by Ali Gripper
at its ornate domes in the late afternoon light never failed
to soothe him, and he would walk back to his studies with
renewed vigour.
Besides, soon after arriving, Ruit gained something more
important than popularity: his peers’ grudging respect for
his work ethic, particularly his ability to study through the night. Some of the students became resentful of his academic
prowess.
Like most of the first- year students, he had any squeamish-
ness knocked out of him by learning how to dissect a cadaver.
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‘My God, the smell!’ he says, recalling the overpowering
smell of formaldehyde as he walked into the dissection room.
Four students were assigned to each body. He remem-
bers the way the room spun about him; and that he had to
hold onto a bench to stop himself from passing out when he
approached the body he’d been assigned to. Ruit’s task was
to dissect the thorax, the flesh at the front of the chest, which seemed to be still pulsing with blood and nerves. His hands
trembled when he picked up the knife and gingerly poked
at the flesh. He couldn’t stop thinking about the man lying
before him on the cold steel table. How many children did
he have? Who had loved him and who had he loved? How
had he died? He was shrunken and dark, and Ruit guessed he
might have been a rickshaw driver. He had to take a shower
after each session to wash off his revulsion.
But within weeks, ‘surgery on dead people’, as he called
it, became a routine part of the week. He had become desen-
sitised to the process. After a while, it didn’t feel like he was cutting into a person. It was simply a piece of flesh on
which he needed to learn how to skilfully wield his surgeon’s knife. The same process happened with the skeleton in a box
assigned to each new student that they were expected to keep
in their hostel room. The first night, his skeleton kept him
awake for hours; at 3 a.m. he admitted defeat, got up, pushed the box outside his door and went back to bed. The next
week he brought the box back in. ‘By the end of the semester, I was stashing peanuts in the eye sockets.’
One thing was patently clear: the boy from the backblocks
had an uncanny gift for surgery. One of his first examinations involved being able to dissect one of the walls of a pelvic
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cavity within 45 minutes. He had to identify and display all
the parts immaculately as he went along, painting the arteries red, and the veins blue. He was working away furiously,
completely absorbed in the task, and when he looked up he
realised he’d beaten everyone else by almost ten minutes,
without making one mistake. He had won the university’s
gold medal for dissection. It was the first time in his life he had truly excelled at something. It was one of the happiest
days of his university life.
After that, he blazed his way through his medical degree. He
stayed up late, night after night studying, memorising the textbooks. ‘There were many dawns when I woke up and found
I’d fallen asleep over my textbook. My desk was my bed.’
It was a period of great intellectual curiosity. He was
enthralled by the mechanics of anatomy, as his understanding
deepened of the genius of the human body. ‘Once you see
how it works, you begin to have enormous respect for the
delicacy and strength of human tissue.’
The lectures were in English and Ruit was now much more
proficient, thanks to his voracious appetite for Reader’s Digest, and any other English magazines he could get his hands on,
and an eight- month stint at the reception desk of Hotel Annapurna, a large, four- star tourist hotel in Kathmandu before he went to university.
He began as a bell boy at the hotel. Within a month, his
vocabulary had expanded rapidly, alongside his ability to
converse with foreigners from every level of society. His work ethic and impeccable manners were noticed by management,
and he was asked to work at the front desk of the foyer. ‘It
was the very best way to learn English,’ he says. ‘I knew
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instinctively I would need to be fluent, and the hotel was
jostling with foreigners—British, American, Canadian—all
expecting excellent service. My job was to speak to them
and make them feel at ease. I started with basic phrases like
“Have a nice day” and “Where are you from?” and “Can
I do anything to help?” I enjoyed learning to understand all
the different accents, and the different characteristics, too.
The British were so systematic and softly spoken and had
such style, and the Americans were so outgoing and enthu-
siastic. I admired all of them, I sort of had stars in my eyes.
I would try to emulate them when I spoke English.’
The graduation ceremony for Sanduk’s medical degree in
1978, in the great hall of King George’s, was a momentous
day for his peers. Sanduk joined them as they filed up one by one to the stage to collect their medical degree in their traditional academic robes and caps. For him, though, it was just
an ordinary day. He knew the 1000- kilometre trip to witness
the ceremony would have been out of the question for his
parents. ‘Everyone else’s family came except mine. I wasn’t
sad. I was expecting it.’
His years at boarding school had made him stoic.
