batali go wrong yep depressed hunched
and twisted in a small wooden smokey hut
at 10,000 feet near faff Luna Paul
outside sword spectacular snow mountains
but she haven’t seen them in five years
outside children were playing and
laughing but she had never seen them
she sat depressed and waited to die then
her husband not being heard about my
clinic that was taking place at a
hospital two days walk from their home
so he took his emaciated wife put it in
a wicker basket put her on a chump line
on his back and carried her for 34 miles
over steep rocky trails when I met
fatality I was really surprised to see
that her age was listed as 56
she looked decades older but the next
day when we took the patches off
it was amazing there was this moment of
wonderment she looked around trying to
see what was happening and then a smile
is bright and broad as the Himalayan
ranges just spread across her face she
saw a grandchild for the first time
tears were streaming down her face her
husband not-being started dancing
spontaneously within an hour she was
walking erect and straighter and excited
to walk home the next day and resume
taking care of her family in our world
but she everyone please close your eyes
for a moment everybody close your eyes
tightly and think about what your world
would be like if you were totally blind
would you be able to leave this theater
in an emergency what if you had to go to
the toilet now consider if you lived in
a place where there were no indoor
plumbing there were no roads for 14
million people more than the population
of Canada this is their fate they’re
blind unable to perform the tasks of
daily living 90% of those visually
impaired people live in low-income
settings 80% of the blindness on our
planet four out of five blind people it
could have been prevented or we can
treat it half of the blindness on our
planet twenty million people are from
treatable cataracts okay open your eyes
a great transition think and consider
that there’s a surgery than in ten
minutes for $25 can restore your sight
people say it’s impossible but we have
to dare the impossible impossible starts
with the first step and we need to
create a brave new world where no one on
our planet is needlessly blind now what
you’re looking at now is the east face
of Mount Everest in 1983 when we set out
to climb and make the first ascent of
the east face of Mount Everest people
said it was impossible the lower head
while you’re looking at is 5600 feet
more than a vertical mile with technical
climbing similar to climbing El Capitan
and vertical ice and we were climbing
from Tibet where at the time logistics
were very difficult and we had no native
support on the mountain whatsoever so
how do you dare the impossible well
first you have to put in the background
the training and develop the skills but
you still have to have the passion and
belief that you can do it impossible
does start with the first step there may
have been better individual climbers in
1983 but there could not have been a
better team than myself my 11 teammates
who really believed we could make the
first ascent of the East face of Mount
Everest and on October 8 1983 we did
reach the summit of Mount Everest and
our route now 34 years later still has
never been repeated so what does this
have to do with world blindness well
traveling and climbing in Asia and
Africa allowed me to witness firsthand
the effects of extreme poverty on health
and the difficulty of life and the
disparity in access to health care
so by the time I matriculated at Harvard
Medical School I already knew I wanted
to do something in global health it also
gave me the opportunity to meet Sir
Edmund Hillary who walked into our
Basecamp in 1983 Sir Edmund who’s been a
hero of mine not just for his climbing
exploration and what he’s accomplished
in the mountaineering realm but for what
he’s given back
he built schools he built hospitals when
I finished medical school I had the
privilege of working as a doctor at one
of the hospitals he built in the hills
of Nepal and much of it was very
frustrating there were a lot of things
an individual doctor couldn’t do we had
a lot of problems that were really the
result of public health poor access to
water
I saw a ciated children come in and die
from diarrhea and pneumonia and things
that could be so easily treated in
America I also saw the devastation of
blindness it was just accepted at that
time in Nepal that you get old your hair
turns white your eye turns white and
then you die once you go blind in the
developing world the life expectancy is
1/3 that of agent helps match peers and
for blind children the fade is worse but
this devastation of blindness extends
beyond the individual to the family and
to the whole community
blindness perpetuates poverty and in
turn poverty really magnifies the
devastation of blindness it takes an
able-bodied person out of the workforce
to care for the blind person or a child
like this one who will never be able to
go to school because he has to take care
of his blind father several studies have
shown that the economic impact of sight
restoration in the developing world
returns four dollars to the economy for
every $1 spent and that doesn’t even
include the indirect cost such as the
lifetime earnings of this boy if you
were able to go to school or what potala
can contribute back to her family with
childcare and cooking and I was so
excited seeing the miracle
of cataract surgery not just restoring
sight but restoring life then I came
