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out to Nanda, who was ‘so shy she hardly said anything. It
must have been a huge shock for her to be in such a different culture.’
‘It was a wonderful year for Nanda and me to get to know
each other without the pressure of society around us. It also gave me a year to think about the big picture, and what
I wanted to achieve when we got back home,’ Ruit says. ‘We
had such a beautiful year in Sydney.’
Fred and Ruit would sit up late into the night, outside on the veranda in the summer, drinking too much whisky and scotch
as they talked about how to wipe out avoidable blindness.
They were united in their outrage that the governments of
developing countries were unwilling or unable to spend the
money to look after the poorest people. Ruit’s bold vision
earned Gabi’s admiration.
‘It was obvious, right at the start, that he was going to
move mountains if he had to, to see it through. Fred would
have been so proud of him, because he’s just kept plugging
away doggedly at the task. Fred said shortly before he died,
“You know, if all I’ve achieved is launching Ruit, then my
life’s been a success, because I know he’ll change the world.”’
Despite Fred’s colourful language and crotchety moods,
there was undoubtedly a real connection between the two
of them.
Ruit was looking for leadership from the Western world
and he certainly found it in Hollows. He was enthralled by
his friend’s first- rate mind and conversation.
Hollows used to love the storms that rolled in over
nearby Coogee Bay, several kilometres south of Bondi Beach.
Hollows would stand on the sandstone veranda, gazing out
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at the lightning over the bay and shout to the heavens, ‘Come on, send her down, will you! Send the rain down!’
The Australian journalist Ray Martin often joined Hollows
and Ruit at Farnham House and was struck by the deep
accord between the pair and the way they were both hypno-
tised by the thrill of helping people see.
‘Fred was always such a cock- eyed optimist. I knew that,
in the real world, the money just wasn’t there, so I thought
to myself, Dream on . . . The two of them were like soul brothers.’ But they were both mesmerised, intoxicated by the
power of giving people the gift of sight. Fred would say, ‘This is too f- - king good. This is the sort of medicine you don’t need to get paid to do!’
Ruit was of the same opinion, even though he didn’t use the
same language. It could be seen in Ruit’s face, the same deep satisfaction as he unwrapped the bandages, shining a light in the eyes of a patient and witnessing them seeing the world.
Martin interviewed Hollows and Ruit on The Midday
Show, a popular television show that ran for decades in Australia. They passed a hat around the audience—mainly
middle- aged housewives—and raised a few hundred dollars
for Ruit’s work.
‘Ruit was incredibly shy to interview,’ Martin recalls. ‘He
really thought that without Fred he would have been a humble
eye doctor in the Third World. Fred was the inspiration who
launched him up to the next level.’
Ruit and Nanda’s year of sunshine and freedom was
drawing far too quickly to an end. They were tempted by the
idea of staying in Australia, enabling Ruit to take a well- paid position.
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But the gravitational pull back home to Kathmandu was
strong. Ruit needed to help his own people—‘the most deserv-
ing people in the world’.
Although Fred and Gabi weren’t well-
off themselves
kitchen table. The Nepal Eye Program Australia or NEPA,
as it was called, started with about $2000 to its name. The
first donation of $500 came from the Nepalese Australian
Association which had raised the money by hiring a hall at
the Prince of Wales Hospital, where they showed slides of
Ruit’s work curing the blind, and served homemade Nepalese
dumplings, tea and coffee.
NEPA was small, but it was stacked with talent. The pres-
ident of ‘Ruit’s cheer squad’, as Dr David Moran refers to it, who gathered around Fred and Gabi’s kitchen table, was Tim
Macartney- Snape, the first Australian to climb to the summit of Mount Everest.
The tiny support group grew into the biggest success story
in Nepal. What made it work was that there was always
a great deal of trust involved. Everyone in NEPA believed
wholeheartedly in Ruit.
Hollows drove Ruit and Nanda to Sydney airport with
duffle bags full of intraocular lenses, the tiny sequin- like pieces of plastic that, at $200 each, are worth their weight in gold in Nepal. Hollows had no hesitation plundering supplies
if it was for the disadvantaged.
Setting up the first free Aboriginal Medical Service several
years earlier, he had reversed a truck into the storage cupboards of the Prince of Wales’ pharmacy and helped himself to as
many medical supplies and equipment as he could fit into the
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back. For his young Nepalese friend, Hollows had no hesita-
tion liberating lenses for a higher calling. He begged, borrowed or procured as many from surgical companies as he could.
