Ruit ran to the factory to find Murphy lying on his back on
the concrete floor, having stopped breathing. Ruit knelt down and did cardiopulmonary resuscitation, furiously pumping his
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chest. The Australian didn’t lose his larrikin streak, even on death’s door. Looking up at Ruit’s 80- kilogram frame bearing down on him as he regained consciousness, he shouted, ‘Get
off me! Get the f- - k off me!’
To top it all off, they were about to be embroiled in a
public relations scandal. The Sydney Morning Herald was preparing to run a scathing article that The Fred Hollows
Foundation had lost half a million dollars on the faulty
lathes. Mike Lynskey, the CEO of the Foundation at the time,
swung quickly into damage control, assuring the journalist
that not only had the problem been solved, but that they’d
just completed a big sale of lenses using the new machines
from Florida. The story went no further.
‘It would have been a terribly anxious time for Ruit,’
Lynskey recalls. ‘It was a lot of work for us, but, at the end of the day, we could go back to Australia. Whereas Ruit had
to stay in Nepal where his credibility was really on the line.
If the intraocular lens factory [in Nepal] had not worked,
it would have seriously undermined his claims that it was
possible to make world- class lenses at a much cheaper price.
He had a lot of opposition, he had the Indians looking over
his shoulder at his every move, and he really stuck his neck
out. The pressure on him was enormous. The whole idea was
Fred’s, but then he left us to work out how to do it. Both
The Fred Hollows Foundation and Ruit took a massive risk
getting it up and running.’
The risk paid off handsomely. But by the time the intra-
ocular lens factory opened in June 1995, it was more akin
to a laboratory in Switzerland than something you’d expect to find in the developing world. Inside, the air and temperature 173
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were closely monitored, the equipment was computer- driven,
and the staff wore space- age- style blue protective clothing as they meticulously cut, ground, polished and sterilised the lenses that sold for $5 each compared with $100 in the West.
It was the first factory in Nepal to be quality- assured with international standards. Thanks to Avery’s finesse, the plant has since gone on to produce more than five million ‘little
pieces of magic’, as Gabi Hollows calls them, which are sold
in more than 70 countries around the world.
The lenses Avery produced were so good that Indian
competitors and large multinationals could not believe that a product stamped with ‘Made in Nepal’ could be world- class.
It was a classic case of David and Goliath—a small charity
in Nepal pumping out world- class lenses for a fraction of the cost of the ones produced in the West.
‘The big multi- nats were absolutely furious with us,’ Avery
says. ‘At medical conferences, Indian manufacturers would
stand up and shout, “You’re cheating! You’re trying to ruin
our business!”
‘The senior executives must have been so threatened,’
Avery says. ‘They couldn’t believe we were making these
superb lenses in Kathmandu.’
‘Ray Avery did such a fantastic job,’ Ruit says. ‘He built
the first factory in Kathmandu that was quality- assured and
documented. What the lens factory proved is that if you can
do something like that in Nepal, you can do it anywhere in
the world. The factory he built was one of the real keys to our success. We were finally able to take on the big multinationals and show the world that we could produce the same quality
for a fraction of the price. We were able to keep the cost of 174
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the operation right down to the barest minimum. And we
were one of the first in the world to do it.
‘The factory [symbolises] that, no matter how poor you
are or where you live, everyone deserves high- quality sight.
The laboratory did away with the haves and the have- nots,
once and for all.’
Avery is sanguine about his success. When he met Ruit, he
realised he was dealing with a man of great substance. Ruit
didn’t pat him on the head. He had simply chosen Avery, as
he had chosen his initial team, to carry out a certain task
because he knew Avery was exactly the right person to do it.
Avery regards himself as a changed man after finishing the
factory. He found himself profoundly moved by the thought
that millions of people could now see clearly because of the
lenses he helped produce in Kathmandu. He never worked for
another chemical company again. Instead, he set up a charity, Medicine Mondiale, which manufactures medical equipment
such as incubators for premature babies at a fraction of their usual cost for the developing world. He received a knight-hood for his philanthropy in 2011.
The factory continues to produce 600,000 lenses a year.
Ruit has ambitions for it to eventually produce three times
that amount. ‘It’s a big market—as the population ages,
there will be an increasing number of cataract surgeries.
The lenses will help Tilganga to become even more self-
sustaining,’ says Ruit.