back to the states and I trained as an
ophthalmologist I then did an advanced
fellowship and corneal transplantation
and advanced cataract surgery in
Australia and then went to Nepal to work
with this man dr. sondik Ruiz that
really it’s an amazing man who grew up
in one of these remote hill villages in
Nepal four days walk from the nearest
road no electricity no running water no
schools at age eight his father walked
him for 11 days and left him at a Jesuit
school outside of Darjeeling India and
from this background relief rose to earn
scholarships at the best medical
institutions in India he trained as an
ophthalmologist at the All India
Institute of Medical Sciences in Delhi
then went on to advance fellowships
first in the Netherlands and then in
Australia and he returned to Nepal with
a full understanding of state-of-the-art
Western eye care and began thinking of
how he could bring this top quality care
to the poorest citizens of Nepal at a
cost that was affordable one initial
obstacle was the lens implant in modern
cataract surgery what a cataract is it’s
a clouding of the proteins in the
crystalline lens of the eye and in
modern cataract surgery which is the
most common surgery performed in America
and it’s such a great surgery when soon
as people start having trouble driving
at night in America they get their
cataract fixed you know a little bit of
blur in one eye next to the other I get
my cataracts fixed but in Nepal there
were no lens implants what we doing
surgeries we make a small self-sealing
incision in the eye wall take out all of
the clouded bits of the protein and then
replace it with a customized lens
implant that gives perfect focus but
when dr. Murray returned to Nepal the
least expensive lens implant on the
world market was $200 that’s more than
the average yearly income of a Nepali
citizen and absolutely prohibitive so
the only surgery
people in Nepal are getting was a very
crude operation that was done in the
1890s in the West where you basically
fillet the eye in half take the whole
lens out and if the eye survives the
surgery you get these thick coke bottle
light glasses that even in the best of
cases gives a distorted vision ruies
felt this was unacceptable that everyone
deserves the same best surgery whether
they can pay or not and he went to his
australian mentor professor Fred Hollows
and together they raised the fonts and
started the first low-cost lens Factory
in Kathmandu and these lenses
manufactured in Kathmandu are exactly
the same quality as what I implant in my
$3,000 cataract surgery here in the
states but they cost four dollars and
this instantly brought the price of the
material cost of a cataract surgery down
under $25 dr. Ruiz he developed a system
where no one does anything that anyone
with lesser skills can do and began
training doctors nurses and technicians
and I went on a first outreach cataract
program with dr. Ruiz and it was a
little schoolroom that his his team had
set up at 10,000 feet and sterilized and
for three days we worked side by side
and we did 224 sight restoring cataract
surgeries which sounds semi impressive
until you get the breakdown that dr.
really did 201 surgeries while I did 23
and what was more I had to call dr. rue
lead over to my table ten times out of
my 23 cases for help I just wasn’t used
to operating on these advanced cataracts
the system he had developed for this
outreach with particular attention to
detail of sterilization has the same
complication rate that we have in the
West and the results were just
incredible 224 families and the joy is
just indescribable I still get such a
kick out of the day after surgery taking
off the patches and the way people look
in wonderment
the smiles and the joy not just of the
individual but also their whole family
so we began teaching dr. Reid’s method
of cataract surgery and delivery
we trained ophthalmologists to do better
cataract surgery but we also trained
nurses in a one-year program after
nursing school to be up thalmic nurses
ophthalmic technicians in a three year
program after twelfth grade then we
started taking some of our best young
ophthalmologists and sending them to
Australia or America for subspecialty
training and then we started a full
world-class ophthalmology residency
program in places that were too remote
to have a doctor we started primary eye
care centers staffed by nurses and
technicians we started a full
world-class Institute of Ophthalmology
and Kathmandu for training and we began
teaching more widely dr. Reid also
developed a cost recovery system where
the elite who pay for their surgery
cross-subsidize and provides for the
free care for the poor and by engaging
the powerful we were able to provide
great care to the powerless and we did
begin reaching the poorest of the poor
and we began spreading into Bhutan Tibet
and into Africa and began teaching in
Ghana and Ethiopia and the thing that
really drove and drives our whole
program is quality because quality is
what drives demand even in the poorest
of the poor and we’re going beyond just
teaching a man to fish we’re teaching
fleets of fishermen to cast their nets
widely and through the quality we’re
teaching them to sell the fish we
brought one of the really great
ophthalmologists of America David Chang
to Nepal to do a prospective randomized
trial looking at the results of our
surgery and we established his identical
operating them to what he has in Los
Gatos California and a monastery in
Nepal and working side-by-side with dr.