Although Nanda had missed her family, the thought of
return ing home filled her with trepidation. Traditionally, when Nepalese go to the West to work, they bring back household
equipment, clothes, toys, and, most importantly, money, to be distributed among family and friends. As Ruit and Nanda had
not worked, they had nothing to offer—other than intraocular
lenses, and Ruit’s audacious dream of wiping out avoidable
blindness in his country.
They knew it was going to be hard when they went back
home to face the disapproval of their family, but nothing
prepared them for just how shunned they would feel.
No-one was there to meet them at the airport. Not one
person. And no-one was prepared to take them into their
home. They lived very simply for about a month with one
of Ruit’s friends, in a run- down flat with a shared bathroom outside. They had only a few rupees between them and kept
to a simple diet of porridge, and rice and curry. Nanda had led a very sheltered life, protected by her family. Now, because of her marriage, she was living in a small flat on her own all day, isolated from her relatives, and almost completely broke. ‘It was a really tough time for Nanda. I felt terrible,’ Ruit says.
The only consolation he could think of was to constantly
reassure her with the phrase: ‘I am your father, your mother, your brother, your husband.’ He made sure she felt comfortable all the time, and that she had his total support.
Nanda’s brothers and sisters finally paid a visit, six months after the couple had returned home. They told Nanda that
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she could come back home whenever she wanted to, which
was a polite, Nepalese way of saying that they didn’t approve of the match at all. But Nanda had no regrets. She was in love with her husband, and focused on building a life with him.
Ruit’s father was the first to give his tacit consent to the
marriage by allowing the couple to live in a small flat that
he owned, above a photo shop, and under his own apart-
ment, on a busy road near the Bagmati River, not far from the Nepal Eye Hospital. The days were long for Nanda. She was
on her own, with not a soul to talk to, from 7.45 a.m. when
Ruit left for work until often 8 p.m. when he returned home.
Sonam, being a thrifty trader, was dividing his time between
his flat in the capital city and Hille where Kasang and the rest of his family continued to live. Despite the fact that Nanda
cooked for Sonam whenever he was in Kathmandu, such was
the rigidity of the caste system in Nepal at the time, that he completely ignored her. He refused to talk to her.
Not only had his son married a Hindu, but he had married
someone from a different caste.
their marriage. ‘I think being shunned by our families drew us closer together. It made us put extra effort into our relationship. The obstacles we faced only seemed to make us grow
closer. It made us really strong, because there was no one else around to lean on. We had to rely on each other.’
And besides, Ruit knew there was one sure way he could
cut right through the prejudice and restore their place in
society: by becoming one of the country’s finest doctors.
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8
Against the wind
By 1988, when Ruit had returned to the Nepal Eye Hospital,
he had refined intraocular cataract surgery to the point where the wound was so tiny that no stitches were needed at all and his patients’ eyes healed of their own accord.
The self- healing surgery was far less expensive and much
safer than the older style of surgery. No glasses were fitted afterwards. At the first outreach camps he organised, funded
by the hospital and the World Health Organization, he
witnessed how truly life- transforming the self- healing surgery was for patients. They could literally get up and walk home
on their own with perfect vision a few days after surgery.
Ruit wasn’t the only one working on the revolutionary
technique, but no-one else was prepared to take on such a
colossal task as travelling on foot, or horseback, or a rattling old bus, for days on end, to take the new technique to some
of the most remote communities on earth.
He was on the threshold of developing a system of modern
cataract surgery that could transform eye care in Nepal, and
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right through the developing world. The time was ripe to
get started.
Yet, in what would become one of the most monumen-
tal frustrations of Ruit’s life, the senior eye doctors showed no interest in adopting the new techniques. He met a brick
wall of opposition every time he raised the subject. The harsh reality began to dawn that he might have to leave the security of his position at the Nepal Eye Hospital and strike out on his own to achieve his lofty ambition.
Ruit was so low, he was at the point of despair.
Working on the national survey into blindness, he had seen
first- hand the devastating numbers of Nepalese who were left blind, simply because they were unable to make it to a clinic or hospital and receive modern eye care. He was desperate to start changing things for the better. He longed for intraocular lenses and portable microscopes, to start setting up clinics in rural areas. But every time he tried to make a start, Nepali bureau-cracy came down on him like a tonne of bricks. As a junior
doctor at a government hospital, he had no authority or clout.
