by Ali Gripper
It is not just doctors who are being trained in the Nepalese
art of eye surgery. Entire medical teams—nurses, anaesthe-
tists, technicians and clinic managers—fly in from every corner of the world for expert tuition at Tilganga. They fly in from India, Pakistan, Bhutan, Myanmar, Indonesia, North Korea,
China, Thailand, Cambodia, Vietnam, the Maldives, Ethiopia,
Mongolia, Kazakhstan, Ghana, Uganda, Sudan, Iraq, South
America and South Africa. They stay for weeks at the hospital, absorbing the system Ruit and Tilganga have elevated to an art form in order to replicate it when they return home.
Often the real training begins when the teams are
dispatched to an eye camp in a small village in the hills or
mountains. Here, Ruit’s elegant, but precise system, which
one volunteer described as ‘like the inner workings of a Swiss watch’, is drummed into them. Everything has to be planned
to perfection. Can the patients walk into the eye camp, from
along rocky mountain trails? Can 500 patients be easily fed?
Can they be housed in tents or makeshift accommodation
while they recover? Can everyone be screened in an efficient
way? Will everyone receive proper counselling, so they under-
stand what’s going to happen afterwards and that they need
to come back for check- ups?
Job Heintz says that part of the magic of Tilganga’s training system is that it creates ‘a sense of the possible’.
‘If you took these teams to America or the UK or Austra-
lia, they may not believe they could do the same thing when
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they got back home. But seeing that Ruit does it, in one of the poorest countries in the world, creates this incredible sense of possibility for them. They go home believing and knowing
they can do the same thing,’ Heintz says.
One of the most important things the team learns is how
to be self- sustaining. It’s something that’s absolutely crucial in countries where the government is unable or unwilling to pay
for health care, and foreign aid is patchy. If they can’t sustain themselves, they won’t survive. The key is replicating Ruit’s sliding scale of payment for the operations, a brilliant idea born out of sheer necessity.
‘We started trying out the sliding scale at Tilganga, mainly
because we had no other option,’ Ruit says. ‘We had no other
resources. There were no grants. It was the only way we could afford to buy beds, and pay the staff. It was the only way we could make the hospital self- sustaining.
‘Because of the credibility of my work, we knew we could
invite powerful people to come and have surgery. The results
are always good and they are happy to pay the full price.
Then out of that money, we are able to provide for a large
number of people who cannot pay to have free surgery. The
poor receive exactly the same quality surgery, but they pay
less. So, there is no such thing as second- class sight. Everyone gets first- class sight, no matter how rich or poor they are.’
As he enters his sixth decade, Ruit’s hands are rock steady.
But he is also increasingly aware of his personal limitations.
He’s more reflective than ever before, as well as frank about his faults and flaws.
One of these moments was realising that he needed to step
away from the governance of the hospital.
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Tilganga had become so much bigger than he ever imagined,
with more than 400 employees and a complex hierarchy. He
began accepting the fact that colleagues such as Dr Reeta
Gurung were much better at running the hospital than he
was. And that there was a need for more managers—corpo-
rate managers—as well as financial and governance experts.
‘Everyone is born with strengths and weaknesses; my
strength has always been in my hands and my eyes. I took far
too long to appoint Reeta as the CEO. I lack the culture of
corporate management. I’m good with managing my imme-
diate team but not large- scale corporate management. I’m a
bit slack when it comes to being decisive. I’m full of faults, you see. What I’ve learned is that it is better to stick to what you’re good at. That’s what I feel more and more. Nowadays,
I’ve started saying, “That’s not for me. Somebody else should do this.” It’s become very clear that the right way for me to spend my days is to sit at the operating table, helping people see. I want to keep doing this for as long as I can.’
It was a relief to step away from the administration, and
concentrate on his patients—as well as training his latest
‘batch’, as he calls them, of up- and- coming surgeons. One
of the major things he drums into them, as well as technical
finesse, is that a little kindness goes a long way.
No matter how many patients he has operated on, Ruit
still likes to connect with each and every one. Even if it’s just for a few moments. He might reach out and put his hand
on their shoulder and explain what he’s going to do. ‘It’s an exchange of positive energy. If you do this, then the sincerity of what you do will bear fruit in the long term. You gain an
excellent reputation, which is more valuable than money.’
