Geoff Tabin:
And there, in those days we were taking a shaving razor and breaking it in a blade breaker and using that as our knife. So really, it was doing the same quality surgery, but with much lower resources.
Erik Weihenmayer:
It's easy to talk about the successes, but what doesn't get talked about enough is the struggle. My name is Erik Weihenmayer. I've gotten the chance to ascend Mt. Everest, to climb the tallest mountain in every continent, to kayak the Grand Canyon and I happen to be blind. It's been a struggle to live what I call a no-barriers life, to define it, to push the parameters of what it means. And part of the equation is diving into the learning process and trying to illuminate the universal elements that exist along the way. In that unexplored terrain between those dark places we find ourselves in the summit exists a map. That map, that way forward is what we call No Barriers.
Diedrich Jonk:
Producer Diedrich Jonk here. Our guest today is Geoff Tabin. Yesterday, he returned to the US from Ethiopia after a two-week surgical outreach, where he and his team completed over 1000 sight-restoring surgeries. He's the co-founder of Cure Blindness. Their vision? A world where no person is needlessly blind.
Diedrich Jonk:
Tabin has been at this for over three decades. It all began with a climbing expedition to the Himalayas in the '80s. The conversation today veers from stories on the front lines of healthcare in the world's poorest countries, ideas around the moral imperative behind healthcare delivery, challenges of doing something so bold in the face of naysayers and in a funny twist, how he found himself behind bars in an Indonesian jail on what should have been his first day of medical school. Enjoy.
Erik Weihenmayer:
All right everyone. Welcome to our No Barriers podcast. We're psyched to be back and we have an amazing guest, my buddy Geoff Tabin on. Hey Geoff, I read your book when I was in my '20s, I think. I actually had it recorded at a studio for the blind because it wasn't on audio at that point, Blind Corners, and so I loved your book. I still remember it 25 years later. And then I got to know you and you invited me out to come ice climbing where you lived in Burlington and we went around and climbed all these amazing ice faces on the northeast. And you introduced me to some amazing people that I'm still friends with, so it's been really good to know you since, I think that was 2003.
Geoff Tabin:
Yep. I remember it well. It's one of my favorite climbing stories was our climb on Mt. Washington that weekend. I don't know how we did it. Maybe it's less wonderful than the way I remember it.
Erik Weihenmayer:
Go ahead. Let's hear your off-color, distorted memory of it.
Geoff Tabin:
Well first you came. You started rock climbing with my buddy Nick Yardley, who is one of my main rock climbing partners, I think was one of your first climbing mentors.
Erik Weihenmayer:
Yep. He was part of a group that took a bunch of blind kids rock climbing. I was 16 years old and that guy was the nicest guy and took me under his wing, just like you have, too.
Geoff Tabin:
So Nick was and still is one of my really close friends and one of my closest climbing partners on the East Coast. And he told me about you. I remember you came out, you stayed at a place in Burlington and then we went to first time, the Black Dike, which we climbed as a group of three. That's one of the really classic ice climbs of the East Coast. It's a grade V ice, but also, it's a mix climbing up to about five-eight, five-nine on verglassed rock.
Geoff Tabin:
But the most impressive thing to me was the way you actually went to the base of the climb. And I remember you talked to me early on about whether I thought you could climb Mt. Everest. This was the actual thing that made me know you could climb Mt. Everest was your following the approach because it's boulder hopping on a scree feel that was pretty iced-up and pretty treacherous. And you were just following on the ski poles and went to the base and then we climbed the Black Dike together. It's a party of three, but then the next day, we went as a ...
Erik Weihenmayer:
Hold on. Hold on Geoff. Before the next day, though, the best thing happened on the Black Dike. So there's the glissade down.
Geoff Tabin:
I guess I closely killed you.
Erik Weihenmayer:
Yeah. You almost killed me. There was a glissade. There was a gully. A gully, you know the ...
Geoff Tabin:
Let me tell the story, okay?
Erik Weihenmayer:
Okay. You tell it. Yeah. It's your show.
Geoff Tabin:
You actually couldn't see it, but I saw it very clearly. When you climb the Black Dike, it's an ice climb that's about 600 feet of climbing and then you scramble up a little bit high on Canon Mountain. And the descent is a very steep snow slope and people sit on their butt and slide and glissade and you pick up really pretty significant speed. It's like a bobsled run.
Geoff Tabin:
And you fortunately were wearing your helmet because as you came down, there was a fallen tree that had gone right across the bobsled run and so at that point, rather than sitting up, you have to lie down completely flat in this little chute to go under it. And I went under it and I go, "Oh no! Erik's going to be in trouble." So I stopped and you were coming down and actually lying completely flat in the groove and I tried to warn you. And I said, "Erik." And you sat up and went at high speed, bam! Right into the tree.
Erik Weihenmayer:
Yes. That's why I've never been the same since. I can't ever remember my birthday.
Geoff Tabin:
you were wearing your helmet.
Erik Weihenmayer:
Jeff Evans, does that explain it?
Jeff Evans:
I'm just thinking how close we came to not fulfilling our destiny thanks to Dr. Tabin.
Geoff Tabin:
That was the first thing, but the more exciting one was we went the next day just the two of us to climb Pinnacle Gully on Mt. Washington, which when it was done in the 1930s was felt to be the hardest ice climb in America and one of the hardest in the world. And it was very famous that when Yvon Chouinard, when he invented his change ice climbing tools did the first one-day ascent of Pinnacle Gully and did the first front pointing up. And it's one of the really cool mountain routes in New England. And Erik did a great job following that, taking out all the ice screws and getting to the top.