Ruiz the results were exactly the same
the only difference is
were the cost and the speed 80% of the
patients
see well enough to pass the American
driver’s test one day after surgery 99
percent have a success at a year and we
continue to teach and expand actually I
just got back from Ethiopia this past
Tuesday and working with Ethiopian
nurses and doctors in two weeks we
restored sight to 2500 people so we’re
real we’re really going beyond but the
thing that’s important is you know we we
still have 18 to 20 million people blind
from cataracts on our planet and it
sounds really daunting but the thing to
keep in mind is that as we’re working
each of these individual people like
Fatali they’re not a statistic they’re
now cured 100% and as we work these are
people who are being restored to site
and restored to life
[Music]
[Music]
consider that in the time I’ve been
speaking to doctors in Nepal could have
restored sight to six people for a cost
of under $200 it’s time to dare the
impossible for five hundred million
dollars and that’s less than the United
States government spends every month on
our war in Afghanistan for less than we
spent every month on our war in
Afghanistan we could restore sight to
every person blind with cataracts on the
planet Helen Keller said just because I
can’t do everything doesn’t mean I won’t
do something that I can do and
eliminating avoidable blindness is
something we can do thank you very much
[Applause]
and twisted in a small wooden smokey hut
at 10,000 feet near faff Luna Paul
outside sword spectacular snow mountains
but she haven’t seen them in five years
outside children were playing and
laughing but she had never seen them
she sat depressed and waited to die then
her husband not being heard about my
clinic that was taking place at a
hospital two days walk from their home
so he took his emaciated wife put it in
a wicker basket put her on a chump line
on his back and carried her for 34 miles
over steep rocky trails when I met
fatality I was really surprised to see
that her age was listed as 56
she looked decades older but the next
day when we took the patches off
it was amazing there was this moment of
wonderment she looked around trying to
see what was happening and then a smile
is bright and broad as the Himalayan
ranges just spread across her face she
saw a grandchild for the first time
tears were streaming down her face her
husband not-being started dancing
spontaneously within an hour she was
walking erect and straighter and excited
to walk home the next day and resume
taking care of her family in our world
but she everyone please close your eyes
for a moment everybody close your eyes
tightly and think about what your world
would be like if you were totally blind
would you be able to leave this theater
in an emergency what if you had to go to
the toilet now consider if you lived in
a place where there were no indoor
plumbing there were no roads for 14
million people more than the population
of Canada this is their fate they’re
blind unable to perform the tasks of
daily living 90% of those visually
impaired people live in low-income
settings 80% of the blindness on our
planet four out of five blind people it
could have been prevented or we can
treat it half of the blindness on our
planet twenty million people are from
treatable cataracts okay open your eyes
a great transition think and consider
that there’s a surgery than in ten
minutes for $25 can restore your sight
people say it’s impossible but we have
to dare the impossible impossible starts
with the first step and we need to
create a brave new world where no one on
our planet is needlessly blind now what
you’re looking at now is the east face
of Mount Everest in 1983 when we set out
to climb and make the first ascent of
the east face of Mount Everest people
said it was impossible the lower head
while you’re looking at is 5600 feet
more than a vertical mile with technical
climbing similar to climbing El Capitan
and vertical ice and we were climbing
from Tibet where at the time logistics
were very difficult and we had no native
support on the mountain whatsoever so
how do you dare the impossible well
first you have to put in the background
the training and develop the skills but
you still have to have the passion and
belief that you can do it impossible
does start with the first step there may
have been better individual climbers in
1983 but there could not have been a
better team than myself my 11 teammates
who really believed we could make the
first ascent of the East face of Mount
Everest and on October 8 1983 we did
reach the summit of Mount Everest and
our route now 34 years later still has
never been repeated so what does this
have to do with world blindness well
traveling and climbing in Asia and
Africa allowed me to witness firsthand
the effects of extreme poverty on health
and the difficulty of life and the
disparity in access to health care
so by the time I matriculated at Harvard
Medical School I already knew I wanted
to do something in global health it also
