The Barefoot Surgeon

by Ali Gripper

  almost as if he had entered another world. The Dalai Lama’s

  touch was like receiving an electric current or volt. It was

  as if his batteries had been being completely recharged. His

  Holiness remains a steadfast supporter. Since that initial

  blessing, the Tibetan Buddhist leader has continued to

  endorse the eye doctor’s work, and to offer his assistance in any way he can, particularly with his outreach camps and

  his work in Tibet. ‘Dr Sanduk Ruit is a man from a humble

  background who has made the most of opportunities offered

  to him and dedicated his life to the well-being of others,’ the Fourteenth Dalai Lama says. ‘His life and work embody real

  altruism in action . . . Dr Ruit is driven by the conviction that everyone with treatable blindness has a right to have their

  eyesight restored, and that problems and solutions transcend

  geographical boundaries.’ As for Ruit, he continues to regard Tenzin Gyatso’s blessing as a form of empowerment, vastly

  increasing his capacity to help others through his work.

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  Farewell to a friend

  Business was almost non- existent for the few years of Ruit’s small private practice in New Road. Hardly anyone sought

  him out. He didn’t even have his name on the door.

  ‘I used to call it “catching flies”, sitting there in the evening, doing nothing, just waiting for patients to turn up,’ he says.

  But by the late 1980s, Ruit’s reputation had grown so

  much that there was a long waiting list to see him. Patients

  travelled long distances to go under his knife.

  The French Buddhist monk and writer Matthieu Ricard,

  who had been bringing monks to him for treatment, was so

  impressed by Ruit’s surgical skills that he arranged for his

  93- year- old mother to fly into Kathmandu. ‘Everyone said,

  “Are you crazy? You want your mother to be operated on in

  Nepal?” But I already regarded him as the greatest artist in the world when it comes to operating on cataracts, so I told my

  mother I would definitely prefer [she have it done] in Kath-

  mandu rather than in Paris,’ Ricard says. ‘When we got back

  to France, her doctor said, “Wow, this is impeccable work!”’

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  When Swiss- French public health expert Dr Nicole Grasset,

  known as ‘Mother Teresa in a Dior dress’, needed cataract

  surgery, she refused to see any other surgeon than Ruit. She

  flew all the way to Kathmandu from Geneva for Ruit’s finesse.

  But, just as Ruit’s career was about to take off, his world

  came crashing down around him. In 1992, he learnt the devas-

  tating news that Fred Hollows had terminal cancer. Ruit was at an eye camp at Nuwakot, a picturesque village about an hour

  north of Kathmandu. Film maker Catherine Marciniak took

  him to one side as the team sat around the fire one evening,

  enjoying a drink. She pulled her chair up close. ‘Dr Ruit, I’m sorry to tell you this, but Fred has been diagnosed with cancer.’

  Ruit sat there in stunned silence. Hollows had been having

  treatment on his kidney when his surgeon discovered he

  had cancer that would probably spread quickly to his lungs.

  There was nothing really that could be done to control it.

  Each word felt like a physical blow to Ruit’s chest.

  His mind was reeling. Hollows was only 62. He had

  smoked all his life. But why did he have to go now? They

  had so many plans: building an intraocular lens factory, and

  a new hospital, for a start. They had such a long way to go

  together.

  ‘He and Gabi were my surrogate family. I felt I wouldn’t

  be able to continue on with my work if Fred was not there.

  I wasn’t sure how I could go on. My sister Yangla had died

  far too young—that was devastating—but the news that Fred

  was dying too now came as such a terrible shock. I was devas-

  tated in an entirely new way.’

  Ruit rang Gabi when he got back to Kathmandu, deeply

  concerned about her.

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  ‘I knew she wasn’t working and the children were still so

  little and needed her so much.’

  Hollows had been Ruit’s mentor, teacher, champion and

  brother.

  Over the years Ruit had tried to emulate Hollows, by

  learning to speak up about the things that mattered, having

  more confidence in himself, and, most importantly, inspiring

  confidence in others.

  ‘Fred had an incredible charisma, and a capacity to inspire

  others with a desire to help carry out his dream,’ says Ruit.

  ‘He was very direct. He would say, “If you don’t do it this

  way, I’ll kick your arse,” but he was usually right. He was

  such a deep thinker on all sorts of issues, especially anything to do with public health.’

  What Hollows taught Ruit was that it was possible to do something in public health that made a difference. He had

  drummed into his protégé that countries in the developing

  world like Nepal had to learn to do things themselves with

  the money they received in overseas aid, rather than rely on

  fly- in, fly- out foreign expertise. Hollows was always outraged that so much of Nepal’s foreign aid money went back to the

  First World in the pockets of Western doctors. He scornfully

  called these doctors ‘medical tourists’.