Geoff Tabin:
As we got to the top of the ice climb, one of those really nasty nor'easter storms was blowing in and the winds were picking up and the ice crystals were blowing at pretty high speed into our faces. I said, "Erik, it's a little dangerous up here. I don't like these conditions. The weather's getting bad, let's go down." And Erik said, "No. I came all the way to the East Coast. I want to go to the top of Mt. Washington." And I said, "Erik, really this is a pretty nasty storm." And Erik said, "Come on, Geoff. You climbed Mt. Everest. You climbed the highest mountain in Antarctica. Can't you just get me to the top of Mt. Washington?"
Geoff Tabin:
So I said, "Okay." I leaned into this wind and Erik took a stuff sack out of his backpack and put it over his head like an executioner's hood. So he had this black stuff sack completely over his head. And it's just walking and a little scrambling to get to the top, but it was nasty strong wind. But it didn't affect Erik, because his head was completely in a stuff sack.
Erik Weihenmayer:
Geoff, you know how you say I have revisionist history memory? Geoff, has even worse revisionist history memory.
Geoff Tabin:
We were the only two people stupid enough to go to the top of Mt. Washington that day and then we started down and as we started down, we were coming down the Lions Head trail which is a walking trail and there was a fairly steep section, maybe 45 degrees and it was a little bit icy. There was a guide with a guided party who turned back and he was yelling at his clients into the wind, "Hey. Everyone put on your harnesses. I'm going to rope you all down this section and put on your crampons."
Geoff Tabin:
Erik, of course, just follows the sound of a ringing bell. So I came up ringing the bell and this guy glowered at me, "That's really annoying." I said, "Well, my friend here is totally blind and he just follows the sound of a bell." And Erik came up wearing this black executioner's hood over his head and I said, "Can you get your people out of the trail so we can get by?" And he goes, "No. We waited our turn at this section. You wait your turn." I said, "Yeah, but you're putting on crampons and using a rope." He said, "Yes. I suggest you do the same because it's very scary and very dangerous here."
Geoff Tabin:
I said, "Really? It doesn't look very dangerous or scary for my blind friend. Come on Erik." And I rang the bell and Erik stepped over all the clients and we disappeared on down.
Jeff Evans:
Trying to imagine with a stuff sack over his head, how do you not suffocate with a stuff sack on his head?
Geoff Tabin:
I'm not sure-
Erik Weihenmayer:
Don't worry about the details of the story Jeff Evans. All right. Well let's move on. That's amazing. So we have a great connection. We climbed the east buttress on El Capitan together.
Geoff Tabin:
El Capitan together. Yep.
Erik Weihenmayer:
We've done all kinds of fun things. So it's really great to have you finally on the podcast. You have a really busy schedule. You just got back from Ethiopia. So you started, are a big part of the Himalayan cataract project Now Cure Blindness. What attracted you to ophthalmology and to the eyes? Going to med school, you could have focused on anything, so how did you first of all get interested in the eyeballs?
Geoff Tabin:
Actually it was ... I'll backtrack a little bit. It's a little circuitous. I was always into sports and pretty fanatical about climbing and interested in sports medicine and sports physiology and also, high-altitude physiology and I thought that I would probably be an orthopedic surgeon. That was my thought when I was in college. I had a couple of charismatic orthopedic surgeons who really motivated me and that's what stirred me towards going into medicine.
Geoff Tabin:
And then I was given a scholarship to go to Oxford University for two years after college, before medical school. I'd already been accepted to medical school. I deferred for two years and I studied philosophy at Oxford. And I looked at the moral imperative behind healthcare delivery and really focused on the lower resource countries of the world and the disparity between access to and quality of care between the haves and the have nots.
Geoff Tabin:
By the time I matriculated at medical school, I already knew I really wanted to do something in global medicine. The other thing that Oxford did for me, I'd been just a pretty fanatical rock climber. Oxford had these indigenous trust funds that were remnants of the time when Oxford students were expected to civilize various aspects of the world. And one in particular, the AC Irvine grant for Oxford students to enjoy strenuous holiday in mountains abroad, given after Andy Irvine who died on Everest with Mallory. It turned out the more exotic the locale you chose, the more cash money they gave.
Geoff Tabin:
So my partner, Bob Shapiro, and I were able to go to a couple of remote big walls and it really expanded my horizons in the climbing realm, but moreover, it also allowed me to experience first-hand what hospitals were like in poor countries and really see how little care was accessible in Asia and Africa.
Geoff Tabin:
So by the time I started at medical school, I knew I wanted to do something in global medicine. I wasn't really sure how or what. Through some just ridiculous serendipity of circumstances, I was able, got invited to go on a couple of trips to climb in the Himalayas and I developed a fondness for the people in Nepal and in Tibet.
Geoff Tabin:
After a climbing expedition in '88, where I was fortunate and got to the top of Mt. Everest, I was asked by Sir Edmond Hillary to fill in at one of his hospitals I a little hill village called Phaplu. I worked as a doctor in Phaplu. I was seeing that there wasn't really much impact that an individual doctor could make. Most of the big issues were lack of vaccinations, lack of clean water, infectious diseases.
Geoff Tabin:
I was just on the cusp of applying to go to PhD programs in public health, which is where I thought it could make my most impact when I saw a Dutch team come in and do cataract surgery. It was a Dutch doctor named Jan Kok. In our little village were about 30 people who were blind, waiting to die. In Nepal at that time, it was just accepted that you get old, your hair turns white and your eyes turn white and then you die.
Geoff Tabin:
People get depressed and they can't really contribute to the family. When you're in a subsistence agrarian economy, a name for a blind person in Nepal is a mouth with no hands. It's just a huge burden to have a blind person in the family.
Erik Weihenmayer:
Right. And no eye [inaudible 00:15:03] that talk. There's no computers like I'm on now with my JAWS software talking to me. There's no long white canes. There's no Braille writers. Right? There's no opportunities.
Geoff Tabin:
There's no smooth road. You can't walk. The roads are completely uneven and their trails just getting to the outhouse.
