brown, and when she walked outside into the sunlight, they
sparkled with flecks of gold. Her whole face began to shine
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with joy. Within a few hours, she was singing Hindu love
songs. Gomi could see, and her future had changed. ‘Now
one day I might have a husband,’ she said. ‘I can have a life of my own.’
‘It was such a joy to see Mainala leave the hospital in a
new dress, and full of hope,’ Ruit says.
A masterstroke of the corneal donation program was Ruit’s
idea for a team of counsellors to gently approach families,
just as they were about to organise for their relatives to be cremated. The Shrestha clan was a classic example. When
they brought their 80- year- old mother to Pashupatinath, one of Ruit’s counsellors, trained by the head of the eye bank,
Shankya Twyna, quietly made her way through the throng
toward them.
The grand dame had suffered a heart attack at 3 a.m. that
morning. After unloading her from the ambulance, her family
burned incense on each corner of her stretcher and lay mari-
golds and carnations over her shroud.
With her luminous brown eyes, soft wavy hair and a pink
sari, the counsellor approached the family, and, with great
sensitivity, asked if they would consider donating their mother’s corneas to Tilganga, just on the other side of the road. It will only take a few minutes, the counsellor explained, and there
will be no harm done. The corneas will give a patient a second chance at life. The men of the family quietly conferred, heads bowed together, over their mother’s stretcher.
A short time later, they nodded to the counsellor to go
ahead. When the first corneas were collected by Twyna, they
were taken out right next to the funeral pyres by the banks of the river. Later, excision rooms were built. For the Shrestha 195
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family, technicians from the electric crematorium set up a few hundred metres away from the river bore their mother on her
stretcher into the excision room where she was transferred
onto a steel operating table. Her steel- rimmed spectacles were removed, and placed on a tray. One of Tilganga’s eye bank
technicians went to work, removing the transparent covering
of her eyes with his scalpel and forceps. He placed her corneas into a sterilised bottle, and put them in a small refrigerated box which was whisked away to the hospital.
Small plastic caps were placed over her eyes, her eyelids
were closed, and she was returned to her family. The family
stood around her stretcher in a circle, and their wailing filled the room. The doors to the crematorium opened, and she was
engulfed in flames.
Within hours, across the road at the hospital, one of the
surgeons began suturing her corneas into place on a patient.
The Shrestha family’s matriarch was no longer with them,
but, for one fortunate person, she left the gift of sight.
The Tilganga Eye Bank now has all the corneas it needs.
It sends surplus corneas around the world, from Bhutan to
China, Malaysia, Pakistan, Cambodia, Bangladesh, Indone-
sia, Thailand and East Timor. Ruit and his team have made
donating corneas as ordinary as donating blood.
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21
Shining star
Staying in Nepal has meant Ruit has not made a great
fortune, but neither he nor Nanda have ever been particu-
larly materialistic. All too often, they had seen specialists on big salaries who had every material advantage and yet never
seemed satisfied. That’s not to say there haven’t been a few
temptations along the way. One of the positions Ruit turned
down early in his career was as the personal physician to the Sultan of Oman, which would have come with a large house,
a personal driver, and a chef. A lucrative position in Sydney beckoned after their year living with Fred and Gabi Hollows.
A hefty salary could have been his for the taking if he’d moved abroad to the United Kingdom or the United States.
But he looks genuinely puzzled when asked if he has
any regrets about the path he chose instead. The idea of
amassing the trappings of wealth such as fancy cars or expen-
sive overseas holidays seems to have barely registered in his consciousness. He’s probably the most unlikely international
star Nepal has ever had. After more than 30 years on the road 197
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as an eye doctor, restoring sight still bewitches him. It’s a form of intoxication that never fades. There’s nothing as satisfying, apart from seeing his three children gain educations and start navigating their way in the world. ‘None of them are high-flyers, they just all put their head down and work hard. We’re very proud of them,’ he says.
By turning his back on the trappings of materialism, Ruit
had become a cultural hero in Nepal. The Kathmandu Post
regularly features front- page stories about him receiving yet another award. Travelling with him is akin to being with
royalty; hospital and hotel staff make way for him like the
parting seas. The country’s most influential businessmen
and politicians are contacts on his iPhone, whom he’ll occa-
sionally ring from the back seat of one of Tilganga’s Toyota
LandCruisers on the way to the next camp.
