Second Suns

by David Oliver Relin

  To their left they could sense a void and hear a constant roar of either wind or water. “The climb was steep, and we had a lot of young, juicy boys and girls with us,” Ruit says. “They’d not seen much difficulty in life, so I had to figure out how to push them, isn’t it?” After an hour, when he began to hear grumbling, Ruit deployed his secret weapon. “Sonam was a talented musical boy,” Ruit says. “His singing was really palatable to everyone, so I told him we needed to hear the most romantic songs he knew.”

  “You should not be so cold to me when I’m trying to romance you,” Sonam sang, luring the line of trekkers uphill like a snake charmer with the sinuous allure of his voice. “Let’s talk about love and affection before too long. You are like the rhododendrons on the hillside. Your beautiful colors draw my eyes.”

  Ruit couldn’t help thinking of Nanda. He’d asked her to stop working after Sagar had been born. Nanda hadn’t been happy about it. She’d protested, arguing that if he was going to wage a war, she should be by his side, joining the fight. Despite his maverick approach to eye care, Ruit could be quite conventional socially. He’d insisted that her place was now with Sagar and the rest of the children they hoped to have. Still, marching uphill, away from the home they’d made, he realized how rarely they’d been apart and just how much he missed her. She really was the rhododendron on his hillside, he thought, lost in the romantic spell Sonam had cast in the darkness.

  The spell was broken by a fetid scent drifting down the trail that caused him to scrunch up his face in distaste. “Who ever is making such a stench?” Beena Sharma asked in her refined Brahman accent. “If you can’t control yourself, move to the back. There’s not enough air to breathe up here anyway!” They were still laughing and singing when they arrived in Tepani, just after midnight.

  Examining the classroom where they planned to operate the next morning, Ruit was dismayed by the challenge of making it into a sanitary space. He looked at the muddy floor, the cobwebs, and the pile of roughly cut lumber the villagers had gathered for them to cobble together an operating table. Ruit thought of the immaculate Australian operating rooms he’d worked in, and laughed when he imagined the horror a doctor like Fred Hollows would feel if he had to perform surgery in such a place.

  His team shared a quick breakfast of boiled ramen noodles. Then, for the next three days, they paused only to eat and sleep. He was gratified to see that the staff he’d chosen proved as energetic as he’d expected. They transformed the filthy classroom into a suitable operating theater, banishing rodent droppings and spiderwebs, nailing surgical drapes over the frames of open windows to keep flies from the patients’ eyes, and hanging plastic sheets from the ceiling so dirt and insects couldn’t drop from the thatched roof onto the unsteady operating table they hammered together.

  Ruit operated over the course of two twelve-hour days, with each case averaging nearly forty minutes. It was hard to keep the room dark enough for the Konan’s low-powered lamp, so staff members took turns holding flashlights over the patients so Ruit could see clearly enough to remove the cataracts, slide the artificial lenses into place, and stitch the wounds closed. He was optimistic that the work they were doing, even under such challenging conditions, was solid.

  Their last morning in Tepani, Ruit assembled the patients outside. “There was one boy I was really worried about,” Ruit says. “He’d come with his mother, but she paid him no attention. He just squatted on the ground, curled up with his head between his legs.” The boy wore torn and filthy clothes. And when Ruit asked about him, his mother said they’d stopped sending him to school five years earlier, when he lost his sight. “I hate to say this about my own son,” she said. “But it’s like living with a stone. He can’t work the fields or feed himself. He does nothing but sit by himself. He’s just a mouth with no hands.”

  Ruit removed the boy’s bandages anxiously. He knew that the child’s quality of life was at stake. Before surgery, when he’d examined him with a penlight, the boy’s retinas had flashed red, indicating that they were equipped to process visual information if Ruit removed the opacity that blocked light from reaching the backs of his eyes. He was relieved, after he unrolled the bandages, to see that the boy’s eyes looked untraumatized, and Ruit asked, in his slowest and clearest voice, if he could hear him.

