The Power of Partnerships
In the six months since it was established, the Delhi Centralized Hospital Cornea Recovery Project (DCHCRP) already has many “firsts” to its credit. Among them, nine corneal transplants in a single day, telephonic consent, and a record three donor assents in just one hour.
The project is itself a first-of-its-kind initiative in India to collectively address the challenges in collection and utilization of transplantable tissues. Four organizations — the National Eye Bank at AIIMS, GNEC, Dr Shroff’s Charity Eye Hospital and SightLife — have joined hands to make DCHCRP a story of successful public-private initiative.
“DCHCRP has shown encouraging results in a short time,” says Dr. Radhika Tandon, Medical Director, NEB. In the 6-months since its launch, NEB, GNEC and SCEH have reported an average 107% growth in number of transplants done in 2012, compared to their performance in 2011. More importantly, 72% of the total transplants done in the latter half of 2012 were from tissues generated through DCHCRP. “We are excited about the project and are enjoying the outcomes so far,” adds Dr. Tandon.
To ensure smooth functioning of the project, two committees have been formed for continuous guidance, support and review. Overall direction-setting is provided by the Steering Committee, which has top-level representation from all partners. The Working Committee, meanwhile, comprises key persons from each eye bank and ensures implementation of the project. A dedicated manager is responsible for managing the project on a day-to-day basis.
“Because of DCHCRP I have been able to operate on young and bilateral blind patients who had been waiting for tissues for a long time,” says GNEC’s Medical Director Dr. Ritu Arora, showing her recipient records. “The waiting list is decreasing day by day.”
A distinguishing feature of the DCHCRP is sharing of tissues generated through the project. Each eye bank has a reserved quota per month. Once that is met, the tissues are shared between themselves at a no-cost basis.
“When the intention is clear, the mechanism will appear. DCHCRP is proof of this saying,” says Dr. Umang Mathur, Medical Director of SCEH. “The intent was clear and there was motivation to contribute towards efforts in treatment of corneal blindness. SightLife provided the direction and technical support that allowed us to share our talents and strengths with each other.”
EDCs: The Backbone of the Project
EDCs are integral to the success of hospital cornea retrieval programs. A two-pronged approach was adopted to ensure that the project was supported by a group of dedicated, motivated and trained personnel. Of the total 15 EDCs in the project, seven have been pooled in by SightLife, six by SCEH (two of them senior EDCs) and two by AIIMS.
The SightLife-led hiring process included three rounds of selection, including field visits by the applicants. The Selection Committee itself comprises representatives from all partners. In the first phase of hiring, five EDCs were appointed and, along with their peers from AIIMS and SCEH, they underwent 15 days of extensive training and onboarding programs. Two more EDCs were hired in October. Of the 15 EDCs, four EDCs are posted at AIIMS and the hospital’s Trauma Center, three at LNJP Hospital, two at R.M.L. Hospital, one each at GB Pant and DDU Hospitals, and four EDCs in smaller hospitals.
Within the first month, the program’s EDCs were posting significant results:
65 corneas transplanted during the first month
343 corneas transplanted in 6 months
average per EDC was 5.4 transplants a month
EDCs Deepak and Pooja reported the highest productivity with an average of 10 transplants a month. The fact that all EDCs have reported a 100% attendance is proof of their dedication to the project. “I feel very special and proud to be chosen for this job as I am able to help people see this beautiful world,” says Pooja. “This job made me a responsible person.”
To ensure EDCs continue to be motivated and are armed with adequate training, team-building sessions and coaching programs are conducted on a monthly basis. The DCHCRP Manager also tailors training programs according to individual needs, and carries out field visits to provide hands-on real-time guidance in the hospital environment.
Pooling of resources is not limited to EDCs. The medical directors — Dr. Mathur, Dr. Tandon, and Dr. Arora — work in close collaboration on standardization of processes, including adopting a common contraindications protocol.
The DCHCRP team delivered 9% above-target performance in 2012. The goal for 2013 is to achieve 1,100 transplants by:
hiring more EDCs
adding new hospitals to the partnership
focusing on hospital services
creating professional development plans for all eye donation counselors (EDCs)
standardizing recovery and evaluation processes, including a refresher training program for technicians.
The dedicated DCHCRP team that is learning from each other and is open to sharing has the potential to make the project a model that can be scaled and sustained in other cities in India and developing countries where tissue availability is a challenge. “We are optimistic that DCHCRP will develop into a successful model that can be replicated elsewhere,” says Dr. Tandon.