state of the art manufacturing facility for intraocular lenses
funded, designed & constructed by FHF, TIO had started off considerably well-equipped
in its journey towards blindness prevention and eye care. After fourteen years, TIO is still
determined in its mission to be the hub for ophthalmic services, academia and research.

TIO has crossed many milestones and has now grown into a center for high quality
ophthalmic services, products, training and academia. However, the burden of blindness
in Nepal is still large, TIO and its staff feel there is still much more to do and many more
challenges to overcome.

1.2 OBJECTIVES

 To know the different management techniques used by this organization.

 To know about the various social activities carried out by the organization.
 To know about the sustainability of the organization.

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  To know their future plans, e.g. opening a new eye center/upgrading their
equipment, etc.

1.3 LIMITATIONS OF THE STUDY

 Lack of adequate time for preparation.

 We couldn’t get additional information due to the lack of required information on
the official website.
 Power cuts at unexpected times also created problems.
 There were also some highly confidential data that the organization did not want
to share with us.

1.4 NEED AND SCOPE OF THE STUDY

This study is aimed at getting a better view of the way that Tilganga Institute of
Ophthalmology operates. We want to learn how such a big company implements the
managerial strategies. Also, we want to learn about the effectiveness and efficiency of the
managerial strategies we learn during our bachelors studies.

Apart from the classic managerial strategies, we also want to peek into their unorthodox
techniques. We want to see the unconventional ways that they use (if any) and learn its
effectiveness. We also admire the way that this organization has managed to stay in the
long run, with various social activities going on in the background simultaneously.

We did this research for better understanding of one of our nation’s biggest organizations.
We want to thoroughly study how this organization runs, and try and implement their
techniques in the organizations that we work in. Their managerial techniques may have
some flaws, but we want to learn how to tackle such situations as well. Not just
techniques, we want to learn about each aspect of the organization.

TIO is also known for organizing various training programs. We also want to understand
the methods while organizing such an event. While they have many social works lined
up, training programs from this organization are highly regarded.

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The scope of this study

 This report is mainly aimed at giving a better understanding of the different

managerial strategies Tilganga Institute of Ophthalmology uses.
 This study aims at providing some information to future researchers regarding this
institute.
 New similar organizations that want to register themselves can also look into this
report to find some information regarding this field.
 People looking to get into this sector can get some knowledge and be prepared
accordingly.

1.5 LITERATURE REVIEW

By: Anya Gushchin (anya.gushchin@gmail.com)

1.5.1 A day in the life of an OPAL surgeon

I was fortunate to get a chance to return to Nepal as a Himalayan Cataract Project (HCP)
International Ophthalmology fellow. My first experience at Tilganga was during medical
school, and since then I couldn't wait to return to see the exciting changes and growth of
this incredible teaching hospital. I spent 9 weeks working with Dr. Ben Limbu and Dr.
RohitSaiju, Tilganga's oculoplastic surgeons. Along with their fellows Dr. Puja
Rajbhandari and Dr. SulaxmiKatwal we made a cohesive, dynamic team. Some of the
goals of my rotation were to become more efficient, hone teaching skills on an
international level and operate as independently as possible in preparation for going to
Africa. What I needed to learn about efficiency I learned from day one! In my mind,
Tilganga is a model hospital for delivery of high volume, high quality eye care in this
region as well as patients from all over Nepal, India, and even farther away. Their reach
is even further due to the numerous outreach camps that are organized worldwide with
HCP doctors and staff. Many visiting fellows come to Tilganga to take part of the many
opportunities provided by HCP in order to streamline care for patients and learn the “tips
and tricks” from the experts in maximizing impact in resource poor areas.

3
All students and visiting ophthalmologists usually stay at Nima's Guest House. If the
rotation is longer, there are now apartments on site at the new Tilganga Centre. I was
happy to return to my home away from home at the Guest House that is comfortable,
close to the hospital, not to mention the chance to be part of a great family and meet
many guests while having delicious breakfasts and dinners.