  “The problem is not with my ears,” the boy said.

  “Then let’s see if your eyes are working,” Ruit said. “How many fingers am I holding up?”

  “How should I know? Didn’t my mother tell you I’m too stupid to count?”

  Secretly pleased by the boy’s defiance, Ruit moved on to his next patient. “But I kept an eye on him while I was working,” Ruit says. “And every time I looked over, it was like watching one of those fastmotion movies of a plant growing. He uncurled. Then stood up straight. Then held his head high. He bloomed like a flower right in front of my eyes. I know his mother saw it, too. She looked at him as if he’d just grown a second head or a third eye. And I knew now he had at least a fighting chance. That we had brought little bit of brightness back into the boy’s life.”

  Tepani is set between huge rock outcroppings, at the edge of a ravine dropping down to the Melamchi River. Ruit asked an elderly man he’d operated on if he could see well enough to walk. The man climbed up a curving path to a ledge above the village, then stepped off the trail and picked his way confidently down a treacherous slope of scree until he stood, grinning, face-to-face with Ruit.

  “What a moment that was!” Ruit remembers. “With everyone cheering like we’d all performed a magic trick. Can you imagine what it was like to be blind in a place like that? Now dozens of Tamang farmers could return to working their fields, rather than sitting at home all day, burdening their families. For three days we’d pushed ourselves to the edge. But seeing what we’d accomplished, we were so happy we felt like we could fly back to Kathmandu.”

  They packed quickly and trekked back down the trail they’d climbed by torchlight. “When we started walking, we were alarmed to see what we had come up in the dark,” Ruit says. For more than two miles they descended along a ledge less than two feet wide. Hundreds of feet beneath them, the white water of the Melamchi rushed around boulders that had fallen from the heights. “We walked carefully along that ledge, just hanging there in space, looking down at a very angry river far, far below,” Ruit says. “I think we all realized we could have ended up down there like those boulders, and I said to the team, ‘I think the patients pulled us up. They didn’t let us slip down. They needed us and wouldn’t let us fall.’ ”

  Riding back toward Kathmandu on the VW’s roof, Ruit felt he’d proved something important: It was possible to bring the best modern medical care to people in remote areas. You just had to dedicate yourself to traveling a more precipitous path.

  Ruit spent several weeks prior to a Kathmandu conference of the International Agency for the Prevention of Blindness refining and fretting over a speech he was due to give. Fred Hollows, who by that time had become a globally known figure in ophthalmology, was flying in for the event, and he and Ruit planned to give a presentation on the viability of bringing high-quality cataract surgery camps to rural areas not only in Nepal but across Asia.

  “Jesus, Sandook, you can’t do that out in the bush! Think about the infection rates!” Hollows had said when Ruit had first told him he was operating in rural areas. But Ruit had taken his team to several other remote villages since his return to Nepal, and had replicated the success they’d had carrying a mobile surgical theater up the crumbling trail to Tepani. He’d sent Nabin Rai to follow up in these villages, studying the condition of the patients. Rai documented that the quality of the surgery Ruit had done in Tepani and other villages was virtually indistinguishable from the excellent results he regularly achieved in the controlled environment of his hospital.

  The data persuaded Hollows that Ruit had made a major breakthrough. And he came to Nepal to say so to his peers and to suggest that they follow Ruit�
��s lead. Hollows and Ruit presented their findings at the conference, held in a meeting room at Kathmandu’s historic Yak and Yeti hotel. Leading ophthalmologists and public health policy makers listened to them argue for a fundamental reorientation of the way the world medical community fought cataract disease. They said that providing the latest technology, and the best possible care, to blind patients in the most remote rural areas was not only morally imperative but practically feasible because of the procedures Ruit had been perfecting in the field.

