Country Staff

As Nepal's first Lama ophthalmologist, Dr Sanduk Ruit's reputation as a highly skilled and respected surgeon precedes him.

Born in a small remote village in the north east of Nepal, Dr Ruit's start in life was tough. His village, which sits at an altitude of 11,000 feet, was poor and had no electricity.

The nearest school was 11 days walk away but Dr Ruit was fortunate to attend an english school in India and was then selected to go to King George Medical School in Lucknow, to undertake a Bachelor of Medicine.

Even in these early stages while studying, Dr Ruit showed promise as a surgeon. He later completed his ophthalmology training at the All India Institute of Medical Science.

Dr Sanduk Ruit's connection with The Fred Hollows Foundation comes from a long and extraordinary personal history with Professor Fred Hollows.

Dr Ruit had a special friendship with Fred Hollows. They both shared the same outlook on life, medical philosophies and vision - of a world where no one is needlessly blind.

Their mutual belief, that people living in developing countries should have access to affordable and quality eye care, led to a determined and shared journey to take modern cataract surgery to all corners of Nepal and the world.

In the mid 1980s, when they first met, Dr Ruit was working as a Medical Officer with the Nepalese Prevention of Blindness Program. Fred Hollows was visiting the program as a consultant with the World Health Organization (WHO).

As often happens when strong friendships form, Dr Ruit and Fred were destined to meet again. In 1988 Ruit visited Australia to live, laugh and learn with Fred for a year.

"Fred was always behind me all the time. He always thought that what I was doing was right. With Fred's values we were as one," says Dr Ruit.

Based at the Prince of Wales Hospital in Sydney, Dr Ruit spent his time studying and learning the techniques of modern cataract surgery from Fred.

Listen to what Fred Hollows had to say about eye care in Nepal and Ruit's surgical technique.

During his time in Australia, Dr Ruit was also involved in setting up the Nepal Eye Program Australia (NEPA), which continues to support and raise funds for sight restoration in Nepal.

At that time modern cataract surgery, using an intraocular lens (IOL) wasn't being used in developing countries to treat cataract blindness. It was thought to be too expensive, risky and difficult.

Dr Ruit and Fred were determined to challenge that assumption - they believed the modern technique was more effective and resource efficient, than the traditional method of removing the clouded lens of the eye and not replacing it, but rather relying on glasses to provide sight.

Dr Ruit then returned to Nepal and began training local doctors in modern cataract surgery. Word spread throughout Nepal and the new technique was slowly but surely adopted as the standard.

Dr Ruit was even more determined to take cataract surgery to people living in the extremely remote areas of Nepal. Makeshift but high quality eye clinics were set up by Ruit and his team in remote areas, to treat the thousands of Nepalese living in darkness. The vision was coming alive!

Fundraising efforts through NEPA and The Foundation then helped to establishTilganga Eye Centre in Kathmandu, which was officially opened in 1994 - a year after Fred Hollows died.

Now called the Tilganga Institute of Ophthalmology, the eye hospital comprises of the Fred Hollows Intraocular Lens Laboratory, an Eye Bank and a Surgicentre has since screened more than 1.5 million people and performed well over 74,000 operations. Cataract surgeries account for the majority of these operations.

Dr Ruit, who is the Medical Director at Tilganga Institute of Ophthalmology, has personally performed more than 70,000 sight restoring operations since 1988. He has also trained local surgeons in China, India, Nepal, North Korea and Vietnam.

"We are playing a role of total skill transfer in terms of surgical and clinical quality, efficiency, financial sustainability and community service. We work with different organisations in all these areas and one of our most trusted partners is The Fred Hollows Foundation. It is good that they and others have trust and total confidence in our approach," says Dr Ruit.

In the ongoing refinement of his surgical techniques, Dr Ruit and his team developed a sutureless form of cataract surgery in 1996 which was heralded around the world.

Many of the training programs supported by The Foundation, train surgeons in the new sutureless technique, along with the standard ECCE + PCIOL technique.

A new IOL design has also been developed to match the needs of sutureless surgery. Known as the FH105, the IOL - which is smaller in diameter - fits snugly into the eye through a tighter incision.

In 2001, the former Tilganga Eye Centre developed a further refinement to its sutureless technique, called 'temporal' section, which makes an incision on the side, rather than the top of the eye. This helps with improved recovery of vision.

De Ruit has completed fellowships in microsurgery in the Netherlands and Australia, as well as additional ophthalmic training at the Wilmer Eye Institute of the Johns Hopkins University School of Medicine and the University of Michigan.

In 2005, Dr Ruit was awarded one of the Royal Nepal Academy of Science and Technology's two annual awards, in recognition of his continuous work for the people of Nepal and other developing countries. It is the first time an award has been granted in recognition of surgical achievements.

And in 2006, Dr Ruit has been awarded the Ramon Magsaysay Award for International Understanding. Also known as Asia's Nobel Prize, the honourable award recognises Ruit and his efforts in placing Nepal at the forefront of developing safe, effective and economical procedures for cataract surgery, enabling the needlessly blind in the world's most poorest countries to see again.

In 2007, Dr Sanduk Ruit received some highly regarded awards - Reader’s Digest named Dr Ruit as Asian of the Year and The Governor-General of Australia awarded him an honorary appointment as Officer in the Order of Australia (AO). In the same year, Ruit also received the Prince Mahidol Award for contribution to medicine and public health.

Fred Hollows' belief in Dr Ruit and their connection to each other was strong - he thought of Ruit as his soul mate and protege.

Known as Dr Ruit's right hand, Dr Reeta Gurung studied medicine in Leningrad and trained in ophthalmology - "I did my eyes!" - in England.

She's not sure why she picked the speciality. "I'm an impatient person, maybe I wanted to have the results then and there! I really enjoy it when someone sees the next day - that's pretty quick."

Dr Gurung, or Dr Reeta as her staff affectionately call her, spent a year helping establish a new hospital in Pokhara, west of Nepal, before joining the fledgling Tilganga Eye Centre team in 1993.

The early days were uncertain, she says. "We didn't have money in the first place. There were only the two of us (surgeons). In the back of my mind I thought, 'what would we do if we didn't get patients', and then 'what would we do if we do get them!'"

At that stage they were working out of an office in Kathmandu. "We were looking after the bricklayers, and buying flymesh and electrical things for the eye camps. We didn't have anything to do except training". Training the first intake of nine paramedical staff and nurses - the 'boys' and 'girls' as they are called - was vital.

Paramedics play a big role in screening and treating patients, and in the back-up work for surgery. Dr Gurung, said to be a skilled surgeon, cites this training as her proudest achievement. "I'm happy I can do many cases but I really admire the girls who stand beside me the whole day."

Tilganga once had to convince patients to come and had to establish its credentials in the medical community. Now it's a much more confident place, has consolidated its patient load and is specialising more, she says.

Dr Gurung, a warm, engaging person, studied in Holland last year, upgrading her corneal work, has travelled overseas for conferences and went to China recently to evaluate The Fred Hollows Foundation program.

She'd like to do more scientific work, work in less cramped surrounds and faces the usual frustrations of working in a developing country. "But I'm pretty happy with what I do."

This profile was written by Anne Crawford, The Age (Australia) in 2002. It is reproduced here with permission.