“You know, we’ve had our struggles also,” Ruit said. “Nanda has sacrificed. A lot. And my children often couldn’t bear it when I was away, especially Satenla here. But I’ve tried to make them understand leaving doesn’t mean loving them less. Just the opposite. So my final word of advice to you on the subject is to trust talk. Trust talk. Trust, trust, trust!”
There was a loud silence after Ruit finished speaking. The rain that had been hammering on the tin roof over our head since we’d arrived had stopped. Satenla took advantage of the silence to say something heartfelt to her father in Nepali. When she finished, Ruit’s face was flushed with happiness. “Tell them what you told me, Sat. In English.”
“I never really knew what my father did,” she said in her soft voice, her eyes cast down demurely. “I mean, I knew he was a doctor who helped people and such like that. But on this trip I’ve made a new understanding. I told my father I’ve decided to pursue a career in medicine.”
We applauded her decision and toasted Satenla with thimblefuls of scotch, embarrassing her thoroughly enough that she left for her room to write in her diary. In the glow of the oil lanterns and the whiskey, Ruit began talking about the future. He pulled up his pant-leg and tore off the thick knee brace I hadn’t known he was wearing. I saw how badly his leg was bruised. “I have to be realistic,” he said. “Trekking all the way to Olangchungola is too hard. I’m getting old. But there is one thing I’d like to do while I’m strong enough. I’d like to spend one full year traveling around the world to every eye center we support, and operate at each one, doing about ten thousand surgeries total. After that,” he said, “I could really hang my boots happily.”
Tabin wasn’t having any of Ruit’s talk of retirement. “You’re not dead yet, Sanduk,” he said. “We’re just starting to make a difference in Africa and China.” Tabin took out his pocket camera and showed Ruit photos from a recent trip to Nigeria. Interspersed with images of women grinning as their peeled-back bandages hung from their cheekbones, he showed us shocking photos of children with softball-sized tumors protruding from their eyes.
“What can you do about that?” I asked.
“Nothing,” Ruit and Tabin said in tandem.
“Get to them sooner,” Tabin said.
“I’ve seen tumors this advanced in China also,” Ruit said. “For such a modern country, eye care in rural areas is as bad as anywhere in the world. That’s where I really see our growth coming on in Asia.” It had taken only a few blurry photos to stop Ruit’s talk of retirement and reanimate the impulse I’d seen when he’d noticed the stuttering eyes of the family living on the rock. Ruit began describing the one hundred rural eye clinics he, Tabin, and David Chang had discussed building in China, and the incentives they were talking about with the Chinese government to lure talented doctors to them from their lucrative urban practices.
Tabin changed the subject to the challenge he was most passionate about—Africa—and gave Ruit a progress report on the eye hospitals and training centers in Ghana, Ethiopia, and Rwanda. Tabin sat cross-legged as he talked, hopping slightly and waving his arms with growing enthusiasm about his plans. A wave of exhaustion swept over me then. I excused myself, stumbled to my string bed a few feet away, and crawled into my sleeping bag. Lulled by their excited voices as they plotted the next phase of their global campaign to combat blindness, chattering on with energy no mortals should still possess, I closed my eyes until morning.
Walking along the upper Tamor River, knowing we’d reach our destination in a few hours, was an entirely different experience from our forced march of the last three days. Trails of unstable stone still zigzagged up nearly vertical walls, but I stepped up them deliberately, at a guide’s pace, enjoying the view of terraced fields spilling down from the heights and the houses of the families who worked them tacked to hillsides by stilts that seemed too fragile to prevent them from tumbling into the river. Comparing this journey to trekking the crowded trails of the Khumbu, I realized what a privilege it was to travel through the remote Kangchenjunga region. The Tamor grew wilder as we climbed, and I could see it as a young Ruit must have, a live thing, stamping its way down from frozen glaciers to foreign lands, tearing boulders out of its way or bulling over them with its power.
