Before the film crew arrived, Ruit received a request from another high Maoist official for emergency treatment. “By then, we’d worked out a system of security when they came to Tilganga,” Ruit says. “I’d ask them to wear a certain color cap, red or blue, and be escorted by young ladies in pink kurta pajamas, so I’d know who they were. And I’d always have them arrive at the end of the day, so they wouldn’t be exposed to too many prying eyes.”
While the Maoists’ secretary of trade unions waited on a plastic chair, with a patch over an infected eye wound and wearing a blue baseball cap as instructed, Ruit saw two thickly built men step into the waiting room and scan the patients. “They were obviously army guys, wearing civilian clothes,” Ruit says. One of them dialed a number on his cellphone, and the mobile the secretary was nervously toying with began to ring. The men grabbed Ruit’s patient by both arms and walked him out to their waiting vehicle.
“The arrest was big news,” Ruit says. “It was in all the papers that he’d been caught in my clinic, and a few days later, a big boss from the army came to see me. He threatened that he’d shut Tilganga if I didn’t stop treating Maoists. I told him very clearly, ‘I’m a doctor. I treat everybody. I treat thieves and saints equally, and I’ll continue to do so.’ I’d come to the level where I didn’t get scared by threats. I was confident in my abilities and that my work was correct. Maybe too confident.”
In the days after the arrest, Ruit began to worry about whether the sensational news splashed across the front pages of the local papers would interfere with Tilganga’s reputation as a neutral medical facility, uncorrupted by either the government or the Maoists. “The army was threatening me and calling me a traitor,” Ruit says. “And I knew I’d be suspected by the Maoists after that, that some would think I’d played a part in helping the army with their arrest.”
Ruit had spent years earning a reputation in Kathmandu that rose above politics. His greatest worry was how the arrest would affect his staff’s ability to operate in rural areas, where the number of checkpoints, both military and Maoist, had proliferated since King Gyanendra had announced his decision to crack down on the uprising.
Ruit tied white silk katas around both of the sideview mirrors and threaded one through the grille for an extra measure of luck. Tilganga had acquired the aging city bus because it was capable of carrying thirty passengers and far more medical equipment than Hilda; the staffers christened it “Lady of Sight,” painted it bright blue, and pushed it hard. The scale of their work in rural areas had expanded dramatically since the days when Ruit, Rex, and a few others could haul all they’d need for a few days’ work in a single Land Cruiser.
Ruit, Tabin, and six support staff rode together toward Mustang to meet Khem Gurung’s advance team and the National Geographic crew who were flying to the trailhead. The mood in the Lady of Sight wasn’t especially somber, but the war was clearly on everyone’s mind. Red hammers and sickles were spray-painted on the walls of nearly every town they passed, on banks, on government buildings, and even on police posts, many of which were pocked with bullet holes or scrawled with the slogan “Burn the old house down.” Posters of the Maoist leader Prachanda, a man who looked more like a mild professor of literature than a revolutionary, were plastered the length of the route to their trailhead.
At first, Tabin was anxious about the Maoists, but after the bus had been waved through six or seven of their checkpoints without incident, he relaxed. When he got out and shouldered his backpack, he stopped thinking about the Maoists at all. “Once we were hiking, I was just happy to be trekking in the hills I considered my second home,” he says. “Ruit set a blistering pace. I was still in pretty incredible shape in those days, and Lisa struggled, at first, to stay with us, but she was tough and eventually she got used to the altitude.”
As they crossed high passes heading for Upper Mustang, Ling was amazed by how far Ruit and Tabin were willing to travel to reach their patients. “A steep, unforgiving landscape holds anyone without sight hostage,” she said in her voice-over, “but Dr. Ruit knows that for many, Kathmandu is too far to travel, and so eight to ten times a year, he makes house calls.”