His suggestions were met with snide remarks. He knew that to
turn his vision into reality, he needed to break away from the government hospital, and the inertia and corruption that accompanied it. But it was a daunting task. The stakes were high. To do so would be seen as treason by the ophthalmic hierarchy.
The big stumbling block was that each intraocular lens
cost about $200, which would take a Nepalese villager about
six months to earn. Although the Nepalese elite could fly to
Delhi or Bangkok, Thailand, for a state- of- the- art operation, the price tag of those little pieces of plastic kept them well out of reach of the estimated 600,000 blind in Nepal.
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As well as being expensive, they were hard to obtain.
Ruit’s only source were outdated versions from the West.
The rapidly changing designs in intraocular lenses meant that manufacturers were able to donate the older ones that still
worked well to the developing world. His work had begun
attracting the attention of surgeons from the West, who
were fascinated by his cause and wanted to help. Every time
American doctors such as Richard ‘Dick’ Litwin flew into
Kathmandu, Ruit would ask them, ‘Don’t forget to bring me
a box of eyes, will you?’
Litwin, a laid- back Californian, became known as ‘Santa
Claus’, not just for his snowy white beard, but because he
never failed to turn up at Kathmandu airport without duffle
bags filled with the feather- light lenses. He would charm his way through customs by telling the officials that they were
to ‘help your grandmothers see again’. Litwin’s sweet- talking worked every time, but Ruit knew it was not a long- term
solution to solving the heartbreaking backlog of patients
needing cataract surgery.
The more Ruit tried to persuade his superiors to adopt
modern cataract surgery, the more they declined to engage in
his idea. Some of his adversaries were openly hostile. ‘Stop
dreaming, Sanduk. You don’t have the equipment—or the
lenses—to do it,’ they would tell him; ‘It’s never going to
happen. What you’re trying to suggest is impossible. It’s just far too expensive.’
They argued the case, telling him that for every $200 spent
on one intraocular lens, 50 older- style surgeries with glasses could be performed. They pointed out that there were not
enough trained surgeons who knew how to do modern cataract
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surgery. ‘They’re very complicated to insert,’ his opponents
would argue. ‘That’s fine for you to go out there and operate on someone’s eye, but who is going to go back and do the
second one?’
They threw every trick in the book at him. The one that
truly galled him was the accusation that the technique had
not been proven by clinical trial.
‘But it has been proved in the West,’ Ruit would reply
wearily. ‘They’ve shown it works on white people, they just
haven’t done trials to show it works in the developing world
as well.’ He knew prejudice was at play, and there was nothing he could do about it.
He was hamstrung. In
retrospect, Ruit says, carrying out
a clinical trial would have probably helped his approach
to become accepted much faster, but at the time, it was an
impossible task. The Nepal Eye Hospital was on a shoestring
budget and an enormous amount of time and money was
needed to conduct a clinical trial. Large numbers and clear
protocols were required to analyse it properly.
‘Everyone in the ophthalmology field knew that intra-
ocular surgery would work extremely well in the developing
world. All you really need is a clean room, sterile equipment and a good team.’
Ruit remained impeccably polite in the face of disapproval,
but what his critics didn’t realise was that he’d become
completely enthralled with the new technique. There was no
turning back for him. Every time he did an intraocular lens
operation, he was quietly musing about how he could train a
squadron of doctors to perform them throughout the devel-
oping world; how to reduce the prices of the lenses; how to
obtain robust, portable microscopes that could be bundled
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up onto buses, jeeps, and onto the backs of horses to be taken to far-flung valleys and up to remote mountain tops. He was
obsessively driven about applying his technique to the worst
pockets of blindness in Nepal.
He grew enraged that a second- rate treatment was being
tolerated, even championed by his peers. All he could see was that hundreds of thousands of people were getting second-class treatment, or remaining blind, simply because the Nepal Eye Hospital was threatened by the new technique. He met
patients fitted out with glasses who had slipped so many times on the terraces in the monsoon season that they were covered
in bruises and scratches. Many patients lost or broke their
glasses and were unable to replace them; there are very few
spectacle shops in the Himalayas.
‘It was really hard for Ruit,’ recalls Litwin. ‘He wasn’t in
charge of the hospital, but his heart was with the Nepalese
people and he could see the government wasn’t going to help.
He must have felt so held back. The intraocular lenses weren’t just a threat in the Nepal Eye Hospital, they were a threat
to an entire generation of ophthalmic surgeons in the US as