Articles

A Volunteer with a Vision

By Sandi Smith

“Why don’t you come with me to Nepal?” Jay Merten excitedly asked me.

My heart raced at the thought of saying yes. Nepal was so far away, so undeveloped, and so foreign to me. How could I possibly manage in a place with little English, strange food, no electricity, and no running water? I thought of a million reasons not to go, including the fact that being absent from my business for five weeks could cripple it for months to come. But I couldn’t help thinking about how Jay, a skilled ophthalmologist, had not only survived but thrived during five previous volunteer trips to the remote, rural town of Sandikharka. As a volunteer of San Francisco-based Seva Foundation, he performed hundreds of delicate sight-restoring eye operations on Nepalese people under unbelievably basic conditions. If I went with him, all I would have to do is keep him company. For a split second, my curiosity overcame my fear, and I heard myself squeak out a yes.

After two days, three flights, and 12,000 miles, our Airbus made a bumpy descent amid steep mountains and landed on Kathmandu’s short runway. The turbulent flights, the 11 hour and 45 minute time change, and the strange surroundings left me dizzy and unprepared for the commotion in Kathmandu.

Rickshaws, honking cars, bicycles with riders clanging their bells, motorcycles with loud engines, people, and cows bombarded us on the maze of dusty streets in Kathmandu. Incense, car exhaust, and cow manure perfumed the air. Signs with English misspellings proclaimed services such as Happy Travel and Nirvana Restaurant. Shop owners tidily swept the street in front of their shops. Outside a trekking shop, blue backpacks and black sleeping bags hung over the shop entrance. Another shop displayed brightly colored Buddhism artwork. Pilgrim’s Bookstore was crammed full of English books, and across the street, you could call home on dicey phone lines for 150 rupees (less than $3) a minute.

“Change money, madam?” a Nepalese voice asked as I passed by. “Rickshaw, madam?” another one asked hopefully. “Tiger balm, madam?” Street vendors thrust handmade music boxes and a wooden hand-carved miniature violin into my face. My senses felt overloaded with new, strange stimuli.

Jay couldn’t wait to have a meal of dal bhat, a local staple of rice and lentil beans blended with exotic Asian spices. He had grown to enjoy the healthful meal that supported his vegetarian lifestyle, although it hadn’t always been that way. The first year, he didn’t know if he would like the strange foreign food. As we entered a Nepali restaurant that served dal bhat, the delightful smell of ginger greeted us at the door.

“I think I’ll buy a pressure cooker this year so I can cook authentic dal bhat at home,” Jay said.

“Good idea,” I said skeptically. After we ordered and ate, I said, “Is the rice better here than at home, or am I crazy?” And later, I added, “Maybe I’ll get a pressure cooker too.”

The next day we flew in a 19-person Twin Otter. After we climbed the rickety stairs and found our seats, I glanced at the emergency exit, a habit for a frequent flyer like me. “Jay, where is the handle to the emergency exit?” I asked nervously. Jay was an experienced pilot and even had his own airplane.

“It’s missing,” he said. We both glanced at the other emergency exit. It was missing its handle too.

“At least they match,” I muttered. I pulled my seat belt as tight as it would go and, for the first time in my life, started looking at the pictures on the emergency instruction card.

Krishna greeted us at the Bhairahawa airport and drove us to the Lumbini Rana-Ambika Eye Hospital just south of town. The hospital served as the base of operations for the yearly eye camp that traveled the 140 kilometers to Sandikharka. Here we met the seven hospital workers who would lead the expedition. The seven workers, all Nepali, included three surgery team members, three outpatient clinic workers, and one driver. Four of the Nepalis spoke fairly good English. Jay and I spoke little Nepali. Mid-morning the next day, the nine of us piled into a Toyota Land Cruiser with our luggage strapped to the top and headed overland.

Sandikharka is a quiet, rural town of 40,000 people, mostly farmers. At an elevation of 5,000 feet, the town is roughly 60 miles to the south and slightly west of the great Annapurna range, home to some of Earth’s tallest mountains. One dead-end, sandy mountain road is the only way to get to Sandikharka. For three months out of the year, during the monsoons, the road washes out and is not passable, even by a 4-wheel drive vehicle.

Amar Gurung drove the Land Cruiser through 70 kilometers of flat, paved road before we came to the mountains. At Butwal, the foothills rose up behind this city, and the road turned into a sandy mountain road full of switchbacks and spectacular scenery. A lush green wheat crop filled the valleys and rose up into the terraced hillsides. Water buffaloes instead of tractors worked in the fields. Along the road, farmers carried baskets of wheat, children carried smudged schoolbooks, and road workers carried rocks to spread on the road.

A bus crammed with people snaked its way up the hill toward us. The road was only wide enough for one vehicle. Amar hugged the hillside with the Toyota and started to back up, but the bus was already starting to pass. It edged its way too close to the cliff that steeply dropped off hundreds of feet below. Tires trampled the plants, rocks, and mud at the edge of the cliff. I held my breath and leaned my body into the hill in a vain attempt to help the people on the bus. The overloaded bus creaked and moaned as it swayed on the mountain’s edge. Somehow, the bus made it around us. I let my breath out.