Erik Weihenmayer:
Tell me about it. I remember trying to get to those outhouses.
Geoff Tabin:
And the surgery just was transformative. People literally went from blind to perfect vision the next day and just their [inaudible 00:15:39] looked 20 years younger and began walking and contributing. And I went, "Wow. This is a place I can make a difference." I went back to Katmandu, this was in the mid 1980s, and there was no one in Nepal at that time doing modern cataract surgery with lens implants. I got so excited.
Geoff Tabin:
I thought wow, this is a place I can really make a difference. We can start a program. We can train Nepali doctors to do this. And I came back and I started my residency back in the States. And then I was looking for how can I get involved to get back to do what I wanted to do? The one person in global medicine who was really advocating teaching local people and had been working a bit in Nepal was an Australian ophthalmologist named Fred Hollows.
Geoff Tabin:
And so I went to Australia to do a corneal transplant and advanced cataract surgery fellowship in Australia under the guise of the Fred Hollows Foundation with my mentor, Hugh Taylor, and they sent me back to Nepal at the end of my fellowship to work with a Dr. Sanduk Ruit. And what I didn't realize, Erik, was that Dr. Ruit, when I was looking to find out if anyone was doing modern surgery in Nepal, at that time Dr. Ruit was finishing his final fellowship in Australia.
Geoff Tabin:
He's an amazing guy. When you talk about no barriers and where you come from and how you come up, Sanduk was born in a small, little hill village near Kangchenjunga in far Northeastern Nepal, three days walking the nearest road, no electricity, no running water and no schools. His father was a salt trader who brought caravans of yaks with salt over the Himalayan passes into Tibet and then would bring salt from Tibet back down to India.
Geoff Tabin:
I'm wondering as I'm working a lot of poor areas where I would be and what I would be doing if I were born in that environment. He had two siblings who died very unnecessarily, one from just diarrheal illness and one from tuberculosis. At age eight, his father walked him to Darjeeling, India. He spoke not a word of English and not a word of Hindi and his father left him at a Jesuit-
Erik Weihenmayer:
Doesn't it take 10 days to walk there, too?
Geoff Tabin:
It took 10 days to walk there. And his dad left him at this school and seven years later, he won a full scholarship to one of the best medical schools in India. He graduated number one in the nation of India in his medical boards and then did his ophthalmology training all in the Institute of Medical Sciences in Delhi. He then did a fellowship at the Arav;ind Eye Hospital in Tamil Nadu, which was at that time the best cataract center in India. He then came back-
Erik Weihenmayer:
I'm canceling this interview. I want to interview Dr. Ruit. Sorry. Yeah.
Geoff Tabin:
You should. He's good. When you talk about No Barriers, what he's accomplished. Honestly, he's the genius behind anything that I've done. I liken my role in the program to being the fat boy who plays because I bring the ball. But Dr. Ruit is really the genius and just try to hang on his coattails.
Geoff Tabin:
He was noticed, actually, by the same Dutch doctor that I worked with, Jan Kok, who brought him to the Netherlands to learn modern microsurgery and then Fred Hollows brought him to Australia and he did two years more of fellowship in Australia. So he was a master surgeon in top Western techniques. The same week that I started my three-year ophthalmology residency in America, Sanduk came back to Nepal to start his development program.
Geoff Tabin:
In a lot of medicine, most of Western medicine we have people trying to think of how can we make things one-tenth of one percent better even if it's 100% more expensive? Sanduk was the one really brilliant mind who said, "How can I bring the same quality of care that's 100% as great as the most expensive, best Western care at a cost that's affordable to the poorest of the poor?"
Geoff Tabin:
He brought the system to Nepal. When I went on my fellowship to work with him, I was so blown away when I finished my training. It's funny, the first trip I went on with him, we did an outreach and his team set up a sterile operating room with a small school way up in the hills. We operated side-by-side for three days and did 224 cataract surgeries. And again, it was just crazy. The joy, the screaming, the dancing, the family, the hugging, people crying with joy and seeing.
Geoff Tabin:
It sounds semi-impressive, but we were two surgeons. We did 224 surgeries in three days. So you get the breakdown that Dr. Ruit did 201, while I did 23. And what was-
Erik Weihenmayer:
I want to hear a lot about that training, Geoff, but I want to interrupt you just to back up a tiny bit and tell us so people get the context of those eye camps that you do, what is the primary reason people do go blind in those developing countries? What's the need there that you saw?
Geoff Tabin:
At the time, the need in Nepal was huge. It was about 250,000 people totally blind from completely treatable cataracts. And cataracts were at that time about 80% of the blindness in Nepal and another 10% were people who were rendered irrevocably blind from really bad cataract surgery. So 90% of the blindness in Nepal in 1994 was from cataracts. Worldwide, cataracts account for half of the blindness. About 18 million people on our planet could be restored from blindness to perfect sight.
Jeff Evans:
I'm really curious if you could maybe explain to us what sort of environmental factors contribute to the cataracts? Just so folks [inaudible 00:22:16].
Geoff Tabin:
A cataract is a clouding of the crystalline lens. The crystalline lens is a protein structure with proteins that fold into crystals that focus light. It sits right behind the pretty-colored part of the eye called the iris. As we all get older, the lens slowly has its proteins break down. If we all live long enough, we'll all have cataracts. It's the most common major surgery performed in the United States.
Erik Weihenmayer:
Not me, Geoff.
Geoff Tabin:
Not Erik. I take that back. The majority of us will have cataract surgery if we live to be 100 years old. It's such a great operation. When people start having trouble driving at night in America, we do their cataract surgery. But what happens is the crystal structure breaks down. Instead of focusing light, it begins to scatter light. And then with time, it breaks down even more and rather than scattering light, it begins absorbing light and becomes completely opaque.