Ruit always stayed well above politics—his own leanings
are a mystery—but, by 2000, his stature in the country had
grown to such an extent that he’d been asked to head several
of Nepal’s political parties. He always said no, much to
Nanda’s relief. But there was one diplomatic role Ruit was
proud to perform: that of unofficial adviser to the Nepalese
royal family, especially to the much- loved late King Birendra.
The surgeon had been invited several times to dinner at the
royal family’s home, Narayanhiti Palace. Despite the fact that he felt distinctly ill at ease, he would sit quietly through the formal five- course banquets under glittering chandeliers with the upper echelons of society. The dining room walls, decorated with giant oil paintings of former kings, and the heads of stuffed tigers, trophies from hunting expeditions, were a world away from his simple apartment and private consulting room.
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‘I could never work out how someone like me, with such
a modest background, ended up having dinner at the palace,’
he says. ‘I must admit I never felt truly comfortable being
there, but the king, God bless him, always tried to make me
feel at ease; he would call me “Doc” and ask very nicely about my work.’
Like many Nepalese, Ruit had conflicted feelings about
the royal family; he felt the country should move toward
becoming a democracy, but he also adored the king.
Tilganga had become an example of what Nepal could
do, beyond politics, free of corruption, and King Birendra,
wishing to take the same approach governing the country,
asked Ruit’s advice on many occasions
. He respected Ruit
because he knew he was in touch with the common people.
Ruit also met the king’s son, the Crown Prince Dipendra,
known as ‘Dippy’ for his habit of breaking the speed limits in his sports cars and his penchant for semi- automatic firearms.
‘He was a good drinker, much like Fred,’ Ruit recalls.
‘I remember how he used to love washing down Scotch
whisky on the palace veranda.’
Many Nepalese regarded King Birendra as something of
a demigod. He was a unifying force in a deeply fractured
country, with many different ethnic groups and castes. He
made people feel safe, especially during the brutal, ten- year civil war (1996–2006), which saw thousands of Maoist rebels
trying to overthrow the government to alleviate centuries of
poverty and suppression.
Ruit, like millions of Nepalese, was devastated by the events of 1 June 2001. Just when peace talks with the Maoists were
starting to look hopeful, nine members of the royal family
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were massacred by one of their own—the heir to the throne,
Prince Dipendra.
The bizarre episode of regicide plunged the country into
the world’s spotlight.
Prince Dipendra, purportedly crazed with anger that his
family were not allowing him to marry the woman he loved,
and fuelled by a cocktail of drugs and alcohol, walked into
the dining room and slaughtered most of his family with a
machine gun. He shot his father first, then turned his rage on eight other members of his immediate family, including his
mother, Queen Aishwarya, his brother Prince Nirajan, and
his sister Princess Shruti. After trying to blow his own brains out, Prince Dipendra died two days later in hospital.
It was the worst mass killing of royalty since the Romanovs
were murdered in 1918 during the Russian civil war. Ruit
received a phone call in the middle of the night at his apartment telling him the news that ‘His Majesty has just been
shot’. ‘We were just in disbelief. Nanda and I simply could
not believe it at first. We thought it was some joker, playing a hoax,’ he recalls.
‘We were all absolutely devastated,’ Ruit says. ‘I had such
an affinity with him. He was such a good man, a man of the
people. We were on very good terms and I had seen him
the week before for his glaucoma. I loved his simplicity, his love of the people. He had shared his many thoughts with me.
He really wanted the Maoists to sit down with him and work
it out, for the good of the country.’
After the initial physical shock, and what seemed like
the arrival of every media organisation in the world to
cover the tragedy in Kathmandu, the entire nation went into
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mourning. There was a huge outpouring of grief when the
king’s body was taken to the funeral pyres of the Pashupati-
nath temple by the Bagmati River. Thousands crammed onto
the streets to wail and say farewell.
Ruit, Nanda and the children gathered on the roof of a
building near the palace to watch the procession.
Ruit’s voice quavers as he recalls that grim day when
many Nepalese felt as if they had lost a father. The entire city closed down. All the shops rolled their shutters down, and
the restaurants locked their doors. The streets were filled with people crying, and beating their chests. As the funeral procession passed by, thousands threw flowers and white scarves at
the coffins. It was a genuine outpouring of grief and sorrow, the likes of which Nepal had never seen before.
