well. It meant they would have to learn a whole new way of
cataract surgery and many retired rather than convert to the
new procedure. A lot of older ophthalmologists resisted and
disapproved of the new technique.’
Ruit’s main opponent for many years was the head of the
Nepal Eye Hospital, Dr Ram Prasad Pokhrel. ‘RP’, as he
was known, didn’t like his brilliant young protégé breaking
away from his empire. ‘He didn’t say “No” up front, but his
body language was critical. His body language was that he
wouldn’t endorse it,’ Ruit recalls.
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Ruit’s homelife meant a great deal to him as he faced such
tough opposition. Nanda had grappled with her new role at
first as a stay- at- home wife. She was a highly accomplished ophthalmic assistant, widely respected at the hospital, and
had initially been reluctant to give up her career. But as Ruit’s hours grew longer and longer, and the scope of his vision grew clearer, they settled on traditional marriage, with well- defined roles. Ruit was the breadwinner and Nanda did the shopping,
organised the cooking, and packed Ruit’s bags when he set
off on a trip.
‘I don’t think he’s ever held a shopping bag in his life,’ Nanda likes to say. ‘We joke it’s because it might wreck his hands.’
‘I know Nanda has always appreciated how hard I work,’
says Ruit. ‘I worked such long hours at the hospital and she
never complained. She’s never intruded on my work or tried
to interfere. She just never doubted that everything would
work out. Having her by my side has been the greatest gift.’
Ruit’s devotion to Buddhist teachings was also a mainstay.
His commitment to several Buddhist teachers—and awe
of some of them—stems from his father’s own unswerving
devotion. The memory of Sonam, sitting crossed- legged at
his shrine before dawn every morning in their wooden house
in Walung, saying prayers to the deity Guru Rinpoche, was
stamped in his psyche. ‘I saw my father as the epitome of
moral values. I knew instinctively that his moral compass had been shaped by Buddhism, so I was naturally drawn to the
same teachers as well.’
Although Ruit didn’t go to temples, his commitment to the
teachings of the Buddha imbued all his actions, and gave him
courage and strength in times of adversity.
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‘In a complex situation or a challenge, if the problems keep
coming, then very often I shut my eyes and I get this bright
pool of light in front of me. I know it’s come from the teachers I’ve met,’ he says. ‘All I know is that it gives me a very relaxed feeling of taking on challenges and problems. It’s always a
relief after I close my eyes and see this bright phenomenon
coming. Afterwards, the problem doesn’t seem to bother me.’
~
Ruit was forced to draw on his faith as he faced the increas-
ingly loud chorus of complaints against his work. Things
came to a head in 1989 when the International Association
for the Prevention of Blindness held a conference in Kath-
mandu. The agenda was ‘To discuss the latest developments
in intraocular surgery’, but it would be safe to assume that its aim was to put the audacious young surgeon firmly back in
his place.
Says Ruit: ‘We were doing sophisticated surgery in the
bush and that was making the big five- star surgeons uneasy.
They thought, What are these bastards doing? There were a lot of people who were threatened by what we were doing.’
The conference was held at Hotel Yak & Yeti, the finest
conference hotel in town, complete with ornate mirrors and
soaring ceilings. The foyer was decorated with potted palms
and banners to welcome twenty of the best ophthalmolo-
gists from around the world. One of them was the legendary
Dr Govindappa Venkataswamy, or ‘Dr V’, from Aravind
Hospital in Madurai, India, with whom Ruit had worked
during his ophthalmology postgraduate degree. Dr V, who set
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was a philanthropic surgeon and a guiding light for young
surgeons like Ruit. Despite being afflicted by rheumatoid
arthritis and finger deformities, he performed thousands of
sight- restoring operations. Empowered by his spiritual guru, Sri Aurobindo, he regarded his work more as a sacred task or
calling than a job. ‘His leadership, spirituality and commit-
ment to his patients were unforgettable,’ Ruit says.
Ruit felt sick with nerves as he walked into the conference.
He was not a good public speaker but he desperately needed
to show his peers his team’s superb results implanting intra-
ocular lenses in remote villages.
A group of doctors began showing slides of the old- style
surgery for cataracts. Fred Hollows had returned to Nepal
for the conference to support Ruit. The two comrades sat
next to each other and grew white with rage as they listened.
‘Thousands of cases of surgery without intraocular lenses.
How could anyone be proud of using these old- school tech-
niques?’ Ruit recalls. ‘Why would you boast about a technique that left people with inferior vision?’
