The Barefoot Surgeon

by Ali Gripper

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  Blinded by the light

  Ruit always loves to hear about his patients and how their

  lives have turned out after their operations. A classic example is Kanchi Maya, the timid young mother brought to his eye

  camp who saw her baby for the first time after Ruit operated

  on her. A team from Tilganga recently returned from Kanchi’s

  village to find her a changed woman. Today, she is the matri-

  arch of her home. She makes a living picking corn from the

  fields with the other women, fetches water, cooks, sews, and

  sends her son, now a healthy eight- year- old, off to school, dressed neatly in his school uniform. She looks ten years

  younger, and stands taller. She greets her friends and family with a thousand- watt smile.

  ‘Kanchi had big white cataracts and was cut off from

  the world. Now she’s got her authority back, her place in the society,’ Ruit says with a touch of pride. ‘She’s very much in control of the house. It’s beautiful to see.

  ‘To me, this shows how one operation can affect the whole

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  have been tragic. The baby was so malnourished, he was

  close to perishing, and the mother was anaemic. The whole

  household rhythm had been broken. We see this over and

  over again, not just in Nepal, but in subsistence families and agriculture in India, Asia and Africa where we work. Blindness breaks the rhythm of the family, the whole society. When we restore sight, we restore the whole balance,’ Ruit says.

  ‘Often, they remind me of wilted plants that suddenly

  bloom when potted in the sun. Their dignity is restored

  because they can earn money or help out on the family’s farm.

  There are no side effects of cataract surgery. There are no

  downsides.’

  Kamisar Tamang, the woman who was once so lonely that

  she wanted to kill herself until her husband strapped her into a basket and brought her to Ruit, also stays in touch. She’s a sprightly 70- year- old now, and whenever she comes to Kathmandu, she brings Ruit fresh eggs or potatoes. Her husband

  has passed away, but she’s a part of the fabric of her village; she works for her brother, and enjoys looking after her nieces and nephews.

  Gifts of chickens, eggs and corn, and bottled fruit from

  patients, are a common sight at Tilganga. For those who

  cannot afford anything else, they are a simple way to say

  thank you to the man who gave them back their sight. Ruit is

  always touched by the gifts, and takes them home to Nanda to

  cook, or gives them to other staff members. Another patient,

  Toprasad Sharma, likes to bring ghee and bottled pickles

  when he comes to Tilganga for a check- up.

  Sharma came to Tilganga in the late 1990s from his village

  in the foothills to the north- west of Kathmandu. He was 21,

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  but he looked a decade older. Thin and stooped, he clam-

  bered off a bus, and shuffled across the bridge to the hospital gates on a hot summer afternoon, clutching the shirt tail of

  the man leading him. At the time, he had nothing to his name

  other than five rupees in his pocket and the clothes he was

  wearing: a shirt, shorts and a pair of slippers.

  For the previous fourteen years, Sharma had been trapped

  in the half- life of the blind. When he was seven, an operation at a local clinic had badly botched one of his eyes, both of which were already clouded white with calcified cataracts. His father was afraid of going to the hospital again. He was ashamed of

  his son, and wanted him to stay at home in the back room,

  away from the gaze of visitors and friends. His former school friends teased him and played tricks, such as making him trip over thorns or walk headlong into the path of a bullock. His

  mother’s love was his only comfort, and when she died when

  he was seventeen, he became unbearably lonely.

  His dreams of becoming a teacher had faded and he no

  longer went to school. Scared of falling over a cliff or into a ditch, his world shrank to the confines of his two- roomed

  mud home. He would spend his days sitting on the doorstep,

  listening to the sounds of the village around him.

  ‘I lost all hope after that,’ he says, as he tells his story in a Kathmandu cafe close to the hospital. ‘I used to hear my

  father talking about me to his friends, saying that my life was over. It used to make me cry. The only thing I started wishing for was to die. It was the only way I could think of escaping the sadness of getting through my life.’

  Finally, after a sleepless night, he decided to give his life one last chance. He would use all his money to catch a bus

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  to Kathmandu, 24 hours away by bus. If he couldn’t find

  anyone to cure his sight, he would end his life.

  ‘That’s easy when you’re a blind person,’ he says. ‘You just

  listen for a bus or a truck and step out in front of it.’

  But within minutes of arriving in Kathmandu, and asking

  directions to the disabled people’s hostel, a stranger told him about a new hospital that was curing blind people for free.

  Plucking up the last remnants of his courage, Sharma took a

  deep breath and said, ‘Can you take me there now?’