1.5.3 Outpatient Tilganga

A typical work week begins with two days of clinics. On an average day we would see
50+ patients in the morning. The clinics are on a first come-first served basis and patients
are triaged to any of the slit lamps in our room by our nurses Charmila or Manisha.
Depending on which room we were in, sometimes there were 4 slit lamps and I was
fortunate enough to have a slit lamp to work with, otherwise I would float between
stations and examine patients with our attending or fellow. My goal was to be useful, so I
really enjoyed the opportunity to see patients on my own and develop a treatment and
follow up plan for them.

After about 2 weeks I commanded enough Nepali to elicit a pleasant surprise on the
patient's faces when I asked them questions or counseled their instructions in their native
language. After a few weeks, the level of difficulty increased as we started seeing a fair
number of patients who spoke Newari (a very different regional dialect native to
Kathmandu valley) and Hindi. It was great to have the nurses with us, because while
transcribing our prescriptions for the patients, they were able to test the patients to make
sure they understood my instructions. For example, it's critical after DCR
(dacryocystorhinostomy surgery) that patients didn't put the nose drops in their eyes and
vice versa. I got pretty good at making the patients realize the difference between the
bottles, though.

At the conclusion of the morning clinic there was a break for lunch and the early
afternoon we would see patients with follow up lab studies and review referrals (for
instance ENT or radiology). It always amazed me the turnaround times: patients would
often return from radiology with their films or from the ENT consultant the same day so
that we could make a prompt decision on the surgery they needed. After the afternoon

4
clinic, the paid clinic began for the attending and I got a chance to spend the afternoons
working on my research project or join one of the attending in the operating theatre for
unusual cases.

1.5.4 Operating Theatre

Tuesday through Friday we spent in the operating theatre. Each day there was an
assignment of cases to be done that day organized by level of difficulty/time. In the
morning would be the general clinic cases and in the afternoon we had “paying” patients.
As far as I could tell, the difference was the afternoon patients could afford to pay more
of the cost of their surgeries, subsidizing the care for the patients who could not afford
their treatments. This is what makes Tilganga sustainable, and of course we would take
care of them no matter what.

I really enjoyed the seamless way that the techs work in the OT at Tilganga. We had
sisters who were scrub techs, circulators, and anesthesia techs who helped make
everything run smoothly. I didn't have to go searching for instruments because our
Instrument Sister would lay out all the instruments for the day on a back table, and if the
cases had to switch in order, or be done in a different operating room, it was all easily
available at our fingertips.

There are 8 OTs at Tilganga, and one of them is dedicated to patients who need general
anesthesia – which we used quite a bit. The remaining rooms are divided depending on
how many retina, cornea and cataract cases are to be done that day. It was not unusual to
have an OT list that is 40-50 patients long. Oculoplastics cases in general tend to be
longer, so oftentimes if there were other smaller cases to be done and an operating theatre
became available, we could utilize that room so that patients would not need to wait as
long. I found myself wishing this was so easy in the US!

The majority of our cases could be done under local anesthesia. All patients received
intramuscular diclofenac and then local lidocaine anesthesia. I cringed the first time we
went to perform a dacryocystorhinostomy under local, but it was not a problem. With a
good regional block, the patients did not experience any more discomfort than at a
dentists office (or equivalent).

5
I was very fortunate to participate in several cases that I didn't get to see or do in my
fellowship last year, including several dermis fat grafts and a fascia lata sling. Both of
these procedures require good knowledge of regional anatomy of the abdomen and thigh,
something that is out of the scope of a typical ophthalmologist. With Dr. Rohit and Dr.
Ben's guidance I now feel very comfortable with managing these types of cases.

We also had a series of challenging reconstructions and flaps in patients with trauma or
oncologic causes of eyelid malpositions. The best part about our team approach is that we
would all discuss the possible ways to repair and as a result discuss all the possible
approaches. This is very useful for the fellows' training to come up with a plan and
discuss pros and cons so that they learn the logic behind some of the reconstructions.

In general I scrubbed on all the cases and assisted the fellow through the cases. On
several days when there was an open OR, all of us would grab a room and I would
operate on my own. One important skill that is never taught in the US is how to be an
effective solo surgeon. In training, we almost always have or are expected to have an
assistant and, unless you are in private practice, you never get to figure out on your own
some of the pearls for doing procedures easier. This type of experience is invaluable.

