known
American ophthalmologist, Professor Alfred Sommer, from
the John Hopkins Bloomberg School of Public Health, went
even further by stating that what Ruit was doing was not
only defensible, but that to perform any operation apart from intraocular implants would be malpractice.
‘Those articles did a lot of good. They really legitimised
what I was doing,’Ruit says.
Fred Hollows, too, really started to respect Ruit for
the results he was getting doing intraocular lens surgery at the remote camps. Hollows and Ruit had talked a great deal,
often over a late- night whisky, about their vision of providing high quality surgery to every person, no matter how rich or
poor, or where they lived. But now Ruit was actually going
out and doing it. He’d turned their dream into a reality.
118
The Barefoot Surgeon_TXT.indd 118
9/5/18 2:23 pm
the barefoot surgeon
Ray Martin recalls, ‘He started to see him in a new light
when he went out on his “barefoot doctor” campaign’.
Hollows couldn’t believe it at first when Ruit rang him to
tell him about the results. Hollows told Martin he thought
what Ruit was doing was ‘f- - king amazing’ and soon began
accompanying him on the camps.
Several Western surgeons began joining Ruit on his cataract
camps, as well as Hollows. Ruit was always pleased to have
them on board. ‘There were people in the West, similar to
Fred, with good hearts, who wanted to help us. Working with
us helped their careers as well, when they went back home.
So, it was a win- win situation all round.’
Dick Litwin was one of Ruit’s early patron saints. Litwin
used to tell him, ‘Sanduk, if there are any mistakes on this
camp, you tell everyone they are my mistakes.’ Despite
the fact that there were few mistakes—Ruit estimates only
1 per cent—having someone of Litwin’s calibre onside gave
him the imprimatur to keep going.
Western surgeons such as Dr Litwin were prey to the
afflictions of rough conditions, especially at high altitudes.
Everything seemed so primitive. In the West, eye doctors were starting to use sophisticated techniques such a phacoemulsification which broke up the cataract with an ultrasound
needle. Yet here they were helping Ruit out in the remote
countryside, using the most basic of equipment.
Before Ruit found cheap portable microscopes, his team
operated with loupes, a type of magnifying glass that jewellers use. When it was cold, these would fog up, and the surgeons
couldn’t wipe them because they were trying to keep their
hands sterile. If they were lucky enough to have a microscope, 119
The Barefoot Surgeon_TXT.indd 119
9/5/18 2:23 pm
ali gripper
often the motor that helped it move up and down to focus
wouldn’t work. Or the power would cut out in the middle of
an operation, and the nurses would have to hold a torch so
the doctors could finish the job.
Often, doctors had respiratory problems or gastroenteritis.
Litwin used to say, ‘Anyone can do this when they’re not sick.’
They just muddled their way through, as best they could.
Despite all the ailments and discomfort, many of the
Western doctors who helped at the camps regard it as one of
the most life- affirming experiences they had ever had. When
they looked up, and saw a queue of blind people standing
anxiously in line, nervously clutching their paperwork,
knowing this might be the only chance they ever have of
modern eye surgery, they knew they could not possibly stop.
They were operating on patients who were totally blind
in both eyes, so the results were astonishing. These were not Westerners who needed to read and drive at night. They were
mountain people who needed to be able to look after their
Litwin was deeply impressed by Ruit’s simplicity of
purpose. ‘I’m not sure if he was just born that way, or if it was because his sister had died from tuberculosis, but it was clear he really wanted to do something to help and he had
met some remarkable people along the way, such as the
3rd Jamgon Kongtrul, who had really guided him, and whose
advice informed everything he did. There was no doubt that
Ruit had a rare quality. He was a monomaniac, obsessed with
just one goal in life. He’d wake up every morning and think
about how many blind people they could cure that day.’
120
The Barefoot Surgeon_TXT.indd 120
9/5/18 2:23 pm
the barefoot surgeon
Litwin was amazed that they could do so much with so
little. The sutures, a special needle with the thread forged into them so there’s no bump when the eye is sewn back up, were
often used four or five times each. What was left over was
sterilised with alcohol, and then used again.
Begging, borrowing, scrimping and saving for equipment
had become a way of life for Ruit, and he eventually found
small portable microscopes to take on the camps: $6000
Konan microscopes from Japan rather than $40,000 ones
from Germany or the United States. ‘They were small and
sweet and did the job,’ he says.
The camps, held in natural catchment areas in the country-
side, slowly metamorphosed into a series of district clinics. If patients kept turning up at a particular camp several years
in a row, Ruit would organise for a doctor to work there in
a full- time clinic. They became part of his network of care
spreading across Nepal.
On the last night at an eye camp, a big bonfire would be lit, and everyone would sit around drinking and dancing. If the
camps were in safe places, Ruit adored having his family with him. By the time they were in their teens, Sagar, Serabla and Satenla were usually busily employed as volunteers; they’d
help do the vision testing before the operations, and enter the patients’ information on their laptops.