Ruit’s hands were sweating, and his heart was racing. His
mind was filled with the herculean efforts his team had gone to in order to provide world- class eye care in the toughest conditions. He thought of the bus rooftops his team had clung on to, the mountains they’d trekked with heavy packs and baskets,
packed to the gunnels with medical equipment. He thought of
his father, Sonam, who told him, ‘Whenever there is an easy
road, and a hard one, son, always take the hard one.’
When it was time for Ruit to speak, he walked up to the
stage, clutching his notes. His guts were going berserk. A hush fell over the delegates.
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Ruit put his head down and stuck to his notes. Stiff and
awkward, he doggedly ploughed through his speech, showing
slides of the successful intraocular lens implantations they’d done in the countryside. The news was met with a stony
silence. Then, as Ruit recalls, ‘Everyone just stood up and
said, “Shit, you’re not allowed to do that!” It was a real
uproar. They were outraged. They were raising their hands,
and a representative from the World Health Organization
asked why we hadn’t done a clinical trial.’
The comments of one dapper doctor wounded him to the
core. ‘This gentleman told me that I should stop talking such nonsense.’ Ruit says. ‘He said that we simply could not afford to help everyone in the way I wanted to. He said that for
every blind person I cured with an intraocular lens for $200, they could cure 60 or 70 with old- style surgery and old- style glasses. He said there were far more important things to be
talking
about and that I should sit down and stop wasting
everybody’s time.’
Years of painstaking work had just been snuffed out like
a candle. It was as if the entire ophthalmology community
was against him. He felt enraged that the validity of his
work was being called into question.
Despite his nerves, Ruit would not be silenced.
‘Somehow, I found my voice,’ he recalls. ‘The words were
faint at first, but I managed to get out what I wanted to say to the delegates. I asked them, “If your son or daughter was
blind, would you want him or her to lie on their bed without
moving all week, after their lenses had been taken out, and
then fitted with thick glasses which they would probably lose or break? And what about all the people who can’t even get
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to a hospital? The ones who can’t afford the bus fare, or who can’t read or write, and don’t even know that help is available and that they can get their eyes fixed? We need to think about them as well. We have a duty to look after them as well. And
if they can’t get to us, we need to go to them!”’
Hollows was renowned for his explosive candour, and,
just in case Ruit wasn’t forthright enough, he walked up
onto the stage, and told them what he thought of their attitude.
‘I can’t repeat what Fred said because of the colourful
language, but it was along the lines of: “One day, you mark
my words, the World Health Organization will recommend
intraocular lenses, just like Ruit is doing, rather than those ridiculous Coke- bottle glasses. And you bloody American
imperialists will be eating humble pie.”’
Then Hollows turned to the other delegates in the room,
glared at them over his glasses, and abused them for clinging to a second- rate method. ‘He told them they were bloody
fools, that they were colonial upstarts, sitting there on their arses knowing they were giving world- class eye care to rich
white people, and second- rate care to the people in their own backyard. He told them they should be ashamed of themselves. You could hear people gasping. Their mouths literally dropped open.’
British- born ambulance driver Rex Shore, who acted as
Ruit’s scribe, translator, secretary, engineer, postman and
driver, was waiting anxiously in the foyer. The pair had met
in Sydney, where Ruit had asked him to ‘help with a dream
he had’. Shore, already infatuated with Nepal, resigned from
his job, booked a flight to Kathmandu, and quickly proved
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invaluable, drafting endless letters for Ruit and becoming a
jack- of- all- trades.
‘Ruit came out looking terribly flustered and saying to
Fred, “I wish you wouldn’t speak like that!”’ Shore recalls.
Ruit and Hollows salved their battle wounds at the hotel
bar. After a couple of strong whiskies, Ruit realised that he could never go back to the establishment. He was regarded as
an outlaw. A renegade. A madman, even. And it was strangely
liberating.
Ruit’s dogged refusal to back down and fall into line, his
inability to accept mediocrity and play by the rules, meant
many of his colleagues began to have a grudging respect
for him. Many people in the ophthalmic world began to be
swept into ‘the cause’. They wanted to be part of Ruit’s wild utopian dream.
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9
Mavericks
The year after Ruit and Nanda had moved back to Kath-
mandu from Sydney, they were kept firmly at arm’s length
by his family. The ostracism continued, even if they’d been
invited to lunch at Ruit and Nanda’s flat, and Nanda had
cooked an elaborate meal. His family would talk among
themselves, completely ignoring her, despite her hospitality.
