The Barefoot Surgeon:
The Inspirational Story of
Dr Sanduk Ruit, the Eye Surgeon
Giving Sight and Hope to the
World's Poor
The Barefoot Surgeon: The Inspirational Story of Dr Sanduk Ruit, the Eye Surgeon Giving Sight and Hope to the World's Poor|by Ali Gripper
Perspective

A BAREFOOT SURGEON WITH A VISION

Dr Ruit is the Founder & Executive Director of the Tilganga Institute of Ophthalmology, the implementing body of the Nepal Eye Program.

Dr Sanduk Ruit

Poor and blind, what’s a worse recipe for a miserable life? That too, in a region which is not exactly known for its medical facilities? Thanks to a ‘Man with Vision’, the ophthalmologist Dr Sanduk Ruit, many poor people with ‘avoidable blindness’ have been able to get back their eyesight. This, not just in his home country of Nepal, but also in other neighbouring Asian countries as well as in Mongolia, North Korea, Ethiopia, Vietnam, Cambodia and Kenya.

Dr Ruit is the Founder & Executive Director of the Tilganga Institute of Ophthalmology, the implementing body of the Nepal Eye Program. Tilganga has an international centre of excellence for ophthalmology training, and its surgeons have been conducting camps to train eye-surgeons elsewhere in the pioneering small-incision low-cost cataract micro-surgery technique using the innovative implanted intraocular lenses, which is sutureless and self-healing. Dr Ruit has perfected this technique from his mentor and renowned Australian eye-surgeon, Dr Fred Hollows. The ‘Nepal Method’ is also taught in the United States Medical Schools.

‘All it takes is five minutes and three dollars’, says Dr Ruit. He has proved it by doing approximately 1,20,000 cataract surgeries so far, in makeshift hospitals in the remotest of places where people have no access to affordable quality healthcare. He has been hailed with epithets like ‘The Barefoot Doctor’, ‘Man with Vision’, ‘God of Sight’ and many more. And been showered with honours ranging from the Magsaysay Award for Peace and International Understanding to the Padmsri from the Government of India and the National Order of Merit of Bhutan, and many many more. There’s even an asteroid named after him, Asteroid 83362 Sandukruit.

But this was not always the picture. Dr Sanduk Ruit, his first name Sanduk means Sky Dragon, has come a long way from where he lived once. The remote mountainous village Olangchunggola, located 11000 ft above sea level, right in the lap of Mt. Kanchenjunga, along the border with Tibet in northeast Nepal had no power, no school, or health centre, or communication facility. In fact, it’s a snow-covered village for most parts of the year. A subsistence living from small agriculture, petty trading and livestock farming was all his rustic and illiterate parents had, to raise their six offspring. But Ruit’s father knew the value of education, and sent his son to the nearest school, St. Robert’s School, which was a whole 11-days’ walk away, at Darjeeling.

At school, Sanduk was bullied and lonely. And on vacations, while most of his school mates left for home, little Sanduk almost always stayed back with the priest in charge. Home was too far away and too remote to visit. His education was the priority. But when the Indo-China war broke out, Sanduk had to go back, and he continued his high school education at Siddhartha Vanasthali School, Kathmandu. Sanduk had the ambition to become a pilot at one point. But something happened then, that changed his mind and his future. His little sister, his closest companion, Yang La, died of tuberculosis. He had already lost an elder brother and a younger sister before this. And his family had been too poor to afford treatment each time. Sanduk thence resolved to become a doctor, and to work for the poor.

He gained a scholarship to study MBBS at King George’s Medical College at Lucknow, India and then went on to do a 3-year Ophthalmology residency at the All India Institute of Medical Sciences, New Delhi; the latter in the beginning of the 1980s. Once this was concluded, he then went back to Nepal.

In Nepal, Dr Ruit was working on the National Blindness Survey when he met the iconic and incomparable eye-surgeon, Dr Fred Hollows. Their passion for their work soon brought them close, and Dr Hollows became DrRuit’s mentor, inspiring him to choose his life’s vocation: viz. to restore eyesight to people who are blind, but need not remain so. Dr Ruit went on to the Prince of Wales Hospital, Sydney, Australia, to study with Dr Hollows.

Both Dr Ruit and Dr Fred Hollows were convinced that all people with ‘avoidable blindness’ have the right to reinstated vision. As also, that people in developing countries needed accessible and affordable quality healthcare at par with those in the developed world. Cataract surgery in the West is typically performed with complex machines, which poor countries can hardly afford. And in Australia Ruit learned about a cataract micro-surgery technique using implanted intraocular lenses. He understood that this was exactly the technique he needed to take home to help the poorest of the poor. And he did just that. In 1994, Dr Ruit helped found the Tilganga Eye Center at Kathmandu with the help of the Fred Hollows Foundation; where he became the first Nepali surgeon to do cataract surgery with intraocular lens implants. He then refined small-incision microsurgery to remove cataracts without sutures and went on to pioneer a high quality micro surgical procedure in eye camps at remote locations.

Indeed, there was plenty of scepticism in the medical field when the doctor set out on his life’s mission. But Dr Ruit’s ingenuity brought on a surgical procedure which was safe, of excellent quality, and had high volume outputs at a fraction of the cost in other places. And this at make shift camps, in places that was thought filthy by western counterparts. It was at this juncture that the American Journal of Ophthalmology brought on a study of a randomized trial of Dr Ruit’s technique. The study declared that not only was Dr Ruit’s method less expensive and quicker, it also had the same outcome as the machine-induced surgery in the West. The outcome was put at 98% success at a six-month follow up. The sceptics did not have anything more to say.

Tilganga hospital gets around 2500 patients a week. But not all of them need to pay. And for those poor patients who cannot come to Kathmandu, Dr Ruit travels to them; trekking into remote parts of the country and outside and setting up mobile eye-camps at wherever possible. He walks miles, wades through waist deep water, rides horseback and what not, to reach that bunch of patients; who are waiting for him to open their window to the world. The moniker The Barefoot Doctor comes from his preference for being barefoot while doing surgery, for improved management of machines he operates.

Now called the Tilganga Institute of Opthalmology, the venture manufactures 450,000 micro lenses needed in cataract surgery, of excellent quality, and at a mere US $3.50 as against the US $ 200 in the West. These are exported to at least 50 countries.

Dr Suit is now in his mid-sixties but has not let up in going out to remote eye-camps. His astonishing skill and speed in surgery would be in demand in the highest-paying medical establishments, but the good man is intent on one thing, bringing vision to those who cannot afford treatment. His best reward? The happy expression on his patients’ faces as they get back their vision. Nothing can beat that, says he.

Dr Sanduk Ruit’s biography, The Barefoot Doctor by Ali Gripper, lays out the life, trials and tribulations of this medical giant, in its truest essence.

Aster Medical Journal
www.theamj.org