Improving ophthalmic care in low-resources settings requires innovation, determination, and dedication. One physician who exemplifies these traits is Sunil Thakali, MD, a comprehensive ophthalmologist and chief of the Hetauda Community Eye Hospital (HCEH) in Hetauda, Nepal. This article spotlights his journey to becoming a physician against incredible odds and his tireless passion for creating a healthier community for his people.
Dr. Thakali has worked with limited resources to provide world-class ophthalmic care at little to no cost to his patients. In addition, he leads efforts in remote parts of Nepal to provide eye screenings for individuals who cannot access his hospital. In the following conversation, he shares more about himself and his day-to-day life.
Karen Chen, MD, MPhil: Tell me about your hometown and upbringing.
Sunil Thakali, MD: I grew up in Jomsom, which is situated in the Mustang district, about 100 miles north of Pokhara, the capital city of Gandaki Province in Nepal (Figure 1). Jomsom has approximately 1,500 residents. It is a windy place with rocky cliffs, deep valleys, and a high elevation in the Himalaya mountains. It has one of the deepest gorges in the world, and it’s visited by trekkers hiking along the Annapurna Circuit Trek.
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Figure 1. Dr. Thakali grew up in Jomsom, Nepal, a town of 1,500 residents situated in the Himalaya mountains.
I have eight siblings—four brothers and four sisters. I completed my early education in Jomsom and finished middle and high school in Pokhara. My father inspired me to become a doctor and serve the community, especially those in need.
KC: What was your training like to become an ophthalmologist in Nepal?
ST: I graduated with a medical degree in 2007 from Chongqing Medical University in Chongqing, China. It is common in Nepal to go abroad to obtain a medical degree since there are limited medical schools within the country. I learned Mandarin to complete my medical degree. During my studies, I remember one of my professors briefly discussing retinal transplantation, which sparked my interest in ophthalmology. I became determined to specialize as an eye doctor to help people with visual impairments, particularly retinal diseases. After studying, I would spend hours searching for abstracts on retinal transplant techniques.
KC: What did your practice look like when you first became a physician?
ST: After graduation, I returned to Nepal and completed my compulsory 2 years as a house medical officer in my hometown. These years are similar to an internship year of residency in the United States. The main difference was that I practiced independently. While practicing in Jomsom, I encountered many patients with eye diseases, but due to my limited expertise at the time, I often had to refer them to Pokhara for diagnosis and treatment. This experience deepened my resolve to become an ophthalmologist.
KC: How did you pursue ophthalmology in Nepal?
ST: I passed the entrance exam and joined the ophthalmology residency program at Lumbini Eye Institute in Nepal, sponsored by the Himalayan Cataract Project (HCP). During my residency, I was profoundly inspired by Sanduk Ruit, MD, the founder of the Tilganga Institute of Ophthalmology (TIO) in Nepal (Figure 2). His mission to make quality eye care affordable and accessible strengthened my commitment to serve.
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Figure 2. Dr. Thakali (back row, second from left) with TIO Founder Sanduk Ruit, MD (back row, fourth from right), and HCEH staff and patients.
After completing my residency in 2013, I joined TIO and pursued a 1-year comprehensive ophthalmology fellowship, which I completed in 2017. Following my fellowship, I was promoted to chief of HCEH.
KC: What does your day look like as the chief of HCEH?
ST: I live on campus with my family and start my day at 8:00 am with two other comprehensive ophthalmologists at the hospital. Between the three of us, we see almost all the patients at HCEH (Figure 3). There is usually an ophthalmology resident rotating through the locations. We provide a wide range of services, from corneal abrasion management to fortified antibiotics for endophthalmitis, intravitreal antivascular endothelial growth factor injections for proliferative diabetic retinopathy, and panretinal photocoagulation for diabetic retinopathy. We see about 40 to 50 patients in a half-day. In the afternoon, I usually go to the OR to perform high-volume cataract surgery. In my spare moments, I plan cataract camps and retinal eye screening camps to bring eye care to remote locations.
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Figure 3. HCEH provides a range of affordable ophthalmic services, including community outreach retinal screenings, for those in need.
KC: What makes HCEH special?
ST: HCEH is the first of its kind. TIO, located in Kathmandu, is Nepal’s main hub for eye care. It is the HCP’s blueprint for providing ophthalmic services for those in need, regardless of their ability to pay. There are various community eye centers throughout Nepal that screen patients locally before referral to TIO. HCEH is the first satellite eye hospital of TIO to provide both surgical and medical management (Figure 4).
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Figure 4. HCEH is a key hub for eye care, located about 45 miles southeast of Kathmandu Valley. It is the first satellite eye hospital of Tilganga Eye Institute to provide both surgical and medical management.
The hospital was established in 2008 and is located about 45 miles southeast of Kathmandu Valley. It serves as a key hub for eye care, not only in Makwanpur district but also in nearby districts. Now, citizens do not need to make the arduous, days-long journey to Kathmandu for routine eye care or cataract surgery. Patients are referred from HCEH to TIO only for subspecialty care. HCEH has four community eye centers from which patients can be referred directly to HCEH for more complicated pathology outside of routine refractions. In addition, we are breaking ground on our own IOL factory in Hetauda to make cataract surgery even more accessible and affordable for our patients.
HCEH provides cataract surgery, retinal laser treatment, and ocular trauma management, among other comprehensive services. The hospital also has 24/7 coverage for urgent cases related to ocular trauma. Patients trust HCEH to provide quality services because of the influence of Dr. Ruit and the dedicated hospital staff. There were 91,000 outpatient visits in 2023, serving 68 districts in Nepal and a small percentage of international patients from neighboring countries. Overall, HCEH is known for its affordability, access, specialized services, and continuity of care. It has become an essential resource for eye health in this area.
KC: What is the next big initiative for your eye hospital?
ST: We have three ophthalmologists to treat a population of about 200,000 people. Preventive eye care is key not only for the benefit of our patients but also for resource management. We provide community outreach retinal screenings through the generous funding from our local government and private international donors. We screen mostly for diabetic retinopathy, which is prevalent in our population. To review all the fundus photos taken at HCEH and screening camps, we work with Orbis International and their Cybersight AI technology to prevent physician decision-making fatigue.
Many of our citizens face financial barriers to obtaining care at HCEH, so our outreach camps are an essential part of the care that we provide. Additionally, community screening offers a platform for public education on eye health, risk factors, and the importance of regular check-ups. It also fosters community involvement, helps build trust in medical providers, and ensures that timely referrals and follow-up care are afforded to individuals who are identified as having eye conditions. Ultimately, through the timely identification of eye disorders, the screening services play an important role in the prevention of avoidable blindness, improvement in quality of life, and reduction of visual impairment in the community.
KC: How can ophthalmologists from abroad aid your efforts?
ST: To become involved in the HCP, visit cureblindness.org/get-involved. There are four pathways to choose for making a difference. With the advancement of teleophthalmology, there is a greater need for virtual collaboration from subspecialists. We also welcome surgeons who are interested in visiting our facilities to exchange surgical skills and medical management knowledge.
Interview edited for clarity by Dr. Chen.