gave me the opportunity to meet Sir
Edmund Hillary who walked into our
Basecamp in 1983 Sir Edmund who’s been a
hero of mine not just for his climbing
exploration and what he’s accomplished
in the mountaineering realm but for what
he’s given back
he built schools he built hospitals when
I finished medical school I had the
privilege of working as a doctor at one
of the hospitals he built in the hills
of Nepal and much of it was very
frustrating there were a lot of things
an individual doctor couldn’t do we had
a lot of problems that were really the
result of public health poor access to
water
I saw a ciated children come in and die
from diarrhea and pneumonia and things
that could be so easily treated in
America I also saw the devastation of
blindness it was just accepted at that
time in Nepal that you get old your hair
turns white your eye turns white and
then you die once you go blind in the
developing world the life expectancy is
1/3 that of agent helps match peers and
for blind children the fade is worse but
this devastation of blindness extends
beyond the individual to the family and
to the whole community
blindness perpetuates poverty and in
turn poverty really magnifies the
devastation of blindness it takes an
able-bodied person out of the workforce
to care for the blind person or a child
like this one who will never be able to
go to school because he has to take care
of his blind father several studies have
shown that the economic impact of sight
restoration in the developing world
returns four dollars to the economy for
every $1 spent and that doesn’t even
include the indirect cost such as the
lifetime earnings of this boy if you
were able to go to school or what potala
can contribute back to her family with
childcare and cooking and I was so
excited seeing the miracle
of cataract surgery not just restoring
sight but restoring life then I came
back to the states and I trained as an
ophthalmologist I then did an advanced
fellowship and corneal transplantation
and advanced cataract surgery in
Australia and then went to Nepal to work
with this man dr. sondik Ruiz that
really it’s an amazing man who grew up
in one of these remote hill villages in
Nepal four days walk from the nearest
road no electricity no running water no
schools at age eight his father walked
him for 11 days and left him at a Jesuit
school outside of Darjeeling India and
from this background relief rose to earn
scholarships at the best medical
institutions in India he trained as an
ophthalmologist at the All India
Institute of Medical Sciences in Delhi
then went on to advance fellowships
first in the Netherlands and then in
Australia and he returned to Nepal with
a full understanding of state-of-the-art
Western eye care and began thinking of
how he could bring this top quality care
to the poorest citizens of Nepal at a
cost that was affordable one initial
obstacle was the lens implant in modern
cataract surgery what a cataract is it’s
a clouding of the proteins in the
crystalline lens of the eye and in
modern cataract surgery which is the
most common surgery performed in America
and it’s such a great surgery when soon
as people start having trouble driving
at night in America they get their
cataract fixed you know a little bit of
blur in one eye next to the other I get
my cataracts fixed but in Nepal there
were no lens implants what we doing
surgeries we make a small self-sealing
incision in the eye wall take out all of
the clouded bits of the protein and then
replace it with a customized lens
implant that gives perfect focus but
when dr. Murray returned to Nepal the
least expensive lens implant on the
world market was $200 that’s more than
the average yearly income of a Nepali
citizen and absolutely prohibitive so
the only surgery
people in Nepal are getting was a very
crude operation that was done in the
1890s in the West where you basically
fillet the eye in half take the whole
lens out and if the eye survives the
surgery you get these thick coke bottle
light glasses that even in the best of
cases gives a distorted vision ruies
felt this was unacceptable that everyone
deserves the same best surgery whether
they can pay or not and he went to his
australian mentor professor Fred Hollows
and together they raised the fonts and
started the first low-cost lens Factory
in Kathmandu and these lenses
manufactured in Kathmandu are exactly
the same quality as what I implant in my
$3,000 cataract surgery here in the
states but they cost four dollars and
this instantly brought the price of the
material cost of a cataract surgery down
under $25 dr. Ruiz he developed a system
where no one does anything that anyone
with lesser skills can do and began
training doctors nurses and technicians
and I went on a first outreach cataract
program with dr. Ruiz and it was a
little schoolroom that his his team had
set up at 10,000 feet and sterilized and
for three days we worked side by side
and we did 224 sight restoring cataract
surgeries which sounds semi impressive
until you get the breakdown that dr.
