Second Suns

by David Oliver Relin

  Not all of the children whose families brought them to Quiha hospital were as lucky. Eleven-year-old Cherkos had been dropped at the hospital by his father, who’d told a nurse he’d be back for his son in a few days, after he’d climbed to a church hollowed out of a rocky cliff, consulted with Coptic priests, and completed his prayers for the boy’s recovery.

  Cherkos’s homespun clothes were dirty and torn, his head had been shaved to ward off lice, and his left eye was severely traumatized. If I understood the medical technician who had stepped in to interpret correctly, a chisel he’d been holding had skipped off a rock he was helping his father split and had punctured the center of his eye, driving down through his iris. A village healer had bandaged it with a poultice of herbs, hastening the infection that killed much of the surrounding tissue. After I placed Cherkos on Tabin’s table and told him the story, Tabin just shook his head. “At least he has vision in his other eye,” he said. “There’s nothing I can do for this one.”

  I led two twelve-year-old girls named Louam and Maharene to Crandall’s table. They were friends from the same village north of Quiha, and both suffered from cataracts. The girls sat together as they waited for their surgeries, their hair braided identically and pinned in place with pink bands, holding hands and talking, excitedly, about being able to see. It was a straightforward matter for Crandall to repair Louam’s eyes. But when he looked at Maharene under the microscope, he simply said, “Shit.”

  “Do you know what happened to her?” Crandall asked.

  “Her parents said she had an accident with a knife while she was cutting firewood.”

  “Well, it must have been when she was very young. This girl’s cataracts are traumatic, and it looks like the injury occurred a long time ago,” Crandall said. “I’m not getting a response from her retinas. And her brain’s unlikely to be able to process visual information after so long with no input. I can clean her eyes up and make her look better cosmetically, but …” His voice trailed off, and that was as close as I ever came to seeing the imperturbable Dr. Crandall cry.

  I brought the bandaged girls out to their families after their surgeries. In the recovery room, I made myself look their parents in the eye, and through another interpreter, I passed on the prognosis for each of their daughters. Louam’s mother was elated, her eyes shining with excitement. But it was the faces of Maharene’s mother and father that stayed with me long after I left Ethiopia. They didn’t look shattered so much as stoic, subsistence farmers in a poor country whose lives had taught them too many hard lessons. I hated to be the bearer of another.

  That evening, we had a formal meal with the Tigray Region’s minister of health and his staff, in an airless private room off the lobby of our hotel. For two hours, we sat trapped in oversized chairs, picking at the hotel’s bland interpretation of continental cuisine, watching Tabin fidget in his seat, struggling to transition from experienced surgeon to fledgling diplomat. Waiters wandered in listlessly, delivering the beers we’d ordered thirty minutes earlier one or two at a time. When one placed a lukewarm bottle of local St. George lager in front of me, Tabin snatched it, drained a third of the bottle, and replaced it before his own beer arrived.

  Tabin was hoping to make Quiha hospital and the attached nursing school one of the HCP’s centers of excellence he’d talked about with Sachs. He outlined his ambitious plans to the minister, including expanding Quiha hospital, making it capable of supporting itself by charging a sliding scale for cataract surgeries, and offering Lasik surgery and an eyeglass boutique to the middle-class residents of Mekele.

  “Implementation may take longer than you think,” the minister said. “This is Africa.”

  “I don’t accept that,” Tabin replied with something resembling Ruit’s steel in his voice. “There are people willing to work hard and people who aren’t. The staff of Quiha hospital has been fantastic so far. They’re willing to work hard.”

  The minister conceded the point. But perhaps to rectify the criticism he’d leveled at his continent, he pointed out that the American medical system was not without flaws. “America still leads the world in developing the latest technology. But Australia, Sweden, Great Britain—these are the places I really study. We can’t learn much from your medical system because you don’t actually have one, in my opinion. Your country has only a crisis-management system.”

  I realized the minister was making almost precisely the same point Al Sommer had in his office at Johns Hopkins. If the minister could see clearly how broken the American health care system had become from this distance, from the high desert of northern Ethiopia, why, I wondered, couldn’t so many of our own politicians?