About a month into my rotation I prepared a morning lecture for the third year residents
on eyelid malpositions. This was not only useful to gather and organize my photos to
make a cohesive lecture, but also a topic that I've never had a prior lecture on. In creating
a succinct powerpoint I learned a lot about what it takes to teach oculoplastics across
cultures. For instance, my experience at Stanford was with a lot of Asian patients, but
their eyelid anatomy is quite different than the mongoloid eyelids of several Nepali ethnic
groups. As a result we had a great discussion on how the approaches might be similar or
different when it comes to reconstructions.

During my stay at Tilganga we hosted the 2nd National Oculoplastic Conference in

Kathmandu: http://ocn2014.com It was well attended by local ophthalmologists as well as
international guest speakers from India, US, UK, Australia, The Netherlands, Thailand
and Israel. The two day conference was held downtown and was a great medium for
sharing regional techniques in orbital, lacrimal and facial plastic surgery. In the evening,

6
we put on an entertaining cultural program and also got to attend Dr. Suman Thapa's
benefit concert right next to the conference center. Dr. Suman is a glaucoma specialist at
Tilganga who is also a talented musician and plays in a rock band with the proceeds from
his concerns going to subsidize treatments for glaucoma patients. Check out the Rusty
Nails and this video that shows how well music and medicine go together
(https://goo.gl/3rX4DoAs) a med student I had joined Dr. Suman on the first glaucoma
outreach camp, so it was neat to come full circle and support his work now also.

1.5.5 Overall

My time at Tilganga was an incredible opportunity. I would highly recommend coming to

spend time with the teams there. The dedication of the physicians and staff at Tilganga is
unmatched, and it was inspiring to get a chance to work side by side toward a common
goal. During my time there we had a medical student and an undergraduate student who
also came to clinics with us and I feel like the experience is worthwhile at each level of
training. Each one of us was able to take away something to bring back home or in my
case to apply when I go to Africa. I feel like Tilganga prepared me well for a career in
International Ophthalmology and helped me make lasting friendships with likeminded
people.

1.6 RESEARCH METHODOLOGY ADOPTED

Primary: Interview with a TIO Official who did not want to disclose their name.

Secondary: We used Tilganga’s official website. Anya Guschin’s blog was used for the
literature review. Apart from that, we looked into various other blogs and articles to
collect more data and learn about the different social activities carried out by the
organization as our secondary source.

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 CHAPTER II – DATA ANALYSIS

We interviewed Mr. Dinesh Khanal of Tilganga Institute of Ophthalmology. He has been

working as an Assistant Manager for 2 years in this organization.

We first asked Mr. Khanal to give us a brief introduction to Tilganga Eye Institute. He
said that TIO is a Non Governmental organization which looks for the welfare of the
people’s eyes. He also stated how people from the rural areas were target more often by
various campaigns organized by TIO. He told us that they were funded by some foreign
organizations, which has made their day to day jobs much easier. World class doctors and
state of the art technology is what Tilganga Institute of Ophthalmology is renowned for.

Next, we asked Mr. Khanal about the competition that TIO has. He told us that they did
not have the competition as seen in other markets. He says the primary objective of this
organization is to provide people with world class service, so the competition is among
every organization to do better and treat more and cure their diseases. He also strongly
believes that serving the people is more important than anything else in this sector.

We then talked about how Tilganga managed to get its funds. On account of not
disclosing much information, he only told us that they had a foreign donor and hence it
was easier for them financially. According to him, being an organization that works for
social welfare, they have to be very careful of the budget allocations.

We wanted to know about the average age group of patients was at TIO. Mr. Khanal told
us that there were patients ranging from kids to old people.

Looking at the popularity of TIO, we talked about the patients. Weather they received a
lot of national patients or international ones. Mr. Khanal replied that they received more
national patients, but they also get a considerable amount of international patients too.

