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OPHTHALMOLOGY PRACTICE
Year : 1995  |  Volume : 43  |  Issue : 2  |  Page : 89-94

An ophthalmologist's journey along uncharted paths


Department of Ophthalmology, University of Toronto, Canada, USA

Correspondence Address:
Prasanta Kumar Basu
Department of Ophthalmology, University of Toronto, I Spadina Crescent, Toronto, Ontario M5S 2J5 Canada
USA
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How to cite this article:
Basu PK. An ophthalmologist's journey along uncharted paths. Indian J Ophthalmol 1995;43:89-94

How to cite this URL:
Basu PK. An ophthalmologist's journey along uncharted paths. Indian J Ophthalmol [serial online] 1995 [cited 2019 Aug 22];43:89-94. Available from: http://www.ijo.in/text.asp?1995/43/2/89/25267

I was born in the early 1920s in Mymensingh town, now in Bangladesh, into an educated, upper-class Bengali family. During the 1930s, as a teenager, I was exposed to several episodes of the freedom movements in India, and was involved in various types of social work. Experiences gathered from these activities encouraged me to take a special interest in relief work in later years. In 1941 I entered the Calcutta Medical College and in 1946 passed the MB examination of the Calcutta University.

As a medical student, I gave paramedical services during several events, such as the August Revolution, and the Japanese air raid on Calcutta in 1942, and particularly the Great Bengal Famine in 1943. Soon after I graduated in medicine, a ferocious political riot in Calcutta in August 1946 took the lives of over 5000 people in four or five days. Calcutta streets were littered with savagely mutilated corpses, and the city belonged to the vultures. During those terrible days, several of us hardly left the casualty department of the Calcutta Medical College Hospital, where we were on duty. The fatalities in Calcutta could have been greatly reduced if the city had an efficient first aid and ambulance service. Consequently, Calcutta doctors soon established a few well-organized voluntary relief organizations. I became closely associated with one - the Relief Welfare Ambulance Crops [RWAC], the Patron-in-Chief of which was Mr. Jawaharlal Nehru, the future Prime Minister of India.

The RWAC gave its services in many places in India during the political disturbances at the time of the division of British India. In Calcutta, during 1946-47, I was involved in emergency operations, such as treating riot casualties, rescuing and sheltering displaced persons, providing ambulance services to sick and pregnant women, distributing milk and food during curfews, and giving cholera inoculations and smallpox vaccinations. Anticipating an outbreak of severe communal riot during the Sylet referendum in July 1947, a RWAC relief and ambulance team was organized under the sponsorship of the Bengal Provincial Congress Committee {BPCC], which deputed me to take the team to Sylet. There we engaged in extensive first aid and ambulance services under very strenuous and precarious conditions.

I had been one of the three doctors nationally selected in early 1947 to lead a good-will medical mission to Indonesia, a project jointly undertaken by the Indian Government, the Indian Red Cross Society, and the Indian Medical Association. The mission, however, had to be cancelled at the last minute, as severe communal riots broke out in the Punjab. At the call of the Indian Government, I prepared to take a RWAC team to work in Delhi and East Punjab. On the day of India's independence, August 15, 1947, while the Punjab was on fire, the city of Calcutta, usually most vulnerable to communal riots, miraculously remained quiet. This was due to Mahatma Gandhi's presence there. Under Gandhi's direction, a Peace Committee was formed in Calcutta to rehabilitate Hindus and Muslims uprooted by earlier riots. The BPCC gave me the responsibility of resettling the displaced persons in a highly affected area.

The Punjab riots had burst out into genocide on August 14, 1947. The mass murder resulted in the migration of millions of non-Muslims (Hindus and Sikhs) from Pakistan, and of Muslims from India. On September 20, 1947, our relief team comprising 28 doctors and medical students, left Calcutta for Delhi. In Delhi, we worked in Muslim refugee camps for a few days. On September 25, we were taken by a military Dakota plane to Firozepur, a border city in East Punjab. Looking down from the plane, we saw several refugee columns, each 40-50 miles long, some moving eastward and others westward. At Firozepur, we came in actual contact with the non-Muslim refugee entering India. Their plight was horrible. As L. Collins and D. LaPierre wrote: "They were tortured by hunger and thirst and were enrobed in a stench of urine, sweat and defecation.... Theirs was the trek of the uprooted, each mile menaced with exhaustion, starvation, cholera and violent attacks against which there was often no defence."[3] Along the refugee routes, the vultures, wild dogs, and foxes feasted on human dead bodies.