Geoff Tabin:
Part of it is genetic. People who live in intense UV sunlight, UV light breaks down the protein structure. So people who are in an environment with a lot of light and also have a low level of antioxidants in the diet, the UV light causes oxidative damage to the proteins. So a combination of light and lack of antioxidants. So people who are out in the sun a lot, high-altitude sun, who eat rice and dal and don't have a lot of green, leafy vegetables.
Erik Weihenmayer:
Hey Jeff Evans. Remember when we were in Tibet the yak herders didn't have sunglasses. They would take a yak tail and spread the, what is it? The fur over their eyes almost to filter the sun away.
Jeff Evans:
They didn't want the sunglasses. They were opposed to the sunglasses because I don't know, culturally it didn't seem to fit into their identity.
Geoff Tabin:
Another huge factor that affects early development of cataracts is chronic fluid shift from having diarrhea and having bad water supplies. And then another huge factor, one thing you can do in America if you really want to get a cataract early is smoke cigarettes. When you live in a hut where you're burning wood fuel and you're inhaling the smoke all the time, it's like smoking cigarettes. Not only does it cause lung disease, but it also leads to an earlier formation of cataracts.
Geoff Tabin:
People who have light skin like you, Jeff Evans, or you Erik, although you don't have to worry about this, our most common reason for losing vision as we get older is age-related macular degeneration. People who live in more equatorial or sun-intensive environments, the lens of the eye becomes opaque at an earlier age and it may be a way of preventing the light hitting the retina and protects against age-related macular degeneration.
Jeff Evans:
How much do you feel like particulates from burning yak dung and so forth inside a small, little room, how much does that play into it?
Geoff Tabin:
No. That's what I was saying. It plays in hugely. It's very similar to the one biggest risk factor in America is smoking cigarettes.
Erik Weihenmayer:
Right. So it's all related, I think.
Geoff Tabin:
When you're inhaling a particulate matter, even though you're not getting the nicotine buzz, you're doing the same damage that you would have if you were smoking a lot of cigarettes.
Jeff Evans:
It's the inhalation of the particulates more than just the particulates being on the ...
Geoff Tabin:
Yeah. It's inhalation of the particulates. Burning of the yak it makes no difference.
Jeff Evans:
I see.
Geoff Tabin:
It makes you uncomfortable. It makes you tear and your eyes don't feel so good, but it does not affect the cataracts, essentially inhalation of the particulates.
Jeff Evans:
Okay.
Erik Weihenmayer:
So back to that camp. You go to that camp. Or excuse me, not even a camp at that point. You're just doing surgeries with Dr. Ruit. I was really fascinated by this part of your story because I've heard you say in another interview he was schooling you. You had to bring him over 10 times to say, "How do I do this?" "How do I do that?" You're this highly trained ophthalmologist. Why was he so good and what did he know that you didn't?
Geoff Tabin:
Really the experience with that sort of advanced pathology. In America, they say we have one ophthalmologist for 18,000 people. So when you start having a little bit of problems when the cataract is still fairly soft and easy to operate on, we do the surgery in America. Also in America, we have really incredible equipment. When I operate in America, I've got a $150,000 microscope that has incredible focus at every layer. And I have something called a phacoemulsification machine that helps break up the lens and makes it extremely safe in a lot of ways that costs about 100 or $150,000 dollars.
Geoff Tabin:
Dr. Ruit developed a way of doing the same quality surgery, but without the fancy equipment we have in America, so getting the same results, but with a $15,000 or even a $7000 microscope instead of a $150,000 microscope and without a lot of the fancy machines that make surgery much easier and much safer in America.
Erik Weihenmayer:
I see.
Geoff Tabin:
So it was a combination of just not having experienced the cataracts that have been going on for 10 years after someone has been blind combined with not having the same visualization and combined with not having the same instruments. In America, we have the most amazing diamond blades and incredibly perfect, sharp blades that we use once and throw away. There in those days, we were taking a shaving razor and breaking it in a blade breaker and using that as our knife.
Erik Weihenmayer:
Oh my gosh.
Geoff Tabin:
Really, it was doing the same quality surgery, but with lower resources.
Jeff Evans:
I'm trying to remember what year it was that we did [name of a mountain] and you were set up in Lukla. You had a massive clinic set up in Lukla and I think I had just gotten ... I got out of PA school in 2000 and medicine was still just fascinating to me. It still is, but I was really just hungry for it. And you took us through. You took me and a couple of the veterans through your OR suite and I was blown away by how you had full sterile procedures in multiple rooms.
Jeff Evans:
And I know you're talking about the beginning you were using rudimentary and you were just making shit up as you were going, but I think that was the pioneering part of it. At some point, you got it tight, man. Because I remember you were working with very little and you got a lot, right?
Geoff Tabin:
A lot of it is detained. Again, Dr. Ruit's the one who developed the approach and the team approach and training ophthalmic technicians in a three-year program after high school and training ophthalmic assistants in a six-month program after eighth grade who become so good and just an incredible team effort.
Geoff Tabin:
But I ought to backtrack here and tell one other funny story which was I only found out later. I was so blown away by Dr. Ruit, I said, "Dr. Ruit I really want to work with you. When I finish my fellowship, I want to move to Nepal and work with you." In Nepal, they don't just say no. He would say, "Well, I'm not sure that's a really good idea. We won't be able to pay you the sort of salary you'd have in America. I'm not sure we could even pay you and I don't really think it's a very good idea." I said, "No. No. I really want to."
Geoff Tabin:
I came to Nepal. The medical year finishes July 1st, so I came to Nepal and I spent about three weeks trying to learn his surgical techniques. After about three weeks, he said, "Okay, I'll send you to Bharat Nagar. I want you to start teaching the doctors in Bharat Nagar." That was right at the height of the monsoon. Bharat Nagar is a big city on the border with India that in July, has an incredible infestation of mosquitoes and cobras and it's pouring rain every day and 100 degrees and 100% humidity with drenching monsoon storms.