‘I’d become completely used to the fact that I had no family
nearby. They lived too far away to be there, and it would have involved taking too much time out of my dad’s trading schedule,’
he says. Still, the importance of his degree, and his graduation day, did not escape him. The death of Yangla, Chundak and
his older brother had brought about a clear- sighted vision that being a doctor was what he was put here on earth to do. To
realise he had a physical gift as a surgeon was thrilling.
~
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There were few accolades at Ruit’s first job as a junior medical officer at Bir Hospital, the general hospital in Kathmandu.
He started on the bottom rung, and was rotated from one
chaotic department to another every couple of months. They
were long days, and the work was tough. In the operating
theatre, his role was to hold the retractors, the metal instruments used to separate the edges of the surgeon’s incisions. If he didn’t hold them properly, the senior doctors would slap
his hand, or yell at him.
But it was a prestigious position for a boy from a remote
mountain village. It was almost unheard of at the time for
someone with no connections, from the Walunga tribe, to
be working as a doctor in Nepal’s busiest hospital. Sanduk
rented a tiny apartment, and fuelled up for his long shifts in the hospital at the small cafe across the road every morning
with a plate of fried rice and a cup of tea. He missed his fam
ily acutely—they were still in Hille, more than 400 kilometres
away, a journey that took days by bus on the serpentine,
mountainous roads. But his head was held high as he walked
to work every morning as a fully- fledged doctor. ‘I had an
extreme sense of accomplishment when I first arrived at
Kathmandu as a doctor. I really felt like I was on top of the world. There was even a slight sense of “Look at me now!”,
you know?’ His father Sonam finally stopped cajoling him to
join the family business. He began acknowledging his son’s
medical career was a rather fine thing, a feather in the cap, in fact, for the Ruit family.
Within months, Ruit’s talents as a doctor began to shine. He
was sent back to several rural villages, including his boyhood village, Walung, as the doctor for a government team surveying 49
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the border of Nepal and China. He saved several lives including a four- year- old boy who was close to death with gastroenteritis. The revival of the boy created a sensation in the village.
Sanduk was flooded with a sense of elation.
‘It felt so good, just so good, to come back to this place
where I was born. This was where I had lost my elder brother, and here I was back again, saving a life. I remembered the
strong grip of my sister. I remember feeling her presence
very strongly and thinking, Yes, Yangla, you’re right, this really is what I was meant to be doing.’
Working on the survey forced him to become painfully
aware of the chronic need of medical care in Nepal’s rural
villages. ‘I was able to look very closely at the ways of life of people. I saw the neglect, the poverty, how downtrodden they
were.’ He knew he would never be able to turn away from
the suffering.
Ruit’s watershed moment happened when he was asked to
join the ophthalmology department, and he went with them
on one of their outreach surgical camps.
In Nepal, like other developing countries, many people
in remote or rural areas were simply unable to travel to
city hospitals or clinics to have their eyes fixed. Often, they couldn’t afford the bus fare, or were unable to take a week
or two away from work. They were mainly farmers scratch-
ing out a living on the terraced hills and mountains. Unable
to afford cars or motorbikes, they walked everywhere. They
often went without basic necessities, such as paracetamol,
antibiotics and soap.
So, the ophthalmology department would go out to them
instead, packing up a small travelling surgery into a bus or a 50
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truck, and after travelling several hundred kilometres would
set up a makeshift field hospital wherever they could—an old
schoolroom, a clinic or monastery.
For Ruit, it was to be a week in which he felt as if he observed medical miracles. More than 300 blind people shuffled down
mountain trails to the clinic in the foothills of the Annapurna range, holding onto the back of a relative’s shirt tail, or holding their hand. They jostled to get to the screening table, clamouring for the chance for an operation and to see their loved ones again.
In 1980, a survey on blindness in the country had shown
that 0.8 per cent of the population in Nepal were blind—not
just visually impaired, but completely blind. That’s about half a million people. What staggered Ruit was that 4 per cent of
those cases had been caused by botched cataract surgery.
The cataracts in their eyes had paralysed them. The unlucky
hand that fate had dealt them was to stay at home, often on
their bed, totally dependent on their family. Because every
family member contributes to the household’s welfare in Nepal, blindness is a cruel blow.
