Jan 28, 2020
It would be hard to get an
accurate count of the number of lives that Dr. Geoff Tabin has
either saved or improved, often by his own hands. The figure is in
the thousands because he and Dr. Sanduk Ruit are co-founders of the
Himalayan Cataract Project. As its website name, cureblindness.org
suggests, the project provides high-quality eye care in some of the
most remote or under-served parts of the world. And, as Geoff
Tabin, Professor of Ophthalmology and Global Medicine at Stanford,
will happily tell you, this project, his life’s work, never would
have happened had it not been for some serious
serendipity.
Key Takeaways:
[:23] Ray Hoffman introduces Dr. Geoff Tabin, Co-Founder of the Himalayan Cataract Project.
[1:05] In the poorest countries, 85% of blindness is preventable or treatable. Of all cases of blindness, 50% are from treatable cataracts.
[1:52] Dr. Tabin was specifically inspired by a Dutch ophthalmologist running a humanitarian program called Eye Care Foundation Himalaya doing lens implants in Nepal. These implants altered lives and the welfare of families.
[2:34] Dr. Tabin talks about his educational path and what inspired him at Yale and Oxford, England. On a mountain-climbing scholarship named for Andrew Irvine, he went to Asia and Africa to climb. He observed first-hand the disparity between the haves and the have-nots, regarding medical care.
[4:24] Dr. Tabin matriculated at Harvard Medical School with the intent of working in global medicine to bridge the gap in care between the wealthy countries and the poor countries.
[4:47] In 1988, Dr. Tabin climbed Mt. Everest while he was working as a general doctor in Nepal. He was searching for a way that an individual doctor could make a difference. He saw the Dutch ophthalmologist team set up and give new hope to cataract patients. He was amazed by how the surgery could change lives.
[5:45] Dr. Tabin immediately found an ophthalmology residency at Brown University in the States and came back to enter the residency.
[6:21] At the same time, Dr. Tabin’s future partner, Dr. Sanduk Ruit, was finishing his training in Australia. Dr. Ruik came from a small village in Nepal with no running water, electricity, or schools, a three-days’ walk from the road. After a house fire, his parents had taken him to a monastery in Nepal where the monks saw he needed an education.
[7:03] As a child, Dr. Ruik’s father walked him 11 days to Darjeeling, India to an English Jesuit school. Dr. Ruik only spoke his native language. He emerged from the education with a full scholarship to one of the best medical schools in India. He got top boards. He trained as an ophthalmologist in Delhi and did a cataract fellowship also in India.
[7:42] Dr. Ruit returned to Nepal and caught the attention of the same Dutch ophthalmology group Dr. Tabin had seen. Dr. Ruit went to the Netherlands for training in microsurgery and to Australia for a two-year fellowship. He came back to Nepal as a world-class ophthalmologist, looking to bring high-quality eye care to Kathmandu.
[9:20] Dr. Tabin spent a couple of weeks during his fellowship working with Dr. Ruit. He told Dr. Ruit he wanted to work with him. When he finished his fellowship, he moved to Nepal to work with Dr. Ruit.
[9:36] This project wouldn’t have come to pass if not for Dr. Tabin’s passion for mountain climbing, and a lot of help from great mentors. Dr. Tabin explores the serendipity involved.
[11:03] Dr. Tabin learned hiking from his father, a nuclear physicist who worked with Enrico Fermi on the Manhattan Project. Dr. Tabin tells how his father hiked with Enrico Fermi and later, with him when he was a teen. Dr. Tabin started studying as a teen about the great mountaineers and explorers.
[12:14] In Dr. Tabin’s later teen years, he focused on tennis and was recruited to play tennis at Yale. At Yale, he started rock climbing with a friend.
[12:56] Dr. Tabin tells how he and Dr. Ruit co-founded the Himalayan Cataract Project. It started with transferring skills to doctors, ophthalmic nurses, ophthalmic technicians, and ophthalmic assistants. They taught primary health care workers a basic understanding of eye diseases. They created a teaching system.
[13:39] Dr. Tabin and Dr. Ruit took the best cataract surgeons and sent them to specialty surgical fellowships for pediatric ophthalmology, glaucoma, retinal surgery; all the sub-specialties. Once they had the full range of specialties, they had a world-class residency program.
[14:07] They were not getting funding from the U.S., so they turned to other countries, but they were also skeptical. To gain credibility, Dr. Tabin took an assistant professorship at the University of Vermont. The doctors decided to incorporate as a 501(c), named the Himalayan Cataract Project, with a website cureblindness.org.
