Trachoma is an infection of the mucous membrane lining the eyelid. It’s caused primarily by unsanitary living conditions and is easily treated. If trachoma is allowed to progress to the stage where it leaves lasting scars on the cornea, it causes blindness. At nearly every stop in the outback, Hollows found entire communities suffering from advanced trachoma.
Hollows thought that he’d seen every eye condition in existence. When he started examining patients in aboriginal settlements, “it was like something out of the medical history books,” he wrote, “eye diseases of a kind and degree that hadn’t been seen in Western society for generations! The neglect this implied, the suffering and wasted quality of [human lives] was appalling.”
Hugh Taylor was one of Hollows’s lieutenants on the survey, and has since become one of the world’s leading academic ophthalmologists. “I was led astray at an early age by Fred, and I’ve been astray ever since,” Taylor told me over cups of bracingly strong espresso at his Melbourne office, sitting in front of a wall of framed photos of a younger, sunburned version of himself. In one, he and Hollows sit on the tailgate of a Range Rover streaked with bright red dust, smoking their pipes meditatively. “When it rained in the outback it was like trying to drive through chocolate mousse. But the biggest obstacle to our work was the attitude of the white cattle station managers. I came across aboriginal patients who were called Spider, or Airplane, or Potato Chip, by drunk station managers who were too lazy to learn their real names. You have to remember that aborigines were only granted Australian citizenship in 1967, and these men seemed to think they were worth less than their livestock. I remember one big, tough white bloke walking over to us as we were beginning to examine aboriginal patients, and saying, ‘I’ve got cows that could use your help. Why waste your time on our niggers?’ But what we found—some communities with trachoma follicles in eighty percent of the aboriginal children—caused a scandal that changed the country.”
Fanning the flames of outrage, Hollows championed the creation of a national aboriginal health service, the most important improvement to aboriginal living conditions in Australia’s history. Dry data about the prevalence of eye disease wasn’t about to capture the nation’s attention, so Hollows held press conferences after he returned home, publicity stunts aimed at shaming Australian politicians. “Fred liked getting up the noses of people, especially powerful people,” Taylor said.
At his press conferences, Hollows gave the kind of crisp, angry reports from the field that were guaranteed to capture headlines. He recalled one of the first visits to an aboriginal settlement that got his blood pumping about disequity. “I examined a hundred and fifty black fellows sitting by Watti Creek and found the amount of eye disease you’d need to look at about a million and a half whites to discover,” he said. So what are you going to do about it? Are you willing to live in an Australia where much of the population is forced to live like dogs? were the unspoken questions that hung in the air after each of his public appearances.
The political establishment tried to mollify Hollows by offering him the nation’s highest honor, the Order of Australia, for his work. He turned it down. “My God,” he wrote in his autobiography, and in letters he sent to Australia’s leading politicians, “this is not the time to be accepting accolades for pointing out problems in Aboriginal health.” It was time, in other words, to take action to fix them.
Among the medical workers accompanying Hollows to the outback was a striking orthoptist, a specialist in visual disorders that primarily affect children, named Gabi O’Sullivan. Hollows was immediately attracted to her. “Gabi must have examined two hundred people that day, and she was as soothing and agreeable to the two hundredth as she had been to the first. I noticed something else: Gabi’s tone of voice, manner and body language didn’t change, whether she was dealing with the station manager or the oldest, most withered Aborigine in the camp. That kind of innate goodness is rare,” Hollows wrote. Rare enough that Hollows felt extraordinarily lucky when Gabi agreed to marry him.
The naturally shy Nanda was also lucky to have Gabi as her host. As perhaps the most talkative citizen of Sydney, the aptly named Gabi set Nanda at ease, smoothing over hiccups in her emerging English and filling any uncomfortable lulls in the conversation with lighthearted chatter. “Gabi was so kind you can’t imagine,” Nanda says. “She knew Sanduk and I couldn’t afford to do much in a city as expensive as Sydney. So she was always slipping us pocket money and changing the subject when I tried to thank her.”
Ruit was less interested in sightseeing than in exploring a first-world medical facility. He seized the opportunity to work with the latest technology at the Prince of Wales Hospital. “From my side, I don’t think I needed training so much as real access to resources,” Ruit says.