  ‘All they want to do is a bit of work at the hospital before

  they go on their holiday trek in the mountains. What long-

  term good does that do?’ Hollows would bark furiously.

  Nepal had to learn to stand on its own two feet. What the

  West should be doing instead, he said, was to ‘Give them a

  fishing rod, teach them how to fish, and then piss off.’ What he meant by that was that he and Ruit needed to set up

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  hospitals and train as many local doctors as they could, so

  that they could continue his work—long after their biological lives had ended.

  Ruit and Hollows saw each other twice before his death. The

  first time they travelled to a surgical camp in south- west Nepal after Hollows’ kidney was removed. He had to be propped up

  with pillows in the four- wheel drive during the long, bumpy

  road up out of Kathmandu Valley. The last time they saw one

  another was in Hanoi, Vietnam. Hollows had promised the

  government of Vietnam he would teach intraocular lens surgery there, even if it meant taking an oxygen mask with him.

  In June 1992, after a seven- hour operation, Hollows pulled

  the tracheotomy tube from his neck, bandaged the wound,

  and discharged himself from hospital. A week later he met

  Ruit in Vietnam.

  Using the most basic equipment, the pair held an eye surgery

  workshop in Hanoi’s old communist hospital. Hollows was

  too sick to operate, so Ruit did the bulk of the 107 procedures, and Hollows oversaw the 60- odd operations undertaken by

  Vietnamese trainees. He
stood behind the doctors saying,

  ‘Do it this way’ or ‘Do it that way.’

  He tired easily and used his oxygen mask a lot. ‘I was

  really shocked when I saw him,’ Ruit says. ‘He’d lost so much weight and he was really struggling, he was trying to speak

  through his tube, but he couldn’t speak properly. It was just so sad to watch someone who had been so robust needing all

  these devices to stay alive.’

  Within days, the pair had shown the trainees how to

  perform the fast, affordable, delicate new technique Ruit had perfected.

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  ‘I think they felt more confident because I was someone

  they could relate to,’ says Ruit. ‘They had a notion in their head that this is a surgery only a white person could teach.

  It was unthinkable at the time, but, there I was, this misfit from Asia, doing the operations in seven minutes rather than

  45 minutes as the French had been doing. And showing them

  that they could do it too.’

  The results the next day, when the first batch of patients had their bandages unwound, left the young Vietnamese surgeons

  thunderstruck. ‘When they saw the first ten or so patients

  seeing so well again, they could hardly believe it. From that moment on, the ball was in our court. They were in awe.’

  That initial training program went on to revolutionise eye

  care in the country, making Vietnam a world leader in the fight against avoidable blindness. In 1992, a mere 1000 modern

  cataract operations were done; today, more than 200,000 are

  performed each year.

  One of the patients Hollows and Ruit operated on that

  year was Tran van Giap, a nine- year- old who went blind in

  his right eye after a piece of glass accidentally lodged in his cornea while he was playing with glass tubes.

  Giap was the youngest and brightest of six children and

  on the threshold of starting school. It was a cruel blow for

  his whole family. His father, Tran Duc, made the expensive

  trip to Hanoi, 170 kilometres away, seeking treatment for his son. They waited for about three weeks, only to be told there was nothing that could be done. They were just about to turn

  around and go back home to their village when Hollows and

  Ruit turned up.

  Listening to music and humming a little as he operated,

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  Ruit worked on the youngster the next day. Hollows and

  Ruit changed his life. Instead of having to stay at home to

  help his mother in the garden or his father in the rice field, Tran van Giap was able to go to school, study and enjoy

  a career as a high school teacher. A photograph taken by

  Michael Amendolia of Hollows examining Giap’s eyes in

  Vietnam has turned Giap into something of a poster boy for

  The Fred Hollows Foundation; he is living proof that restor-

  ing sight changes lives. (The photograph, used during several promotional campaigns, has since raised millions of dollars

  for the Foundation.)

  Hollows was just skin and bone and using his oxygen

  mask a lot when Ruit talked to him for the last time in Hanoi.

  ‘I said, “Fred, how are you feeling?” and he said, “Sanduk,

  you know my days are numbered.”’

  Hollows gave his friend a big bear hug and said, ‘I reckon

  we’re going to have difficulty seeing each other again, mate.

  They’re going to do some more treatment on my lungs, but

  I don’t think I’m going to get any better. You just keep your work up. What you’re doing is great. Keep going.’