We wanted to know about the challenges that TIO faced as an organization. Mr Khanal
was quite elaborative. He told us that they had many challenges, most of them arose
when they conducted their training seminars and other social activities. According to him,
the political instability is one of the major factors. The people in the rural areas need eye

8
care, and when they go for conducting such campaigns, the local parties of that area
sometimes disrupt their campaign. Also, there are a lot of challenges in the hospital itself.
The large amount of patients that they receive is a good thing and a bad thing at the same
time as they are unable to manage the patients properly. The traffic problems in the valley
do not allow doctors to reach the hospital in time, and then patients are the ones who
suffer and complain. Apart from that, they have more challenges like maintaining a good
relationship with their donor parties. The donors constantly look for progress reports to
evaluate TIO. According to Mr Khanal, they have to be very careful of the report and
make sure they have no mistakes.

We wanted to know how they managed funds for such social campaigns and other
trainings. To this, he replied that they had a hefty amount of funds for the welfare of
people’s eyes. If someone was not able to pay for their surgery, the hospital would
consider the amount that they couldn’t pay. They also operate on many patients for free
on a regular basis. The free cataract campaign is even carried out by the world renowned
doctor, Dr. Sanduk Ruit in rural parts of Nepal on a regular basis. According to Mr.
Khanal, this is all possible thanks to the right management of funding and manpower.

We then tried to get into the way their organization runs. We asked Mr. Khanal how they
managed their day to day activities. To this, he replied that they had experienced
managers to handle different types of work, and the methods that they applied here were
more or less the same as that we study in our course during bachelors. According to him,
they occasionally conduct various leadership training seminars, teamwork seminars, etc
to build the required skill.

We then asked Mr. Khanal about the research that TIO carries out. He said that TIO was
a leading organization in eye health research. In this organization, they felt that the need
for ophthalmic research was very high, which led the team from TIO to work in this field
in the first place. This also motivates TIO to commit to social values, and dream to create
a world class research facility available in the country.

After interviewing Mr. Khanal, while returning back, we decided to interview a random
cleaner in the organization. We wanted to ask them about their satisfaction with the

9
organization as a whole. So, we bumped into Maya Devi Bhandari, a cleaner who has
been working at the organization for the past 7 years. We asked her about how she felt
about the organization, and how the doctors and others treated her. She replied that she
was very satisfied with the organization. The help that she had been receiving over the
years has overwhelmed her. According to her, the newer recruits have some “attitude
problems” but the senior members of the organization are very helpful.

We asked her about the facilities that the hospital provided for the employees. She said
that they had shuttle service for the employees, so that they would reach the hospital on
time. The hospital operates from the early morning so they have to be at the hospital very
early to operate smoothly.

2.1 SWOT ANALYSIS

Strengths

Advanced technological equipments

Experienced and well known doctors

Trust from the patients as it is the oldest hospital

Very helpful and cooperative workforce

Weaknesses

Unmanaged patient queue

Busy schedule of doctors

Opportunities

Lack of other similar organizations in this sector

Threats

Lack of services

Political Instability

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2.2 CHALLENGES OF THE ORGANIZATION

According to Mr. Khanal, TIO faces various challenges. First of all, this organization is a
huge organization. This organization has the objective of making sure the people’s eyes
are taken care of. The eye, being an important sense organ is very sensitive. This
organization, too, has to be very careful while working with the patients. Small mistakes
during the operation could blind the patient for life, which has an unimaginable impact on
their lives.

The mere size of this organization is another blessing in disguise. The big size means that
they need more manpower. In case of deficiency in any factor, this organization suffers
heavily. For this organization to run smoothly, there are numerous tasks that need to be
done precisely at the right time. If a doctor runs late, the staff at the hospital has to hear
from numerous patients. At the same time the doctors need communicate with patients in
a good way. The behavior of all the staff of this organization reflects on the organization
as a whole, so everyone has to be on their best behavior.

Another challenge this organization has is the political instability. Although this
organization is not connected to politics, any change in the government affects this
organization directly. This organization conducts different types of social activities and
campaigns in different parts of our country at different times but on a regular basis. The
government’s interference in such activities hampers the organizations’ campaigns.
Instead of supporting the organization, sometimes, local parties vandalize the campaign
area and destroy equipments. The proper management of such activities is also seen as a
major problem for this organization.

Another challenge for this organization is the fact that this organization is dependent on
funding. Of course, they do charge people for the service they give them, but the
organization is driven majorly by the funds provided to them from foreign donors. For
constant from the donors, they must maintain a clean record whilst maintaining a good
relationship with them.