‘All we could think of was what we had lost. I was incon-
solably sad. I felt that we had lost someone who was so great for our country. I think a lot of people still miss him. A lot of people feel their guardian had gone,’ he says. Like most men, Ruit shaved his head out of respect and grief. It was the end of the royal family which had occupied the throne in Nepal
for more than 200 years.
‘And as we predicted and expected, his death was the start
of a series of tragedies for our country. We’ve never really
recovered. The downfall of Nepali history really came from
the royal massacre.’
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22
On a clear day
Despite decades of extraordinary results, providing thou-
sands of people with a new life, Ruit’s surgical technique
continued to be viewed by some in the international ophthal-
mic community with derision or disdain. It was regarded as
a cheaper, second- rate way of restoring sight to the poorest people on the planet.
But international opinion about him finally began to shift
after a dramatic head- to- head contest with one of America’s top cataract surgeons. Ruit’s work was finally given the global gold stamp of approval in 2005 when Dr David F Chang was
invited to take part in a clinical trial with Ruit at the Pullahari monastery about 40 minutes north of Kathmandu.
Chang had to work so hard to keep up with Ruit that he
down to work with his usual finesse, tackling more than 50
patients blinded by mature cataracts. He had brought along his $100,000 state- of- the- art phacoemulsification machine from 203
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California, which, with its ultrasonic probe, is the most sophisticated way of removing cataracts in the developed world.
In his temporary operating theatre next door, Ruit quietly
worked through a similar-
sized case load. The barefoot
surgeon performed his operations using his simple toolkit of
scissors, knives, forceps and cannula probe. Aside from his
steriliser and $9000 microscope, none of Ruit’s instruments
required electricity.
Despite the breathtaking surroundings—the monastery,
which is studded with hundreds of exotic subtropical trees and flowers, and which seems to float like a heavenly realm above the chaos of Kathmandu—Chang found himself pushed to the
very limits of his abilities during the one- and- a- half- day trial.
His theatre door kept swinging open, and, one after the
other, a conveyor belt of challenging cases was brought to
his operating table. Almost every one of the patients had the massive calcified advanced cataracts Chang usually saw only
a few times each year at his California clinic. Extracting them using phacoemulsification was unrelenting work.
‘It was an incredibly stressful two days,’ he admits. ‘It’s
never good for your reputation to operate in a strange place, in the developing world after a long plane flight, but 80 per cent of the cases were the sort of exceptionally difficult cases that I’d only occasionally see at home. I really had to work hard
just to complete my share of the patients and to keep up with Ruit. I was completely spent by the end of the day.’
The results of the clinical trial were patently clear. Despite the
simplicity of his equipment and costing about an eighth
of the price, Ruit’s patients could see just as well as Chang’s the next day. A year later, Ruit’s patients were measured
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again. Their vision was still of equal quality to those Chang had operated on.
In fact, Ruit’s technique was not only faster and cheaper, it was also more appropriate for advanced cases. Chang openly
admits he uses Ruit’s technique on the very worst cases and
the densest cataracts he sees in his Californian clinic.
It had been a long time coming, but the trial finally gave
Ruit the international reputation he deserved.
‘Doctors like Ruit have a lot to teach us in the developed
world,’ he says. ‘Watching him at work, and his high- volume, low- cost cataract surgery, was nothing short of a marvel.’
Ruit says that one day something far less invasive will
probably be used to treat cataracts, such as medical drops
that dissolve the clouded areas. It might be a robot that does the surgeries on a conveyor belt. Surgery will be so fast and straightforward, like ‘getting your coat dry- cleaned’, as he puts it.
But in the meantime, there is still so much work to do. Ruit
wants to leave a legacy not just in bricks and mortar, through his community hospitals, but by training an army of eye
doctors; he loves fostering the careers of younger surgeons
who are spreading his technique like wildfire throughout the
developing world.
Ruit’s favourite way of training is to have two or three
surgeons working alongside him in his operating theatre.
This way, the most delicate of manoeuvres are magnified on a
television- sized screen inside the theatre, which the surgeons watch with hawk- like intensity.
Ruit teaches according to their level. With someone
from Indonesia who has had fewer advantages and is low
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in confidence, Ruit will be gentle and encouraging. But with
graduates from elite Western ophthalmology colleges, he will
be a hard taskmaster. As Tabin puts it: ‘He’s an expert in
getting surgeons from good to great. He expects perfection.’