by Ali Gripper
would join his medical caravan. Rex Shore would tease them
by calling them ‘The Princesses’ because they were so pretty, as well as being tonnes of fun. Both are still working by Ruit’s side in the operating theatre. Despite their gentle voices, they run a trim ship.
Dr Reeta Gurung, the current CEO of Tilganga, was also
tapped on the shoulder. Gurung was cut from the same cloth
as Ruit, having grown up in a small rural village with no
school. She had the same focus and determination as Ruit
and forged a reputation as a brilliant surgeon, with a steady, 96
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even temperament that earned her the nickname ‘Cool- hand
Gurung.’
‘I burst into tears when he asked me to join his band of
outlaws,’ she says. ‘There was no doubt in my mind that
I was going to work for him, and it was going to lead to great things. Ruit was working on the new technique and we knew
it would be a breakthrough. Our aim was simple. To avoid
the papers and protocols. To get away from the system and
just go out and do it. That’s what united us all.’
And of course, there was his ever- faithful right- hand man,
Rex Shore.
With the team first assembled, they did the work under-
cover. No fanfare. No permission asked. They just did it. Ruit didn’t even tell Fred Hollows that he’d started doing the new intraocular lens surgery at the camps. ‘Nobody knew about
it,’ Ruit says. ‘I started in a very quiet way. If I’d let people know about it, they would have killed me.’
Meanwhile, Shore would hire any transport he could find
to reach the most underprivileged villages. These were usually battered old buses from India with dodgy engines, worn old
tyres, with a top speed of about 30 kilometres an hour. They
christened one rattling old jeep from Russia ‘Khrushchev’,
and another from China ‘Mao’. At one stage, they hired a
tractor to drive their surgical equipment up to a village at
the top of the mountain.
They’d always start the night before, packing all the
equipment they’d need to set up their makeshift surgeries:
anaesthetics, syringes, green surgical drapes, face masks, caps, rolls of gauze, scalpels, forceps, sutures and medical tape,
and black plastic to line the walls for hygiene. Also, boxes of 97
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donated intraocular lenses, and, if they were lucky, some basic microscopes. If the region they were going to had no electricity, they would bundle a generator onto the bus as well.
The jeep or bus was often so cramped that they had to take
turns riding on the roof. Anyone unlucky enough to be on the
top had to grip the rails as they teetered on the cliff’s edge, just inches away from precipitous drops below. Ruit sat on
the roof a couple of times, but was usually inside, nursing a precious microscope on his lap.
It was a terrifying way to travel, swinging wildly around
hairpin bends with crumbling cliff edges, brightly decorated
buses bearing down on them from the opposite direction with
their musical horns blaring. Both vehicles would come to a
shuddering halt as they negotiated who would go around the
bend first. Often there were no road barriers, and the roads
were scenes of carnage. Buses and trucks that had plummeted
over the edge were a frequent sight.
One tragic night, a bus rolled off a cliff nearby and injured passengers had been brought to a local clinic. Ruit and his
team rushed in to find about 30 people lying quietly in a
room on tables. ‘Many were quiet because they were dead,’
recalls Dick Litwin, the Californian doctor whom Ruit had
befriended years earlier.
Safety improved when they managed to scrounge enough
money to buy an old bus of their own. Shore adapted it by
pulling out the back seats for the equipment.
Ruit and his team relied on word of mouth to notify locals
about the outreach camps. They would let the local police
station, radio station and school know which day they were
arriving. The boy scouts would go door- to- door.
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Ruit’s team would spend the first day setting up a camp,
using anything from local clinics, veterinary clinics, school houses and monasteries as operating theatres. Once or twice
during the Nepalese Civil War between 1996 and 2006, when
a group of rebels known as the Maoists tried to overthrow
the Nepalese monarchy, the team even used rebel army posts.
Once they had established an impromptu theatre, they
would brush out the cobwebs, sweep out the dung and the
straw, tape plastic over the ceiling to prevent any mice or rats in the roof from falling onto the operating table, and tape
up the windows with heavy cloth or newspaper. They would
swab the place down with antiseptic. If there was nothing else available, kitchen tables or school desks were borrowed, and
placed end to end, to use as operating tables.
The recovery rooms were just as rustic. After their opera-
tions, the patients were often laid out on crude beds of straw in barns or cowsheds. At night, the team would sleep in tents, barns, haylofts or as guests with local families.
