Nepal Diary: The Gift of Sight Expedition
Eye doctors travel to the remote region of Mustang to treat and cure preventable blindness
Blindness is a severe public health problem in Nepal, especially in its relatively inaccessible mountainous areas. This spring, an expedition of international ophthalmologists and eye care professionals, sponsored by Dooley Intermed International, provided free eye examinations, eyeglasses and cataract surgeries to villagers in the remote Mustang region of Nepal.
The 2013 Gift of Sight Expedition's goal was to examine and treat approximately 1,000 villagers in urgent need of eye care, including comprehensive eye screening, refraction, prescription eyeglasses, cataract and ophthalmic surgeries. It is estimated that 80% of blindness in Nepal is avoidable or curable. Here is a diary of the expedition, with photos by Daniel Byers of Skyship Films. (You can view more photos of the expedition here.)
May 15 - We're Off
After months of scrambling, untold emails flying back and forth between Stamford and Kathmandu, and calls to opthalmic manufacturers for diagnostic equipment, three members of the Gift of Sight crew can finally relax tonight as they depart JFK for Nepal.
It was touch and go there for some team members who had to arrange to place their private lives on hold for two weeks—in one case a family emergency two days before departure that resolved itself at the last minute—for the good of this important mission.
We carry with us vitamins for the monks, Sherpa Adventure Gear for the entire crew, and a DeLorme two-way satellite communicator that will permit live texting from the field. Our Keeler retinoscopy rack and indirect opthalmoscope are safely swaddled in expedition leader Scott Hamilton's carry-on.
First stop is Doha, Qatar, for an overnight stay on Thursday, then a four-hour flight Friday morning to Kathmandu. Our accommodations in Kat are at the legendary Yak & Yeti Hotel. We've been warned to avoid the tap water lest we board the Lomotil express for a wild ride on the porcelain pony. More on that later, I'm afraid.
On the reading list for tonight is "I'll Call You in Nepal" by Bernadette McDonald...about the renowned Kathmandu journalist Elizabeth Hawley who has chronicled Everest expeditions for decades.
The mission begins.
May 17 - Kathmandu at Last
We left last Wednesday evening and two days later, Kathmandu at last. We breeze through customs and are met outside by Bibhu, our local guide from Himalayan Holidays. Now here's a nice touch: we're all given garlands of marigolds to wear to the hotel, helping stave off that distinguished pungent scent that permeates the body after too many hours in the air.
En route, we see locals on mopeds everywhere—as if we were transported onto an Indiana Jones movie set.
Many residents are wearing medical masks due to the air pollution. Thousands are simply standing around along the city streets for reasons that remain unknown to both Bibhu and this first-time visitor.
A quick stop at the Sherpa Adventure Gear store to thank our clothing sponsor and pose for photos, then check-in at the famed Yak and Yeti Hotel, a favorite destination of Himalayan climbers for decades.
The team meets for dinner shortly, then some badly needed horizontal time back in the room. We leave this frenetic city tomorrow morning for the relative calm of the lakeside village of Pokhara where we'll await arrival of our team of ophthalmologists. Then the real work begins.
May 18 - A Partnership with Monks
Daniel Byers, Scott Hamilton, Apa Sherpa and the author
Apa Sherpa is the Michael Jordan of Nepal. People stop him on the street, in restaurants, wherever he goes. We stopped him too at the Yak and Yeti Hotel this morning in Kathmandu.
It was our honor to sit with Apa, 53, because in all the world, this is the one man who knows the top of Everest best. Here he was back on home turf. Scott Hamilton, our expedition leader, climbed with him in 1994, but for me it was like meeting Elvis in Las Vegas.
Apa, a gentle man who resides in Salt Lake City, holds the world record for most Everest summits: 21. But not for long—another Sherpa tagged the top for a 20th time on May 10 and plans to tie it up with an additional ascent before the start of monsoon season in June.
Apa received an honorary degree from the University of Utah and spends his retirement from climbing involved in environmental education in Nepal.
Then it was on to Pokhara, which lies in the shadow of Annapurna III in the foothills of the Himalaya.
We visited the Pema Ts'al Sakya Monastic Institute where we were presented with kata ceremonial scarves, and visited their Buddhist temple as guest of the Venerable Khenpo Kunga Dhondup, a friend of Scott's, who blessed us with holy water (we figured it couldn't hurt considering the challenges that lie ahead).