Monks Ruit had recruited preceded the team on their trek, chanting, “The eye doctors are coming, bring your blind to Kagbeni.” And in Kagbeni, the village where they set up their surgical center in a dirt-floored schoolhouse at 9,500 feet, Ling grew nearly too emotional to speak on camera while she watched patients’ sight restored. A sixty-two-year-old woman named Tsering was so incredulous after Ruit removed her bandages that her laughter and tears spilled forth simultaneously. Ling took a picture of her with a Polaroid, and when Tsering saw herself she was surprised, but hardly upset, by how many wrinkles had appeared on her face in the years since she’d lost her vision.
Ling’s cameraman cut in close on Ruit while she asked him why he was willing to work so hard and travel so far to restore sight. Ruit stared up at the stark crenulations of Mustang’s mountains before speaking. “What I really believe is life is very short and what you can do in that period you must do. We have now got a system where we feel that we can [get close to] ninety-eight percent of exceptionally good vision with our patients immediately after surgery. If you can do that to hundreds of patients, I think walking for five or ten days is worth it, isn’t it? It can change their life. It can change the life of their family. And for them this world is going to be totally different.”
Ling and her crew left by chartered helicopter, flying away with footage Ruit and Tabin hoped would coax considerable donations from National Geographic’s viewers. On the five-day trek back they had ample time to discuss the challenges facing the HCP. Money was the key to much of what they hoped to do, of course, but so was convincing officials in other countries of their work’s merit. Ruit had made much progress toward obtaining permission to operate in China, a country with an alarming shortage of well-trained ophthalmologists in rural areas, but they conferred about who might be most capable of breaking down the walls China’s bureaucrats still maintained to keep foreign doctors at bay.
Mostly, they discussed ways to spread the word of what they’d been able to achieve: a model, easily replicated, capable of curing much of the preventable blindness on earth. Videotaped evidence flown away in a helicopter might help. But to go global, they had to target a group more influential than any film’s general audience; they had to take their dispatches from the field directly to their peers in international ophthalmology. Hiking down toward rebel checkpoints, on a rugged trail in one of the poorest nations on earth, their minds churning in concert with their legs, Geoff Tabin and Sanduk Ruit debated how, exactly, to launch their own revolution.
Ravishing Beautiful Flowers
In medicine, we focus on that 2 percent improvement, that little refinement in equipment and technology, much as, I imagine, the space program does. But too often we ignore the 90 percent of people who need our services. That’s the importance of the work Tabin and Ruit are doing. They’re outsiders delivering a message many in my profession don’t want to hear. That we have a duty to all of the world’s patients.
—Dr. David Chang
In 2004, for the first time in the nation’s history, there were more cataract surgeries performed in Nepal than new cases of cataracts reported. Politicians tried to meet—and be photographed with—the doctor identified with the turnaround, hoping to align themselves with one of the few inarguably positive stories to come out of the country in a time of war. Ruit refused most of these entreaties, careful not to allow himself to be used as a political pawn.
During 2003 and 2004, at the peak of the violence of the People’s War, Ruit and Nabin Rai traveled the length of Nepal, sparking new projects and partnerships. They met with regional Maoist leaders and local politicians the rebels considered the least corrupt, and together they identified the best sites to serve the maximum number of rural patients. In towns where hospitals existed, such as Dhangadhi, on Nepal’s western border, and at Jana
kpur, in south-central Nepal bordering India, Ruit pressed administrators to update their ophthalmic departments and to send staff to Tilganga for in-depth training. Across the length of the mid-hills, at seven regional hubs where passable roads remained more rumor than fact, Ruit directed the growing funds he had at his disposal toward the construction of seven community eye clinics, where technicians could prescribe glasses, treat all but the most serious trauma, and send patients with more severe problems to Tilganga.
Constructing such a comprehensive network during wartime, when Nepal’s government had retreated to the safe bunker of urban centers, where they struggled to provide even basic services such as electricity and trash collection, was the work of Sanduk Ruit in his role as social architect, thumbing his nose at his country’s corrupt leadership. He protested the state of his nation with actions rather than words. “Why, if we are able to do so much with such meager resources,” the successes he piled up seemed to be saying, “are you, with all the mechanisms of governance, able to do so little for your people?”
