Superb surgeons have qualities that set them apart. In addition to the intelligence needed to practice good medicine, they possess dexterity, physical stamina and, equally important, supreme confidence in their skills and an insatiable desire to fix things. But very few surgeons aspire not merely to cure a disease case by case but to vanquish it in an entire region of the world. That was the dream of Sanduk Ruit, a brilliant Nepalese doctor born in one of his country’s poorest and most remote villages, who became a pioneering ophthalmologist, revolutionizing cataract surgery and creating a medical network to deliver the sight-restoring operation to blind people throughout the Himalayas and in other developing countries.
Watching Ruit rapidly carry out impeccable cataract extractions in a bare-bones clinic in rural Nepal was the experience that first made David Oliver Relin consider writing about him. “I’ve always loved watching any physical task performed flawlessly,” Relin notes. But it was Ruit’s determination to cure cataracts, the world’s leading cause of preventable blindness, on a massive scale that convinced the co-author of the best-selling “Three Cups of Tea” that he had to tell the surgeon’s story.
And it is Ruit’s dogged personality and his remarkable accomplishments that make “Second Suns” a compelling and inspiring book. Ruit’s mother lost three of her six children to treatable illnesses — diarrhea, fever, tuberculosis — and young Sanduk, sent away to boarding school in Darjeeling, India, at age 7, soon resolved to do his part to remedy the lack of health care that had led to his siblings’ deaths. “They died because resources the rest of the world had were not available to us,” he recalled. “I realized I had to become a doctor.”
As a foil to Ruit’s superhuman focus, Relin also traces the trajectory of his unconventional partner, Geoffrey Tabin, an American ophthalmologist who seems, in the book’s early chapters, like a caricature of a talented but overly privileged and self-centered young doctor. Athletic, hyperactive and risk-loving, Tabin repeatedly dropped out of Harvard Medical School and later left an orthopedics residency to join mountaineering expeditions, even abandoning medicine to spend a few years as a journalist and world-class climber. But while volunteering at a Himalayan clinic after summiting Mount Everest, Tabin witnessed a cataract operation and decided to become an ophthalmologist. Years later, fully trained, he arrived in Kathmandu to work with Ruit, who at first refused to take him seriously. “Lots of foreign doctors came round in those days,” Ruit recalled. “I chalked him up as just another one of those jokers.”
To his credit, Tabin was so inspired by Ruit’s surgical skill and altruism that he did whatever his mentor demanded, eventually becoming both an expert eye surgeon and the chief fundraiser and grant-getter for Ruit’s Himalayan Cataract Project, as well as helping to expand the program’s training of eye surgeons to serve other medically needy countries, including India, Ghana, Ethiopia and Rwanda.
Ruit’s technical breakthrough is a simple operation that takes as little as four minutes and costs $20 per patient; his teams also use high-quality, implantable lenses manufactured in Nepal for $4 apiece rather than spending $150 each for lenses manufactured by first-world companies. Ruit’s results, measured and published in a meticulously conducted comparative study, are as good as those of a top-flight U.S. eye surgeon using expensive, state-of-the-art technology. In Nepal, “Geoff was doing entire surgeries for less than we spend to drape a single patient” in sterile cloths before the procedure, noted Tabin’s admiring boss, Randy Olson, director of the Moran Eye Center at the University of Utah.
“Second Suns” portrays heroic health care delivered under harrowing conditions: Ruit and his teams carry their equipment on multi-day treks up steep mountain trails, sometimes hiking at night with flashlights or head lamps, to reach settlements where they typically spend several days operating on hundreds of villagers in makeshift surgical theaters. They kept traveling and working throughout Nepal’s decade-long civil war, operating on government sympathizers and Maoist rebels alike.
In Nepal, when Ruit began his career, cataracts were commonly seen in children and young adults as well as in old people. Such blindness can be a death sentence for villagers who must walk hazardous mountain trails daily to obtain water and food.People often said, “Your hair grows white, your eyes grow white, then you die.” Relin recounts the story of Kamisya, a seamstress blinded by cataracts at age 40 who tried to kill herself by running off a cliff but was tackled at the last moment by her mother. Kamisya’s husband then carried her on his back in a bamboo basket to Kathmandu, where Ruit restored her vision. Twenty years later, when Relin met her, she could still see clearly.
In 1994, the year Ruit opened his eye hospital in Kathmandu, there were 24,000 cataract operations in Nepal. In 2007, there were 167,000, and the number of new cataracts diagnosed annually has declined sharply thanks to successful treatment of the country’s visually impaired residents. By his wife’s count, Ruit has performed more than 80,000 surgeries, and he and Tabin have trained hundreds of eye surgeons from other developing countries.
Despite Relin’s obvious admiration of his two medical heroes, he never discusses the reasons for the high prevalence of cataracts in the Himalayas, and he gives short shrift to the region’s other rampant health problems, which include nutritional deficiencies, infectious diseases and injuries. Although I guessed while reading the book that, compared with living at sea level, living at higher altitudes might expose people to higher cumulative doses of ultraviolet radiation — an important cause of cataracts — a cursory search of the medical literature suggests that’s false. The frequency of cataracts in the region may instead stem from a combination of environmental and genetic factors, including ultraviolet exposure.
Relin’s earlier blockbuster, “Three Cups of Tea,” provoked controversy in 2011 when Greg Mortenson, his co-author and the book’s protagonist, was accused of having fabricated parts of the story of his exploits in Pakistan and Afghanistan and of having misused donations to the charity he founded, the Central Asia Institute. A class-action lawsuit accusing Mortenson, Relin and the book’s publisher of defrauding readers was dismissed last year, but Mortenson agreed to repay the charity more than $1 million.
Ruit’s and Tabin’s achievements, as detailed in the new book, appear to be well documented, and their dedication is impressive. Indeed, at more than 400 pages, “Second Suns” is about 20 percent too long, with too many repetitive descriptions of grueling treks to remote surgical camps. Relin took his own life last year, at age 49, a fact that strikes me as especially sad in view of the passionate, persuasive case he makes for one human being’s ability to make a difference in the world. He compares Tabin’s personal transformation to the Buddhist image of a wave realizing it is part of the sea, not an independent being. “He was water, at one with this ocean of humanity who looked toward him and Ruit with such hope,” Relin writes. “He was here because he was needed. And now he needed to get to work.”
Two Doctors and Their Amazing Quest to Restore Sight and Save Lives
By David Oliver Relin
Random House. 415 pp. $27