The Gift of Sight

Eyes Wide Open: Tabin and HCP crew celebrate with patients after successful operations. Photo: Ace Kvale

I am walking through the Amsterdam airport carrying a box of human tissue. Inside a matrix of tape, Styrofoam and ice are almost a dozen corneas, harvested like seeds, from the husks of fresh donors. We’re running late to the gate. The terminal bustles with commuters going a million directions. I pass images of Euro models hawking perfume—their eyes glower behind plate glass, as if they caught me lusting after them, as if they know my cargo. Ahead of me hurries Dr Geoff Tabin, a leading international ophthalmologist who has dedicated his life to reversing world blindness through the organization he co-founded, the Himalayan Cataract Project (HCP).

Tabin’s energy is legendary and his approach to life unorthodox, at one point putting his Harvard medical studies on hold to take part in establishing a first ascent on Mount Everest. That makes him my perfect mentor. We connected a few years earlier at a mountain film festival where we were both presenting—Geoff talking about curing blindness and me sharing comedic stories of climbing adventures with disabled athletes.

“You’re the second funniest presenter I’ve ever met,” he said, stopping me on the sidewalk. “And you must be the first,” I replied, tacitly confirming my acceptance into our mutual appreciation society. “No, no, you’re a funny guy, we should go climbing.”

We were a few hundred feet off the ground and enjoying the scenic morning in the San Juan Mountains when he casually said, “You should really come to Africa with me and assist at a cataract clinic.”

I thought, I can barely get an eyelash out of my own eye, let alone help someone cure blindness. And now here I am hassling with Dutch security who finally let me, and the corneas, on a plane to Nigeria (the Himalayan Cataract Project is a slight misnomer, as many of the organization’s projects now operate within Africa).

The great thing about Tabin is that even though he’s a mix of Mother Teresa and Fred Hollows, the Aussie innovator who deflated the cost of cataract surgery for the masses, he’s not just about the cataract. He’s also parts Marco Polo and Edmund Hilary, with a measure of Houdini throw in and a pinch of fourth grade Asperger savant. The point being that even though he’s well into mid-life and graying and may someday suffer canonization he retains a similar robustness of body and mind that decades ago propelled him up the highest peaks on all seven continents. At his core he’s a shower stealing, scabby handed, ground sleeping climbing gypsy. He values the outdoors as much as his work inside the operating room.

The week before our trip Geoff called from Chicago where he was visiting his Pop who recently suffered a stroke. “TO, we need to get our flights,” he yelled into the phone from inside a blues concert. “Make sure you pack for Zuma Rock.” Then he seriously added, “And bring your lucky charms O’Neill.”

“Why’s that?” I asked, unsure if he was joking.

“Because Zuma Rock is cursed and the only guy to climb it is dead, and two others who attempted it also got the chop.” Then he took another phone call and hastily hung up. I Googled it immediately and found he wasn’t kidding. It turns out we’d not only be curing preventable blindness in Africa, we would also be climbing a serious route with a deadly history.

Welcome doctors,” booms Dr. Abdulkadir Rafindadi, a rotund, good-natured man, when we arrive at the Ahmadu Bello Teaching Hospital. Rafindadi wipes a handkerchief across his perpetually perspiring forehead as he greets us. His glasses resemble the inside of a hothouse. “Please come inside out of the heat gentlemen. We already have over one hundred cataract patients and those hopeful for a transplant are waiting.”

I don’t disabuse Rafindadi’s inclusion of me as a doctor. It must be akin to what the guitar-tech feels when the groupies show up backstage—although they recognize the lead singer there’s no need to clarify who’s actually in the band.

“Alright TO, let’s get to work,” Geoff says. He then grabs the box of corneas and walks into the building, and into the darkness.

