The Barefoot Surgeon
Page 17
thousands of tuktuks, motorbikes and trucks clogging the streets starts to choke the city as the monsoon season approaches. But 7 June 1994, the day the Tilganga Eye Centre opened, dawned
gloriously clear and bright. The temperature was 24 degrees and, in the distance, you could see the snow peaks of the Himalayas.
Inside the hospital, Ruit was pacing the plain brick corri-
dors, fraught with nerves.
Hundreds of people had gathered outside the hospital
to watch King Birendra of Nepal (who reigned from 1972 to
2001) and Prime Minister Koirala turn up. The two were arch
enemies, and this was the first time they had ever appeared
in public together. Early that morning, workmen at Tilganga
had knocked down a three- metre- high brick wall in front of
the hospital they had only built the previous day. Ruit and his team suddenly realised that so many people were coming that
they would need extra room for a big marquee for the guests.
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Ruit’s nerves were quavering at the thought of the daunting
task before him: performing live surgery in front of the huge crowd. The display, which magnifies a surgeon’s microscopic
moves on a giant screen outside the operating theatre, is
regarded by eye doctors as the Olympics of eye surgery.
‘It’s very scary,’ says Ruit. Even those at the top of their
game avoid it if they can.
Australian ophthalmologist David Moran, who was at
the opening day on behalf of The Fred Hollows Foundation,
describes it this way: ‘When you’re doing live surgery, every shake, every wobble shows, and woe betide if you screw up.
Eye surgery is a craft which imposes a brutal honesty on its
practitioners. Nothing can be hidden. It becomes obvious for
everyone to see, as quick as a flash, and all in real time, if you’ve made a mistake. You have to have nerves of steel and
a very healthy ego to be able to do it.’
Ruit tried to have a good sleep the night before his ordeal,
and a light breakfast—fried rice, an egg on toast and a cup of tea. Coffee was out of the question.
The fact he had to perform on opening day, in front of
everyone he knew in Kathmandu, including every one of the
city’s dignitaries, made the pressure excruciating. ‘It really felt like the eyes of the world were upon me,’ he says.
Ruit felt as if his whole life—all the late- night study at medical school, breaking away from the Nepal Eye Hospital, crossing
rivers and climbing mountains to reach remote eye camps—had
been a long, arduous preparation for this one day. He was as
keyed up as a musician about to give the performance of his life.
The hospital staff were on edge, from weeks of frenetic
activity making sure everything in the hospital was running
perfectly. No one had got enough sleep. Even Gurung, Ruit’s
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second- in- command, known as ‘Cool- hand Gurung’ for her
toughness under pressure, was shaking like a leaf. Although
Nepal was a democracy, the royal family were still as revered as deities. For the king to come and open the hospital meant
a great deal to them.
By 9 a.m., every handrail, piece of machinery and doorknob
had been polished until it shone. The foyer was fragrant with marigold flowers. The place started filling up with hundreds
of visitors, as well as television cameras, newspaper reporters, and all the dignitaries of Kathmandu in their finest clothes.
Nanda and Sonam watched on with a mixture of pride and
terror. The head eye surgeon of Bhutan, Dr Kunzang Getshen,
wore the full traditional costume: a knee- length robe, complete with belt and dagger.
Today, the reception area of Tilganga is teeming with
people in need of help, crammed in together, standing cheek
by jowl, as they make appointments, clutching their paper-
work. But the day the Tilganga Eye Centre opened, Ruit and
his team were so worried they would not attract patients that they posted staff on the nearby roads advertising ‘free cups of tea with free eye surgery’.
‘It’s hard to imagine now, isn’t it?’ Ruit asks.
Every twenty minutes or so, there was an update from the
Narayanhiti Palace about when the king would be arriving.
‘He’ll be here in one hour!’ his assistant would announce; ‘He’ll be here in fifteen minutes!’ Finally, the king arrived, in a swirl of dust in his black Mercedes. He was driving himself, and so quickly that his police escort had trouble keeping up. Gabi
Hollows greeted him, looking proud and serene, along with
Fred Hollows’ two brothers Monty and John.
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Dr Getshen presented a traditional silk scarf to the king as
a sign of respect.
The late Australian author Bob Ellis reported on the
opening for Good Weekend, his senses reeling as he rode in a tuktuk to the hospital: ‘After 20 minutes of bone shaking
and beeping, risk to life and limb, we arrived. There was a
dirty bridge, a filthy river, two burning corpses, a number
of golden splashing children, a temple carved with penises,
a monk on a hunger strike and 20 hectares of marijuana
growing as untended and unremarked as paspalum. Before
the factory, a brick wall was being pulled down by the same
Nepali workmen who had built it the day before. All of Asia,
I decided, in 300 metres . . .’