The blind have to rely on another family member—usually
the youngest daughter—to cook for them, dress them, lead
them out into the sunshine for a walk, and take them to the
toilet. Their carer usually had to leave school or work. So,
one blind person removed two people from being involved
in their community. They were treated with as much care as
their family could give—but sometimes, some of them were
treated worse than animals. ‘I saw some cases that really
shocked me,’ Ruit says.
Often, the blind were malnourished, and the social isolation
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and lack of exercise made them susceptible to diseases, as
well as depression.
‘It’s been proved several times that the life expectancy of
people who are blind is shortened by at least 20 per cent, often more,’ Ruit explains. ‘The lack of authority in the family,
and the loneliness, also makes it worse. Blind children in the developing world have a life expectancy of about five years.’
Some of them had walked for days to get to the camp;
many had been lugged down along the mountain paths in
basket taxis or carried in relative’s arms or supported by them.
It was here that Ruit first did eye surgery, under the gaze
of a senior surgeon. ‘It was very difficult. I was very clumsy.
I must admit I found it nice to watch but difficult to do. We worked like crazy, operating on more than 90 patients, finishing late in the night.’
Over the next few days, he helped unwrap many of their
bandages and fitted patients with thick glasses, and got his
first taste of the magic of restoring sight.
‘Watching a blind person see again, become part of the
visual world again, was so deeply moving,’ he says. ‘I’ll
never forget a family of five who were all blind, and as we
watched them make their way back home, this time on their
own, I realised that when you give people in these places
their sight back, you give them their very life back. The eye is such a small organ, but it plays such an important role in a person’s life.’
Ruit had found his mission in life. When he heard that the
World Health Organization was offering a scholarship for an
ophthalmic postgraduate degree in India, he used every ounce
of his determination to win it.
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He sailed his way through the examination. Armed with
a recommendation from Dr Ram Pokhrel, the head of the
Nepal Eye Hospital, and a senior director at the World Health Organization, the scholarship was his. The normally bolted
door into the elite world of ophthalmology was opened for
the talented young doctor from the border of Tibet.
What his medical colleagues might not have been aware
of was that just as his career was beginning to take flight,
Ruit was nursing a private heartache.
After living so far away in northern India for six years,
Ruit was looking forward to seeing more of his family.
Instead, he was shocked to discover a dramatic change in his
younger brother, Ladenla.
Ladenla, as bright as his elder brother, brimming with
potential, was dispatched to a prestigious boarding school
&nb
sp; in Darjeeling. But away from home, he’d fallen in with the
wrong crowd and had become addicted to hard drugs.
Like the rest of the family, Ruit desperately wanted his
brother to have self- respect, to be responsible, and to uphold the family name. They could only watch helplessly on the
sidelines as he changed into someone who was tired and
unreliable, and unable to hold down a regular job.
Ladenla stayed in Ruit’s tiny Kathmandu flat for weeks at
a time, and sometimes with his friends. For Ruit, it was like living with a complete stranger.
‘My head was spinning. We loved him so much, but none
of us knew what to do, how to help him.’
It was a painful time for the whole family, who did everything they could to help him overcome his addiction. They took him
first to the doctor, then a rehabilitation centre in Kathmandu.
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As the elder brother, and the doctor in the family, the
responsibility fell heavily on Ruit to steer his brother back on track. But for the time being, he had to try and keep tabs
on his brother from afar.
He was bound for the All India Institute of Medical Science
(AIIMS) in New Delhi, India.
With its cutting- edge technology, extensive research library and public hospital that treated millions of people a year for a low cost, AIIMS was the Holy Grail for medical students.
By 1980, the year Ruit began, it was as competitive to get
into as Yale or Harvard in the United States. Every year, more than 75,000 students compete for its 70 positions. Deepak
Chopra is one of its most famous graduates. During the first
few weeks of Ruit’s scholarship, it all seemed too good to
be true. ‘I walked around the campus pinching myself. I’d earned a place here? I was a little incredulous,’ he says.
What Ruit probably didn’t realise was how much time he
would spend with monkeys during his ophthalmology degree
in Delhi. As well as seeing 30 or 40 patients a day, and giving tutorial presentations, he wrote a thesis examining whether
tuberculosis caused blindness in monkeys. He needed to
find out whether the disease swelled the macula, the small
area of the retina that humans rely on for reading, writing
and seeing colour. About twenty rhesus monkeys were kept
in cages on the top floor. As Ruit walked up the last steps
and approached the door, he could hear them chattering and