Our duties at Firozepur, where every system of sanitation had collapsed, included giving mass inoculations, and treating thousands of refugees for wounds, cholera, and other ailments. External eye infections, particularly trachoma, were extremely common. I had never seen so many people with ocular diseases in one place at the same time. I did epilation on hundreds of eyelids with trichiasis - the only remedy I could offer to save the patients' corneas. We also had to supervise water supplies, as well as proper disposal of wastes and dead bodies. I was given charge of a very large cholera hospital. The nursing staff was meager and there was a severe shortage of medical supplies, which could reach Firozepur only by air. The air service was very irregular. A large number of patients were dying of dehydration, largely due to an insufficient supply of injection kits. Often we could do nothing to save these patients.

On September 28, Firozepur was suddenly inundated by a severe wide-scale flood. The building where we were staying capsized, burying all our personal belongings and medical supplies. The lack of food, shelter and transportation to a safer place made us refugees ourselves. Several of our team members became sick with gastroenteritis and many became mentally very upset. It was indeed a great task for those of us who were well enough to look after them. As nobody could help us in Firozepur, we decided to proceed toward to Delhi. We plodded through the flood water for miles, rode on refugee trains or trucks when they were available, and after about a week's hardship reached Delhi. Finally we returned to Calcutta. I was given a special award for my work in East Punjab, and was invited to broadcast my grim experiences over All India Radio.

Professor Kiran Sen, an uncle of my mother, was a doyen of Indian ophthalmology [Figure - 1]. One day after my return from the Punjab relief, he told me that he had heard my radio talk, which he found impressive, but he frankly told me that this type of work would not take me far enough as a successful medical doctor. He advised me to specialize in a specific clinical area that had importance in India, and he suggested that I study ophthalmology at the Eye Infirmary, Calcutta [Figure - 2]. At that time, in the postgraduate physiology department, I was learning tissue culture techniques from Dr.N.N. Das, an Indian pioneer in this field. After much thought, I took Professor Sen's advice. I entered the field of ophthalmology, and enrolled in the Diploma of Ophthalmic Medicine and Surgery (DOMS)course of the Calcutta University.

After attending to the victims of a large explosion, I became seriously concerned with the treatment of corneal blindness, as I found that at that time in Calcutta there were no facilities to treat corneal opacity by keratoplasty. I also sadly realized that until I reached my middle age, I might not get the opportunity to do this kind of advanced surgery in Calcutta. I therefore planned to go to some smaller place, where I would be able to work and learn independently.

Because of repeated encounters with the rural population during my relief work, I had developed a strong inclination to work among them. I wrote to many small organizations, and finally became seriously interested in a job in a rural area about 1000 miles from the bustling city of Calcutta. Although my family was in favour of my taking up the challenge, my teachers felt very unhappy about it. They thought that by leaving Calcutta I would ruin my career. However, I decided to meet my future employer, Swami Pragnanananda, the administrator of the Ramakrishna Mission Sevashrama, a charitable hospital at Vrindaban, Uttar Pradesh, India [Figure:3]. He offered me the job of the "In-charge" of their eye hospital, saying, "Dr. Basu, we will not be able to give you a salary that you deserve, but we will give you all the cooperation you would need to fulfill your dream. I assure you that you will not regret the experience." He had such an inspiring personality that I fully believed him. As I had to go against the wishes of many of my wellwishers, I was not fully happy.

I joined the mission hospital at Vrindaban on August 3,1951. It had a general medical division, and its eye division was called the Nandababa Eye Hospital. The establishment was run by Hindu monks belonging to the Ramakrishna Order.