Nanda put her head down, kept cooking, and remained
quietly confident that one day they would accept the marriage.
Her instincts were right. One day, her in- laws finally looked at her as she was serving them lunch. It was one of the happiest days of her early married life with Ruit.
The rift was finally healed with the arrival of Sagar,
their first child, in 1989, almost exactly a year after they
had returned to Nepal. Sagar was a healthy, bright- eyed
3.9- kilogram boy, and Sonam and Kasang were yearning to
see and hold their own flesh and blood.
The couple took Sagar to Hille when he was about eight
months old. That led to a full reconciliation. It was really
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then that their unofficial marriage was accepted. Kasang gave Nanda her traditional wedding dress to wear and the couple
exchanged rings again, this time with their whole family as
witnesses. ‘It was very touching, we felt really accepted,’
Nanda recalls. Kasang and Sonam began visiting Nanda and
Sagar in Kathmandu, keen to spend time with their plump
little grandson.
‘I’ll never forget the moment when I had a sudden glimpse
of family togetherness. It was wonderful. It meant so much to us,’ Ruit recalls.
Sagar’s first birthday, in 1990, marked another major mile-
stone in Ruit’s life. That was the year he decided to walk
He was heading into the field to do modern cataract surgery
himself, and to eventually set up his own hospital, even if it meant being a scourge to the establishment. Perhaps something of his mentor’s attitude had finally rubbed off on him.
‘Don’t tell me what you can’t bloody do,’ Hollows would say.
‘Tell me how you’re going to do it.’
Ruit’s departure sent shockwaves through the ophthalmic
community. Ram Pokhrel was furious when he heard the
news that Ruit was resigning, and that NEPA, the Australian
charity supporting him, was withdrawing its funding.
Pokhrel was Brahmin, the highest caste. He was used to
having total control over the hospital and he didn’t want
to lose the talented young doctor.
But once Ruit took a deep breath, and stepped out of the
system, nothing could shake his resolution.
Even with such a strong inner guidance to rely on, Ruit
could not do this kind of work on his own. He needed a loyal
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team to help shoulder the load. He has an uncanny flair for
choosing the right people for the job. He watches them care-
fully, gets the measure of them, before he asks for their help.
It’s rare that his instincts are wrong.
Ruit chose seven staff, whom he later dubbed ‘The Magnif-
icent Seven’, from the Nepal Eye Hospital to help run his
microsurgical camps. All excelled in their work. And all of
them, he figured, believed in him enough to take a big risk
and t
o handle the physical hardships involved.
Ruit called them into his tiny office in the small, private
practice he’d set up soon after graduating to help support
his family. During his six years working at the Nepal Eye
Hospital, Ruit’s typical day had involved working from
8 a.m. until 4.30 p.m. at the hospital, earning a salary that was about 2500 rupees (AU$30) a month. To supplement
his income, he also worked most nights, from 4.30 p.m. to
9 p.m., at his own practice in New Road, charging private
patients a small fee to prescribe them glasses. ‘My private
practice was never for operations. I could have easily done
that, and made an enormous amount of money, but neither
Nanda nor I felt it was a good example to set.’ Now this
tiny room was to become the unofficial headquarters for
his campaign.
Over cups of extra sweet chia, Ruit outlined his plan to take modern eye surgery to every corner of Nepal. ‘I don’t
know if I’ll succeed or not, but I have a strong feeling this will work,’ he told them.
The Nepal Eye Program (NEP) charity was formed to
support Ruit’s work, along with NEPA in Australia.
NEP had only $200 to its name, but it had heft. Shambhu
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Tamang, the youngest person to ascend Mount Everest,
advised on camp logistics, and Hari Bansha Acharya, one of
the country’s most popular actors, helped with publicity. The legal adviser was Sushil Pant, who later became the country’s attorney- general.
Today, working with Ruit is seen as a prestigious position,
but, back then, venturing with Ruit to the outreach camps
was truly leaping into the unknown.
‘I encouraged them to join me by telling them that I’d
handpicked them all for their special qualities; a combination of technical skill and good hearts. I told them that although our country wasn’t doing anything for the blind, our small
group might be able to actually make a difference if we tried.’
All of them said yes.
One of them was Nabin Rai, a talkative young assistant,
smart, kind and trustworthy—‘the sort of person you’d
depend upon in a life crisis’ as Ruit puts it. Rai had a flair for coordinating with far- flung villages, and is still working with Ruit as the medical coordinator at Tilganga. He also
asked two nurses, Beena Sharma and Karuna Shrestha, if they