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18
Lean on me
Ruit can be gruff and intimidating to newcomers. He had
learnt to have his guard up against ambitious Western
doctors who had professed a desire to help Tilganga, only to
discover they were simply what Hollows used to call ‘medical
tourists’. By this, he meant doctors who wanted to chalk
up a few dozen operations in the developing world on their
resume before heading for the Himalayan snow peaks and a
bit of an adventure.
Ruit’s standards have always been dizzyingly high, and
he is notoriously difficult to impress. So, at first, he hardly noticed the young American surgeon Dr Geoffrey Tabin, who
had been sent to him as part of his corneal fellowship by
Professor Hugh Taylor from the University of Melbourne.
In those early days, no-one would have suspected that,
together, Ruit and Tabin would eventually form a dynamic
collaboration. They created a charity called the Hima-
layan Cataract Project (HCP) in 1995. It’s small but potent,
punching way above its weight; the staff of eleven raise more 177
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than US$1.3 million a year to support the work of Tilganga
Institute of Opthalmology, as the eye centre was later named.
But first, Ruit and Tabin had to make friends. It seemed
unlikely at first, as the two got off to a disastrous start.
To say Tabin is ambitious is an understatement. Before he
turned up in Ruit’s world, he had not
only studied at Yale,
Oxford, Harvard and Brown Universities but had climbed
to the top of the world’s seven highest mountains. As well as bungy jumping in his spare time, he was searching for a way
to make a difference in global health.
Yet, the initial impression he made on Ruit was that of a
‘hyperactive jumping jack’. ‘He just seemed to be unable to
sit down in one place,’ says Ruit. ‘He made me feel giddy.’
Ruit took one look at Tabin’s climber’s hands and told him
they were too rough and the knuckles were ‘too bent’ for
him to ever become a decent surgeon.
Tabin recalls Ruit was ‘stand- offish’. ‘He wasn’t warm and
fuzzy. It was pretty clear he was the professor and I was the student.’
He thought Tabin was yet another medical tourist who
wouldn’t stick around long enough to make a difference.
But Ruit became intrigued by the young doctor when
he came along to an outreach surgical camp in the lower
ramparts of the Himalayas. At their end-
of-
camp party,
a Tibetan surgeon got drunk and passed out under one of
the dining tables. He was a giant of a man, over 100 kilo-
grams—so heavy that none of the Sherpas could move him.
Despite being at an altitude of about 9000 feet, which makes
everything a lot slower and harder to do, Tabin somehow
managed to pick up the heavyweight by his feet and drag him
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backward into his bunk. Tabin told Ruit casually over break-
fast the next morning that he had also summitted Mount
Everest. Ruit took a second look at him.
He still missed Fred Hollows. And he was well aware that
Western doctors gave his work real clout, and could launch
his work onto the global stage. He knew how powerful the
resources and advocacy of a Western business partner could be.
Tabin, at any rate, was already hooked. On that surgical
camp, he had been moved watching a blind grandmother see
her grandchildren for the first time in years after surgery. As the tears of joy ran down her sunburnt face, he realised he’d never come across anything quite like it in medicine.
‘It was one of the most cost- effective health care interven-
tions I’d ever seen,’ Tabin recalls. ‘I realised it was possible to make a permanent change for the better in their lives after one short operation. The euphoria of the patients seeing again was intoxicating.
‘Watching the patients who had walked for days across the
mountains, lining up at the screening tables for the chance to see the world again [were some of] the most extraordinary
moments in my life. I was this brash, confident American
who thought I was going to be teaching the Nepalese some-
thing about state- of- the- art cataract surgery. Instead, I was the one who ended up doing all the learning. I just stood there watching in awe, mesmerised by the way everything flowed,
the way Ruit and his team delivered world- class care to so
many patients in such a short amount of time. My head was
spinning. His technical skills were incredible. His work ethic was phenomenal. He did surgery for eight hours a day and
kept directly talking to the trainee who was operating on an
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adjacent table. It became immediately obvious that he had
truly revolutionised care for the poor.’
When Tabin returned to the United States after two weeks
in Nepal, he began pestering Ruit, ringing him every few
days, telling him how much he wanted to help. He just would
not let go. Finally, Ruit decided to test him to see what sort of stuff he was made of.
He dispatched Tabin to a large hospital, the Golchha
Eye Hospital in Biratnagar, on the stultifying hot plains of
southern Nepal, near the border of India, about as far away
from the romance of the Himalayas as possible. During the
monsoon season for good measure, too.