Ruit and Tabin walked ahead, deep in conversation, climbing staircased stone trails so high, winding, and treacherous that the doctors resembled figures from Chinese silk paintings, tiny human animals, dwarfed by the magnitude of the natural world. And yet, I thought, the ripples that emanated from them were transforming entire continents. Tilganga now exported the inexpensive lenses produced in its laboratory to eighty countries. They’d constructed twelve regional community eye centers across Nepal and a full-scale surgical center in Hetauda, and they supported five eye hospitals spanning from Tibet to northern India to Indonesia. In Bonsaaso, Ghana; Quiha, Ethiopia; and Kigali, Rwanda, three more treatment and training centers were about to come online.
These two men had told me they were responsible, between them, for training hundreds of surgeons like the Kims, Drs. Olo and Kesang, Hitler Pradhan and B. P. Dhakal, Sona Yonjo, Chris Kurz and Huckleberry Holz, Matt Oliva, Kunzang Getshen and Dechen Wangmo, Tilahun Kiros Meshesha, John Nkurikiye, and an even greater number of nurses and technicians who were working with them in the countries most cursed by blindness. By my estimate, if you took into account all the other organizations with which they’d shared Ruit’s innovations, more than two million sight-restoring surgeries could already be traced to these two men and the motivated individuals they’d set in motion. Pound for pound, footstep for footstep, who was doing a more impressive job of making the world better for those whom poverty had dealt the worst hand?
We walked down through the templed light of a forest of mature golden bamboo, toward Sinwa. The elders of Olangchungola had trekked to meet us at a flat spot on the trail, with a pitcher of tea and a tray of sliced oranges and apples.
Entering Sinwa, through a bamboo gate erected for our arrival, we were greeted by the town’s entire population. Once again, we were draped in katas, and garlands of orchids were placed around our necks. Ruit let himself be celebrated just long enough to satisfy custom, then rushed over to inspect how well his staff had converted the barren village health clinic into a well-organized operating theater.
The staff had worked most of the night to have it ready and had found innovative solutions to the site’s considerable challenges. Sinwa sat on a narrow sliver of rocky land, wedged between the three-thousand-foot walls of the river’s canyon, and was unusually windy. The patients’ vulnerable eyes had to be protected from insects and flying grit. The clinic had only iron bars for windows, so the staff had nailed heavy woolen blankets directly into each window frame. Ruit pronounced the solution acceptable, and he and Tabin scrubbed in.
I sat on a boulder in front of the clinic, watching storm clouds gather to the west. From my perch I had a long prospect upriver, and I could see patients being carried toward us, down the winding trail from Ol-angchungola. Many of them were older Walung women, who tended to be broader and heavier than their men, whose work as porters required sinewy strength. I watched the gentle way these slight men lowered their sightless wives and mothers from the baskets on their backs, wrapping them in warm blankets and propping them carefully on benches in the clinic’s courtyard, and I wished Ruit could see the gallantry the men of his village exhibited as they delivered their blind down from the heights of his boyhood home to the hands of its most accomplished son.
The storm hit just after surgery began. It started as rain on the clinic’s corrugated tin roof, then turned to hail, hammering with such force it seemed capable of bringing the ceiling down. I stepped outside, then jumped back in. Hail the size of baseballs was pummeling the landscape, and a small detachment of uniformed policemen who’d been ordered to watch over the surgical camp put their weapons aside, pulled on ponchos, and hefted sheets of corrugated tin from a stack of building materials to form crud
e lean-tos for the patients.
In the operating room, Ruit and Tabin worked quickly, side by side as usual, but had to shout to their nurses over the hammering of the hail to request tools. Satenla sat at a child-sized desk, calmly entering patients’ vital statistics into a laptop, while Khem Gurung and the rest of Ruit’s staff led patients in and out of surgery. The pale yellow phaco machine puttered away on its stand behind Ruit’s head, having proved rugged enough to survive Thapa’s fall in the dry creek bed. The brilliance of Ruit’s system could withstand anything, it seemed. Despite the apocalyptic scene outside, the operating room was running as smoothly as Tilganga’s.