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He teaches the young surgeons to think of the patient lying
in front of them as someone from their family. It might be
their mother. Their father. Their brother. Their sister. You
never know, it might be a boy from Walung, all alone in a
strange hospital.
It might even be a Maoist rebel, brandishing a machine
gun. Because the harsh reality of staging eye camps through-
out every region of Nepal meant that for many years, his
surgical team often had to run the gauntlet of explosives,
Molotov cocktails, machine guns and hand grenades.
Nepal is thought of as a country of peaceful Sherpa guides
and tinkling temple bells, but during the Nepalese Civil War, the country was torn by bloody domestic strife.
More than one million Nepalese peasants are estimated
to have been recruited as Maoist soldiers, in an attempt to
overcome centuries of suppression, and to overthrow a
succession of corrupt governments after the country voted to
become a constitutional monarchy in 1990. The aim of their
brutal uprising was straightforward—they wanted to allevi-
ate poverty.
By the late 1990s, when the rebels controlled more than
a third of the country, being pulled over at their checkpoints became as commonplace for Ruit and his mobile clinics as
stopping to re- fuel for petrol. But after the windows had been wound down and the rebels discovered it was Ruit sitting
resolutely in the passenger seat, the soldiers would usually
wave him through with their Kalashnikovs and a nod, or a
friendly smile.
The rebels respected the doctor’s work restoring sight to
the poorest peasants no matter what caste or creed. Clad in
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thei
r military uniform and a cap with a star on it, they called him ‘Dr Sahib’, meaning ‘respected doctor’, and offered cups
of tea and biscuits. Several times they even let Ruit and his team use their headquarters—usually a former army post or
police station—as makeshift field hospitals.
Some politicians felt Ruit should have turned his back on
the Maoists, and refused to treat them. He certainly disagreed with their violent methods. He abhorred the slogan they’d
borrowed from the Chinese communist leader, Mao Tse-
Tung: ‘Political power grows out of the barrel of a gun.’
But he was sympathetic to their cause and worked out
a way to discreetly treat any Maoist soldier who came to
Tilganga or any of the eye camps.
Mostly they got in touch with Khim Gurung, one of Ruit’s
assistants who organised the camps, but they also approached
Ruit personally many times, too, and each time, he was more
than happy to talk to them.
Ruit built up a good rapport with many of the leaders,
who respected his work. They’d meet out in the field, while
he was setting up a camp, and he would always tell them the
same thing: they had to lay down their weapons and become
a political party. He told them they had to try talking to
the government, and that he was always happy to act as a
go- between.
‘It was the only way they could change things for the better.
The violence sickened me, and I knew it wouldn’t achieve
anything. But I continued treating them, no matter what
people said. I thought it was vital that we kept operating in Maoist strongholds because they were usually hubs of blindness. I thought it was important to show that Tilganga was
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beyond politics. And, besides, they were often young men
with simple weapons, who, out of desperation, were trying to
make a better life for themselves and their families.’
Every evening, at about 5 or 6 p.m., whatever region he
was in, after Ruit had finished working on his last patient
for the day, a girl from the Maoist rebels would come and
sit quietly in the waiting room. The girl would always be
wearing a pink kurta—a long loose tunic and trousers in the
style of cotton pyjamas—which were the secret signal to Ruit
that a Maoist soldier needed treatment.
‘Sometimes it was almost as if I could feel their pain as they lay in front of me on the operating table,’ Ruit says. ‘Many of them felt truly exploited, unable to gain an education, or buy land. They were people like you and me who just wanted the
same as everyone else in the world—schools, hospitals, jobs,
the end of the caste system. They wanted the chance to give
their children a better future than their own.’
The plight of the women soldiers who donned a military
uniform and picked up firearms always made Ruit’s heart
sink. One came to him for treatment at an outreach camp
and told him she lived in a house with electricity. Although
she’d had no schooling herself, she dreamed of sending her
own two children to school, but their chances were slight.
Their future, as far as she could see it, was to resign them-
selves to continue to eke out an existence on the family’s
small farm. ‘The final straw came when she’d borrowed
money to take her sick mother to the nearest clinic, only
to have the money lender threaten to take away her goats
and chickens when she was unable to repay him on time,’
he says.
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As Ruit operated on her, all he could think of was that she
could have been him, if his father hadn’t sent him to India
to gain a proper education at a boarding school. His back-
ground gave him great sympathy for the Maoists he treated.