Hugh Taylor agrees. “It was obvious from the moment you watched him that Ruit was going to be a superstar,” he remembers. The cases Ruit treated at the Prince of Wales were much less challenging than those he saw in Nepal, but having an unlimited supply of intraocular lenses, and first-rate microscopes, he was free to experiment. He streamlined his technique, hoping to return home having perfected a simplified form of the surgery, appropriate to practice in the villages of Nepal, where resources would be scarce.
After Ruit returned to Nepal, he used and taught many of the Prince of Wales Hospital’s surgical techniques. But when Hollows flew to Nepal and looked in on Ruit’s progress, he was amazed to learn that Ruit had improved and refined so many of Hollows’s own methods for operating on cataracts that the Prince of Wales Hospital adopted his improvements and renamed their style of cataract surgery the “Nepal technique.”
“Spending a year in Australia was a wonderful way for Nanda and me to really fall in love, from both sides,” Ruit says. “We had time to talk and talk and talk. But Nepal was our home. Nanda said our battlefield had to be there, and I agreed. All the while we were in Sydney I thought about what to do when we returned. My duties at the Prince of Wales were not too taxing, and I had time to plot and plan how I wanted to change eye care in Nepal. Being away, it became clear to me that I had to break off on my own when I got back and start my own center. So what was my plan? I was a mosquito, buzzing in Fred and Gabi’s ears the whole time we were there, asking for help to make that happen.”
Before he left, Ruit and Gabi founded a modest organization dedicated to raising funds to support Ruit’s dream. They named it the Nepal Eye Program Australia. Ruit and Tim Macartney-Snape, who, with his climbing partner, Greg Mortimer, had been the first Australians to summit Everest, spoke at a small fund-raiser they organized. And at the end of the evening, Ruit had $500 of seed money to establish NEPA in Nepal.
After a year of intoxicating freedom at Farnham House, the Ruits returned home with a duffel bag full of intraocular lenses and microsurgical instruments, Hollows’s parting gift. Sonam, who was the first family member to accept his son’s mixed marriage, left his shopkeeper’s life in Dhankuta and bought a narrow lot in central Kathmandu. He built a three-story structure, leased out the ground floor to a camera and copy shop called Archie’s Photo, and moved his family in. Sonam and Kasang lived on the top floor; Ruit and a pregnant Nanda moved into the one-bedroom flat one floor below.
It was a dank, depressing place, with little natural light and limited ventilation. When they cracked open the small windows, the fetid scent of the Bagmati River seeped into the crowded rooms from across the street, mingling with the fumes drifting upstairs from film-processing chemicals. But it was a home of their own. And in July 1989, after Nanda gave birth to their first child, a boy named Sagar, which means “ocean of happiness” in Sanskrit, Ruit’s relatives began to visit.
Nanda’s family was slower to accept the mixed marriage. A few of her relatives arrived, bearing sweets and baby clothes, but Nanda’s parents continued to keep their distance. Nepal’s calendar, especially among the Newari, is a kaleidoscope of religious festivals. Being married to a Bhotia meant that Nanda wasn’t comfo
rtable celebrating them publicly. Late at night, while a dozing Sagar breathed softly beside them in the bed they all shared, Ruit told Nanda that he was sorry she had to miss so many holidays on his account.
“We’re our own festival,” she said, kissing her husband passionately, and putting both him and his concerns to sleep.
Satisfied patients are an eye surgeon’s best form of advertising, and Ruit’s patients were more satisfied than most. While Ruit continued asking Hollows for help establishing an independent eye center, Ruit returned to his position at the Nepal Eye Hospital. Word of his skill spread beyond Kathmandu, and patients began asking for him by name.
One day a handsome young Buddhist monk arrived, accompanying three older monks in matching crimson robes who all suffered from severe cataracts. They had traveled for several days, from Kalimpong, in northern India, and the young monk politely requested that Ruit perform the surgeries. Ruit removed their bandages the following morning, gratified to see that all three monks’ eyes appeared clear and free from complications.