  ‘Dr Ruit talked to me more gently than anyone else I’d

  met,’ he says. ‘He was the only person who’d ever spoken to

  me with such kindness. He was much nicer to me than my

  own father.

  ‘He explained I had a good chance of seeing again, and that

  he would pay for my accommodation while I was waiting for

  the operation. I could hardly believe what he was saying, but I started to place my hopes in him.’

  After a nurse anaesthetised his eyes, Sharma was led into

  the operating theatre. Ruit spoke to him gently as he made a

  tiny incision into the side of his lens. He flawlessly removed Sharma’s cataracts, which were the size of small pebbles, and replaced them with the small plastic intraocular lenses made

  in the laboratory next door.

  ‘It was the happiest day of my life,’ he says of the magic

  of being able to see again, after Ruit unwound his bandages

  the next day. ‘First, I looked at the doctor’s face, which was even kinder than his voice. He looked like someone from the

  mountains, like someone from where I lived, not a typical

  city doctor. Then I looked out the window, and I could hardly believe what I saw. I could see the ridgeline of the mountains!

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  Birds! Buildings! Buses and trucks and people everywhere!

  The tops of the temples! What world was this I was living in?

  Everything seemed new again.

  ‘Then I looked in the mirror and looked at my own face. It

  was amazing, after fourteen years, to see what I looked like.

  I was crying with happiness.’

  As Sharma recovered, his world expand
ed. He visited

  all the temples in Kathmandu. He began to dream of going

  back to school and becoming a teacher. Almost twenty years

  later, every detail of those ecstatic days is vividly etched in his memory.

  ‘When I went back to the village after the operation, my

  father was so ashamed that he had not sought help any earlier, and he begged my forgiveness.’

  He works as a high school teacher, and has bought a house

  in his village for his wife and five children.

  Years of blindness have given him an appreciation for

  the world that is sharper than most. ‘I really just want to

  enjoy everything now in my life,’ he says. ‘I’d love one of my children to become an eye doctor. And I’d like to see more of this beautiful world.’

  ‘I don’t know how I can really ever thank Dr Ruit,’ he says.

  ‘For me, there is God and there is Dr Ruit, and those two

  things are the same. He gave me more than my sight back. He

  gave me my life.’

  The blind are already some of the most vulnerable people in

  the developing world—easily abused, overlooked, neglected.

  Restoring sight to young women, particularly, can save

  them from the very worst form of exploitation. So, it was

  a golden moment when Ruit operated on two blind sisters,

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  fifteen- year- old Maslia and nineteen- year- old Nurasni Nubis, at an eye camp in Northern Sumatra.

  The pair had been blind for more than a decade; Maslia

  was three when cataracts cast a shroud over her world, and

  she could not see the toys in front of her. Nurasni was nine

  when she went completely blind and had to leave school.

  Their blindness was possibly caused by malnutrition, either

  during development in their mother’s womb or as babies.

  ‘When the patches were taken off, the sisters were holding

  hands, there were tears of joy everywhere you looked,’ Effi Jono, the director of A New Vision, Tilganga’s partner in Singapore, recalls. ‘Everyone was crying with them, even the onlookers.’

  The girls’ father died of lung disease a year after their operation. Soon after, their mother died after suffering a stroke, leaving them with only two elder brothers, and in a vulnerable situation.

  Many blind women are abused by their husbands and are

  unable to leave. They’re trapped. Young pretty girls from

  poor families are already at risk of being forced into prostitution, but if they are blind, then that risk multiplies.

  Today, Maslia is married and Nurasni looks after their

  home, and Jono keeps a close eye on them. ‘The hardest thing

  to overcome in young women is a lack of confidence and the

  belief that they deserve to fulfil their dreams and have educations and careers. Women are so often told their place is at

  home, and that they don’t need anything else to be happy. It

  can really hold so many young women back.’

  Now they can both see, their chances are much brighter.

  Jono is hopeful she can persuade them to continue their

  studies.

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  Kathmandu calling

  Ruit’s drive is remarkable. Somehow, against the odds, he’d

  managed to build a world- class hospital in the dysfunctional capital city of Kathmandu, where power and petrol shortages

  are a way of life, corruption is rife, and a series of self- serving governments have left the country on its knees economically.

  Not content simply to restore sight to multitudes, Ruit

  then set up a system of training surgeons around the world in his technique. He’d built a laboratory that made intraocular

  lenses for a fraction of the price they cost in the West and, by doing so, had started to make a serious dent in cataract

  blindness. But he still needed to keep pushing on with the

  gargantuan task of reducing the backlog of the blind. Next

  on his list was stemming the floodtide of corneal damage, the second most common cause of blindness in Nepal.