  By the fourth afternoon of surgery in Quiha hospital, I could barely keep my eyes open. I wished I could draw some juice from the batteries that drove Tabin, but they powered him alone. Our driver and fixer was named Mulu Mohari, which he said meant “strong medicine.” Mohari had short gray dreadlocks, wore mirrored aviator glasses day and night, and wound a dashing Palestinian-style kaffiyeh around his neck. “You look tired,” he said. “The strongest medicine I know is our Ethiopian coffee. Come, come.”

  We drove north, past shouting boys playing foosball on tables placed at the side of the road. Mohari overtook a flock of sheep tended by a teenager wearing shorts and green rubber gum boots, then swerved around a donkey towing a handmade wooden cart rolling on car tires. Lashed upright to the cart, looking like a vision from an alternate universe, was a gleaming silver Westinghouse refrigerator.

  We stopped in front of an unmarked cinder-block coffeehouse, and Mohari fetched a powder-blue plastic thermos from under his seat. Ethiopia claims to be the cradle of both humankind and coffee. Before entering that building, I thought my local baristas back in Oregon took the transformative power of roasted beans seriously. I learned that an Ethiopian coffee ceremony raises the preparation from art to spirituality.

  A young girl spread freshly cut grass at our feet and set on our table a woven basket full of popcorn, coffee’s traditional accompaniment in Ethiopia. The girl’s mother sat in the corner, on a low stool, roasting green coffee beans over a charcoal brazier. When the beans were black and shining with aromatic oil, she held the pan under our noses and wafted the scent toward us with a reed fan. She then crushed the beans with a mortar and pestle, mixed the ground beans with water, and set a long-necked black clay jebena on the coals to brew. She served us the coffee in espresso cups filled to the brim, the brew splashing onto our saucers, a symbol of abundant hospitality.

  Perhaps it was the guilt and pleasure I felt at stealing a moment while the others were still at the hospital, but I’d never had a more satisfying cup of coffee. I drank a second, feeling Mulu’s strong medicine taking effect, fortifying me to go back. We filled the thermos and borrowed a dozen china cups for our colleagues.

  By the time we returned, more than two thousand people were crowded into Quiha’s compound. Women tended large earthen stoves, turning out yard after yard of the flat, spongy injera bread that is the staple of the Ethiopian diet. Hundreds sprawled on mats, sleeping or nibbling roasted barley they had brought in burlap sacks. At the center of each recovery room, buckets for the patients who couldn’t find their way to the concrete squat toilets fouled the air.

  Every time I stepped outside, trying to breathe, mothers held up babies with infected wounds and pressed them to me, or elderly men unbuttoned their shirts to show me tumors. I tried to explain that I couldn’t help them, that I was just a journalist. I tried to convince myself that my writing would raise awareness to make more work like this possible. In the face of overwhelming need, storytelling felt like a poor excuse for my presence. I closed my notebook, rolled up my sleeves, and scrubbed my hands.

  Tilganga’s training coordinator sat outside the operating room, cataloging the numbers of cases completed and patients still waiting for surgery. I asked Chansi if, whenever he had a few moments free, he could teach me how to be helpful. He showed me how to change IV
bottles and present surgical tools so they remained sterile. He demonstrated the correct way to carry patients onto the operating table, how to tape bandages over their eyes when the surgery was complete, and how to cross their hands in front of them so they’d follow confidently as I led them to the recovery rooms. No one would have mistaken me for a medical professional, but at least it was better than standing around and observing.

  The first patient died that day: An elderly man scheduled to have surgery the following morning had a heart attack and collapsed on a bench in the courtyard. We heard his family wailing through the windows of the operating room. The second died soon after. The night before his surgery, a man in his forties who had traveled from his village near the Eritrean border slipped while walking to a bathroom in the middle of the night. He hit his head on the concrete floor of the toilet and bled to death before he was discovered.

  “That’s horrible,” Tabin said the next morning when he heard the news, looking up from his operating table. But he sounded surprisingly matter-of-fact. When I asked him about it later, he said, “Blindness in a place like Ethiopia is often a death sentence. The life expectancy of blind people in the developing world is less than one-third that of people with sight.”