Unlike most of his patients, who were often overcome with emotion after their sight was restored, the monks simply smiled, as if noting no difference between the internal world of darkness where they’d been residing and the bright material world to which they’d returned. The young monk bowed to Ruit and led the older men away. Every few months from that point on, small groups of blind monks arrived at the hospital, always accompanied by the handsome young monk, and always requesting Ruit by name. Ruit resolved to ask the young monk more about himself, but he was always too busy between surgery and his clinical work to find the time. One morning, while Ruit was still at the Nepal Eye Hospital, the young monk arrived alone, with a request that the doctor join him and some friends for dinner.
The taxi driver sped through Kathmandu at rush hour, threading skillfully through bullock carts, cycle-rickshaws, and cows that diverted traffic with lordly indifference. They parked in front of a gated colonial-style mansion, in the wealthy Buddhist enclave of Boudha. The number on the gate matched the address the monk had written down for him, but that couldn’t be right, Ruit thought.
A servant in formal livery swung the filigreed iron gate open, and an elderly lama in scarlet robes whom Ruit recognized as one of his former patients led him through a set of grand wooden doors carved with designs of dragons, and into the home. The lama, whom the young monk had brought to Ruit with very mature cataracts, wore no glasses and stepped nimbly up a long marble staircase, leading him to a reception room thrumming with conversation.
“His Eminence the Jamgon Kongtrul will see you now,” the lama said.
Ruit took a moment to find his bearings. The large room was filled with high-ranking lamas from Nepal and India. Kathmandu businessmen in dark suits and women in jeweled saris and chubas stood talking to them, stooped reverently, or waited their turn in line to receive a blessing. On a raised wooden dais at the end of the room, the handsome young monk sat cross-legged, wearing a tall sunflower-colored cap that curved forward like the beak of a bird and embroidered robes of bloodred and unblemished gold. Ruit picked his way toward him through the crowd, conscious of the short-sleeved work shirt he’d worn to what was obviously a dressy affair. He was led to the front of the line.
“Excuse the formality, Dr. Ruit,” the Jamgon Kongtrul said, grasping the doctor’s hand warmly in both of his. “You know how it is.”
Ruit hadn’t known. The polite clean-cut monk, who’d humbly shepherded so many patients onto Ruit’s operating table, was the Third Jamgon Kongtrul, one of the paramount leaders of Tibetan Buddhism. Ruit knew his story as well as he knew the history of the Walunga, and he imagined how delighted his father, Sonam, would be to see him in such a high lama’s presence. The Walunga had migrated over the mountains from central Tibet hundreds of years earlier. The Jamgon Kongtrul had arrived later. Born in 1954, he’d been spirited out of central Tibet by his supporters in 1959, as had the Dalai Lama. He lived in a monastery built for him by his disciples, in northeastern India, where he was renowned for his encyclopedic knowledge of Buddhist scripture, as well as his charitable works. He was also building a monastic retreat called Pullahari in the hills outside of Kathmandu.
A businessman in a sober suit coughed behind Ruit, impatient for his audience. “When all this hubbub dies down, sit next to me at dinner,” the Jamgon Kongtrul said, releasing Ruit’s hand. “We have a lot to talk about.”
In Nepal, more than 90 percent of the population subsists on two meals of rice and dal a day, garnished, perhaps, with a bit of meat or whatever boiled vegetables are available. Ruit was part of that group. But what waited for him this evening, on a long, starched saffron-colored tablecloth in the home of a wealthy donor, could only be called a feast. There were plates of onion, pumpkin, and lotus root pakoras, fried in batter as light as clouds. Uniformed servers placed steaming curries and biryanis of cauliflower, potatoes, peas, almonds, and golden currants in a row of silvery chafing dishes.
“Please, Doctor,” the Jamgon Kongtrul said from his seat at the head of the table, ladling cauliflower curry onto Ruit’s plate. He sat on a plush cushion that elevated his head above the other diners’, but otherwise he wore his authority with humility. Only after Ruit had taken a mouthful did he begin to speak in earnest: “I asked you to come here tonight because we’ve been watching you for some time. You’ve not only restored sight to many of my monks, but I’ve noticed you treat your patients with true compassion. You’ve done so much for us already. Will you allow me to ask for more?”
“Of course,” Ruit said.
“I’ve heard about the hospital you hope to build, how it will serve people in far-flung areas. I’d like to help you reach patients near my home. And in Tibet, too. The need is very great. Are you willing to travel so far?”
