With over 15,000 civilians injured in violence by State forces since July 2016, hospitals across Kashmir have had to cope with unprecedented medical emergencies. The injured include over 1,000 youth whose eyes have been damaged in shrapnel showers red from pellet guns usually used for hunting birds. Some of these victims will never be able to see again. Most others will have their eyesight partially restored. As these individual and collective tragedies unfolded at Kashmir’s oldest hospital, SMHS hospital, doctors at the ophthalmology ward witnessed the suffering up and close. Dr Raashid Maqbool Wani is an ophthalmology consultant at the SMHS hospital who along with other doctors put all their expertise to work to restore as much vision in the pellet-hit victims. He spoke to Aasif Sultan about it.
Q What is the extent of eye injuries you have come across due to pellets?
We have been receiving eye injuries due to pellets since 2010 when I was a postgraduate in this hospital. I have detailed those injuries in a paper. In that uprising, the percentage was mere 15. Even after the 2010 uprising till 2015 we received pellet-hit eye injuries but those were very few. But since July this year, the trend has completely changed. The numbers are record breaking and the rush has been unprecedented. Just on 9 and 10 July, we operated upon 82 patients with pellet injuries. We even didn’t get time to sterilise the operation theatre, such was the rush. Between 8 July and October, we have received no less than 780 patients hit with pellets in their eyes. Add to this the OPD patients. They are those patients who had superficial pellets close to the eye and were removed immediately and discharged immediately. We have about 100 pellet-hit patients in the SKIMS hospital at Bemina. Then there were those who were managed at district hospitals. Some patients, though small in number, left the hospital without informing anyone. If we go on adding these numbers the figures will easily cross 1000. More than 95 percent eye injuries have been due to pellets.
Considering the prognosis of a particular patient what matters to us is where the pellets hit. Most of the patients we received here were hit above the waist. We have seen patients with hundreds of pellets in their faces. The eye is like a water ball. When the pellet hits the eye it might go through the white of the eye, the sclera, or through the transparent structure, the cornea. It directly goes inside and damages the sclera, cornea and the lens. Then the problem is when it goes beyond, it damages the retina. Retina is the most sensitive structure of the eye which actually forms the image. On the retina, we have a structure called optic nerve which sends the visual signals to the brain by virtue of which we see things. When the pellet hits the retina there is retinal haemorrhage, retinal breaks, retinal tears. Very often we have patients where pellets go beyond the retina. Imagine that the pellet enters from one side of the eye and leaves through the other side. That means the pellet has reached very close to the brain.
Most of the patients we have seen here, more than 90 percent, have retinal injuries. In simple terms, their original vision is beyond restoration. Even chances of restoration of functional vision are very bleak. Though we have the best vitrectomy machine available here, nothing is happening.
Q When can we say the damage is irreparable?
In Insha Malik (a teenager from Shopian) and some other patients we did evisceration. That means the eye was ruptured beyond repair and you have to completely clean it out of the orbit. Such eyes cannot be saved. There was nothing but eyelids and nothing inside. That is one situation. The other situation is where the patient had such grievous injuries that they even can’t perceive the light. We had 43 such cases whose both eyes were injured. Depending on the nature of the injury and after a number of surgeries, we can say whether the eye is beyond repair or not. Most of the patients we operated upon are having less that 6/60 clarity of vision. Legally and by WHO definition such patients are considered blind.
Q How well equipped are hospitals in Kashmir to handle such injuries?
Our department was never expecting such a huge number of eye injuries. We never ever imagined these figures. Initially, we had some issues, later we managed, though it was not easy. We were operating in trauma theatres. On a routine day, we had one or two cases. But the rush was such that we had to convert a trolley into an operating table. The moment we would finish operating upon ten patients, fresh ve patients would arrive. It was non-stop. Some NGOs also helped us in a number of ways and we ultimately managed the injured.
Q Does it require any special training to excavate multiple pellets from a sensitive region as the eye?
Ophthalmology can be divided into two sections: retina and non-retina. I belong to the non-retina sections. We are having three retinal surgeons, Dr Tariq Qureshi, Dr Sabiha Rasheed and Dr Parvez Handoo. Retinal surgeries require special skills and can be done only by retinal surgeons.
Q Sometime ago, some experts from outside were brought here. Did it help in treating such injuries?
Initially, a team of three surgeons from AIIMS came here. They made a list but ultimately I didn’t find them helping us. Then Dr Natarajan came here and he was very helpful. He was operating non-stop. Sometimes he would start at 8am and end at 11pm.
Q What is the maximum number of cases you have received and treated in a day?
It is a coincidence that my duty is scheduled on Fridays and it is the busiest day of the week. One Friday we received around 40-50 patients with pellet injuries.
Q When you see such young people losing their eyesight in such large numbers, how does it affect you at a personal level?
You can’t remain neutral in such situation. I cried bitterly when I saw children dying in front of my eyes. I couldn’t stand on my feet. I called my mother and told her that kids are dying and the situation is getting worse.
Q How do you handle the emotions of a victim’s family members when you know it is a no-hope case?
This is one of the most dif cult jobs to do. You require different expertise to do it. It is very emotional to talk to small kids and to tell them that your eyesight is lost forever. Normally children would take care of their parents in their old age, but here the situation is other way around. When you see parents holding the hands of their adult children to make them walk for they can’t see, it is traumatising. The whole family shatters, and if the patient is married both families are shattered.
Q What is the kind of psychological counseling or other backup required in such cases so that the victim can handle the trauma of losing his or her eyesight?
For this we require a clinical psychologist.
Q What are your thoughts about the use of pellet guns for crowd control when we all know they inevitably cause eye damage?
Pellet guns are lethal weapons. These guns have already killed ten people and maimed and blinded thousands.
Q The most touching case of a pellet injury you have handled till now.
Insha Malik’s injury was really disturbing. Then there was Firdous Ahmad of Sopore. A small kid from Kupwara was in a similar category. There were many other touching cases.
Q Were you under any kind of pressure to speak about these injuries to the media?
There are so many things that happened. I wouldn’t like to talk about these issues.
Q How much apprehensive were pellet-hit patients to reveal their identities?
I won’t comment much about it. The patients and the attendants came to know that if they reveal their actual identities it would ultimately land them in jails and other troubles. When I recently went for a round in the wards I called out the name Muzamil. But there was no Muzamil in any ward. They all had changed their names and their addresses. So my colleague Dr Ishfaq came up with an idea to give a unique number to each patient. We remember our patients by their numbers, not their names.