Sixteen Buddhists monks and four volunteers leave Sunday morning for Tukche to round up patients and help run the free eyecare clinics that start Monday.
I watch as Scott briefs some volunteers, while three monkeys sit outside on a chainlink fence eyeing a bag of peanuts being eaten by four bald youngsters—monks in training, in bright apricot vests and burgundy shorts.
The older monks, all refugees from Tibet, and our partners in this project, are helping impoverished Nepalese villagers of their host country lead better lives through the gift of sight.
May 19 - Staying Healthy in Nepal
The plan is coming together.
The Operation Restore Vision ophthalmologists from New York Eye and Ear Infirmary arrived today from Kathmandu and Scott has gone ahead to scout the route to Tukuche, concerned that early monsoon rains may have washed out some roads.
I’ll follow him on Monday in the second wave from Pokhara, accompanied by the eye docs and videographer Dan Byers who is producing an 8-min. documentary about this year’s project.
I’m the new guy on the Gift of Sight team and have been soaking up health advice from the others. I learn food hereabouts isn’t praised for being delicious or wholesome—cleanliness is what matters most.
The body is under attack from all sides and my tender Connecticut stomach is unaccustomed to this onslaught.
The hands are deadly weapons, threatening to transmit pathogens from tables, door handles, sinks to the nearest bodily portal. Don’t bite your nails, don’t touch your face. Travel with a king-sized bottle of Purell.
“You want to be careful that what you eat hasn’t been blessed by flies who’ve just danced on yak dung,” expedition leader Scott Hamilton jokes, except I realize it’s not a joke.
Tap water is liquid death, I’m advised. Shower with the mouth closed, head down, and don’t trust bottled water unless it’s safety sealed and you’ve checked the cap by holding it upside down and squeezing it.
Food has to be piping hot. Toast is fine. A big open bowl of yogurt—not so good. That craving for a chef salad will have to wait until I return.
There is no OSHA here. If the hotel room phone has a steady ring, don’t answer. It’s likely a power surge somewhere up the line ready to zap.
There are strange wires in the room, phantom switches, and the plug sparks when I charge my phone. There are also lots of sharp edges. Best advice? Take cuts seriously and disinfect immediately.
Finally, Scott advises, “never, ever pet a dog in Nepal. Don’t even think about it lest you contract rabies. Don’t go near the monkeys either—they’re mean little buggers. Back away and let them think they’re the boss.”
Wise advice for someone new in town.
May 21 - Need for Eyecare Becomes Clear
The 16 monks on the Gift of Sight expedition were up at the crack of dawn today here in Tukuche to organize the dental clinic we have converted into a remote eyecare facility. The clouds lifted to provide a spectacular view of 23,166-ft. Mt. Nilgiri as patients began to arrive.
For months the monks have placed billboards and posters and traveled door to door to let people know about the Dooley Intermed eye camps. They created cartoon posters for the 60 percent of the adult population who can't read.
Yesterday and this morning there was even a wizened old man who traveled up and down the street announcing the clinic—a modern-day town crier.
Waiting for us were men and women, most elderly, but youngsters, too, with a number of women carrying small children on their backs. They waited outside the concrete brick building squatting in the unique style we saw yesterday along the countryside during our arduous 7-hr. odyssey to lower Mustang (pronounced MOOS-sthang).
After a brief welcoming ceremony, an assembly line of sorts was formed. First was an eye chart exam run by monks, then an eye exam by Chris Teng of New York Eye and Ear Infirmary, then refraction by our partners at Himalayan Eye Hospital, and basic eyecare by Teng's Operation Restore Vision colleagues, Travis Jenkins and Sanjay Kedhar.
Final stop was a check of vital signs and basic healthcare advice by a volunteer nurse and UK foundation doctor who joined the project.
Within an hour, the Operation Restore Vision ophthalmologists saw serious conditions that rarely progress this far in the States: mature cataracts in both eyes, severe glaucoma, embedded foreign objects, and preventable blindness. Even a case of TB was discovered. There is no shortage of suffering. The most serious will be selected for surgery later this week.
We touched the lives of 250 Nepalese today. In this, our first day in the field, the critical need to provide quality eyecare in this part of the Third World isn't hard to see.