We rinse off the dust from Zuma Rock—which we had scouted out with no ill-effects from the curse, before we arrived at the hospital—and sanitize our hands. Since we only have fifteen tissues, Geoff must select the most suitable from the almost thirty candidates. At first, I think how stoic those gathered were, sitting on uneven wooden benches, crouched on the floor, flies buzzing and they hardly stir. Then I realize I am judging their supposed discomfort through my perspective. They may be stoic for Westerners, but here they were simply being themselves. You are the pain index of your childhood.

I guide each patient by the arm to a dim room and seat them behind a slit lamp, which illuminates and magnifies the eye. I place the patient’s chin and forehead against stabilizing straps. They become a human peephole. Geoff uses an additional lens to peer through the eye, to ensure the retina is vital. There’s no point in placing a new window onto a vacant home. And so our work begins.

One of the last patients is a timid sixteen-year old, with tightly braided hair, named Gloria Caleb. She’s bi-laterally blind and creeps across the room. She’s wearing jeans and a hooded sweatshirt and seems lost.

“Hello Gloria, how are you?” Geoff asks.

“I am fine, thank you,” she says, her voice quavering.

Gloria is fluent in English and has attended a local blind school for the past seven-years.  When she was seven years old a playmate accidentally hit her with a rock in her left eye. Her retina detached and the eye was permanently shuttered. Only two years later she unfortunately lodged debris in her right eye and her grandmother brought her to a local healer to remove it. “When she brought me there I was very afraid and ran away,” she says, “I know this man does crazy things.”

They wrestled her back to the inaccurately named healer and she bolted again. The next time they caught her she wasn’t able to escape with her sight intact. “I screamed and cried and told them please don’t blind me,” she says.

Nigerian local healers, commonly portrayed as voodoo doctors, use an array of medicinal herbs and roots, animal parts and supernatural amulets and incantations in their remedies. They have been relied on for centuries to provide relief through traditional means but sometimes cause irreparable harm and even death using grossly negligent practices. In Gloria’s case, the man used a whiskbroom to literally sweep the surface of her right eye, scarring the cornea into an opaque mass.

“He brushed my eye many times and it was so painful but they wouldn’t listen,” she sadly recounts.

A Nigerian ophthalmology resident that was also listening tells her, “Yes, your story is pathetic and I have even heard more pathetic stories but now you have luck and are getting attention. You might even see again.”

This emphasis on accepting one’s lot and moving forward seems more common in places of abject deprivation, perhaps because they begin with less to lose.

“Yes, I hope to see again,” she says, starting to cry.

“Gloria we are going to take care of your eyes,” says Geoff. And my mouth hangs open and her tears surprise me, as if I thought that blindness provided immunity from grief.

Typically these large volume cataract clinics involve the pre-screening of a large dispersed population who commonly walk to the site, followed by often hundreds of surgeries with exhaustive long days and nights. Tabin and his partners have expanded on the parachute model, of drop-in, fix-up and fly-out, to include not just the legacy of sight but also of infrastructure. They partner with both emerging and established indigenous eye docs to provide comprehensive training, equipment and facilities with the goal of long term affordable care and prevention through education. Even though Geoff moves at a race-car pace and requires a crack pit crew performance the emphasis is on placing new drivers behind the wheel.

There has never been a cornea clinic of this size in Nigeria. I wonder about its efficacy, if it’s really worth the challenge of carrying and installing these precious tissues. The post care—keeping the site clean, administering the drops routinely, making sure loose or inflamed sutures are immediately addressed—is essential. It is not an exercise in vainglory—the people need to see and the doctors need to learn. It just seems very difficult and the outcome uncertain. Then I realize that I’m describing virtually every instance where an incredible advance occurred due to the belief and diligence of a few hard working people. It requires a rare vision, perhaps one bordering on delusion, to perceive the possibility of change in the monochromatic world of the hope-blind.

—Timmy O’Neill is headed back to Africa with Dr. Tabin this month to continue the work of the Himalayan Cataract Project and perhaps climb Zuma Rock.

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