“Very willing,” Ruit said.
He returned to Nanda that evening in a daze, with a painfully full belly, an invitation to conduct cataract surgery for the needy in Kalimpong, near the lama’s home, and the profound gratitude of one of the Buddhist leaders he respected most. There had been days since Ruit had formed his plan to leave the Nepal Eye Hospital and found his own facility when the risks he would take by breaking with his country’s medical establishment worried him, days when pinpricks of doubt pierced the surface of his certainty. This wasn’t one of them.
Ruit began recruiting like-minded medical personnel to his cause. He thought about patients like Kamisya Tamang, about the distance they had to travel to reach his operating table, and became more determined than ever to set out and serve them where they lived. He gathered the young ophthalmic technicians, nurses, and orderlies he judged to be the hospital’s brightest and most dedicated staff, including Nabin Rai, an ambitious ophthalmic technician who had completed a degree in economics before changing fields, and a Brahman scrub nurse named Beena Sharma. He brewed an extra-large batch of tea and set out a plate of expensive Indian-made butter biscuits to sweeten the recruitment he planned to attempt. After the group had arranged themselves in a circle on the floor of his apartment, he called the meeting to order.
“I know all of you have good jobs,” he said, “and good jobs in Nepal aren’t easy to find. Now I’m going to ask you to put your careers little bit at risk. I asked you here because all of you really seem to care about your patients. But the hospital won’t allow us to help the people who need our services most, those who are too poor to come to Kathmandu.”
Then Ruit laid out his plan to begin conducting surgical camps in Nepal’s underserved rural areas and, eventually, build his own hospital. Enough funds had accrued in NEPA’s coffers by then that Ruit had been able to purchase surgical supplies and a portable Konan brand surgical microscope that cost $5,000. With these and the IOLs he’d received from Fred Hollows and other foreign doctors, Ruit would try to provide hospital-quality care to Nepalese in the countryside.
“At the hospital, it was an open secret we were planning to break away,” says Beena Sharma. �
��People asked me, ‘You are a Brahman, but your boss will be a Bhotia. How will this work?’ I told them, ‘Never mind that—I have a social obligation.’ I wasn’t concerned with caste or money,” Sharma says. “I just knew Dr. Ruit would take us to a higher place.”
During a long holiday weekend when they would have extra time off, Ruit declared his intention to travel north to the mid-hills, where they would attempt to provide modern cataract surgeries to Tamang people in the farming village of Tepani. “If they can’t get to us, it’s our duty to go to them,” Ruit told his recruits. “I can’t guarantee you won’t find yourself in some shit with your bosses, but I can see clearly this is the correct path, and I’m asking you to come with me.”
Their departure was delayed by their search for a four-wheel-drive vehicle they could afford to rent; in the end, they settled on an aged, sunburst-orange Volkswagen bus that was at least large enough to hold the team and their supplies. The vehicle was crowded with gear, and members of the team took turns riding on the roof.
Sixty miles north of Kathmandu, the VW strained to climb an un-graded dirt road that wound up into the hills. Ruit clutched the roof rack as they swayed over deep ruts, managing barely five miles of progress per hour. They’d planned to arrive just after noon, but it was dark by the time they reached the trailhead to Tepani. Ruit had dispatched an ophthalmic technician to prepare the village for their arrival. Sonam came from a Sherpa family who lived in the hills beyond Tepani, and he knew the area well. He had already screened potential patients and arranged for Ruit’s team to operate in the single-room village school.
Sonam had also arranged for seven porters to meet them at the base of the trail. The team found only five thin, surly men, smoking in the dark. The porters insisted that the trail to Tepani was dangerous, that it skirted a deep river gorge, and argued that they shouldn’t leave until morning. “In Nepal, porters are often expert cheats,” Ruit says. “I presumed they were trying to negotiate and ignored them, pushing everyone to pack up and leave that night.” The team choked down a meal of uncooked instant noodles, not wanting to lose the time it would take to make a fire, and set off for Tepani. They had two flashlights for fifteen people. The porters walked ahead with the one that functioned reasonably well. “We had one weak torch for the rest of us,” Ruit says. “We couldn’t see a thing. We just put our feet down wherever the torchlight went.”
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