  Nearly every time I looked out through the screened windows of the hospital, which almost succeeded in keeping out the flies, I saw Cherkos standing alone on a boulder that gave him a clear view into the operating theater with his one working eye. At first I took his presence as a reproach, a reminder that we had failed him, and tried to ignore him. As the hours passed, as he watched us while waiting patiently for his father’s return, I made a point of meeting his eye and forcing a smile onto my face. Whenever I had a moment free, I bought him drinks from the roadside stand at the hospital gate and passed him treats from the plastic tub full of power bars, cookies, and candy that Alan and Julie Crandall had brought from Utah. For Cherkos, we served as insufficient entertainment during the hours while he waited for his father. For me, he served as a reminder of the pitilessness of poverty, and the limits of modern medicine’s ability to alleviate its symptoms. I never had a chance to say good-bye. One day when I looked out the window, the boulder Cherkos had stood on for so long was vacant.

  We all got sick. The photographer Ace Kvale had stomach trouble. So did Julie Crandall, but she swallowed antibiotics and Imodium and stayed by her husband’s side in the operating room. Chansi had a sore throat. Paudel was running a fever. Even Tabin, who typically barked, “Fan-tastic!” whenever anyone asked how he was doing, admitted that he felt only “pretty average.” I began coughing so strenuously that I pulled a muscle in my chest. But we knew our ailments were temporary and our time here brief. We could afford a plane ticket home to another world.

  By the fifth evening the team had completed 699 surgeries, but more patients kept arriving. We had planned to head north the next morning, to relax for a few days at an Italian-run ecolodge where the food and wine were reputed to be the best in Ethiopia. From there we were going to visit the U.N. Millennium Village of Koraro, explore the nearby red-rock wilderness, and climb to churches hollowed out of stone pinnacles.

  Tabin broke the news on the drive back to the hotel. “I’m going to stay here until we’re done,” he said. “This is their only chance to see.” I realized that, despite his protestations, Tabin’s philosophy of trying to do everything at once no longer applied when blind patients required his services. He had packed a pair of climbing shoes, and the sandstone towers to our north beckoned, but Tabin didn’t budge. Despite the fact that Ruit was probably sound asleep on another continent, I couldn’t help feeling his approving presence.

  By the measure of my own disappointment, though, I learned an uncomfortable truth. I was overwhelmed by the heat and dust and suffering, by the impossibility of grasping a moment of privacy anywhere on the hospital’s teeming grounds, by the limitless need of the patients flowing through the hospital’s rusted gates in a never-ending stream. I wanted to flee, to find a decent meal or a comfortable bed. But shamed by Tabin’s dedication, I stayed. We all stayed.

  On our sixth day, I worked beside Tabin from dawn to dusk. I managed flow, taking care to always have someone prepped at the end of his operating table so I could slide them into place the moment I finished bandaging the previous patient. Mohari made frequent deliveries of his strong medicine, and we found an agreeable rhythm that sped the surgeries along, accompanied by Tabin’s electric blues. Just after 10:00 P.M. I dripped antibiotic drops into the eyes of Tabin’s last patient, a frail, emaciated woman who was far too easy to lift onto the operating table. When he was done, I pressed surgical tape over a gauze patch, smoothing it to the woman’s forehead and cheekbone. Tabin and I both noted the number I wrote on her bandage with green marker: 82. She was Tabin’s eighty-second patient, a record for him in a single day.

  He pulled his gloves off, tilted his head back toward the screened window, and, trilling his tongue in imitation of his patients, ululated. To me, his warbling cry sounded like someone being electrocuted. The Ethiopians recognized it for what it was: wild delight. Across the hospital compound, we heard a gentle musical response echo from women resting on reed mats in the various recovery rooms, drowsing on benches beneath homespun blankets, or curled under thornbushes with their families. “Yes, we’re in agreement,” the echo seemed to say. “What’s happening here is cause for celebration.”