Ruit started off quietly, doing a handful of intraocular
lens surgeries at each camp. As his confidence grew, he did
more and more, so that eventually almost all the operations
used the new technique. ‘I went very, very slowly, to make
absolutely certain there were no mistakes. The pressure to
succeed was intense. It was like living on a knife’s edge. I had so many critics in the ophthalmic world that I knew I could
not make the tiniest mistake,’ he says. He knew that what he
was doing—providing high- quality, inexpensive eye surgery
in one of the most underprivileged countries in the world—
was a grand experiment. If he could do it in Nepal, it could
be done anywhere.
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The backlog was immense. No one knows why the rate of
cataracts is so high in Nepal. It might have to do with diet
or altitude, or exposure to sunlight. The lack of access to
doctors, clinics and medical help certainly made the problem
worse. As did the prevalent belief that cataracts were an inevitable part of ageing.
‘There is a saying in many of the villages: first your hair
goes white, then your eyes go white, then you die,’ Ruit says.
‘It’s a fatalistic acceptance of blindness that we are still trying to educate a lot of villagers about.’
Ruit rang Hollows after he felt confident with the results
he was getting. He remembers the long pause at the end of
the line as Hollows digested the news. ‘You’re doing IOLs out in the bush, Sanduk? Jesus f- - cking Christ, what about the
f- - king infection rates?’
The truth was, the infection rates were extremely low,
lower than in the hospitals, in fact, even though he didn’t
have surgical gloves and they were operatin
g on dirt floors.
Ruit’s team sterilised every piece of equipment scrupulously, endlessly swabbing them with alcohol or washing them in
steam sterilisers that looked like giant pressure cookers. The highest risk of infection after eye surgery is if the wound or cut in the eye from the surgery is not well constructed and
ends up leaking. If it seals properly and is completely water-tight, as Ruit ensured, then the risk of infection was very low.
Fred and Gabi Hollows were so impressed by Ruit’s results
in the field that they donated a new Toyota LandCruiser,
which Rex named Hilda, after the valiant Nordic Valkyrie.
‘She was a good and faithful vehicle,’ he says. ‘She lived up to her name, battling blindness in the mountains of Nepal.’
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At every camp, usually funded by Ruit’s support groups
in Australia and Nepal, two or three hundred blind people
would make their way to the screening tables for help. Shore, a highly methodical man, was horrified to see the more desperate patients pushing and shoving to get in for surgery. ‘There were hundreds and hundreds of patients, and it was so chaotic.
There was no system about it at all, it was just madness.’
NEPA printed forms for Shore, enabling him to list each
patient’s name, address, as well as their screening and operation results. Everything else was recorded in exercise books.
They worked out a way to explain to the patients what was
going to happen to them—an early form of counselling that
is a mainstream part of hospitals today. After the operations, they would drum into the patients how important follow- up
care was; that they had to take their eye drops, and come
back for a check- up a few weeks later.
There was an incredible energy, gusto and pace to
the camps. Morale was high. It’s easy to understand why
someone from the Walunga tribe would love being outdoors,
up in the foothills or the mountains, with the wind on his
face, and the sun on his back, helping the people who needed
his help the most. It’s where Ruit felt he belonged. Here, he was not seen as an interloper or a troublemaker. Out here
he was mobbed by patients, and sometimes even revered as
a god. Nanda says that today, more than three decades later,
her husband’s idea of a perfect holiday remains ‘somewhere
picturesque in the mountains where he can do 70 cataract
surgeries a day, and for the whole family to come along
with him’.
Over the next ten years, Ruit’s team travelled to every
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corner of Nepal, India, China and Bhutan. They performed
the new intraocular surgery on every person who could make
it to their microsurgical camps, no matter what caste or tribe, no matter how rich or poor. They operated on the Brahmin,
Chetri and Newari people, as well as the Sherpa, Rai, Gurung, Tamang, Limbu, Tharu and Madhesi. They operated on single
mothers, children, grandfathers, farmers, teachers—even,
during the ten- year civil war, on rebel soldiers. They operated on the downtrodden and the deaf, even the untouchables (the
lowest caste in India).
In many remote regions, such as Tibet, Mustang and
Bhutan, the locals often came up to touch Ruit on the arm, or they took his hand and placed it on top of their head as a form of blessing. They’d ask him to bless their children, or request a lock of his hair. They’d prostrate before him on the ground, or stick their tongues out reverentially. (The practice of sticking out one’s tongue began, as legend has it, because an evil king in Tibet had a black tongue; out of respect, the Tibetans often stick out their tongues to show they are not evil.)
They regarded Ruit as a miracle worker because they felt
he had given them their lives back.
There was nothing mystical about the procedure, though.
