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November 1, 2000

National Geographic

"An Eye on Two Worlds"

National Geographic

November 2000

"You are so brave," Sanduk Ruit tells Seti May Gurung after her surgery in a classroom-turned-operating-room in Bharatpur, a remote village in southern Nepal. The girl, afflicted by cataracts since birth, had walked days to reach the makeshift clinic, then endured shots of anesthetic around both eyes before surgery-with a stoicism far beyond her 12 years. Her reward: 20/60 vision or better. Cataracts are the leading cause of blindness worldwide, and Himalayan nations may suffer most. In Nepal the condition causes more than 80 percent of curable blindness. The reason the region is so affected is unknown, but researchers suspect genetics, diet, and the intense ultraviolet radiation at high altitudes.

Lack of eye care is another factor. Nepal has one ophthalmologist for every 300,000 people.

Enter Dr. Ruit, a soft-spoken Sherpa surgeon who is trying to turn the tide. With the help of the late Australian ophthalmologist Fred Hollows, Ruit perfected high-volume, low-cost cataract surgery that takes less than ten minutes. Some 85,000 Nepalese are treated each year at Ruit's Tilganga Eye Centre in Kathmandu and at remote field clinics like the one in Bharatpur. The poor get the surgery free, while the rest pay on a graduated scale up to $100.

Before Ruit's arrival, most Nepalese received 1940s-era operations that left them dependent on thick glasses, like the homemade monocle held by a crippled man awaiting screening (top right), who was carried to the school by friends. The clinics draw hundreds from the countryside, and they often queue up for blocks.

"It was very difficult in the beginning," says Dr. Ruit. "But after 15 years we have a system so simple that it can be done in remote areas at very low cost without compromising quality."

Relatives and medical students can watch the procedure on a TV monitor connected to the surgical microscope (top). But they'd better not blink-Ruit once performed 101 perfect surgeries in one day, an unofficial world record according to ophthalmologist Geoffrey Tabin. "Ruit is a fantastic technical surgeon," says Dr. Tabin, head of the University of Vermont's Himalayan Cataract Project, which supports the clinics. "He works tirelessly for the poor. The Tilganga Centre sees all comers."

Most who come leave with a better view of life. As one 63-year-old Tibetan woman told Tabin after surgery, "There is a new sky for my eye!"

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