May 22 - Farewell to Kagbeni
The trip into Kagbeni involved crossing the Kali Gandaki river on both a swinging steel suspension footbridge, and fording in our Toyota 4WD—at one point water reached up to the wiper blades. That was a scary moment. We almost turned into a boat.
The last stretch before reaching Kagbeni, our northernmost point on the project—and highest at 9186-ft.—also required a jarring drive along a vertiginous former donkey trail—the only way in from the south. The road, if you can call it that, exemplifies the sheer verticality of this part of the world. The fact that our Nepalese, non-English speaking driver answered a cellphone at a particularly treacherous point was disquieting to say the least.
Today eye camp is in a dusty, windswept schoolyard—flags whip violently in near gale force winds. The drill is the same as yesterday—visual acuity testing, an eye examination, refraction if necessary, and, also if needed, a visit with our nurse and foundation doctor.
"We turned a sparse classroom into an exam room with plastic chairs, school desks, and portable ophthalmic equipment. It did the trick and helped us screen candidates for surgery planned for Thursday," said Operation Restore Vision's Christopher Teng, MD.
Our hotel accommodations in Kagbeni are spartan but comfortable. Most rooms have two cots, a western style toilet (a rarity around these parts), and a hot shower that drenches the entire bathroom floor. Best to wear waterproof hiking boots in there.
Oh, and sorry, but TP and towels are not provided. One soon becomes adept at drying off with dirty clothes from the day before.
The food is quite filling—we've brought along our own cook who has been told the sure fire way to a large tip is to make sure no one gets sick. So far so good.
This afternoon we headed back south. En route to Marpha we stopped off in Muktinath, a sacred Hindu and Buddhist pilgrimage site with 108 fountains.
On Thursday surgery begins.
May 23 - Into the Heart of Darkness
The team above Marpha village
Thursday dawned bright and clear in Marpha, with a cool breeze replacing yesterday's hot winds. Fields of wheat and apple trees dot the countryside. It was a delightful spring day in this part of the world, 8,800 feet above sea level.
It's our busiest day yet. We registered over 100 patients before noon and more were literally coming out of the hills, although it's certainly poetic license to call these 23,000 foot-plus peaks "hills."
Dozens wait their turn outside, while kids play in the front yard of the community hall. In one corner, a Buddhist monk screens for visual acuity. Expedition leader Scott Hamilton, a certified ophthalmic assistant, and Operation Restore Vision's Travis Jenkins, M.D., handle refraction. They check for presbyopia, the inability to read close-up that is a natural part of aging. For those who are illiterate, they're simply called sewing glasses.
Time and again, I see the patient's eyes light up as they can read the bottom line of a hand-held reading card. Even a pair of readers can profoundly improve the quality of life. I know how they feel: I'm lost without mine.
Toronto nurse Elizabeth Fudge, and James Conole, a foundation doctor from Leeds, UK, provide basic medical advice and pharmaceuticals to rows upon rows of locals with a variety of physical ailments.
Meanwhile, around the corner, Gift of Sight and Himalaya Eye Hospital have converted a meeting room into a field hospital, preparing it overnight with an aerosol disinfectant. Here's where the most life changing work is being conducted. Patients screened the previous few days with what would be considered legal blindness in the States, or worse, receive cataract surgery in our makeshift surgical suite.
Filmmaker Daniel Byers of Skyship Films, creator of 2012's "Visions of Mustang," scrubs up to add footage from the surgical suite to his short film about the 2013 project which will premiere at New York Eye and Ear Infirmary in the next few months.
Scott and Dr. Govinda Nath Yogi, ophthalmic assistant supervisor from the Himalayan Eye Hospital, use an iPhone to photograph an image of optic atrophy to consult with Dr. Ronald Gentile of New York Eye and Ear via telemedicine.
On Friday bandages will be removed and visual acuity evaluated during post-op. We anticipate a heartwarming reaction as each patient receives the gift of sight.
Before, during and after cataract removal
May 24 - The Reveal
Back to the Marpha Public Hall Friday morning and a reunion with the Gift of Sight patients who remained overnight under the care of the monks.
Our patients showed, well, great patience, as each sat wearing eye bandages while we took photos and video for our sponsors, without whom none of this would have happened.
Then it was time for the "reveal". Fourteen patients sit in a semi-circle on hard red plastic chairs as ophthalmologists from the Himalayan Eye Hospital and New York Eye and Ear, one by one, remove the bandages, then check each eye with a portable slit lamp.