Tabin arrived in a week of overwhelming heat and
humidity—it was on average 43 degrees every day—with
drizzling rain, and squadrons of mosquitoes. He put his head
down and worked sixteen hours a day, trying to teach the
resident doctors the new style of intraocular surgery, only to receive a distinctly chilly reception. At one stage, Ruit rang him to upbraid him for criticising the hospital staff. ‘He really laid into me, he said, “What the hell do you think you’re
doing, criticising the doctors there? Your job is to improve
surgery, not drive everyone away!” And then he hung up on
me. It was really rough.’
But Tabin proved to be just as tenacious as Ruit. He took
the point, learnt his lesson, rolled his sleeves up and continued to work from sun- up to sundown, for the rest of his six months there. ‘He thought I’d go scurrying back to America,’ Tabin
said. But like Ruit, he was a man who was not for turning.
When he returned to Kathmandu, having vastly improved
the standard of surgery at the hospital as well as performed
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thousands of operations, he detected a flicker of approval from Ruit. Not long after that they started discussing ideas for what would become the Himalayan Cataract Project.
The charity began out of a battered cardboard box in the
back of Tabin’s Honda Civic outside his home at the time
recalls Tabin handing him the jumble of paperwork amid his
tennis racquets and mountain climbing gear. ‘Here you go,
see what you can make of all this,’ he said, passing Heintz
a few years’ worth of tax invoices, receipts and handwritten
reports. Within a decade, Heintz, an environmental lawyer,
and Emily Newick, the current chief operating officer, had
created a fundraising giant.
As well as an ability to attract extremely generous donors,
HCP also has a flair for unlocking the lucrative coffers
of USAID. In 2009, after winning a huge USAID grant of
$700,000, which was matched by $1 million from American
donors, the charity doubled the size of the Tilganga Institute of Ophthalmology. The 12,000- square- metre addition to the
hospital included new training rooms, accommodation for
trainee surgeons and a highly profitable refractive surgery
for paying patients. In the process, they transformed Nepal’s finest hospital into a world- class training centre. In Professor Hugh Taylor’s words: ‘Tabin and the HCP picked up Tilganga
and took it to the world.’
Tabin, now a Professor of Ophthalmology at Stanford
University in California, has become Ruit’s right- hand man.
He readily admits the humanitarian work is ‘far more auda-
cious than setting out to make the ascent on the East Face of Mount Everest’.
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Tabin and Ruit are close, defining their relationship as
‘older brother, younger brother’. Tabin is an extrovert and
Ruit is an introvert. Ruit brings wisdom, expertise, and a
grand vision, and Tabin brings unbridled enthusiasm, energy
and fresh ideas. Sometimes zany ideas.
‘Sometimes his behaviour is quite outrageous,’ Ruit says.
‘I remember once we were sitting down to have dinner with
a minister of Sikkim [a state of India] and his officials. It was quite a formal social occasion, and the king’s youngest
daughter was there. She was very beautiful, and then suddenly Geoff had this lady sitting on his lap. It was completely out rageous to be openly kissing a Sikkim princess like that, even if she was his girlfriend.’
The two are guests in each other’s home, and know the
comings and goings of their family lives. Tabin would talk to Ruit every day if he could; Ruit manages to rein him back
to once every week, if possible. ‘We work really well as
fantastic partners. Sometimes we might squabble, but our
hearts are both in the same place. It’s important to have a
strong partner in the West like Geoff. Destiny brought both
Fred and Geoff to me to help my work. It’s a great partner-
ship—I am hands- on, and am constantly devising new ideas
to improve the system, and they have both nurtured it by
helping with resources, as well as being great advocates.
And [Geoff] fundraises so well. He networks with American
universities—he’s exceptionally good at networking with
high- end ophthalmologists.’
Ruit is proud of the way Tabin has been shaped by his influ-
ence. ‘Tabin has matured so much, he’s become a lot wiser,
and much more influential. And a much better surgeon, too.
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He is someone that I feel a great pride in being able to reshape.
He has moulded himself into a perfect international leader-
ship role. He’s used Tilganga’s ideas of team- building, and
bringing high- quality eye care to the poorest communities.’
Ruit recalls returning to the Jamgon Kongtrul Memorial
Home in Kalimpong, bone- tired from a harrowing day’s drive
across the mountain range, only to find Tabin performing
magic tricks for the orphans living there.
‘He did these crazy tricks with ropes and cards and the kids
were just screaming and giggling with laughter. You always
know when Geoff is around.’