Within a month of joining the hospital, I could see some of the reasons why my teachers were so much against my taking the job. Vrindaban was a great Hindu pilgrimage center and consequently was governed by many kinds of conservative customs and traditions to which my wife and I, who were basically urban people, were not accustomed. The population consisted of Sadhus (holy men) and their disciples, priests and Pandas (religious guides) of numerous temples, pilgrims from all over India, whose number fluctuated depending on the time of year, and many refugees from Pakistan. It was also a sanctuary for poor old people coming from different areas of India. The main creed was "Vaishnavism", and people were forbidden to eat meat, fish, or eggs there. This was not a place where adequate school education could be given to children of our background. Furthermore, with the salary I would get, it would certainly be difficult to run the family.

As I was pondering over these difficulties, I got a letter from Professor Sen. He wrote, "Be careful about what you do there. In a small place if you are lucky enough to do well, you can be popular in a short time. But if you do even small mistakes in a conservative place like Vrindaban you could be soon undone". There were not many things in the hospital with which I could do even what I had learned in Calcutta, not to speak of the advanced types of surgery that I contemplated doing. Moreover, the daily number of patients was overwhelmingly large for a single eye specialist, and my assistants were young monks with no paramedical training. However, with my wife's encouragement, I decided to take the risk at Vrindaban. I was faced with two main clinical challenges. The first was to tackle a huge number of cataract patients. The second, which was significantly more difficult, was the large number of cases of corneal blindness.

One of the first things I did after joining the mission hospital was to train some of the young monks in some special areas of modern ophthalmology. A few of them became so skillful that they could perform entropion operations and even cataract surgery under my supervision. In Vrindaban, I constructed various kinds of surgical instruments and a perimeter. I started doing several kinds of surgery, such as cosmetic squint operations, dacryocystorhinostomy, implantation of Ridley's intraocular lenses, and removal of orbital tumors. As I had no facilities at hand, I sent some tumor tissues to Professor Norman Ashton at the Moorfields Eye Hospital, UK, for pathological diagnosis, which he very kindly did. According to Indian ophthalmological standards of that time, these kinds of operations were indeed very uncommon. Corneal grafting and replacement of opaque vitreous humor using cadaver material were even more uncommon.

For treating corneal opacities, I needed to establish a corneal grafting unit and an eye bank. I had never seen a corneal grafting operation in Calcutta. One of the books in which I had read a very good account of it was Eye Surgery, by H.B. Stallard, published in 1950. This book, in fact, became my bible whenever in Vrindaban I attempted to perform any new procedures. In the hospital there were no corneal trephines or corneal sutures, and the hospital was not solvent enough to buy these for me. With the help of a skillful local blacksmith, I was able to construct, using paired blades of cataract knives, several Castroviejo-type double knives for cutting square grafts. I was also able to secure several Grieshaber corneal needles through a friend in Bombay.I started with these resources. When the Director General of Health Services of the Uttar Pradesh (UP) Government, Dr. Jagadish P. Gupta, learned about my keratoplasty, he came and saw my work and then persuaded his Health Ministry to award a special grant to the mission hospital for developing my pioneering corneal grafting and eye bank program. With the fund, I bought the necessary corneal instruments and the supplies I needed. I was also able to purchase a slit-lamp microscope.

However, before I could establish the eye bank I had to overcome several obstacles. I had no example or model to follow. I had to consider that the society in Vrindaban was very orthodox and that normally it would not entertain any new revolutionary concept, such as the use of cadaver tissues on living human beings. I discussed my plans with Swami Pragnanananda and Dr. S.K. Mukherjee, Civil Surgeon, who was the government medical head of the Mathura District, in which Vrindaban was situated. Both of them had great scientific vision and were quite courageous. I asked them to allow me to enucleate eyes from the unclaimed bodies of patients who had died in the medical division of the mission hospital. The hospital had government permission to throw these bodies into the nearby river Yamuna, where they were quickly devoured by river Yamuna, where they were quickly devoured by big turtles. My request was granted. However, we had to carefully consider the likelihood of adverse public reaction in certain situations - such as when the recipient and the donor would be of different castes or communal backgrounds. We agreed to take the risk.