Until thunder cracked so close overhead that I thought the ceiling had caved in. Then the lights went out. When my eyes adjusted, I heard Ruit calling to me over the battering of the hail. He was operating on Chung Lama Sherpa, an eighty-five-year-old woman from Olangchungola who reminded me of Ruit’s mother, Kasang. She wore the same sort of striped pangi, fastened by an identical silver bird-shaped buckle. Ruit had finished pulverizing one of her cataracts with the phaco machine, inserted a lens, and was in the process of widening the wound in her other eye when we lost power. “Phaco is a useful technique. But it doesn’t work without electricity,” Ruit said. “I’m going to switch to manual surgery so this lovely lady doesn’t lose her eye. Can you bring me a torch?”
Tabin, operating manually, soldiered on as if nothing were out of the ordinary, while a nurse held a flashlight over his patient. I felt around in the dark for my pack, found my headlamp, and dialed it up to maximum brightness. “Good luck,” I said to Ruit, holding it as steady as I could over Chung Lama Sherpa’s open eye.
“This is surgery,” Ruit said in a soothing, authoritative voice. “I don’t need luck. Only light.” In the same time it would take him to complete the SICS he had perfected in a fully equipped urban hospital, Ruit delivered the cloudy cataract out with his cannula and slid the new lens Satenla handed him into his patient’s unclouded eye.
A moment later, the hail stopped and the lights flickered on. “That was fun,” Tabin said. “Kind of like climbing a 5.12 route without protection. Did yours go well, Sanduk?”
“Of course,” he said.
I realized that if I ever needed cataract surgery, wherever these two were—a veterinary hospital, a schoolhouse, or a weathered clinic in northeastern Nepal with blankets beating back the hail—was where I’d want to have it.
In Sinwa, we slept in another teahouse. Tourism was just finding its way to this far corner of Nepal; aside from expeditions attempting Kangchenjunga, few foreigners trekked up this unspoiled river. Our proprietor was prepared for a change in fortune. He’d subdivided the entire second floor of his small home into tiny rooms, with walls built of papier-mâché. After innumerable attempts, Tabin was able to reach his wife and rushed out of our room to the hallway. I would have tried to give him privacy, but there was no point, with walls so thin, so I listened to him apologize for his absences, telling Jean how much he missed her, taking Ruit’s lesson of trust to heart.
Tabin crept back through the door and climbed into his sleeping bag. Cutouts in the top of the walls exposed one room to another, so residents of both spaces could share a single fluorescent fixture on the ceiling between them. The switch was on the other side, in Ruit and Satenla’s room, but once I heard the volume of Ruit’s snoring I wasn’t about to ask him to turn out the light. Tabin had pulled a mask over his eyes and was snoring in concert with his colleague, adding a high-pitched harmony to Ruit’s bass rumble.
The walls had been glued together with political posters and lined pages of students’ homework assignments. Above my head, one student had written, in English, “I am found of helping others. I am found of working hard. I am hopeful of becoming doctor.” From a poster by my feet, Prachanda shook his fist at a gathering of rural youths wearing red headbands and expressions of indefatigable optimism. As I drifted off to sleep, serenaded by the two unusual men I’d followed for so long, I wondered if the dreams the poor of Nepal so richly deserved would ever be delivered.
Our last morning in Sinwa, I retaped my ankle and prepared myself for the three-thousand-foot climb to Taplejung; from there, a rented bus would carry us—presuming the way wasn’t blocked by a landslide or bandh—fourteen hours down a newly bulldozed road, to the flatlands of the Terai. Before they inspected the condition of their patients, Ruit and Tabin crammed into their temporary examination room. The family that lived on the rock had walked down for a consultation, minus the old woman. Ruit hunched over the mother and her three children, peering at their stuttering eyes through his ophthalmoscope. His sigh as he looked at each of them told me all I needed to know. He handed the device to Tabin, and Tabin’s groans confirmed the diagnosis. Some conditions were beyond even their power to cure.
Ruit took the mother aside and spoke to her quietly for a long time. Whatever he said made her smile, and her body, which she had held so rigidly upright with anxiety, sagged with relief. “I told her, if she agrees, I’ll send her children to the Jamgon Kongtrul’s orphanage in Kalimpong. They have experience helping children cope with blindness and continue their studies. They’ll be able to train them up and find them a career. As you can see from the lady’s tears, she has agreed.”