It was a thoroughly modern one. The real miracle was giving
them the same advantages as anyone else in the world.
~
The work Ruit had committed himself to was physically
exhausting, however. He and his team made house calls that
sometimes involved trudging uphill for days with a portable
surgery strapped to the back of packhorses.
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‘I knew my exit from the eye hospital was like walking on a
sword’s edge. I accepted that challenge. I talked about it with Nanda. For me, it’s just how the world works. When something is a struggle, rather than a smooth ride, it makes you
very strong. I knew the best way was to just go out and do
it, and do everything so well that it proved everyone wrong.
When you have people who are critical of you, it makes you
do things properly. It’s the best kind of challenge. In a way, I was always used to being against the crowd. I knew I had
the strength to face the worst.’
What Ruit wasn’t prepared for was that the criticism would
go on unrelentingly for years, and how it would corrode his
health. Not long after he’d started running the microsurgical camps, a group of senior doctors wrote a letter to the prime
minister, Girija Prasad Koirala, complaining that Ruit had
no right to be doing intraocular lens surgery in the mountain villages without having done a clinical trial. Fortunately, Ruit had been asked to operate on the prime minister’s eye shortly after they sent their letter. As Koirala came into Ruit’s clinic, he said with an amused look on his face, ‘I see your friends
have been complaining about you again, Dr Ruit?’ Nothing
more came of it.
The undermining led to long bouts of insomnia. ‘I’d pace
around the flat, trying to work out a solution, and a long-
term plan,’ recalls Ruit. ‘I knew there were a lot of people
who would criticise and even put me in jail if anything
went wrong.’
His blood pressure soared sky- high under so much stress.
His doctor prescribed anti- hypertensive medication. He was
still smoking and drinking heavily.
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So, who did he lean on in times of adversity? Nanda
remained a bedrock. ‘I simply could not have done what I did
without Nanda behind me. She’s always been there by my
side. There’s nothing quite like that sort of undying support and love; it got me through many tough times.’
He would ring Rex Shore in moments of despair as well.
He would sound exhausted, saying he wasn’t sure if he could
go on for much longer. All Shore could say was that he just
had to keep going, because what he was doing was absolutely
right. (Shore stayed working in Nepal on a modest retainer
for more than 27 years before retiring to Australia. He had
dedicated most of his working life to what he called ‘The
Cause’ and the man he called affectionately ‘Dr Sahib’ or
‘respected doctor’.)
Ruit continued to find great strength from two Buddhist
teachers in particular: the late 3rd Jamgon Kongtrul and
Gyalwang Rinpoche. Both had come into his hospital seeking
<
br /> help for some of their blind monks. Both had arrived quietly, without any fanfare. Both were deeply moved as they watched
him work, and by the compassion he showed the poor. They
invited him to their temples, to give him their blessings and empowerments.
Unlike his father, Ruit did not do formal practice by sitting at a shrine, or saying mantras and prayers with his wooden
prayer beads. His approach was more one of integrating
one of the central Buddhist principles—being of benefit to
others—into his everyday life. Ever since his sister Yangla
had died, Ruit had been determined to make a difference in
the world. Bringing high- quality medicine to the people who
needed him the most was his way of doing that.
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For Ruit, the best part of the trips was coming home. Right
from the start, he was determined to balance his professional and personal life by spending quality time with his family.
Ruit’s family were still living in their cramped apartment
under his father’s home near the Bagmati River. The living
room was 3 x 4 metres, and next to it was a bedroom with two
beds; one for Nanda and Ruit, and another for the children.
In 1991, two years after Sagar was born, Nanda gave birth
to a girl, whom they called Serabla, or ‘Sera’ for short. They were overjoyed with their good fortune. Five years later they had another daughter, Satenla. They were to live in that small space for almost 20 years, so that Ruit could save his money
for the outreach camps.
Ruit used a small alcove off the main room as his study,
just large enough for a small desk, a small television, and all his medical textbooks. Upstairs was a kitchen they shared
with Ruit’s parents, and the bathroom was outside. The
concrete balcony overlooked a petrol station and the stench
from the pollution from the river was often so unbearable in
the late evenings that they had to shut the windows, making
it swelteringly hot and dark.
‘It was already a small place, but, as the children grew up,
space got very tight and it started to feel more like a store-room than an apartment. We were really feeling a bit pressed
in,’ Ruit admits.
By the mid ’90s, when the camps were in full swing, Sagar
had grown into a curious five- year- old, eager to explore the world. He was the apple of his mother’s eye. Three- year- old Serabla charmed them as she pranced about the house, telling