‘They were just so downtrodden. All they really wanted was
the chance of a better life.’
His heart went out to them, but he and his team were
always on edge as they approached one of the Maoist- held
zones. It was hard not to feel alarmed; the buildings were
emblazoned in red paint with symbols of hammers and
sickles, or painted with fierce communist slogans such as
‘Burn the Old House Down’. It was intimidating. There was
always the sense that things could turn nasty if they were in the wrong place at the wrong time. They were working in
areas, after all, in which the police themselves were often
afraid to enter.
A few times they came far too close to the fighting for
comfort. Once in south-
west Nepal, Ruit was halfway
through a cataract operation at an eye camp, making a
delicate incision into the patient’s cornea, when the building was rocked by a deafening explosion as the rebels blew up
a local police station. A long blast of machine gun fire then shattered the peace of the countryside around them.
Ruit, shaken, kept his hand rock- steady on his scalpel,
reassuring the patient lying on the table in front of him that the rebels were too far away to cause any problems, and
calmly finished extracting the patient’s cataracts. He’s a man of great forbearance, but this particular episode enraged
him. He was furious with the rebels for putting his team and
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for the way they retaliated by coming down on the rebels so
violently.
‘A lot of the peasants waiting to have their operations
were very worried, especially the poor man lying on the table in front of me, but we told them they would be okay, and
carried on our work,’ Ruit recalls. The local police eventually escorted Ruit and his team from the building back to their
lodgings at the end of their day’s work.
In his small hostel room that night, Ruit’s mind turned
instinctively toward home. His private practice had finally
grown enough for the children to attend the best private schools in Kathmandu. When Sagar was seven, they had enrolled him
at St Xavier’s Godavari School, a Jesuit boarding school about an hour and a half out of Kathmandu. He was still his mother’s favourite, and Nanda would count the hours until he’d come
home again, on the weekends and during the holidays. Mean-
while, every morning, Serabla and Satenla headed off on the
bus to a strict, all- girls’ convent school, St Mary’s High School.
Both Sagar and Serabla were turning out well. They were
typical of eldest children—reserved and responsible—whereas
Satenla, the youngest, was more pampered. ‘She got away
with a lot more,’ Serabla says. ‘She used to fight with Dad
and cry.’
He always missed them when he was away, especially the
girls’ and Nanda’s chatter over dinner at night. His favourite part of the day was after dinner, hearing about their day at
school, and giving his girls a big pat on the head when they
did well in their exams or essays.
He and Nanda were proud of thei
r strong work ethic, and
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as sending them to the best schools they could afford was
endowing them with a sense of being loved. ‘I think they can
see our love for them is sincere and unconditional. And that
we have always set very high moral values for them.’
Having had such an authoritarian father, Ruit hopes he was
a lot softer with his own children. ‘You’ll have to ask them
about it, but I don’t think they’d be as frightened of me as
I was of my dad when I was a boy. It was always very hard to
talk to Dad, he was hard to communicate with, it was hard
to be close to him. I hope my children don’t feel the same way about me. I hope I’m a lot easier to talk to.’
Ruit is, at heart, like so many Nepalese, a family man.
Every two weeks, the Ruit clan would gather together for a
‘pot luck’ lunch on the weekend, when everyone would bring
a dish of food. They would often gather at Tenzin Ukyab’s
home and sit around together all day, the older ones playing
cards, the younger ones playing games on the lawn.
Much of Ruit’s motivation, going to such lengths to restore
sight in far-
flung rural villages, and venturing into such
dangerous zones, is the desire to give his patients a second
chance at the same simple pleasures and a good home life that he revels in.
‘Restoring the natural rhythm of family life, restoring the
balance of the communities, that’s what it’s all about, what
I hope my work is doing,’ he says.
It appalled Ruit that money lenders were still rife in many
of the villages they visited. He views it as one of the most notorious practices in rural areas. That, along with the medieval practice of bonded labour, which sometimes resulted in a
whole family being indentured to an unscrupulous landlord,
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working without payment on his farm until they had paid
their debts. Even worse, sometimes a daughter was sent into
bonded labour, a euphemism for prostitution, in the larger
towns such as Pokhara. It was exploitation of the cruellest
kind, and there had been absolutely nothing the Nepalese