Eye Care on Top of the World

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For nearly seven years, Geoffrey Tabin, MD, has co-directed the University of Vermont Himalayan Cataract Project. The affable, down-to-earth Harvard grad founded the organization with Dr. Sanduk Ruit, a Nepalese ophthalmologist, to try and eliminate preventable and treatable blindness in Nepal and the surrounding region. Given that this area has one of the highest rates of curable blindness in the world – a 1987 Tibetan survey found that 50% of the population was blind from treatable cataracts by age 70, with many people blind at age 40 – that’s a tall order.

But then, Tabin is used to aiming high. When he first visited Nepal in the early ’80s, it was to take on a very different challenge – climbing the last unclimbed face of the tallest mountain in the world. The gulf between scaling Everest and treating cataracts might seem as vast as a canyon in the Himalayas, but for Tabin it was a natural progression; his career path has been guided by his passion for this remote and stunning corner of the world.
A Deep Love for High Places

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“I like to climb,” says Tabin. “There’s A Far Side cartoon that has always appealed to me, in which a bunch of gorillas are sitting around eating bananas and one of them says, ‘Yeah, I know we all like bananas, but, I think, with me, it goes a little deeper than that.'” Tabin’s passion for climbing does go deeper than most people’s. He holds the distinction of being the fourth person to reach all of the Seven Summits – the highest points on each of the earth’s continents.

Tabin’s first, unsuccessful attempt to tackle Everest was in 1981. In 1983, he took a break from medical school to try again. It was a difficult, sometimes hair-raising, climb. He remembers being out on the mountain’s face one day and watching a shelf of rock about the size of a four-story building calve off about 3,500 feet above him. As it broke into pieces, he scrambled for cover, and anchored himself into the ice, back in a crevice. “Everything rocked around me,” he recalls. “I had a couple of big pieces fall within two feet of me on either side, and the whole slope slid away – I just barely stayed on.” While Tabin himself was held back by weather, and again did not make it to the top, other members of his expedition made the first ascent of the mountain’s east face – a route that has never been repeated.

In 1988, Tabin returned to Mt. Everest, this time as the team doctor with an expedition designed to get the first American women to the top of the mountain. This trip took the standard, South Col route, made famous by Sir Edmund Hillary, and was much easier. Tabin was prepared to deal with everything from day-to-day sanitation issues to high-altitude sickness and injuries; fortunately, there were no health emergencies. This time, Tabin reached the summit with his teammates. “I had not a single moment on that whole trip that wasn’t pure joy,” he says.

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Seeing A Way to Stop Blindness

Over the next two years Tabin climbed all over the world. When in Nepal, he began interspersing his periods of climbing with periods of practicing medicine. During this time he spent a total of about six months at the Hillary Hospital in Phaplu, which Sir Edmund Hillary had established for the Sherpa people. He found that many of the problems in the region were of a public health nature. “There were a lot of children who were very sick with dysentery,” he recalls with a sigh. “You would treat them and they would come back two weeks later just as sick as before.” He was extremely frustrated by this cycle, which would often continue until the child died.

Then, at a remote hospital in Nepal, Tabin saw a Dutch team doing cataract surgery. “I was really amazed at the miracle of taking someone who was totally blind and restoring their sight,” he says. “That got me inspired to try and go back and train in ophthalmology.” In the early ’90s, he returned to the United States to do ophthalmology at Brown University in Providence, Rhode Island. In 1995, Tabin took his ophthalmology boards and started his Vermont-based ophthalmology practice. In the same year, he and Dr. Ruit established the Himalayan Cataract Project.

“Eye care is one of the few fields where you can really make an enormous difference,” Tabin explains. “Because we can sterilize the eye ourselves and we can anesthetize it with local anesthetics, we’re able to very safely perform a surgery, which doesn’t require a lot of high-tech things that can break down and cause big problems. The largest cause of blindness by far is cataract, and we can teach a simple, safe technique that allows high-quality surgery to be done at low cost. It’s about $12 in material costs per surgery.”

Tabin still finds the gap in eye care between America and Nepal startling. “In America we have one ophthalmologist for every 18,000 people; in Nepal, there are 37 ophthalmologists for a population of 24,000,000.” The impact of the surgery itself is also vastly different. In America, the average cataract patient is someone who may have a little trouble driving in the rain at night. In Nepal, almost every cataract patient is totally blind, with white cataracts in both eyes. Many of these people also develop cataracts at an early age. The 1987 Tibet survey found that as many as 18% of individuals ages 40 to 49 had blinding cataracts.

At the project’s start, just 15,000 cataract surgeries were done in Nepal. By the year 2000, 96,000 cataract surgeries were performed. In America, performing about 400 major procedures a year makes Tabin a semi-busy surgeon, so he is amazed by what the Himalayan doctors accomplish. “I’m really excited to see how good the local surgeons are getting,” he says. “I’ll teach a doctor in Nepal to do cataract surgery and I’ll come back one year later and they’ll be extremely good – they’ll say, ‘I did 738 surgeries this year.’ I’ll come back after two years and they’ll be incredibly good – they’ll say, ‘I did 1,800 surgeries.’ I’ll return after three years and they’ll say, ‘This year I’m now doing 3,500 surgeries.'”

Tabin is now sponsoring other young doctors from Nepal, bringing them to the United States and financially backing their fellowship training in areas such as retinal surgery, corneal transplants, and pediatric eye surgery, so that they may teach the next generation of ophthalmologists in Nepal. In the upcoming year he plans to begin a Nepal-based ophthalmology residency program, in association with Kathmandu University Medical School.
At Home on Top of the World

Tabin feels he’s been lucky, and not just for having survived his climbing experiences. “I have been very fortunate to be in the right place at the right time for a lot of things,” he says. “Particularly with the timing of when I came to Nepal and saw what was needed. I have been very fortunate in that I found a passion with the work I’m doing in Asia. I found a niche here – a place where I feel like I have a bit of a purpose and a little bit of a home.” He regularly returns three times a year for three weeks at a time.

And he still climbs on occasion. “I’m still flailing at the local rock cliffs in the Adirondacks,” he says. “I don’t climb nearly as well, or as hard as I did a few years ago, but I still have just as much enthusiasm.”

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