philanthropist George Subraj. U.S. eye banks donated
corneal tissue, U.S. surgeons donated their time and
talents, and the Guyanese government supplied
operating room (OR) facilities and postoperative
medications. Media outlets in Guyana promoted
the corneal transplant program’s mission and goals,
which resulted in additional support from the community. Using the PPP model, we were able to bring
the best available medical expertise from the U.S to
a developing country, at no cost to patients, without
relying on direct funding from any U.S. governmental agency.
Our mission was completed in five stages: an exploratory visit, initial performance of corneal transplant
operations, heightened local involvement, refinement,
and gaining of independence.
The purpose of the exploratory stage was to become
familiar with Guyana’s health care infrastructure
and licensing requirements, as well as to become
acquainted with the level of education and motivation of the typical local surgeon who we would train
to establish the corneal transplant service at a private
hospital in Georgetown. During this stage, Stephen
G. Waller, MD, a co-author of this article, joined an
existing program in renal transplantation in Guyana,
founded by co-author Rahul M. Jindal, MD, PhD,
MBA, FACS, and Mr. Subraj. This visionary program,
described in the June 2013 issue of the Bulletin, was
implemented over the course of more than 20 visits
to Guyana and resulted in the successful transplant
of 26 living-related donor kidneys and other associated procedures. 4, 5
Building on the credibility that the U.S. kidney
transplant team established, Dr. Waller traveled to
Guyana in 2014 to meet with local ophthalmologists
and government officials. He established his own
credentials for local medical privileges, investigated
the clinical and surgical capacity of the region, and
delivered lectures on corneal transplantation and eye
banking to approximately 50 local eye care provid-
ers, including George Norton, MD, now Minister of
Public Health in Guyana. Both Guyanese and U.S.
stakeholders agreed that this first stage was a success.
Initial corneal transplant operations
On the second mission in August 2014, we performed
six successful corneal transplants in a private hospital
with donor tissue given ex-gratis by U.S. eye banks.
However, we soon realized that sustainability was
only possible in a public system, free of cost to the
patient. For example, the private hospital charged
$3,000 (U.S.) for each corneal transplant even though
the corneas, instruments, sutures, and services of the
U.S.-based surgeons were provided free of charge.
These successful corneal transplants drew substantial positive publicity, building momentum for
the establishment of an eye bank in Georgetown.
Georgetown is the headquarters city for a regional
group of governments, the Caribbean Community (or
CARICOM), which comprises 15 members—mostly
small island nations with little hope of establishing a local eye bank. Thus, a regional eye bank in
Georgetown seemed like a natural fit for the Caribbean Community.
Heightened local involvement
A total of 11 corneas were transplanted during the
third mission in July 2015, this time at the Georgetown
Public Hospital, which provides specialized services
to the entire country. The local surgeon, Shailendra
Sugrim, MD, a co-author of this article, was heavily
involved in patient selection and the actual operations,
and a second U.S. surgeon, co-author Joseph Pasternak, MD, led the surgical work. All of these efforts
were conducted with the support of the local government and The Subraj Foundation, and the U.S. surgery
team continued to assist with follow-up via e-mail after
returning to the U.S.
MAY 2016 BULLETIN American College of Surgeons
SUSTAINABLE EYE BANK PROGRAM