Inside, Ellis noted the hospital was ‘crammed with elderly
blind, silent people who looked like Bible illustrations, often two together, man and wife, sometimes lying stoic on a single stretcher, holding hands.’
Ruit got to work, tackling his usual assembly line of oper-
ations, about one every seven minutes. He was absorbed in
removing a particularly stubborn cataract in a female patient when the strangest thing happened.
It had been sixteen months since Hollows had passed away,
but Ruit suddenly had a strong sense of his friend being there in the room, watching over him. It was at once spine- tingling and completely reassuring.
‘It was as if he was just another one of the surgeons in the
room. It felt like he was standing there behind me, staring at me over his mask with his hands on his hips, just as he used to.
And he was saying in his grudgingly approving way, “That’s
it, Sanduk, you’ve got it. That’s very good.” In a way, it made 164
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total sense. I knew that he would have been so glad to see the way it came together. I was almost in tears when I finished my last patient that day,’ says Ruit.
‘It still makes me very emotional remembering that moment.
After I’d finished all my operations for the day, Gabi, being the sweetheart she is, gave me the hugest hug. I think she’d
felt Fred’s presence very strongly too, and she knew how
monumental this day was for me. The Nepalese don’t really
have a culture of hugging, but this was the warmest, most
beautiful hug I could ever remember. It contained so many
complex emotions. Sadness t
hat Fred wasn’t here to see it.
Joy that it had opened. Relief that the big day was over. Pride in what we had achieved.’
The emotions of the opening day left indelible memories
for David Moran, too. ‘Ruit would have really been under
the gun. He looked absolutely terrified. But like most top
surgeons he would have performed the public surgery bril-
liantly no matter what was happening, whether there was an
earthquake or if he was operating on the king—or both at the
same time.
‘The opening of the hospital was an extraordinary day.
Ruit and his team had surmounted so many obstacles to
make it happen, and he’d tackled them all. It was a day of
frenetic activity and a sense of mission in the fullest sense.
You don’t get progress of such radical nature and rapidity
without conflict. But beyond that there was a sense of every-
thing being suffused with joy.’
Despite all the naysayers, all the people who said he was
crazy, and that it couldn’t be done, Ruit had done it. Just
eighteen months previously, The Fred Hollows Foundation,
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set up the year Hollows died, had assessed the feasibility of building the hospital and had been sceptical that it could be done. But once it saw that the factory was going to start manufacturing 50,000 world- class lenses a year, and a squadron of surgeons was going to be needed to put them in, they had
come on board. They raised more than $10 million for the
lens laboratory, which has gone on to become the hospital’s
beating heart.
The Tilganga Eye Centre was open for business. Most of
the staff went out to celebrate that night, but Ruit was spent.
He couldn’t wait to go home to be with his family.
~
The Nepalese calendar is a swirling profusion of religious
holidays. Daishan, a fifteen- day- long festival in either late September or early October, is set aside specifically for family feasts during which women wear tikkas on their forehead (a mark made with vermilion powder). A month later, Deep-awali sees fairy lights strung up over the city’s temples and courtyards. Bright orange marigold flowers are festooned
over cows, dogs and buses, and, night after night, family
gatherings and parties linger into the wee hours.
During such festivities, Ruit would always make sure
he and Nanda seized the chance to go on a small trek with
their family in the foothills of the Himalayas. It was always a physical relief to climb out of the valley in a four- wheel drive, away from the hospital, and set off in his walking
boots, comfortable clothes, a small backpack and his cloth
cap, through the pine forests and scenic trails, and take in
great lungfuls of mountain air.
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Ruit is never as happy as when he’s trudging uphill,
giving his huge heart and lungs a workout, gazing out at
the white peaks, or out over the great terraced valleys of the region, slowing down only to wait for everyone at the next
teahouse.
Like his own father, Ruit has an abiding love of nature and
the rugged beauty of Nepal. Taking in a view of Kanchen-
junga, his home mountain, always soothes his frayed nerves
or dejected spirits. His favourite season to go trekking in the foothills or mountains is in early spring, between February
and April, when the rhododendron forests are abloom with
blood red, pink and white flowers. ‘The whole feel of the
place, the smell, and the atmosphere, calms me down.’
One of Serabla’s vivid memories as a girl was of her father
‘. . . walking so fast. He would stride along, telling me that it wasn’t his body that was moving quickly, it was his mind.
He used to tell me that determination was the most import-
ant thing.’