  For a while, after Fred died in February 1993, Ruit was

  plunged into a deep melancholy, as he had been after Yangla’s death. He was bereft without his friend. He found it hard to

  accept that Hollows was gone for good, and that he somehow

  had to carry on without him. He was dumbfounded that this

  man who had lived so passionately, who had such a huge

  vision, and who had achieved so much, was no longer in

  his life.

  He knew Gabi would support him, but also that she could

  not do what Fred could. He rang Gabi, who told him to keep

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  going, because that’s what Fred would have wanted him to

  do. He talked to Nanda, and confessed to Rex Shore how

  lacking in confidence he felt. Rex said the same thing as Gabi: just keep going, even if Fred’s not here. Do it for his sake. And that’s exactly what Ruit did.

  Ruit had a great vision for what he wanted to do. He had

  the surgical skills, but, for a long time, he needed Western

  help—mainly equipment and funding—to achieve his vision.

  Ruit firmly believes that without Fred and Gabi, he would

  not have gone on to carry out his lofty goal. Part of Fred

  Hollows’ spirit has stayed with him, propelling him onwards,

  Ruit says. His friend is still watching over him.

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  The best of my love

  After their operations, Ruit’s patients enter a thrilling new world in which everything is bright and well- defined. Faces, trees, food—everything about them looks fresh. Sometimes

  seeing the world again can come as a shock, too. Some patients are saddened by how old their relatives look, or how humble

  their homes are. One Laotian single mother was horrified

  when she returned home after sight- restoring surgery to see

  the dilapidated hut she had been sharing with her children.

  She’d been unaware that their home was little more than a

  bamboo shack that was in danger of being swept into the

  river whenever it rained.

  But usually new vision is a cause of relief, and great jubilation. One of the most dramatic physical transformations Ruit

  ever witnessed was that of a homeless old woman brought

  into their annual clinic held at Kalimpong, northern India.

  The woman looked like she’d just been dragged out of the

  gutter. Her face was battered, her skin was shrivelled, she was stooped over, and her few clothes were almost in tatters. Her 147

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  gnarled, rickety legs and worn feet were almost blackened

  with dirt and she smelled as if she hadn’t washed for about a year. ‘The people who brought her in told us she would sit in the corner of a lane and wouldn’t eat for days,’ Ruit says. ‘She slept in the corner on a sack and was half demented. Sometimes she would hit the wall and shout. She had no family or

  friends to speak of.’

  Ruit usually only does one cataract at a time, with several

  weeks in between. But this woman was so unbalanced he

  doubted she would come back for the second one, so he did

  both the same day. The nurses showed her the tap and gave

  her a towel and some soap, so she could wash her face and

  hands, then gave her something to eat and drink. The day

  after her operation, they gave her some new clothes: a sari,

  a pair of sandals, and a white cardigan. She couldn’t st
op

  crying when she saw them laid out neatly in front of her. Were they really for her?

  She asked for a few rupees to buy a small plastic comb.

  Someone brought her a mirror, and the first thing she did was arrange her hair into a bun. She had been miserable for so

  long that she’d forgotten how to smile. She had to practise

  pulling the muscles on either side of her face upwards in front of the mirror. Soon after, she took up a loan to set up a small grocery store.

  When Ruit returned to the same eye camp a year later, he

  noticed a new grocery shop that had been set up nearby and

  sent a boy over to buy sweets for the youngest patients.

  The owner wore a soft pink sari, pretty earrings, and her

  dark hair was swept elegantly off her face. Someone asked

  Ruit if he remembered her.

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  He was perplexed. Had she been a school teacher to one

  of his children? A nurse at his hospital? Eventually, the boy said, ‘Don’t you remember? You operated on her last year

  at the eye camp.’ They used to call her ‘The mad woman of

  Kalimpong’.

  ‘I couldn’t get over the change in her, she was like a new

  woman. Work doesn’t get much more satisfying than that,

  does it, when you can do that for a person,’ Ruit says.

  At another of Ruit’s camps, a seventeen- year- old boy was

  brought in by his mother. He was so hunched over, so curled

  up in himself that Ruit’s team thought he was either physically or mentally disabled. His mother said he had been so bright,

  and wanted to be a teacher or a doctor, but that he’d had to

  leave school because he couldn’t see the blackboard. The boy

  had railed against his fate, kicking the walls inside their stone hut. His mother despaired of him. Rather than being able to

  watch him grow into a young man who could go to school and

  make his way in the world, he had become just another mouth

  to feed. Ruit operated on both his eyes for cataracts.

  When his eye patches were unwound, the boy had uncurled

  from his foetal position and stood up straight. He came out

  of his shell, he started talking and exploring his surround-

  ings, he scrambled to the top of a pile of rocks to take in the view. His mother just couldn’t stop smiling. At last, her son had a chance of going to school and making something of his