For the last time, I watched Ruit and Tabin hunch in front of their postoperative patients. Despite thunder, rain, hail, and electrical failure, all eighty-one men, women, and children could expect to temper whatever hardships their future held with excellent vision.
As I looked at their charts, I saw that many of the patients and their families had made the three-day journey down from Olangchungola. Ruit removed Chung Lama Sherpa’s bandages, unwinding them with the care of an archaeologist until her eyes were revealed. She laughed when she saw Ruit and stuck her tongue out to him respectfully, in the traditional way. “I knew your father,” she said. “And your grandfather the gova. They were both fat, too.”
As she reached out and squeezed his jowls for emphasis, Ruit laughed happily.
I wasn’t surprised by what he said next. In fact, I expected it.
“I’m going up to ’Gola,” Ruit announced to no one in particular, and his voice trembled as he spoke. “I worried that Sat wouldn’t speak to me after I decided. But she agrees. She says we’ve come too close to turn back now. She’s got some iron in her. Not bad for a girl raised in the age of the computer.”
We busied ourselves with a flurry of repacking. Ruit would take Khem Gurung, the Sherpa staff, and four porters. The rest of us would begin the long hike up to Taplejung. Judging from the bulging duffel bag of antibiotics, sutures, plasters, and surgical tools I saw Ruit pack, I knew he wasn’t just going to climb a mountain of memories. For as long as he could remember, Ruit’s mind had raced ten years ahead, toward the obstacles he knew an outsider from these mountains would have to overcome. For once, he was focused entirely on the present, on a single objective at an altitude of ten thousand feet, where he’d be equipped to treat nearly any condition when he reached the village where so many had died from lack of basic medical care.
Tabin had his reeking shoes laced. He strapped his pack over the shoulders of the uniform he would wear, from this point forward, while making his most challenging ascents: blue surgical scrubs. He was eager to go, pacing back and forth in front of the former hospital, now converted back to a clinic. He had to hike three thousand vertical feet up a slippery trail. He had to endure the torturous inertia of fourteen hours on a bus before flying to Kathmandu, where he had scheduled a grudge match with his old nemesis, Krishna Ghale, the tennis pro at the American embassy. The following day he would fly to the other side of the world, give an important speech on a few hours’ sleep to an audience of thousands in Boston, push forward his projects in Africa, help reorganize the U.S. military’s medical outreach, and attempt to spend more meaningful time with his wife and children. He was going to try, as usual, to do everything at once. He certainly was, as he had once said t
o me, someone who could get things done. But he was more than that; he was a genius of achievement.
Before he left, Tabin had to do one more thing. “Get over here, Geoff,” Ruit said, crushing him against his chest. “And give me a bearly hug.”
Then Ruit, with so many gold-colored katas from grateful patients draped around his neck that he looked less like a bear and more like a lion with a silk mane, shook hands all around, before fixing his eyes on the trail that spiraled up toward the snow peaks.
Sonam Ruit had walked his seven-year-old son down this same trail once, to give the boy a chance to make something of himself. If Satenla had decided on a future dedicated to carrying on his work, the least Sanduk Ruit could do was take his daughter back up that path, upriver into their shared past, show her where her family came from, teach her what it meant to be Walung, and prepare her for the challenges that lay ahead on her long climb through life.
“Come, Satenla,” Ruit said, leaning on his trekking pole and limping north up the trail toward Tibet. “We’re going home.”
Sanduk Ruit and Geoffrey Tabin on the third day of the trek to Sinwa. David Oliver Relin, 2010
Patients being prepared for cataract surgery at Rasuwa. David Oliver Relin, 2008
At Sinwa, watching surgery on a monitor outside the makeshift operating theater. David Oliver Relin, 2010
An intraocular lens, about to be inserted in a cataract patient’s eye. Ace Kvale/TandemStock.com, 2009
Patali Nepali seeing for the first time after having her bandages removed. David Oliver Relin, 2008
With Khem Gurung, left, and Ruit looking on in Pakhribas, Devi Rai jumps to her feet and begins to dance after her sight is restored. David Oliver Relin, 2010
Second Suns Page 45