  “At the time,” Hugh Taylor says, “most of the powerful forces in international eye care were still advocating quick and dirty intracap surgery for people in the developing world, then handing out a pair of glasses. They didn’t like the waves this upstart from the back of nowhere was making, and they were prepared to knock Ruit down a peg or two.”

  As Ruit was presenting data on the low infection rates he’d achieved in facilities like school buildings and army posts converted into temporary operating theaters, an Indian ophthalmologist, one of the world’s most respected authorities on providing eye care to the poor, interrupted in a loud, belittling voice.

  “I’ve done my level best to listen and keep my mouth shut,” he said. “But this is nonsense! There are millions, from Pakistan to Peking, who need our services, and what you’re talking about is simply too costly. Can we kindly turn our attention to more serious matters?”

  A high-ranking American public health official stood and applauded his Indian colleague. “You’re wasting our time,” he told Ruit. “Our resources are not infinite. It’s only logical to make do with techniques that have been proven in the field.”

  Ruit, so firmly in command of his daily life, had always been uncomfortable making formal speeches. Gripping the podium, he told himself to keep his voice calm, to concentrate on making his case with the data he’d ridden on top of buses and climbed canyons in the darkness to collect. But his face reddened at these condescending foreigners dismissing the vision he believed in with absolute certainty: that people trying to survive the rocky footpaths and rigors of existence in mountain villages deserved excellent eyesight at least as much as wealthy citizens of the developed world who lived in comparative ease. He felt his blood pounding in his temples.

  “Would you let your own mother or father be operated on with a technique twenty years out of date?” Ruit asked. “Are you saying these millions, the poor, deserve less than you or I? Are you saying,” he continued, recalling the good, the impoverished, the underserved people of Olangchungola, “that they are children of a lesser god?”

  Fred Hollows patted his friend on the shoulder and reached for the microphone. His face had turned a shade of pink that rivaled Ruit’s. “You,” he sputtered. “You people. You’re the pus in the pimples on the arseholes of everything that’s wrong with the field of medicine.”

  He threw his arm over Ruit’s shoulder. “Come on, Sandook,” he said. “Let’s get the hell out of here, have a whiskey, and figure out how to do it ourselves.” He led Ruit off the podium, out the door, and onto a stool at the Yak and Yeti’s wood-paneled bar.

  Many plots—some successful, too many catastrophic—had been hatched in the bar of the Yak and Yeti. Edmund Hillary and the explorers who’d followed in his large footsteps had haunted the cozy carved-wood sanctuary for decades. Tabin had sat on one of these stools a few years earlier, plotting logistics for his third, and successful, attempt on Everest. Now Ruit and Hollows were laying the framework for another type of assault.

  “You know, it all boils down to the cost of lenses,” Ruit said. “We can’t keep depending on donations.” At the time, the artificial-lens industry was dominated by American and European corporations, who fixed their prices and charged as much as $150 for a single first-rate IOL.

  “I’ve been giving that problem thought for some time,” Hollows said. “We could build a lens factory right here in Kathmandu. Christ, all you’d need to do is throw up a shed and get to work.”

  “I can promise you, no one would work harder at this than we Nepalese,” Ruit said, excited. “We could produce lenses for a tiny, tiny fraction of the cost and sell them to countries across Asia. Imagine the impacts that would have!”

  “It wouldn’t be cheap, but I don’t see why it couldn’t be done if we twist the right arms,” Hollows said, sliding a glass of scotch down the bar toward his friend. “If you can’t work with them …” he said, raising his own glass.

  “Knock them on their ass and teach them to do better!” Ruit said, giggling happily, as they sealed the new Australian-Nepalese partnership with a bracing sip of liquid from Scotland.

  Stream of Sesame Seeds

  We are, all of us, pilgrims who struggle along different paths toward the same destination.