really did 201 surgeries while I did 23
and what was more I had to call dr. rue
lead over to my table ten times out of
my 23 cases for help I just wasn’t used
to operating on these advanced cataracts
the system he had developed for this
outreach with particular attention to
detail of sterilization has the same
complication rate that we have in the
West and the results were just
incredible 224 families and the joy is
just indescribable I still get such a
kick out of the day after surgery taking
off the patches and the way people look
in wonderment
the smiles and the joy not just of the
individual but also their whole family
so we began teaching dr. Reid’s method
of cataract surgery and delivery
we trained ophthalmologists to do better
cataract surgery but we also trained
nurses in a one-year program after
nursing school to be up thalmic nurses
ophthalmic technicians in a three year
program after twelfth grade then we
started taking some of our best young
ophthalmologists and sending them to
Australia or America for subspecialty
training and then we started a full
world-class ophthalmology residency
program in places that were too remote
to have a doctor we started primary eye
care centers staffed by nurses and
technicians we started a full
world-class Institute of Ophthalmology
and Kathmandu for training and we began
teaching more widely dr. Reid also
developed a cost recovery system where
the elite who pay for their surgery
cross-subsidize and provides for the
free care for the poor and by engaging
the powerful we were able to provide
great care to the powerless and we did
begin reaching the poorest of the poor
and we began spreading into Bhutan Tibet
and into Africa and began teaching in
Ghana and Ethiopia and the thing that
really drove and drives our whole
program is quality because quality is
what drives demand even in the poorest
of the poor and we’re going beyond just
teaching a man to fish we’re teaching
fleets of fishermen to cast their nets
widely and through the quality we’re
teaching them to sell the fish we
brought one of the really great
ophthalmologists of America David Chang
to Nepal to do a prospective randomized
trial looking at the results of our
surgery and we established his identical
operating them to what he has in Los
Gatos California and a monastery in
Nepal and working side-by-side with dr.
Ruiz the results were exactly the same
the only difference is
were the cost and the speed 80% of the
patients
see well enough to pass the American
driver’s test one day after surgery 99
percent have a success at a year and we
continue to teach and expand actually I
just got back from Ethiopia this past
Tuesday and working with Ethiopian
nurses and doctors in two weeks we
restored sight to 2500 people so we’re
real we’re really going beyond but the
thing that’s important is you know we we
still have 18 to 20 million people blind
from cataracts on our planet and it
sounds really daunting but the thing to
keep in mind is that as we’re working
each of these individual people like
Fatali they’re not a statistic they’re
now cured 100% and as we work these are
people who are being restored to site
and restored to life
[Music]
[Music]
consider that in the time I’ve been
speaking to doctors in Nepal could have
restored sight to six people for a cost
of under $200 it’s time to dare the
impossible for five hundred million
dollars and that’s less than the United
States government spends every month on
our war in Afghanistan for less than we
spent every month on our war in
Afghanistan we could restore sight to
every person blind with cataracts on the
planet Helen Keller said just because I
can’t do everything doesn’t mean I won’t
do something that I can do and
eliminating avoidable blindness is
something we can do thank you very much
[Applause]
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