Erik Weihenmayer:
Wonderful surgical setting.
Geoff Tabin:
I found out afterward that he sent me there to get rid of me. He thought-
Erik Weihenmayer:
He'd made you quit, right?
Geoff Tabin:
He thought for sure it'd make me quit. And anytime I complained to him about it, he would chew me out and say, "Why don't you just go home. If you can't do this, just go home." And I didn't realize. I thought he sent me to Bharat Nagar because there was so much need. But after I lasted three months in Bharat Nagar through the worst of the monsoon. Slowly he began to accept me.
Jeff Evans:
He was Mr. Miyagi. You were Daniel Larusso. And you were like, "I can do this shit."
Geoff Tabin:
Exactly.
Erik Weihenmayer:
Hey Geoff. Tell us the story ... Like I said, there's these amazing videos out there on YouTube of you at one of your eye camps restoring vision to people. A woman who hasn't seen in 20 years and she wakes ... Not wakes up, but you pull the bandages off and she's like, "Oh my gosh! I can see!"
Geoff Tabin:
It's really so amazing. It's the one real miracle in medicine. There's really nothing else that restores perfect sight. It really is the low-hanging fruit of global medicine. Even though the statistics right now are still that there are 18 million people blind from cataracts, one of the cool things is when we do surgery, each person is no longer a statistic. They're 100% cured.
Geoff Tabin:
I just got back from Ethiopia. We just did about a thousand surgeries in Ethiopia in the last two weeks with good COVID protocol. I still just get blown away. There's this moment of hesitation where they're trying to figure out what they're seeing and then this unbelievable smile. And then they start [inaudible 00:33:56] and dancing and singing. It's one of the really coolest things.
Geoff Tabin:
Actually last week, I had a 12-year-old boy who had congenital cataracts, but they were the type you could see around for a while. So he saw when he was little and when he was six, he was in first grade and they told him he couldn't keep going to school because he couldn't see well enough. When he was nine was when he went complete only light and dark. And now he was 12 and I operated on him last week. Right after the patches came off, he went from seeing only light and dark, he couldn't see the shadow of a hand move in front of his face, to 20/20 vision in both eyes.
Geoff Tabin:
It was the coolest transformation because he was this really sour-looking kid who was really depressed and it was hard for the technicians to even get him in for putting in his eye drops, resisting everything, angry and the way you might have been when you were 12.
Erik Weihenmayer:
But just to reiterate, right? I know I'm beating a dead horse because we already talked about this. But in one of your videos, you said blindness creates poverty. You can't go to school usually in the developing world. We're so lucky as blind people living in America or in Europe. No work. Probably not a wife or a husband. Probably no kids. You're probably sitting in a hut and you're also a burden on the family, right, because now you don't know how to make a living, so people have to feed you and care for you.
Geoff Tabin:
And take somebody out of the workforce to care for that blind person, which is often a child who can't go to school. Or if you've been working as a farmer to feed the family, then your child has to go work on the farm and work in the fields so that the family can eat.
Erik Weihenmayer:
How as a surgeon do you feel when you see that? When you see that oh my God! I just changed somebody's life maybe forever?
Geoff Tabin:
I still get a thrill. We were doing about 200 surgeries a day in Ethiopia and 200, a joy ride. It's just amazing, Erik. I want you to come and just experience it. I thought it would be a cool thing for you to come and just experience the joy of 200 people from blind to seeing.
Erik Weihenmayer:
I could walk through the camp and shake people's hands and say, "I was one of his failures."
Geoff Tabin:
Don't go near him. Don't go near him. [crosstalk 00:36:39]
Erik Weihenmayer:
I'm cursed.
Jeff Evans:
How are you identifying locations anymore? Why is Ethiopia the spot that you're putting a lot of your bandwidth into? I know it's a global thing. You could stay busy for the rest of your days. So how do you identify these places and then get the resources to go to these?
Geoff Tabin:
Our focus really is on teaching and training local people. So it's been identifying young superstars and trying to support them and develop the system. So trying to look ... Nepal is now the only large poor country that's reversed its rate of blindness. We went from a backlog of 250,000 blind people plus about 60,000 new people going blind a year and Nepali doctors only doing 15,000 surgeries a year to now Nepali doctors are doing over 350,000 surgeries a year.
Geoff Tabin:
The quality is uniformly great and unfortunately for me, they all operate better than me now, so there's nothing for me to do in Nepal. It's really the program is self-sustaining. And through paying patients paying for their surgery, that subsidizes the free care. We call it a form of compassionate capitalism where they have sustaining great care now throughout Nepal.
Geoff Tabin:
So we moved seamlessly into Bhutan, which was a great country to work in, really great infrastructure and the forward thinking king, Jigme Wangchuck, who said, "I want to realize the gross national happiness of my people, not maximize the gross national product." And so we were able to dovetail with already a very good public health system, schools, roads. And so that's been a real success.
Geoff Tabin:
Then when I began working in Africa, the first country was in Ghana, which is a relatively stable country, really wonderful people and we have a couple of really good young superstars in Ghana. And then we spread into Ethiopia, which was similar. Unfortunately, the news out of Ethiopia right now is a little bit scary. It's a bit of political unrest. But initially, I started working there, which is now 10 years ago. It was a relatively stable country with a forward thinking health minister. We always work in partnership with the local doctors and the local health ministry.
Jeff Evans:
Yeah. You just got back from there and it's about to reach its crescendo in Addis today or tomorrow, right?