  —Antoine de Saint-Exupéry

  One day, while bicycling his usual circuit through the hills of Sydney, Fred Hollows felt short of breath. He had been an enthusiastic mountain climber in his youth and had led an active life of trekking and cycling ever since. He’d always considered himself a “scrappy little bugger,” because he usually seemed to have enough stamina on reserve for any physical task, so he knew immediately that something had to be wrong. He had a CAT scan performed, and the results were grim. Hollows had a large, cancerous tumor on one kidney, and secondary tumors had spread to both of his lungs. “It was a very sad time for us,” Hollows told his biographer, Peter Corris. “But we made certain resolutions, principally, that we weren’t going to pussy-foot around pretending things weren’t as they are.”

  As Hollows’s reputation had grown, so had his ambition for battling blindness around the world. He’d traveled widely, teaching modern surgical techniques in dozens of developing countries, and the more he’d traveled, the more firmly he’d become convinced that he and Ruit were right: Developed countries controlled the artificial lens business and kept the prices artificially high. He’d decided to champion the construction of factories producing low-cost lenses not only in Nepal but in Eritrea and Vietnam as well.

  Hollows had his cancerous kidney removed and radioactive iridium rods inserted into his lungs, to slow the growth of his smaller tumors. He resolved to dedicate whatever time he had left to turn his dream of lens factories for the third world into reality. Though he’d always had a prickly relationship with the country’s leaders, he’d become a folk hero to ordinary Australians, and news of his cancer led to an outpouring of accolades and public support. In 1990, he received several humanitarian awards and was once again offered the Order of Australia; this time he accepted, knowing the publicity it would lend his cause. He was also named the 1990 Australian of the Year, a position that involved a lengthy speaking tour and extensive media coverage.

  Hollows turned his lectures into fund-raisers and gave interviews from his hospital bed when he wasn’t well enough to travel, determined to surf the wave of publicity as long as possible. “The big goals, the establishment of lens factories … keep me going,” Hollows told his biographer. And the awards “have given me a platform to speak out about the things that most concern me … the responsibility we, as privileged citizens of First-World countries, bear to the people of the Third World.”

  Ruit traveled with Hollows on several of his international teaching trips. Hollows was especially eager to visit and teach in Vietnam, but he suffered a relapse just before he was due to leave and was hospitalized. When his doctors told him he was too weak to make the trip, Hollows, defiant to the end, pulled out the breathing tube they’d inserted in his trachea and demanded to have his lung function measured, to see if he was capable of surviving the flight to Hanoi. When the doctors told him he had a chance of returning home from Vietnam alive, he left the following week. Ruit accompanied him.

  “In Vietnam it was really still the Iron Gate era,” Ruit says. They were welcomed in an official state ceremony by General Vo Nguyen Giap, the elderly architect of his nation’s defeat of both the French and the American armies, a visit that delighted Ho
llows and Ruit, whose sympathies were always allied with the world’s underdogs. At hospitals in Hanoi and Hue, Ruit took the surgical tools from the hands of his friend and mentor, and took the lead in demonstrating modern surgical techniques to doctors. Hollows wore an oxygen mask, tired easily, and was too ill to do more than admire the masterful surgeon Ruit had become.

  Back in Kathmandu, Ruit strolled the length of the vacant lot, lost in thought. He paced every inch of the property, drawing and revising the blueprints in his imagination. The waiting area would be important. Too many medical facilities in Nepal crowded patients into airless rooms. So an open courtyard, shielded from the sun but surrounded by plants—a garden he would tend. The examination rooms should be nearby, so blind patients needn’t be led far from benches where they could wait comfortably, cooled by breezes. Most critically, the lens laboratory would stand near the entrance gate, advertising the advanced technology he had brought to Nepal, trumpeting the improvement in eye care he intended to provide.

  Lying on his deathbed, at home in Farnham House in early February 1993, Hollows learned that the project in Vietnam was plagued by red tape. But he took solace in the fact that they’d raised enough money to build the lens factories in Eritrea and Nepal, and that the Australian government had committed matching funds to see that they were finished.