Nepalis are stoic people. They looked stunned as if realizing for the first time what just happened. They've been through a lot these past 24 hours.
Soon they begin to loosen up. Smiles break out as they look around and blink for a now clear view of the stark, pink-walled assembly hall and fields of wheat and apple trees outside.
Through a translator, a 50-year-old Buddhist nun named Dhawa Sanymo Gurung explains that her life at Muktinah, the nearby World Heritage site, was difficult with only one good eye. Her other eye was clouded by a mature cataract, reducing vision to just six meters.
She came to the Dooley Intermed eye camp by public bus, then on the back of a motorcycle the last 30 minutes from Jomsom, driven by her younger brother.
When asked how she's faring, I get a thumbs up and a hearty "ramro cha," which one of the Tibetan monks translates as "it's very good." Her smile reaches from here to India.
"There were no surgical complications," said Scott Hamilton. "Every patient had their sight restored and we're very, very happy."
"I am also very pleased with the professionalism and extraordinary dedication of the entire team," Hamilton adds.
Eye drops and sunglasses are handed out, and soup is served in steel bowls—a ground wheat, flour and salt mix that our own Gift of Sight cooks have served us.
The visual acuity tests and refraction continue for additional villagers. One man, who is illiterate, walks in and is asked to read a card with symbols, not letters—a circle, a square, an apple. More grins ensue as a simple $1.50 pair of readers will now allow him to do close-up work. He walks away wearing them. A monk runs after him to explain the "magic glasses" are only for near vision, not far.
While eyecare is our main mission, we're doing what we can for other ailments while we're here. Just arriving is a 44-year-old Tibetan refugee from the nearby Tserog camp. James Conole, 28, our foundation doctor and oncologist from Leeds, UK, learns the man was told he needed colon surgery but can't afford the 30,000 rupees (about $345).
Conole is concerned: "Without surgery, this man will die."
Scott and other others take up a pool and offer to pay if the monks working with us from the Pema Ts'al Sakya Monastery can transport the refugee to the nearest hospital.
Later in the day the team was honored at a community celebration presided by village elders. Ceremonial white silk scarves,"katas," were presented to the doctors and monks. They wished us all long life, good health and prosperity.
By the afternoon we were off to Jomson for the flight to Pokhara tomorrow and the beginning of our long trip home.
May 25 - One Final Patient
Our mission finished in Lower Mustang, we're up at 5 a.m. for the flight back to Pokhara. Conveniently, the Hotel Marco Polo is located across the street from the Jomsom airport. In fact, the entire town lines the runway.
There are solitary cows and donkeys walking down the street, two dogs are sleeping on the side of the road, and a group of devout Buddhists are celebrating the birth, enlightenment, and death of Buddha. Burning juniper fills the air, as prayer flags flutter in the cool breeze, each flag "activated" on the spot by a Buddhist priest chanting prayers.
Our 19-passenger Twin Otter appears from out of the wind, makes an impossibly sharp left banking turn and roars onto the tarmac.
We're thrilled to see the plane arrive because it means we'll now get our day back and not have to endure seven hours in a Toyota being Maytagged over the boulder-strewn road to Pokhara.
Scott Hamilton and I are belted into a bench seat in the second row taking photos out the window of both Annapurna and Dhaulagiri as we fly well below their peaks through a mountain pass.
We enjoy a ringside seat just behind the open cockpit, pleased to see they have a GPS, altimeter, and other modern avionics. The co-pilot is even wearing driving gloves, which I take as a good sign.
I smile when a Nepalese member of our team taps the pilot on the shoulder and asks to take a scenic photo over his shoulder. You gotta love flying in Nepal. Try that on the Boston Shuttle and you get hauled away.
This is flying as it used to be, just a step above barnstorming. As the pilot and co-pilot make banking turns and steeply dive into Pokhara Airport as if on a giant slide, I'm thinking how much these guys are really flying. Apparently, in the Himalayas, an autopilot is for wimps.
We arrive in Pokhara to steamy, jungle-like conditions, a departure from the cool alpine weather we enjoyed at each eye camp.
Later that afternoon, adventure filmmaker Daniel Byers wraps up a week-long documentary shoot with one-on-one interviews with our Operation Restore Vision doctors.