Geoff Tabin:
Yeah. So I was there. While we were there, I was working in the south of the country where it's nice and quiet and the US State Department told me to evacuate. And that was on Tuesday, but we still had 400 blind people that we'd rounded up and brought in, so I ignored the government warning. And I talked to my sources who said, "Addis is still pretty stable, so the airport should stay open." I was watching it every day. I stayed in Addis until we finished the last patient and then I stayed in the south until we finished the last patient and then I flew to Addis last Saturday and flew out at midnight.
Erik Weihenmayer:
Hey, there's a piece of the story that we haven't addressed directly. Was it Dr. Ruit that figured out how to manufacture lenses?
Geoff Tabin:
I wouldn't say ... He didn't figure out how to manufacture lenses.
Erik Weihenmayer:
Yeah. Exactly. Tell that story because weren't they a lens, an artificial lens was hundreds of dollars and you guy got it down to manufacturing it for five bucks?
Geoff Tabin:
Actually doc ...
Erik Weihenmayer:
Yeah. Tell me the facts.
Geoff Tabin:
In 1990, the least expensive lens implant ... The lens, as I said, is like a peanut M&M. It has a little outer capsule and the chocolaty mess which is called the cortex and then the hard little peanut is the nucleus. The earliest cataract surgery that was done was by the ancient Sumerians who used to take a little needle from a tree and put it in and just knock the completely opaque lens out of the way, which most eyes didn't survive.
Geoff Tabin:
In the mid 1800s, a German doctor named Dr. von Graefe developed a way to actually take the whole lens out. But when you take the whole lens out, the jelly that fills the back of the eye called the vitreous jelly, that often would come forward. So there were a lot of complications with that.
Geoff Tabin:
Even in the early 1920s, they started using digestive enzymes to loosen the attachments and figure out better ways to take the whole lens out, but then you had no lens to focus. So people would have these thick, Coke bottle-like glasses where you could barely see with the Coke bottle-like glasses.
Geoff Tabin:
A British doctor in the 1950s names Harold Ridley was taking care of an RAF pilot and he found that the windshield of a Spitfire was blown into his eye, it remained inert and hadn't caused any inflammation or infection. So he came up with the idea we could make a lens implant to replace the lens.
Geoff Tabin:
Doctors by the 1960s were now preserving the capsule and taking a lens implant that would be custom made for your eye to give you really good focus so you could see without spectacles and put it back into the little capsule and developed a way of retaining the capsule, just taking out all of the chocolatey mess and the hard peanut and then putting the lens implant back in.
Geoff Tabin:
Still by 1990, everybody in the developing world was getting that surgery. But in the developing world in Nepal, the only surgery they were doing was the same surgery that they were doing in Germany in the 1850s. And Dr. Ruit said, "Hold it. Why are these lenses ... They were being made out of polymethylmethacrylate which was the material of the windshield of a Spitfire plane in World War 2. So why are we charging $250? The polymethylmethacrylate costs just pennies and he started the first lens factory to manufacture the lenses at the same quality we have in America in Nepal and brought the price down to about five dollars.
Geoff Tabin:
Dr. Fred Hollows from Australia helped him raise the funds to do it and they used Western and Australian and New Zealand engineers for the technology. So he didn't really invent the way, but he did the first low-cost lens factory which completely changed the economics of eye care and the ability to restore great sight.
Erik Weihenmayer:
And is that factory in Katmandu?
Geoff Tabin:
Katmandu. Our main hospital is the Tilganga Instituter of Ophthalmology and the factory is just adjacent to Tilganga.
Erik Weihenmayer:
Have other developing countries started manufacturing lenses like that, as that model?
Geoff Tabin:
Yeah. Unfortunately, we thought when we started. I use the word we grandly because again, I was in the right place at the right time and I was there working with Dr. Ruit when it opened and Dr. Ruit was the genius behind thinking of it. We thought that we would be able to sell those lenses for $40 in Korea and in Japan and in Thailand and it would completely subsidize all the free care and be able to overcome world blindness.
Geoff Tabin:
The problem is that as we began manufacturing, we were also at the same time training Nepali doctor, technicians and increasing the amount of surgery and we never had a surplus of the inexpensive lenses because they were all having to go to the poor. As we kept on ramping up, instead of making 10,000 lenses a year, we were making 50,000, then 100,000 and 200,000. Meanwhile, we're now doing 200,000 surgeries a year in Nepal. So we never really had the surplus.
Geoff Tabin:
Several Indian companies, my favorite manufacturer in India is the Aurolab, which is with the Aravind Eye Hospital system, which is a phenomenal organization in Southern India. The cost now is down around three dollars for world-class, same quality lenses that I put in in America and there are also several Indian manufacturers now who are manufacturing lenses that are even less expensive.
Jeff Evans:
It's fascinating that you can change the entire economic landscape of something just by simply just seeing it differently literally and figuratively. So resourceful. Amazing that you were a part of such a thing.
Erik Weihenmayer:
Geoff, do you have advice for other folks who want to start some kind of organization like that and what kind of barriers do you want to warn them that they're going to face?
Geoff Tabin:
I think you have to have a passion for what you're doing. For me, it's been really nice in that I've had the credentials in the academic realm to be able to push things forward. But we had huge resistance from Western ophthalmologists saying, "Yeah, you're doing fast surgery, but it's dangerous and it's not good quality." So we had multiple academic papers that we had to publish to justify what we were doing early on.
Geoff Tabin:
I think the biggest thing if you have passion. Really have passion for what you're doing and be excited about it.
Erik Weihenmayer:
You're not staying in nice hotels and stuff. Timmy O'Neal told me you're ... It's disgusting from American standpoint, right? There's bad sewage, bad food, no AC. It's not great, right? And you're in these places for months sometimes or you used to be.
Geoff Tabin:
Yeah. But again, one of my close friends who unfortunately passed away just about a year ago, a doctor named Allen Crandall. He had one of the greatest quotes I know which is that we were operating in South Sudan and it was about 100 degrees and we were in a tin roof shed with no AC. It was probably 120 in the shed and I had to have a nurse on every case take an alcohol-soaked sponge and put it across my face so I wouldn't drip sweat into the eyes that I was operating on.