While on the topic of maintaining good relationships, maintaining good relationships

with the patients is another challenge for this organization. The fact that it is a hospital

11
makes it clear that there are lots of patients, and as stated earlier, this organization has to
deal with a lot of patients. Also, as stated above, the number of patients coming for
treatment is a fairly large amount and because this hospital is one of its kind, the number
of people is only increasing. The staff has to make sure they show good behavior and
attitude towards the diverse people coming to the hospital in order to maintain a good and
healthy environment.

2.3 MAJOR FINDINGS

Tilganga Institute of Opthalmology is a prestigious institute that works for welfare of

people’s eyes. The organization is determined to treat people who need eyecare using
state of the art equipment and world class doctors. Apart from that, this organization is
very active socially as they conduct many social campaigns and free cataract surgeries for
people from the rural areas. This organization also has many challenges. Being a very big
organization, the management is a difficult task. This organization trusts their skilled
manpower for its smooth operation. They also have a very difficult task of handling the
patient flow. The number of patients that this organization receives is a large number and
management of this is a difficult task. They have a new building, which has given them
more resources but at the same time the number of people who come for treatment has
also increased drastically. They are a renowned organization, so people from all across
South East Asia come to get their eyes cured. The other thing that we found was that this
organization was backed up by some very high profile donors. They funds enough for
them to run smoothly, at the same time carry out health posts and other social activities,
trainings, seminars, etc on a regular basis.

This organization seems to be more into social welfare than anything else. This
organization’s vision is to make people’s vision better. They organization numerous
campaigns aimed directly at the welfare of the people, and this is why this organization
has been able to gain the amount of trust as they have. The belief from the people is so
good that they don’t hesitate to participate or come for eye treatment as long as the
campaign was organized by TIO.

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In conclusion, TIO believes that serving people is the most important thing and they are
determined to do so. They have a dream of having world class doctors and treating people
with world class equipment. The trust that the people have for them is one of the major
factors that drives this organization.

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 CHAPTER III - CONCLUSION

Nepal Eye Program was officially launched in July 1992 to support the prevention &
control of blindness in Nepal and the region. Tilganga Institute of Ophthalmology (TIO)
is the implementing body of the Nepal Eye Program, a not-for-profit, community-based,
non-government organization. With an aim to act as a model for treatment, research and
training, independent yet working in co-operation with all other eye care centers and
organizations in Nepal, the current TIO facility was opened in 1994.

In the early years, working with The Fred Hollows Foundation (FHF), Australia, TIO
played a key role to help refine and adapt a practical, safe, and affordable technique of
intraocular lens implant for cataract surgery in developing countries. Another key
achievement in the early days was the establishment of the country's first eye bank, in
conjunction with Tissue Banks International in Baltimore, USA, and Lions International.

Another vital international association of TIO early on was with the Himalayan Cataract
Project (HCP), USA. They helped to run unique projects empowering local physicians to
alleviate the suffering caused by blindness, including skills-transfer education, cost-
recovery, research, and the creation of a network of eye care facilities.

With the establishment of the state of the art manufacturing facility for intraocular lenses
funded, designed & constructed by FHF, TIO had started off considerably well-equipped
in its journey towards blindness prevention and eye care. After fourteen years, TIO is still
determined in its mission to be the hub for ophthalmic services, academia and research.
The current focus of TIO is on strengthening its academic unit, opening more rural
community eye centers in the hilly and mountainous districts of Nepal and above all
sharing the 'Tilganga' model of eye care concept to others.

Through the assistance of HCP and FHF, TIO is regularly conducting high volume
remote cataract surgery camps and establishing sustainable rural eye care infrastructure in
Nepal. HCP is also partially funding the current expansion project of TIO into a new
building to manage our increasing demand. The FHF has been providing continued
technical assistance to the IOL laboratory over the years and now has completed the total
transition of control of the laboratory to TIO.

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Overall, TIO has crossed many milestones and has now grown into a centre for high
quality ophthalmic services, products, training and academia. However, the burden of
blindness in Nepal is still large, TIO and its staff feel there is still much more to do and
many more challenges to overcome.

15