  During his decades as an eye doctor, Ruit had seen more

  corneal damage than he cared to think about. The damage

  was usually caused by birth defects, farm accidents and

  untreated infections. He was desperate to treat these tiny

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  grape- like pieces of skin that cover the eye like the face

  of a watch.

  As usual, there were friends from the West who were keen

  to help. Geoff Tabin and Dick Litwin, in particular, would

  try to clear the backlog by bringing in about 50 corneas a

  year, carefully packed in styrofoam boxes, whenever they

  flew into Kathmandu to accompany Ruit on the eye camps or

  to help at the hospital.

  But Ruit knew they needed so many more corneas to start

  making a difference. And besides, a typical journey for one of Ruit’s ‘boxes of eyes’, as he called them, would involve them being flown from a teaching hospital in the United States, out across the Pacific Ocean to Hong Kong and then finally on to

  Kathmandu. It was a ridiculously long trip—halfway around

  the world—for such tiny pieces of human tissue.

  Things finally came to a head when Ruit arrived at Tilganga

  early one morning to find the hospital’s best corneal surgeon, Dr Reeta Gurung, slumped over her desk, fast asleep. Corneas

  deteriorate quickly, so she’d had to work fast during the night grafting six fresh corneas that had arrived the night before.

  Something had to change.

  Ruit was deeply frustrated that the Pashupatinath crema-

  tion site, a source of hundreds of healthy corneas, was

  tantalisingly close: just 800 metres away, in fact, from his

  operating theatre. But instead of being able to harvest them

  to graft onto blind patients, the large supply of corneas was consigned to fire every day. He despaired whenever he smelled the smoke from the funeral pyres on the river, knowing all

  that healthy tissue was going to waste.

  Pashupatinath is one of the most holy and peaceful places

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  to depart the world. The only sounds are the lapping of the

  water, the caw of crows, and holy men reciting prayers and

  mantras. The corpses, wrapped in shrouds, are placed on

  stretchers on the ancient stone steps with their feet almost

  touching the river. Soon afterwards, they are carried to the

  timber pyres, and their ashes swept into the water. Men with

  shaved heads, clad in white, set tea lights afloat on lotus leaves further down the river.

  Ruit would walk there whenever he could take a break, and

  he began to quietly approach the Hindu authorities. Would

  it be possible for families to consider donating their relatives’

  corneas before they were burnt? He was scrupulously polite,

  but his efforts were rebuffed every time.

  ‘It was just so frustrating,’ Ruit says. ‘For the Hindu com-

  munity at the time, it was taboo to donate any part of a

  corpse, because they thought this meant the person would be

  without that part of their body in their next life. No matter ho
w passionately I explained the virtues of the act, that such a small part of the body could transform someone’s life, and

  that it was meritorious for both the donor and the donor’s

  family, the Hindu priests would not listen. They were fixated on the idea that we were taking the entire eyeball out. They

  just turned their backs and walked away from me.’

  Ruit railed against their prejudice. His medical training—

  based in scientific logic and facts—was at loggerheads with

  such unbending spiritual beliefs. Surely it was of greater value to give sight to the blind with these tiny pieces of flesh than see them turned into ash?

  But like almost everything else he does, Ruit was dogged.

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  the head cremator at the time, Krishna Thapa, to come to

  Tilganga and see his work. At first, Thapa was sceptical. But Ruit encouraged him to watch several operations, and then

  took him to the recovery rooms. For Thapa, who had spent

  his life among the dead, watching the patients at Tilganga

  having their bandages removed, and then witnessing their

  euphoria when they could see the world again, was akin to a

  revelation.

  Getting Thapa onside made a huge difference. In 1995,

  Ruit formed a partnership with Pashupatinath, which has

  gone on to restore sight to more 11,000 people, thanks to

  donated corneas.

  What kept driving Ruit to set up the partnership was that

  the results, when he actually got his hands on fresh corneas, were spine- tingling. One patient he’ll never forget was Mainala Gomi. Gomi was fifteen when her brother and father brought

  her into the crowded waiting room of Tilganga.

  She had been blind from corneal damage for more than

  a decade. The young woman could not even walk along the

  street without holding onto her sister’s arm for support. She longed to be useful: to go shopping for her family, to cook

  dinner, to finish school, and hopefully one day have a family of her own. But most of her days had been spent lying or

  sitting on her bed. She’d only completed a few years of school, and there was no prospect of marriage.

  When Ruit unwound her bandages after her operation a

  few days later, and Gomi opened her eyes, everyone caught

  their breath. She was captivating. Her eyes were large and