  By the middle of the eighth day, the compound finally began emptying out. Buses and carts drove patients away. People who’d arrived clutching feebly at the hem of a relative’s robe walked confidently, without assistance, toward their homes. I bandaged patient number 907 and, with a shock, saw that no one else was waiting and we would all be leaving soon, too. Most of us would return to our own countries, to sleep as much as our families would allow while we nursed our minor ailments.

  Not Geoff Tabin. He was feeling “fantastic” again and had scheduled a tennis match with one of Ethiopia’s top players on his return to Addis Ababa. Two weeks later, after a few days with his family in Utah, he would climb back into his eternal long-haul seat and travel to Nigeria, where he would lead another high-volume surgical camp. Tabin’s HCP colleague Matt Oliva would arrive in Ethiopia eight months after we left, to help expand an eye bank in Addis and run a surgical outreach with Dr. Meshesha, which would cure another 598 people.

  But while I stood in the stilled operating room, that was all in the future. At that moment there was only Quiha Zonal Hospital and a single hard-won lesson: The overwhelming need of the crowd outside the door made some people, certain rare individuals like Tabin, not only stronger but better. As I walked our last patient out into the blinding sunlight, into the quiet courtyard where for more than a week hundreds of patients had crouched and cried and ululated with joy, I realized we had all found hidden reserves in ourselves that Geoff Tabin had known about all along. And we had become better, too.

  The Road Is Coming

  There are only two mistakes one can make along the road to truth: not going all the way, and not taking the first step.

  —Siddhartha Gautama, the Buddha

  Any remaining worries Ruit had about whether the Maoists trusted him and any lingering resentments he harbored about the indifference American diplomats had shown his work for two decades were put to rest on April 30, 2009. That day, America’s ambassador to Nepal, Nancy Powell, along with Nepal’s prime minister, the former Maoist rebel commander known as Prachanda, arrived to inaugurate the new Tilganga Institute of Ophthalmology.

  Ambassador Powell, a career diplomat, had been posted to Ghana just before the attacks of 9/11. In their scorched-earth aftermath, she accepted the offer to serve as ambassador to Pakistan, managing what had arguably become America’s most challenging diplomatic posting from 2002 to 2004. Adding a tour of duty in Nepal to her distinguished foreign-service career, Ambassador Powell was more attuned to the value of promoting humanitarian aid than some of her predecessors. She gave a speech fo
rmally opening the new facility, which she called “a combination of the best of American intentions and Nepalese ingenuity.”

  Tabin, along with the HCP’s Job Heintz and Emily Newick, stood off to the side of the stage while the VIPs made their speeches, surveying what their five-year fund-raising campaign had made possible. Uphill from Tilganga’s original building, a new five-story, 110,000-square-foot brick hospital stood, connected to its predecessor by an elevated blue walkway that curved between the buildings, like a sanitary version of the Stream of Sesame Seeds that had given the site its name. The series of USAID grants that Heintz wrote, submitted, rewrote, and resubmitted generated almost $3 million for the project. Tabin made personal appeals to his most important supporters, and more than six million additional dollars rolled in to complete the construction, and equip the facility, from both private donors and foundations like Fred Hollows.

  In 1994, the year Tilganga was founded, the hospital and its outreach teams screened 22,290 people for eye disease and completed 1,728 surgeries. In 2009, the new Tilganga and its mobile surgical units would screen 275,430 people and provide 16,603 surgeries. On the third floor, a library, lecture hall, and a suite of offices gave Tilganga the capacity to house and train twenty-eight surgical fellows at once, realizing Tabin’s vision of Tilganga as a formidable incubator for teaching young ophthalmologists the techniques Ruit had pioneered. Four additional operating rooms below meant Tilganga could enlarge its staff, perform more than two hundred surgeries a day, and care for patients in a twenty-five-bed recovery ward.

  Tabin had also convinced the London Vision Clinic, one of the world’s foremost Lasik surgery training centers, to partner with Tilganga. The LVC had donated two late-model Zeiss lasers and was training the Nepali surgeon who would operate them. Once the Lasik suite was functional, Tilganga could cover a significant portion of its operating costs by charging Nepalese of means $500 a surgery, less than they’d been paying for a plane ticket to a facility of similar quality in Singapore.