Geoff Tabin:
We couldn't wear scrubs because it was so hot. I was wearing just a little skivvy shirt and gloves because it was way too hot to have scrubs on. We were-
Erik Weihenmayer:
I wish I could see that picture, Geoff.
Geoff Tabin:
There were biting insects just swarming in the operating room. When we finished the day, my friend and partner, Allen Crandall, said, "Geoff, that was the best day of surgery I've ever had. I've never had that many complex cases and people with this much need."
Erik Weihenmayer:
You have to really be able to thrive on that kind of challenge, right?
Geoff Tabin:
Thrive on the challenge, but also, realize that just the joy of the mission or just the joy of what you're doing outweighs your own personal circumstance a bit.
Jeff Evans:
You also have some seasoning and I think that a lot of folks who spent a lot of their adult lives hanging out in tents and being cold and going through weeks if not months of not a great diet and just basically knuckling down, that's in your DNA from climbing and then it translates over into the way that you practice medicine for all these years, too, right? You're probably more comfortable sleeping on a Thermarest or on a blanket on a concrete floor and sweating your balls off or freezing your balls of than you are sitting right now in your living room, all comfortable, right?
Erik Weihenmayer:
There's a Russian, Geoff, a Russian that was climbing one time and I asked him, I was like, "Man, you guys were hanging on the space for night after night just freezing. Most people would have died." And he was like, "No. Very nice vacation. Better than my apartment in Moscow." So yeah, it is true, right? You have the perspective.
Geoff Tabin:
That's just a small part of it. I don't want to focus on that area. If people want to do things, you don't have to suffer to try and do something and follow your passion. But there's so many barriers. If you're trying to do something different, which is what we did and I've been the main proselytizer of Dr. Ruit's methods which are now widely accepted around the world, but there's a lot of skepticism if you're doing something differently. And you have to have a real, genuine belief that what you're doing is the right thing and not be deterred by people who say no, no, no. You have to really realize in your heart that what you're doing is something you believe in and then go forward with it.
Erik Weihenmayer:
Well, we've kept you a while, Geoff, but I do want to just cover very quickly, you were part of the team that were the first folks to climb the east face of Everest. You were one of the first Americans to climb the seven summits. So we could have a whole other podcast on your climbing resume. Then your book, Blind Corners. My favorite part of Blind Corners was this group that you connected yourself with back in your crazy days when you wrote for Playboy magazine and stuff. It was the dangerous sportsman club.
Geoff Tabin:
Yep.
Erik Weihenmayer:
I loved that part of your book. I laughed my ass off.
Geoff Tabin:
I actually reunited with one of the crazier members of the dangerous sport club. His name is Alan Weston and he is actually currently building an air machine for Sergey Brin and living here in the Bay area. That was at Oxford University. And they would create new dangerous sport. And they had just come back from doing the first ever magma surfing. There was a volcano erupting in the South Pacific and they stole stationary from the Oxford Geology Department and forged documents saying they were official Oxford seismographic expedition.
Geoff Tabin:
They self-manufactured homemade asbestos suits with asbestos helmets and asbestos surfboards and they [inaudible 00:52:20] do the first ever magma surf.
Erik Weihenmayer:
And they paraglided off of Kilimanjaro, they would slide cafeteria sleds down crazy mountains in the Alps. And the craziest, funniest one I still remember is didn't you get, build a big pink kangaroo or something and fill it with helium and then float it across the English Channel?
Geoff Tabin:
Yep.
Erik Weihenmayer:
Tell us that story really quick before we go.
Geoff Tabin:
I'll tell you the story of my own involvement with them. I was on my way. I had gotten one of these AC Irvine grants. There's a north face on Carstensz Pyramid, which at that time had never been climbed. Carstensz Pyramid which you've been to. It's only been climbed at that point four times and so we were going to make the fifth ascent of Carstensz Pyramid and do the first ascent of the big north face.
Geoff Tabin:
And I was at a party celebrating the magma surfing and the leader of the club said, "Oh Geoffrey. You're going to New Guinea. You must try vine jumping." And he was referring to a puberty ritual which is actually not in New Guinea. It's actually in Vanuatu, but he was a little misinformed, where they would build these towers and tie springy vines to the ankles and dive off the towers.
Geoff Tabin:
The person that I just reconnected with, Alan Weston, said, "Oh, well why don't we urbanize New Guinea vine jumping?" And another guy said, "Well, I've got a brother who's in the RAF and I know at the Islington Air Force Base they have these stretchy cords. Let's go get them." So we went at about 3:00 in the morning and permanently borrowed a bunch of cords and we went to the Clifton Suspension Bridge. It was April Fool's Day 1979 and jumped off the Clifton Suspension Bridge with these cords which happened to be made by the Bungee Corporation.
Geoff Tabin:
We unfortunately didn't have a good method of getting back up to the bridge and it was well-photographed. And the tabloid press in Britain had photos that said, "Oxford yo-yos." We were on the front page of the Daily Sun. Then that caught the attention of a TV show called That's Incredible.
Jeff Evans:
You were pioneering something, though.
Geoff Tabin:
Yeah. That was the first ever Bungee jump was off the Clifton Suspension Bridge and then a few months later, they wanted us to do it on the TV show, but David Kirk, the leader of the club, said, "No. We've already done it. There's no sport left in it because we already know the outcome, so it's not really a sport anymore, is it?"
Geoff Tabin:
We had this incredible trip. The least of it was we Bungee jumped off of the Royal Gorge Bridge in Canon City, Colorado. And that was what was shown on the TV show. But I was with these five upper class British twits whose sole knowledge of America was reading Hunter Thompson's Fear and Loathing in Las Vegas.