[15:32] They started raising funds to support the work. After two years, they hired their first full-time employee. They started in Nepal, then brought Bhutanese doctors into the program, then doctors from Tibet, then Indonesia.
[16:42] In 2006, Dr. Tabin took a professorship at the University of Utah. By that time, the surgeons in the program were better than Dr. Tabin, so he was confident for them to continue without his presence. One of the doctors in the cataract project, Dr. Alan Crandall, went to Ghana and was one of the highest-volume cataract surgeons there.
[17:26] Dr. Tabin started going on missions to Ghana with Dr. Crandall to see about extending the program to meet the need in Africa.
[17:41] In FY 2014, the organization had $8 million in assets and did 78,000 sight-restoring surgeries. In FY 2016, they did 97,000 surgeries and treated over one million patients. In FY 2018, they performed 123,000 surgeries with assets of $12 million. Besides these procedures, their focus is on training local providers to perform the same procedures.
[18:58] In 1996, when they started with $100,000, Dr. Tabin never expected to grow into the success they have had to this day. In that period, Nepal went from 0.88% blindness down to 0.2% blindness, today. Nepal is the one poor country that has reversed its rate of blindness.
[20:43] Dr. Ruit instilled in Dr. Tabin that they were looking for the next young superstars. In 2007–08, Dr. Tabin started the first global ophthalmology fellowship in American academic ophthalmology. Now there are eight universities that have a global ophthalmology fellowship, following Dr. Tabin’s example.
[21:20] Dr. Tabin is proud of his former fellows who, as early career ophthalmologists, are pushing ophthalmology forward in Asia and Africa.
[21:56] Dr. Tabin reflects on the expansion and success of the program and discusses potential future expansion in Africa. It is estimated that it would take $100 million to completely reverse blindness in Ethiopia and Ghana. Similar changes need to be made in other African countries. Dr. Tabin names some amazing doctors from the program.
[23:58] Based on the progress of the program, Dr. Tabin sees a realistic goal of turning the tide on needless blindness. The program has brought the material cost of a cataract surgery down to under $25. 12 million people could have their life completely changed from a $25 surgery.
[24:42] Dr. Tabin hopes that Melissa Chen or Mark Zuckerberg will listen to this podcast and be inspired to donate to CureBlindness.org. Blindness is a low-hanging fruit to cure, as diseases go. Dr. Tabin tells about his role as a fundraiser. He speaks about donors.
[25:43] Three years ago, Dr. Tabin went from the University of Utah to take an endowed chair for ophthalmology and global medicine at Stanford University. In Silicon Valley, Dr. Tabin has exposure to a lot of people who could potentially make a huge impact on global blindness.
[26:33] Over the last few years, fundraising has been extremely successful. They always spend less than they secure. They have had USAID grants for big capital projects. Dr. Tabin wants it to be a $30 million charity to fully address blindness in Ethiopia and Ghana. Funding is half from grants and half from private philanthropy.
[27:48] Studies have shown that restoring sight gives a direct impact of four-to-one to the local economy. Dr. Tabin would like to see more direct investments from governments and global funds like the World Health Organization.
[28:29] 88% of their funds go directly into programs. Will that efficiency continue while scaling up? Dr. Tabin explains how it can. Dr. Tabin doesn’t want to spend a lot of money on fundraising.
[30:17] Dr. Tabin talks of the 5,000 cataract surgeries they have done recently in Ethiopia. They are reaching out to Eritrea and are taking Eritrean doctors into their Ethiopia training program.
[32:17] In 2019, Dr. Tabin traveled to Ethiopia, South Sudan, Bhutan (where they just opened a new state-of-the-art eye hospital), and Nepal, while working about six months at Stanford and six months between Asia and Africa.
[32:55] Dr. Tabin hopes people in America realize we are all one world and one human race. It does matter what happens in Africa and Asia. Once someone has the cataract surgery, they are no longer “a statistic” but a person cured 100%.
[33:58] In six years, the organization will be 30 years old. Dr. Tabin hopes that in six years, Ethiopia and Ghana will have followed Nepal and Bhutan in reversing their backlog of blindness and sustaining high-quality care for all their people, and the programs will be expanded into other African countries in great need.
[34:41] Dr. Tabin also wants to be closer in six years, in connection with other organizations, to reversing blindness for the two greatest populations, China and India.
[35:39] Dr. Tabin acknowledges he was in the right places at the right times with some incredible mentors.
[36:15] Ray Hoffman provides the website name, CureBlindness.org and signs off.