While working among the rural people, I soon realized that if once I could prove my sincerity and trustworthiness to them, they would follow my advice faithfully. When the local people saw the successful outcome of my keratoplasty operations, they began to view favorably, the concept of eye donation. I would cite one unique incident to exemplify this. Shyama Dasi, an old, illiterate widow, originally from the province of West Bengal, was a lower - cast Hindu. She was blind in her eye [Figure:4]. She had talked to a patient of mine who was cured of her blindness by keratoplasty. One day Shyama dasi came to me and said, "My left eye is dead. If it can do good to someone, please take it out and use it". Because of her repeated requests made in front of several people, I agreed to enucleate her left eye, which had a clear cornea. I grafted the cornea onto a local young girl named Shanti Devi, who belonged to the highest caste. The success of the operation, which was well publicized, not only broke provincial, but also caste, barriers in Vrindaban, at least medically.

Considering the large number of patients requiring corneal grafting, it was obvious to me that donor materials from unclaimed bodies or from the enucleated eyes of living donors would not be sufficient. Hence, I began to work on my third source, namely, donated eyes from persons who died locally. I approached the leaders of the Sadhu community. In the Hindu religion, the dead body is considered to be a worn-out garment. Further, there are several Indian mythological references to donating body parts for the benefit of others. One example is the ancient sage, Dadhichi, who donated his bones. Further, according to a Buddhist "Jataka" story, in one of his previous births, Buddha, as King Sibi, donated his eyes to cure a blind man. The third example is that of an important Hindu god, Lord Ganesha, whose head was transplanted with the head of an elephant. The religious leaders knew all about these examples and more. Instead of raising any philosophical or religious arguments against my establishing an eye bank in Vrindaban, they supported the humanitarian ideal behind it. Many Sadhus assured me that they would see that their eyes were donated after their death, and that they would also advise their disciples to become eye donors. I also got tacit approvals from their local political and social leaders. Slowly I began to receive eyes donated by local people. In every case of eye donation, I persuaded the legal owner for the dead body to give his consent in writing in the presence of monks and other witnesses. I have preserved a few of the original notes written in the early 1950s. I think they have great value in the history of eye donation.

In Vrindaban, I encouraged parents of school-going children to have their eyes examined. I also encouraged middle-aged persons to have Schiotz tonometry done on their eyes on a regular basis. I tried hard to make people conscious of their ocular hygiene. Patients and their relatives were taught to use individual towels and not to use eyeliners like "kajal" or "surma" with unclean fingers, and to wash face and hands frequently, using soap. They were warned not to let flies and other insects sit on their eyelids and faces, and told to use mosquito curtains whenever possible.

Iatrogenic blindness resulting from cataract operations by quacks and ill-trained persons, privately or in the so-called eye camps of that time, was very common. I was very much concerned about this, as numerous cases with postoperative complications used to come to me. For my public criticism of the inefficiently run eye camps, I fell into disfavor in some quarters. However, my overall performance being satisfactory to the public at large, no harm occurred to me.

The news of my activities gradually spread beyond the Vrindaban areas. My unit was apparently the world's first modern corneal grafting and eye bank center in a rural setting. At the All India Ophthalmological Conference in 1955, a report on this was well received.[1] The famous ophthalmologist, Dr. Karl Lindner, personally congratulated me at the conference. Many important medical and lay dignitaries, including Sir Sarvepalli Radhakrishnan, Vice-president of India, visited the eye hospital. In appreciation of my work at Vrindaban, the UP Government nominated me for a Colombo Plan Fellowship, and I was awarded the fellowship through a national selection. As so many questions had remained unanswered for me in Vrindaban, I had been feeling a great need to do some scientific research using experimental models. When I was given the opportunity of going to Canada for higher studies under the Plan, I was filled with much expectation.