Trekking in the mountains proved to be the antidote for
many of his troubles. By the time Ruit was in his thirties, he had become almost painfully aware of his own faults, the
main one being his short temper. He began to realise what
sort of effect this could have on those around him. His remedy was to head uphill, with one or two friends, using the silence and peace to collect himself.
‘I’ve become more and more aware of my faults as I’ve gone
along in life,’ he says. ‘I’m full of them, and still have things to learn. I have very strong likes and dislikes for instance, and if I don’t like someone I show it immediately. It’s very obvious to the other person. I can’t even look at them. And I can be
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a bit thin- skinned as well. I can brood on things for a bit too long. Thank goodness I have Nanda to smooth things over
sometimes,’ he says.
His mood would lift with every step he took out of Kath-
mandu Valley. ‘I always come back feeling myself again, and
gain a proper perspective on things when I’m up at higher
altitudes, and out in nature,’ he says.
Ruit can be fierce, too. It’s a side rarely seen, but it can feel like a blowtorch for the person on the other end, as some of
his close colleagues can attest. ‘I can be very abusive,’ says Ruit. ‘For example, one of our staff started having an affair.
I told him he was not fit to live with his family. I told him they were too good for him, and that he could go to hell. He
eventually left his job at the hospital. I don’t know where the hell he is now. I’m very protective of family life. I have only harsh words for people who act immorally. Once in a while,
we get a joker in our team like that, who is immediately fired, but I am blessed with 98 per cent of staff who are all exceptional people.’
Trekking was always the best salve for his other major
foible as well—his love of food. Ruit has never been cavalier about his health. But after giving up drinking and smoking,
food became a comfort to him; he was aware that he was
carrying too much weight for his own comfort. Nanda keeps
a close eye on his diet, but he still tucks in with gusto at meal-times. Tenzing Ukyab, his cousin, diplomatically calls him a
‘foodie’.
‘He’s well- disciplined when it comes to not drinking or
smoking since he saw the toll it has on his health, but he’s
not where food is concerned. He loves food and can eat a lot.
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He’s a bit of a connoisseur. Whenever the family goes out to
eat together, we most definitely leave him to do the ordering,’
Ukyab says. ‘I know I have to eat less,’ Ruit sighs. ‘It’s really just the only indulgence I have left.’
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17
Pieces of magic
The intraocular lens factory, which opened in 1995 as part of the Tilganga Eye Centre, was Fred Hollows’ idea.
After breakfast one morning at an eye camp many years
earlier, the starry- eyed surgeon suggested Ruit start making lenses in Kathmandu. Instead of being beholden to Western
hospitals and doctors to donate lenses, he could make his
own, and, in the process, drastically cut the price. ‘All you need, Sanduk,’ he said, ‘is a bloody shed.’
The reality of building a high- tech factory in a country
such as Nepal proved to be a lot more complicated than that,
though. At one stage, Ray Avery, the New Zealand scientist
and engineer commissioned by Hollows to build the labora-
tory in Nepal, called it ‘mission impossible’.
Avery had made a name for himself as a highly successful
entrepreneur, building factories for pharmaceutical companies in China, Thailand and Vietnam. But his days of high- rolling profits came to an abrupt end when he was summoned to
Fred Hollows’ sickbed at his home in Randwick. Hollows
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pointed a bony finger at Avery’s chest and said, ‘Stop making money out of sick people, Ray. Start doing something f- - king useful with your life.’
Hollows first asked Avery to set up a factory in Eritrea.
There, the odds seemed insurmountable. The country was
only just emerging from a brutal 30- year war of indepen-
dence against neighbouring Ethiopia. As well as losing tens
of thousands of its citizens, the capital city, Asmara, lay in ruins. Avery could not find power or water for the factory, let alone new electrical cabling; he had to resort to second- hand cabling from dilapidated buildings.
Once the factory was built, he also realised, to his horror,
that the Australian lathe machines needed to cut the small
pieces of plastic were completely faulty. The manufacturer
Hollows had chosen to make them had completely failed to
do the job. ‘We had dinner in a friend’s house in Kathmandu
that night,’ Ruit recalls. ‘We got drunk and started arguing
about what to do.’ Avery had to go back to the drawing
board; he eventually found a small company based in Florida,
USA, to supply new lathes.
The Kathmandu factory was just as fraught with problems,
too. One Monday morning, as Ruit was halfway through a
corneal transplant, someone burst into the operating theatre
with bad news. An Australian electrician, Stephen Murphy,
had been electrocuted installing lights at the laboratory.
A live fuse had been accidentally left in the box he had been working on.