Last week’s rains turned the road into red slush. The truck jostled the nine of us back and forth as Amar fought to negotiate the frequent three-foot ruts. Squished against the door, I clenched the handle in a death grip while the truck’s tires grabbed and slid in the red mud.

Jay knew most of the road from Bhairahawa to Sandikharka by heart. He pointed out when we were ten kilometers away, then five. He knew these landmarks from the jogging runs he had made along the road. At 50, Jay jogged to keep in good health and was strict about running every few days, no matter where he was in the world. He loved running in a foreign country and seeing the interesting new scenery, and the run from Sandikharka was one of the most breathtaking runs that he had done in the over 100 countries he had visited and jogged in.

At ten kilometers from our destination, Jay said happily, “That’s a new bridge. Now we won’t have to ford the river.” I had to think about whether I felt cheated that we weren’t going to ford a river. Half an hour later, at 5:00 p.m., he pointed to a hill dappled with white buildings.

“That’s it,” he said. “We’re here.”

A banner reading “Lions Club Eye Camp” hung between two tall poles above a gate. Amar drove through the gate and up a steep hill. He stopped in front of a small, brand new building. Jay had never seen this building before.

Bishnu from the Lions Club greeted Jay as we piled out of the stuffy Toyota into the cold fresh mountain air. The new building, a gift from the local Lions Club in conjunction with a Swiss Lions Club, would be the new outpatient clinic building. Nearby, an old dingy white building would be used as the OT, the operations theatre.

Patients waiting Although the camp would not start until the next day, a few patients were already standing in front of the new building. Ladies wore bright colorful Indian saris in oranges, greens, and pinks, and covered their long black hair with shawls. Some had red dye smeared in the parts of their hair, signifying that they were married. Gold jewelry hung from a few of the women’s necks and wrists. The men wore muted colors of brown and gray-blue western style pants and jackets. A few older men wore flax-colored material that hung loose in gentle curves around their thin legs. Some of the children wore jackets but were barefoot. I had my coat tightly zipped up and was cold. Jay recognized one man from last year, Dil Ram, and greeted him. Seventy-six-year-old Dil Ram smiled, showing his one-tooth grin.

“I did his right eye last year, and now he’s back for his left eye. He was completely blind last year,” Jay told me. “It’s nice to have repeat customers.” He smiled at the thought. The competition was fierce among ophthalmologists in Dallas County where Jay had his practice.

“Actually, Jay, you’re the only ophthalmologist that the people of Sandikharka have seen in the last six years,” I teased him.

“Yea,” he fired back. “I never had that much exclusivity back home.” Jay had sold his practice five years ago, in part to make time for the traveling he loved so much and for this type of volunteer experience.

Sadly, the 300,000 people of the Arghakanchi region have only one week each year to obtain quality eye care. Unlike Dallas, where there was one ophthalmologist, available year-round, for every 14,500 people, Nepal was very short of ophthalmologists. Although training programs have expanded in recent years, it is difficult to attract doctors to such a remote region. There is no financial incentive to go there. The people have done without other types of doctors as well, such as gynecologists, and even general practitioners.

Jay remembered that Dil Ram was a Gurkha, a fierce soldier of the British Army. Dil Ram had proudly served in World War II. From his luggage, Jay pulled out a book on Gurkhas and began thumbing through it with Dil Ram watching.

“What regiment were you in?” Jay asked.

“Fourth Gurkha Rifles,” Dil Ram told Bishnu, who translated.

Jay found a picture of the Fourth Gurkha Rifles in the book and showed Dil Ram. Jay also found a translation of Dil Ram’s name, which means “kind heart.”

Unlike some physicians, Jay enjoyed developing an instant, caring rapport with his patients. It didn’t seem to matter if a patient wore a Neiman-Marcus suit and was a businessman from one of Dallas’ wealthy suburbs or was a farmer carrying a walking stick and dressed in old pants, a dusty jacket, and a topi, Nepal’s fashionable head wear for men.

“We’ll get that other eye fixed for you tomorrow,” Jay said.

Dil Ram nodded. He had taken the bus from Thala, a beautiful town about 50 kilometers away. Nestled in a valley with a clear blue lake, Thala was surrounded by mountains dotted with red rhododendron, the country’s national flower. Dil Ram grew wheat and tended the fields. He had been blind for three years before finding out about the camp. Now, here by himself, he set off to look for a guesthouse.

That night, the Lions Club of the Arghakanchi district cooked dal bhat in celebration of the camp’s start. Jay ate two large platefuls. He and I met many local dignitaries, including the mayor and the district judge. We also met a number of middle-class residents of the town of Sandikharka. Because of the generosity of the Lions Club and the Lumbini Eye Hospital, no patient in need would pay for the eye operations performed this week. In the U.S., the operation cost as much as $2,000, six times the average annual income of the people of the Nepal.