On reaching Toronto in June 1955 I was, however, surprised to find that nobody here was doing any keratoplasty, and that there was no eye bank. Dr. A.J. Elliot, head of the Department of Ophthalmology [Figure:5], indicated that they were planning to start these facilities soon under the directorship of Dr. H.L. Ormsby. Because my special interest was to study these areas, and because I had come to Canada for only six months, Drs. Elliot and Ormsby tried hard to help me, and gave me facilities to do some research on corneal graft immunology and corneal preservation. In, turn, I started helping them to expedite their keratoplasty and eye bank program.

At the request of the University of Toronto, the Indian government extended my fellowship period up to the end of 1956.1 presented a comprehensive plan for research and teaching, as well as an overall scheme for the eye bank service of the University of Toronto, at the Annual Conference of the Canadian Ophthalmological Society in June 1956.[2] The paper was the first of its kind in Canada. Later, the Indian government allowed me to study in North America until March 1959, but without any remuneration. I had to look for financial support.

For a short time in 1957 I worked at the Francis I. Proctor Foundation for Research in Ophthalmology in San Francisco, as one of their first fellows, thanks to Drs. Michael Hogan and Phillips Thygeson. There I met a visitor, Colonel E. O'G Kirwan, a former head of the Eye Infirmary of Calcutta [Figure:6]. In the meantime, Colonel E.A. Baker, the founder of the Canadian National Institute for the Blind (CNIB), who was very interested in my eye bank activities in Toronto, offered return air tickets for my wife and our 4-year-old son, so that they could join me in Toronto [Figure:7]. Dr. Ormsby introduced me to Sir Stewart Duke-Elder. When I saw him in New York City, he offered me a job in Gambia, West Africa. However, as Dr. Elliot was able to give me a Research Associateship under a Canadian National Health Grant, I declined the Gambia offer.

On the eve of my departure for India, after spending four very happy and fruitful years in Canada, at my farewell party at the home of Colonel Baker, Dr. Elliot gave me an unexpected gift. He offered me a permanent position as the Stapells Director of Ophthalmic Research at the University of Toronto, if I would return to Canada. Mr. H.G. Stapells, a renowned Canadian lawyer, was personally present at the party.

After returning to India, I discussed the offer with the government of India, who very thoughtfully released me from my obligations to them. Within six months, in September 1959, I returned to Canada with my family as a landed immigrant, to join Dr. Elliot's department. On hearing this, in a very kind letter, Sir Stewart wrote me: "I must congratulate you on your new post. It is a splendid one, because you are the first Director of Ophthalmic Research in Canada, and I feel that the potentialities of ophthalmology there over the next few generations are immense. Moreover, in Elliot, you have a most enthusiastic and sympathetic chief; it is rare to have a clinician who is so understanding about research as he is. It would seem to me that everything is at your feet..."

In retrospect, I see what foresight Sir Stewart had. Later, I became the first Career Investigator in Ophthalmology of the Medical Research Council of Canada, and then the first ophthalmologist to become an honorary Fellow of the Royal College of Physicians and Surgeons of Canada. I received the Canadian Ophthalmological Society Award, and the Canadian Ophthalmological Society Semi-Centennial Award. Many foreign fellows, especially from Third World countries, came to work with me. At the University of Toronto I started the first Canadian course on Third World Ophthalmology for medical students. On several invitations to India and Bangladesh, I lectured at many eye institutes and attended many eye camps. Most important in my life has been team work involving many clinicians and scientists which has resulted in over 300 published scientific communications. The affection and support of numerous kind-hearted persons guided me through the uncharted paths briefly described here. My grateful salute to them all.

 
  References Top

1.
Basu PK: Organization of a rural eye bank. Proc All India Ophthalmol Soc 15:225-226, 1955.  Back to cited text no. 1
    
2.
Basu PK, Ormsby HL: Organization and functions of an eye bank. Trans Can Ophthalmol Soc 8:29-33, 1956.  Back to cited text no. 2
    
3.
Collins L, Lapierre D: Freedom at Midnight, Avon Books, New York, 1976, pp 371-372.  Back to cited text no. 3
    


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