Glimpses of Hope

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More than 100 km beyond the tiny Tibetan village of Gucho stands Mt. Everest. On a clear day, the sharp profile of Everest's northwest face is visible from the village's rocky paths. But not to the dozens of men and women gathered outside Gucho's medical center. They can barely see their own hands, much less the imposing form of the world's highest mountain.

These people are blind, most made so by the high levels of ultraviolet radiation present at the towering altitudes of their homeland. Seared by UV rays, the lenses of their eyes have formed the cloudy patches known as cataracts. In their early stages, cataracts merely dim the sight. But eventually, as they become whiter and denser, they block it entirely. In Tibet, an estimated 30,000 people are blind as a result of cataracts; each year about 1,000 receive operations--and an additional 1,500 to 2,000 lose their sight. Among those over 50, the problem is endemic. Most of the patients waiting at the Gucho hospital are elderly and have been brought in by relatives and friends. Some have been blind for decades.

The duration of their misery is staggering, considering the swiftness of the procedure that will restore their vision. Dr. Sanduk Ruit--a Sherpa from Nepal, where he is medical director of Katmandu's Tilganga Eye Centre--has come to Gucho at the invitation of the Tibet Development Fund on what he calls a "commando mission" to remove cataracts and to train local doctors in his methods. There are plenty of patients available for study; today 72 cataract sufferers are waiting here for relief.

Just 50 years ago, the treatment would have been a crude form of surgery known as couching, which is believed to have been practiced in Tibet for 2,000 years. Couching removed the clouded part of the lens but provided no replacement, meaning that although vision was improved, it remained blurred. Ruit, who has performed 20,000 cataract operations in the past 15 years, replaces the ruined natural lens with a plastic intraocular lens--a method popularized in the 1980s by the late Australian eye surgeon Fred Hollows, who trained Ruit.

The operation is one of the simplest surgical procedures; even a medical trainee can perform an intraocular transplant in less than 30 minutes. In the deft hands of Ruit--who with the support of the T.D.F. has trained dozens of doctors in Tibet since 1993--the procedure is often completed within five minutes. For most Tibetans and Nepalese who have intraocular transplants, it is the first surgery they have ever undergone. Beyond light tugs and scratches felt through the anesthetized eyeball, the experience is painless, the optical equivalent of minor dental surgery. The effect, however, is dramatic. Within a day, bandages covering the eye can be removed. (In cases where both eyes are cataract-blind, operations are usually scheduled one day apart.)

At first, only vague outlines of nearby objects can be seen. After a day or two, patients are able to focus on things farther away, and to make out the faces of children and grandchildren sometimes never seen before. Within weeks, their fully healed eyes can once more take in Tibet's icy, sun-reflecting landscapes.

And, on a clear day, Mt. Everest.