Paediatric ophthalmology in Nepal

Nepal is a landlocked country between India and China; it straddles the great Himalayas and is one of the most mountainous countries in the world. It is the fourth poorest country in Asia and its geography poses major challenge for economic development and healthcare delivery [1, 2]. Ophthalmology in Nepal came to age in 1980s after a large prevalence of blindness survey [3]. A total of 17,423 children aged 0–15 were examined in the National Blindness Survey in 1981 and the prevalence of bilateral blindness in 10–19 year olds was 0.14 per hundred. The high prevalence of blindness lead to establishment of Nepal Netra Jyoti Sangh (Organisation for service to eye & vision in Nepal, NNJS), a national NGO owing the Government responsibility, to set up secondary care hospitals in the country, with the help of international community [4]. Fourteen large eye hospitals were setup in the five zones of Nepal. The zones later gave way to seven provinces in 2016. Most of the hospitals are located in the ‘Terai’ region near the Indian border (many within walking distance!). Most of them serve patients also from India. The districts of India bordering Nepal belong to the states of Uttarakhand, Uttar Pradesh, Bihar and West Bengal and are some of the poorest parts of India with little healthcare and eye care (http://censusnepal.cbs.gov.np/Home/Index). The Nepal Netra Jyoti Sangh and Tilganga Hospital have brought about a revolution in eye care in this mountainous country next to the roof of the world. The hospitals put together performed almost three hundred and fifty thousand surgeries in 2019 (from 11,002 in 1995) for a country that has a population of less than 30 million and per capita of US$ 1071.1 in 2019 (It was US$ 129.6 in 1980) (https://data.worldbank.org/indicator/NY.GDP.PCAP.CD?locations=NP) [5]. The mountainous region has less eye care, but it also has sparser population. The valleys in middle Himalayas have the major towns of Nepal, each with its own eye centre. The Terai region at the Himalayan foothills, bordering India, have the densest population, and most eye care centres.