Serabla regards attending the camps as one of the best
parts of growing up with her father.
‘They were always more like community events, or a
festival. It was always magical when we took the bandages off and the patients could see again. I’ll never forget one patient, a woman, who had walked six hours to come to the camp,
121
The Barefoot Surgeon_TXT.indd 121
9/5/18 2:23 pm
ali gripper
who had been blind for more than ten years. When they took
her bandages off and she could see again, she said she felt like she’d come out of a deep sleep. That’s what it was like for so many of them.’
122
The Barefoot Surgeon_TXT.indd 122
9/5/18 2:23 pm
12
For all the
world to see
At home in the mountain villages of Nepal, Ruit’s fame
continued to grow. At one camp, at a village called Tupche,
in the south- west of Nepal, Ruit told Shore, ‘I will pray to Buddha that we have patients.’ He needn’t have worried:
there were hundreds of patients waiting for him at a tumble-
down school. Others w
ere outside clamouring to get in. To
Shore, it was like a biblical event and the scenes he witnessed were like miracles.
The sense of joy when the bandages were unwound on a
group of 200 patients is still fresh in the mind of Australian actor and filmmaker Joel Edgerton.
Edgerton recalls witnessing ‘an incredible scene’ when he
travelled with the doctor to an eye camp in northern Nepal.
‘The camp was in the simplest of circumstances, just a simple schoolhouse, and the patients had walked for days along
treacherous roads to get there. They were bent over by the
sheer weight of their work and the elements.’
After helping several old ladies to Ruit’s operating table,
123
The Barefoot Surgeon_TXT.indd 123
9/5/18 2:23 pm
ali gripper
he watched in astonishment, when, the next day, Ruit took
off the patches over their eyes, and he asked one of them,
Geeta, to reach out and touch Edgerton’s nose.
‘After she’d playfully tweaked my nose, it was clear she
could see fingers, then faces, and then, eventually the moun-
tains and trees around her. In five minutes in a crappy little cement room he had literally turned all these people’s lives
around. I will never forget the smiles on their faces, and on Dr Ruit’s—his was the biggest. It was just such a celebra-tory atmosphere. The pleasure he receives every day helping
people see again keeps him wealthy in his spirit and soul in a way he never would have if he’d spent his life doing corrective surgery in a private hospital in Dubai.’
As Ruit and his team grew in confidence, they went further
and further afield. His growing reputation helped him to
attract professionals to work with him and travel to parts
of the world that he called ‘hubs of blindness’, which were
difficult to access. He was never deterred by how far he had
to travel, or what the conditions would be like. The simple
fact was that the more blind people there were to cure, the
happier he was.
The Buddhist lama in Kathmandu, His Holiness Gyalwang
Drukpa, invited Ruit to work in Ladakh, a high- altitude camp in the mountains of northern India. Ruit leapt at the chance to do thousands of surgeries in a new area. Later, in Singapore, he met Tan Ching Khoon, who, through his charity, A New
Vision, gave Ruit and his team the green light to restore sight throughout Indonesia and Myanmar.
It seemed nothing would stop the maverick team. No road
was too far, too steep, or too high. At Gucho, in Tibet, Ruit’s 124
The Barefoot Surgeon_TXT.indd 124
9/5/18 2:23 pm
the barefoot surgeon
team managed to perform intraocular surgery on the roof of
the world—5000 metres above sea level. Altitude sickness does strange things to the hardiest of men, and Ruit’s team were
no exception. Up in that thin air, most of them were short of breath. Ruit was beset by splitting headaches and nausea, as
well. Sterilising the equipment took hours because the high
altitude meant the water took a long time to reach boiling point.
‘When you’re up that high, everything feels like it’s in slow motion. I was doing surgery, but at about a third of my usual pace,’ Ruit recalls. He nearly froze to death; he was so cold that his team had to wrap blankets around his back as he
did the operations. He had to keep rubbing his hands to keep
them warm enough to use the equipment.
Staying in a simple country inn and sleeping on hard
wooden beds on thin mattresses meant sleep was hard to
come by. ‘Sometimes you’re not feeling your best. You feel
terrible. But when you look at the type of patients you are
treating, and results you are going to get, then you really feel good. It’s worth the effort.’
In the early days of their outreach camps, most of the
toilets were foul- smelling public areas; to avoid them, Ruit and his team would get up early and relieve themselves somewhere in nature. In Tibet, they had to contend with roaming
mastiff dogs, as well. Trained to fight in battle by jumping
on riders and knocking them from their horses, these wild
dogs bailed up Ruit’s team one morning near Mount Kailash
on the way to their morning ablutions. ‘We were absolutely
terrified,’ Ruit recalls. ‘We stood stock- still and tried not to make a noise. Eventually, a herd of sheep distracted them and they ran away.’