Nothing fazes Daniel; the guy can sleep on a pile of rocks. I call him the hardest working man in show business and look forward to the follow-up documentary to his 2012 film, "Visions of Mustang."
We're out of the hot city, up in the hills at the breathtaking Pema Ts'al Sakya Monastery, home of the 16 monks who were the true workhorses of the Gift of Sight project.
A group of brown monkeys show up during the filming. We learn they often break into the monks' rooms and wreck havoc, especially if they see their reflection and think they're looking at a rival monkey.
Although our field eye camps have completed their mission, and we're back in the city, the project continues with a follow-up examination of a 10-year-old child in Pokhara who suffered traumatic injury to the eye at age two. Now the child's eye can only perceive hand motion. Sanjay Kedhar, M.D., the Operation Restore Vision doctor, tells the father that the potential exists for the child to have improved sight after further testing, better refraction, and possibly future surgery.
Close-up images are taken with an iPhone attachment to use for consultation with pediatric ophthalmologists back in New York.
The Gift of Sight doctors leave Sunday, but if they can examine one more patient before departure, they're thrilled to do so.
May 26 - Mission Over, But the Need Continues
This is the final entry of the 2013 Gift of Sight Expedition log. Through words and images we hope we were successful in communicating the critical need for projects of this nature, as well as the incredible dedication of our expeditionary ophthalmologists who not only donated their time, but paid their own expenses as well.
Then there were the 16 Buddhist monks who demonstrated exceptional compassion for local villagers, devoted untold hours to attract patients, then kept them comfortable during their visit.
Last night we held a final dinner at a Pokhara restaurant attended by a group of local journalists who will cover the expedition over the next few days.
After our doctors left this afternoon, expedition leader Scott Hamilton held a post-expedition briefing at the Himalaya Eye Hospital (HEH) in Pokhara, a pleasant open campus with gardens and breathtaking views of its namesake mountain range. A logbook of some 700 Nepalis treated this week was presented to HEH administrator Narayan Baral along with a certificate of appreciation for each staff member.
The expedition was a success. No one became sick or injured and our Operation Restore Vision doctors worked side by side with Nepal's 2013 Ophthalmologist of the Year, Dr. Indra Man Maharjan, an expert in small incision cataract surgery.
Behind the Scenes
These blogs and images were written and photographed using an iPhone 4S, then sent via cellular or WiFi when and if we could find it. In a few cases, the Internet, already agonizing slow in these parts, and barely faster than dial-up, would mysteriously fail as the wind picked up.
When we were totally cut off from the outside world, our inReach two-way satellite communicator from DeLorme allowed us to send and receive 160 characters at a time.
With the Help of Our Friends
An expedition of this size and complexity depends upon the support of its sponsors, first and foremost the Dooley Intermed Foundation, Operation Restore Vision, the Pema Ts'al Sakya Monastic Institute, the Himalaya Eye Hospital, the Paul & Irene Bogoni Foundation, and Sherpa Adventure Gear, which provided shells and fleece for the doctors as well as our dedicated monk assistants.
Suppliers included Keeler Instruments, DeLorme, and LokSak. Our thanks as well to the New York Eye and Ear Infirmary - Ronald Gentile, MD, and John Aljian, MD, for allowing a dream team of ophthalmologists achieve so much in such trying conditions.
Our mission is done, but the need continues to be great. We learn from the Himalaya Eye Hospital that the extreme Far Western Region of Nepal rarely receives medical assistance of any type. Here, the journey would begin where the road ends. In that remote area, a 2-3 day walk from the nearest road, there's no power and no cellular. Villagers lead a subsistence lifestyle and quality healthcare is non-existent.
I can see the wheels turning in Scott's head as he plans a return expedition to this mystical, vertical land sometime in 2015.
Dooley Intermed International (www.dooleyintermed.org) is a New York-based not-for-profit dedicated to providing crucial assistance to those who lie beyond the reach of traditional healthcare. It has been aiding the people of Nepal for 50 years.
The expedition team included six members from the Himalaya Eye Hospital (www.heh.org.np) in Pokhara, Nepal, including a skilled surgeon, ophthalmic technicians and assistants, three camp staff and assistants, three U.S. team members from Dooley Intermed International, plus two from ISMS-Operation Restore Vision. Also joining were 16 monks and senior students from the local Pema Ts'al Sakya Monastic Institute who volunteered to serve as "advance team" assistants and tri-lingual translators.