One morning in early March, Dr. Woodford Van Meter and employees of the Lions Eye Bank of Lexington carefully packed four round plastic vials into small cardboard boxes, then placed those boxes inside a Styrofoam cooler filled with ice.
The tape that secured the lid was marked "Human Eye Tissue," and Van Meter hoped it wouldn't have to be removed until he arrived in central Africa the following day.
"There's a good chance here in Lexington that they will understand what we're doing. I think there's less chance in Amsterdam," he said of airport security employees.
Van Meter, a University of Kentucky eye surgeon who is medical director of the eye bank, was about to get on a plane with four corneas from two Central Kentuckians who had died and whose families agreed to donate the corneas.
A week later, Van Meter, a volunteer with the non-profit Orbis International, would use those corneas to give sight to four blind people in Uganda.
There was Emmy Sharu, 17, who wants to be a doctor and excitedly accepted Van Meter's gift of an old pair of tennis shoes. And George Agaba, 12, who was afraid of the doctors and had to go through the surgery without his parents, because his older brother had just died.
Patricia Komuro, 22, a social worker, had very blurry vision but could see a little with glasses before her transplant. Her fluent English allowed her to translate for the other patients.
And Anthony Rubuya, 40, supervised other employees at a small company but was still reliant on others for help before the surgery.
Four other patients also got transplants, the corneas donated by eye banks in Michigan and Indiana.
Each of the recipients was blind or had severe vision impairment in both eyes and had to be led into the local hospital by a friend or family member, Van Meter said.
The hope is that the corneal transplants will give them enough vision to be able to function on their own.
"What a gift," said Robert Gayheart, the Lexington eye bank's executive director. "It's a blessing to be able to help people."
Gayheart said there are always corneas available for local people who need transplants, and those who need them get them quickly.
"That's our priority," he said.
But he said the eye bank, part of the UK Department of Ophthalmology, is also able to share corneas with others nationally and internationally.
"Our responsibility is to make sure the cornea gets transplanted," he said. "If they're transplantable, they're transplanted."
The eye bank, which serves 51 Kentucky counties and Huntington, W.Va., is part of Vision Share, a consortium of eye banks that work together to supply corneas when other banks need them.
Gayheart said that when someone dies in those hospitals, the eye bank is contacted, and its staff determines whether the deceased would be a suitable candidate for donation, based on age, health history and other factors.
If the person is a good candidate and the family agrees, one of the eye bank's staff goes to the hospital and harvests the tissue, bringing it back to the eye bank to be evaluated.
A blood sample from the donor is tested for a battery of communicable diseases.
In Uganda, Van Meter said, there is no eye banking, and without medical volunteer efforts like Orbis, blind patients who need corneal transplants would have no hope of getting their vision back.
Van Meter's trip was part of a two-week mission that Orbis undertook in cooperation with the Ugandan Ministry of Health and hospitals in Kampala, the nation's capital.
The organization uses its Flying Eye Hospital, a jet outfitted with an operating room, to provide vision treatment to people in developing countries throughout the world.
It also provides education to eye doctors and other medical personnel in those countries, strengthening their skills to diagnose and treat problems such as pediatric blindness, retinal disease and cataracts.
During Orbis' first trip to Uganda in 2006, the nation's first corneal transplants were conducted, and the organization worked to build support for cornea donor campaigns and eye banking.
But there is still much to be done before corneal transplantation is a regular occurrence there.
On the first day of his trip, Van Meter screened about 40 patients whose eye doctors had recommended them for a transplant.
"Most of these patients could have used a cornea transplant," he said. "I could have used 40 corneas if I'd had them."
But there were only eight corneas available, so Van Meter had to choose carefully, selecting the patients who had a "reasonably good chance at success" and could benefit the most.
Because of Orbis' teaching mission, he also looked for those who "were representative of the type of ocular conditions that cause corneal blindness in Uganda." That way, the local doctors could glean the most benefit from watching him work.
"We wanted a variety of teaching cases with different diagnoses and different age patients."
Half the transplants were done in the local hospital and half on the Flying Eye Hospital.
Van Meter said the transplants he conducted in the local hospital were not performed under optimal conditions.
"They don't do corneal transplants there, so they don't know exactly what we need," he said.
It took some scrambling to find a working anesthesia machine and a microscope that would allow Van Meter to see during surgery.
There weren't enough electrical outlets for all the equipment.
And, Van Meter said, "the hospital smells like a barn."
He said most of the patients wore the same clothing the entire time he was there; on Sunday, when he left, the lawn outside the hospital was hung with laundry.
Van Meter was accompanied to Uganda by a California filmmaker who is working on a documentary about corneal transplantation, the UK Ophthalmology Department's medical photographer and Van Meter's daughter, Mary, a second-year pre-med student at the University of Virginia.
Mary Van Meter stepped in when her father was explaining to the transplant recipients the importance of taking special eye drops for at least a year to prevent their bodies from rejecting the new corneas.
"They were trying so hard to be agreeable," Mary Van Meter said. "A lot of them would just nod and say 'yes,' without really understanding.
"To bring those corneas all the way from Kentucky ... if they rejected their corneas ... ."
So she asked her father to emphasize the need again, in simpler terms. He told them the drops were like "food for your cornea."
After surgery, the patients were given a four-month supply of drops; after that, they are responsible for buying their own medicine, which costs about $75 a bottle in the United States.
An Orbis physician will come back in about six weeks to check on them.
Mary Van Meter said it was clear that the patients wanted to do whatever the doctors said they should.
"The way people perceived health care was so different," she said. "It was like absolute trust."
And she said the gratitude and excitement were palpable.
"Even before their eyes were completely healed, they were just like, 'Thank you, thank you, thank you,'" she said.
She recalled one transplant recipient who, when the bandages were removed, smiled broadly. The woman was seeing the local doctor who'd been treating her for 11 years for the first time.
A medical worker held up several fingers to determine how well the woman could see.
"They kept stepping back farther and farther," Mary Van Meter said. "They got all the way to the back of the room, and she was just jumping up and down."
It will be a year before the patients have fully recovered and receive the full benefit of the surgeries, but, Woodford Van Meter said, "most of these people were so bad to start with that almost all of them could see better by the first day."