125
The Barefoot Surgeon_TXT.indd 125
9/5/18 2:23 pm
ali gripper
Many of Ruit’s patients at these high mountain camps of
Tibet were nomads, dressed in tattered chubas, a type of long woollen gown, that were only washed once or twice a year.
Their faces were caked black from the dust and smoke of
their campfires. They were so dirty that Ruit and his team
had to wash the patients’ faces several times with soap and
water before they attempted surgery.
Although old- style eye surgery had been done in Tibet,
until Ruit arrived with his team, modern intraocular surgery
had never been undertaken. Many of the patients had been
completely blind in both eyes for more than ten years, so the results of Ruit’s operations caused a sensation. Officials came from China, curious to see his work with their own eyes.
‘They thought we were doing some kind of magic. They just
could not believe we were doing it properly,’ says Ruit.
TIME magazine writer Tim Blair was captivated by the reaction of the Tibetan patients. ‘The duration of their misery is staggering, considering the swiftness of the procedure,’
he wrote in 1999. ‘Just 50 years ago, the treatment would
have been a crude form of surgery known as couching . . .
[it] removed the clouded part of the lens but provided no
replacement, meaning that although vision was improved,
it remained blurred . . . Watching them regain their sight is beautiful to behold. At first, only vague outlines of nearby
objects can be seen. After a day or two, patients are able
to focus on things farther away, and to make out the faces
of children and grandchildren sometimes never seen before.
Within weeks, their fully healed eyes can once more take in
Tibet’s icy, sun- reflecting landscapes. And, on a clear day, Mount Everest.’
126
The Barefoot Surgeon_TXT.indd 126
9/5/18 2:23 pm
the barefoot surgeon
So impressive were the results, Ruit was invited to return to Tibet by an organisation run by the son of a former Chinese
leader, Deng Xiaoping. Ruit seized the chance and went on
to train more than 25 Tibetan doctors, as well as perform
thousands of surgeries.
For sheer physical hardship, though, nothing topped Ruit’s
trip to Mustang in 1992, the hidden kingdom tucked between
Nepal and Tibet. The medieval time capsule had been cut off
from modern life for centuries. Entry had been forbidden for
decades; unknown to most of the world, it had been the base
for Tibetan rebels trained by the CIA to fight the Chinese in Tibet in the 1960s and ’70s. In 1992, Nepal’s new democratic
government decided the time was ripe to open the fabled
land. ‘I knew the inhabitants were extremely poor and would
have never been to a hospital, or seen a doctor, let alone have been able to buy a pair of glasses. I was champing at the
bit to work there,’ he says.
Unfortunately, travelling to Jomsom, Mustang’s adminis-
tration centre, instilled a terror of flying in Ruit that he still suffers from. The airport is one of the most dangerous in the world. The only time planes can land safely is before 10 a.m., when the fierce winds of the Kali Gandaki Gorge abate for
a short while. Otherwise, the planes are buffeted about too
wildly on their approach for the pilot to land.
Despite the fact that their 18- seater Twin Otter flew in on
a calm, clear day, the wings were still so close to the sides of the narrow valley that Ruit felt he could almost reach out and touch the mountains. He was literally hanging onto his seat as they descended onto the short runway. With him were a band
of his true believers: Dick Litwin, Beena Sharma, Australian
127
The Barefoot Surgeon_TXT.indd 127
9/5/18 2:23 pm
ali gripper
photographer Michael Amendolia, and Les Douglas, who
was the Australian ambassador to Nepal from 1989–94, and
his brother John Douglas.
After disembarking, the team reeled back in horror. At
the end of the tarmac, in a nearby creek, lay the incinerated, upside- down wreck of another small plane that had attempted
to land in bad weather a week earlier.
On that same trip, they received the devastating news that
a Pakistan International Airline (PIA) airbus had crashed into a cloud- covered hill of Kathmandu, killing all 167 passengers and crew on board. On board flight PK–268 from Karachi
was one of Ruit’s university colleagues, Rupak Sharma, the
captain of the national soccer team.
‘I still have to close my eyes when I’m in the air because of that trip to Mustang,’ Ruit admits. ‘Most of the time when
I’m in a plane I am counting the minutes until we can land.’
Then it was time for the next challenge: getting to
Tsarang, where they would hold the eye camp. In front of
them was the 20,000- metre Annapurna range covered in
snow and ice. They were about to start making their way
up through some of the most treacherous mountain passes
in the world, through the back of the Himalayas up to the
Tibetan plateaus. Their mode of travel? Tibetan packhorses
with hard wooden saddles covered in carpets. This was not a
trip for the faint- hearted.
As they set out, the cold wind tore at their clothes, and