One of the engines driving all this development was a battered cardboard box under the desk in Geoff Tabin’s clinical office at the University of Vermont. This box contained all the financial records, travel receipts, tax forms, and grant applications that made the HCP economically viable. Tabin tried to support the HCP’s expansion by applying for USAID grants, but peeling his way through the layers of bureaucracy ate up so much of his time that in 2003 he finally hired his first full-time American employee.
Tabin asked Emily Newick, who had a freshly minted master’s degree in public health from Dartmouth, to turn the contents of the cardboard box into the administrative framework of an official charity. “I walked into Geoff’s little ten-by-ten office after I’d accepted the job,” Newick says, “and I asked to see all of the HCP’s files. Geoff just pulled that box out from under his desk, and I thought, ‘What have I gotten myself into?’ ”
Tabin hired the HCP’s second full-time employee two months later. Job Heintz, a Vermont lawyer, had the tenacity to plow through the stacks of forms the U.S. government piled between charitable organizations’ aspirations and the financial resources USAID offered. He also had patience and skill enough to dissect the technical language that left so many other grant seekers ineffectually spinning their wheels.
“At first, Job and I would just sort of hang around Geoff’s office and cram ourselves between his piles of climbing gear, tennis racquets, and dirty laundry a few days a week,” Newick says. “He’d rush in from surgery in his scrubs, or jog in after clinical rounds in his white lab coat, spoon his lunch from one of the open jars of Skippy peanut butter scattered around the office, and we’d talk as much HCP business as we could before he’d rush off again. The rest of the time Job and I worked from our home offices, where we could get the HCP organized, free from the Tabin chaos.”
By the end of 2003, the HCP’s files had migrated from the box to proper filing cabinets in Newick’s and Heintz’s homes. They designed and launched a website, hired a part-time accountant, and submitted revised financial records to the IRS. Newick built a database of silicon, rather than cardboard, to hold a file of their donors’ addresses. Heintz sought out other grants that might be available to the HCP and directed his legal skills toward picking the locks of the USAID coffers that held one of the HCP’s most important sources of funding.
When Lisa Ling’s documentary Miracle Doctors aired, on September 28, 2003, it focused on the dedication of Ruit and Tabin and the worthiness of their cause. But the National Geographic editors had also tarted up the final cut with gruesome footage of Nepal at war. Images of the corpses of the royals borne through the streets to their funeral pyres and dead government soldiers in bloody fatigues being carried out of the hills, slung from poles on the shoulders of their comrades, painted Nepal as a country so mired in anarchy and violence that it conveyed a sense of despair neither Ruit nor Tabin felt. The flood of donations they expected after its broadcast never arrived, and the HCP continued to struggle for funding.
The USAID grants were expected to be spent primarily on infrastructure and matched with money the HCP raised from other sources. While building clinics, buying microscopes, and upgrading operating theaters was important, those funds were largely unavailable for what Tabin had come to see as the heart of the HCP’s mission: training a battalion of surgeons and technical staff who could build on Ruit’s innovations by transferring them to medical facilities throughout the developing world.
“Ruit and I have been talking for a while now,” Tabin told Newick and Heintz at a strategy session soon after they’d organized the HCP as a small, efficient charity, “and we think it’s time to expand Tilganga from an outpatient hospital into a world-class training center.”
“How much bigger do you want Tilganga to be?” Heintz asked.
“Ideally,” Tabin said, “the Tilganga Institute would be about three times the size of the current hospital and have classrooms, a lecture hall, and offices for twenty-five surgical fellows to use during their training.”
Heintz began mentally calculating the mountains of paperwork he’d have to scale, and the countless donors he’d have to contact, to start turning Ruit and Tabin’s latest vision into a brick-and-mortar building. To build anything close to the facility Tabin envisioned, they’d need something like $10 million. “Well,” he said, “we better start raising more money.”
