1. How did your interest in international medicine grow from your passion for rock and ice climbing?
I was a ski racer and technical rock climber during my childhood and university years. I first went to the developing world as a climber; however, while I was in Africa and Asia the disparity in medical care and need between the developing world and the United States became obvious to me. I took a leave after my second year of medical school to join an American team attempting to climb the East Face of Mount Everest. We went through remote areas of Tibet, and I assisted our team doctor in clinics we held every evening for the local people.
2. As the Co-Director of the Himalayan Cataract Project, what inspired you to start the project, and what is its mission?
After completing medical school at Harvard Medical School (Boston) and an internship at the University of Colorado Hospitals in Denver, I returned to Nepal and worked as a general doctor at a remote hospital. Many of the problems that I faced were public health issues due to lack of clean water, poor diet, and impoverished living conditions. However, the one miracle I witnessed was cataract surgery. In our village, people accepted that as one gets old their hair turns white, their eyes turn white, and then they die. Blind people were considered a mouth with no hands.
I returned to the United States and trained as an ophthalmologist at Brown University (Providence, Rhode Island). After completing a corneal fellowship at Melbourne University in Australia, I returned to Nepal. I was fortunate to meet my partner, Sanduk Ruit, MD, a brilliant ophthalmologist who was the first Nepali surgeon to implant IOLs and who had already developed a fantastic delivery system for high-quality, high-volume, low-cost cataract surgery.
I stayed in Nepal to work with Dr. Ruit and teach cataract surgery. When I returned to the United States, we started the Himalayan Cataract Project (www.cureblindness.org), which strives to teach ophthalmologists how to develop the infrastructure to provide high-quality eye care in the poorest places on our planet.
3. What are some of the ways that your team applies hospital quality standards in areas that lack electricity and clean water?
We work with a strong attention to detail. No one performs a task that a person with lesser training can accomplish. We use Honda (Tokyo) generators for power, water filters, modern sterilization, and copious amounts of povidone-iodine, which has reduced our complication and infection rates to world-class standards in even the most remote regions. However, it is our emphasis on quality and on individuals—especially the doctors we train—taking responsibility and carefully monitoring surgical outcomes that leads to our excellent results.
4. How do your experiences of working in the Himalayas and in regions of sub-Saharan Africa influence the way that you teach ophthalmology at the John A. Moran Eye Center?
I teach with attention to surgical technique and value each individual patient as a person, whether I am in Africa, Asia, or the United States. Our residents and fellows at the University of Utah benefit from the opportunity to work at our hospital in Nepal, the Tilganga Eye Institute, and interact with visiting fellows from other countries.
5. What did you see when you reached the summit of Mount Everest in 1988?
Mount Everest is 29,028 feet above sea level. I reached the summit at 8 AM on October 2. I had a fantastic view. It was a perfect day with clear skies. To the south and west, I could see all the peaks of Nepal. I could see four of the next six highest peaks in the world. Looking east and north, I saw the amazing Tibetan plateau and the curve of the Earth on the horizon. I felt great in 1988. I spent more than an hour on top of Mount Everest before descending. I was back at Camp 2 at 21,000 feet, celebrating with a beer, by 5 PM.
Five years earlier, I had been with a team that made the first ascent of the East (Kangshung) Face of Everest. Our route included quite difficult rock and ice climbing, and we had no native support on the mountain. In fact, our route has still not been repeated in more than 25 years because of its difficulty level. Six of my teammates reached the top. Unfortunately, I was not as strong and felt the altitude and turned back 800 meters below the summit. In 1988, however, I experienced only joy and was able to fully enjoy the view and the day.