Newick remembers trying not to let her shock show. “You have to love Geoff to work with him,” she says, “because he pushes so hard. He doesn’t believe in limits. Which can be both good and bad. We had just turned the HCP from a stack of paper in a cardboard box to a tiny professional organization, and now he wanted to make a quantum leap from that to trying to cure all the preventable blindness on earth.”
Heintz spent much of 2005 alternately talking to USAID officials and buried in the forms he had to finesse and submit. By the end of the year, the HCP had managed to land $700,000 in USAID grants toward building a new Tilganga, to augment the just over $1 million they’d raised from individual and institutional donors. The following year Heintz coaxed an additional $700,000 from USAID, and HCP’s other donors delivered nearly $2 million more.
The fund-raising for Tilganga’s expansion was on track, but to make it more than a building, to re-create it as a center for battling world blindness, Ruit and Tabin would have to come in from the medical wilderness. By 2005, they’d either built clinics or provided tools and training to the staffs of ophthalmic facilities in Pakistan, China, Tibet, northern India, Thailand, Vietnam, and North Korea. In Bhutan, Kunzang Getshen had made the most of Mark Haynes Daniell’s money and established a network of village clinics capable of diagnosing eye diseases in their early stages and sending patients to Thimphu’s National Referral Hospital for treatment by a growing staff of Tilganga-trained ophthalmologists. Despite these accomplishments, the HCP’s biggest obstacle was the suspicion, still entrenched in the international medical establishment, that outliers like Ruit and Tabin might have achieved some success on the ragged frontiers of eye care but their methods were still too scattershot, unsafe, and untested to be applied beyond the handful of remote communities where they worked.
“If you’re trying to change a model of how care should be delivered in international health, you can’t do it on your own,” says David Chang, a prominent California ophthalmologist. “You need powerful allies.”
In February 2005, after meeting Chang at an ophthalmic convention in San Francisco, Tabin asked him to become one. He believed that Chang, one of America’s most respected ophthalmologists, renowned for his leading-edge cataract surgical techniques, could be not only a potentially powerful ally but the ideal spokesman to publicize the HCP’s mission, providing he could be converted. What Tabin wanted was for Chang to come to Nepal and conduct a clinical trial, operating alongside Ruit, so they could compare and publish their results.
Chang, a tall, eloquent American of Chinese d
escent who effortlessly commands lecture halls full of surgeons who gather to hear him describe the latest technical advances in ophthalmology, would be the perfect messenger to tell the medical establishment about the revolution Ruit was leading. All Tabin had to do was convince one of the busiest academic surgeons in the nation to carve a week-long hole in his schedule and fly halfway around the world to do someone he hardly knew a favor.
On a May morning in 2005 Chang slumped in Hilda’s backseat, trying to shake his jet lag, as they passed mounds of smoldering trash and children scavenging through them for something to sell or eat. He didn’t know where Dr. Ruit planned to operate, but he remembers hoping it would be considerably cleaner than what he could see out his window.
They climbed out of the Kathmandu Valley, into a pine forest a thousand feet above the motorbike exhaust, diesel fumes, and incessant barking of the capital’s thirty-five thousand feral dogs. The Pullahari Monastery straddled a ridge with a distant view of the city and, on clear days, the snow peaks of the Himalaya. The property the Third Jamgon Kongtrul had bought was so lushly beautiful, so removed from its surroundings that the monastery’s grounds crew had been obliged to put up discreet signs discouraging day-trippers from picnicking, so that the meditations of the 230 monks in residence wouldn’t be disturbed.
Pullahari, the name the Third Jamgon Kongtrul chose before he died, means “ravishing beautiful flowers” in Pali, the language of the oldest surviving Buddhist scriptures, and it was the Rinpoche’s hope that this forest sanctuary would be fertile soil for an exchange of Eastern and Western philosophies, that the wisdom cultivated here could bloom in forms surpassing the site’s physical beauty.
Ruit had certainly hoped so, too, when he’d chosen Pullahari to host his trial.
Second Suns Page 29