Geoff Tabin:
We went to San Francisco and first had to rent a white Cadillac convertible to give ride to him to the Hunter Thompson's Great White Shark. Then we needed to get a wheelchair, preferably one that had been died in. It had to be an Everett Jennings, the Rolls Royce of wheelchairs, which is the symbol of the club. I still have my club tie which is black with a purple and silver wheelchair on it.
Geoff Tabin:
We went to a liquor store. We spent about $2800 on liquor and then we started this rolling caravan out to the Bonneville Salt Flats to set the world's high-speed manned wheelchair record.
Geoff Tabin:
Actually, the whole trip was just so off the wall. The least of it was jumping off the Royal Gorge Bridge on Bungee cords.
Jeff Evans:
This is great because what you did just now was paint the picture of how standing over a sterile operating room and having somebody wipe alcohol pad across your forehead to clear the sweat out. That's no big deal. That's an easy day for you because you're a crazy son of a bitch, right? You're always getting after it-
Erik Weihenmayer:
Yeah. I'd like to call you a Renaissance man, but I'm not sure that quite fits.
Jeff Evans:
Type 2 Renaissance man.
Erik Weihenmayer:
Right.
Jeff Evans:
So that whole idea of the Kangshung face. I remember you guys ... Didn't you, there was four of you and you had one sleeping bag or something?
Geoff Tabin:
No. I think you're thinking of the second ascent of the Kangshung face which was by an easier, but more dangerous route, which was with Ed Webster and Steve Annibals.
Jeff Evans:
All right. I remember you being there. I pulled it up a little bit ago, you and Krasinski. Is that right?
Geoff Tabin:
Yeah. Yep. And George Lowe.
Jeff Evans:
And George Lowe. It was rough. You got caught in some pretty mean weather, right?
Geoff Tabin:
Yeah. Absolutely. It was crazy, crazy descent.
Jeff Evans:
And by the way, that was in the early-to-mid '80s, right?
Geoff Tabin:
1983.
Jeff Evans:
Yeah. So now everybody's got this impression of Himalayan climbing and it's fairly easy compared ... You were getting after it in the mid '80s. Shit was real.
Erik Weihenmayer:
I make a jetplash.
Jeff Evans:
You weren't using hot-made boots, but you still didn't have a big fat down jacket. You were still getting after it with some fundamentals.
Geoff Tabin:
We had no support on the mountain whatsoever, as well. We didn't even have a cook. We did everything ourselves.
Erik Weihenmayer:
So last thing. Jeff Evans, when he was a PA and I think he had his first job as a PA and then we got this opportunity to climb Everest and he went and asked for a leave of absence. They said no, so he said, "Okay, screw off," and he went anyway. Don't you have a similar story? Weren't you in med school and they said you are not going to be invited back if you go and leave for three months and you said, "Okay. Later days."
Geoff Tabin:
No. Not quite.
Erik Weihenmayer:
Am I exaggerating of course?
Geoff Tabin:
No. You're underscoring my stupidity. My stupidity was way beyond that. First, after I was accepted into medical school, I deferred for two years to study philosophy at Oxford.
Erik Weihenmayer:
Right.
Geoff Tabin:
And then on our way out from the trip from New Guinea, we didn't actually have permits to go in Turingia. There was a little bit of political unrest there. And we found a missionary or fellowship pilot to fly us in without having a permit. And when we came out, we were actually arrested by the Indonesian government or Indonesian troops. And so I was actually incarcerated in Indonesia when I was supposed to be starting medical school. So I showed up for medical school a little bit late.
Erik Weihenmayer:
I don't think I've laugh so hard in a podcast before.
Geoff Tabin:
So I showed up a little bit late for medical school and I went to Harvard Medical School. And Harvard Medical School went way out of their way to help me catch up and accommodate and give me my own orientation. And then I was invited on this trip to go to the east face of Mt. Everest. I actually had been an alternate for it and I got the go-ahead right before we were going. This was for a post-monsoon trip in the fall of '83. And so I got all excited.
Geoff Tabin:
Geoff, we've got a spot for you. It's all paid for and I went, "Wahoo!" And I went out to San Francisco and was getting all of my stuff ready and all of my climbing buddies were all excited. Then I realized at the last minute that I hadn't informed my local medical school. So I sent the Dean of Harvard Medical School a postcard from the San Francisco airport, saying, "I'm going the last unclimbed face of Mt. Everest. I'll call when I get back. Love, Geoff."
Geoff Tabin:
And then I went and when I came back, I found I was out of medical school. They said, "Well you can't just leave." I said, "I didn't just leave. I sent you a postcard." And they said, "We have certain policies here at Harvard Medical School." And so I actually had to go through a whole faculty committee and it was ... And fortunately, they let me stay and I ended up finishing medical school.
Erik Weihenmayer:
Wow. That's amazing, man. That's a great story.
Jeff Evans:
You really are the type 2 Reinassance man. I think that's it.
Erik Weihenmayer:
Well Geoff, thank you so much, man. And so if people ... Because I know that you get some funding and so forth, but you also, Cure Blindness relies on individual donations, as well.
Geoff Tabin:
Absolutely.
Erik Weihenmayer:
You have a lot of people who believe in what you do, including me. I donate every year and so we'll obviously include how people can donate and get involved in our show notes, but do you want to tell people if they're interested in your work?
Geoff Tabin:
Our website is www.cureblindness.org.
Erik Weihenmayer:
Yeah. It's amazing, man. Great work and great mission. It's really been fun to know you. Thanks, Geoff, for climbing with me and hanging out with me over the years.
Geoff Tabin:
Yeah. We've got more to do, my friend.
Jeff Evans:
I've got one more thing, too, and I have to second what Erik said about Blind Corners. I got up right when we first started this and I ran into my other room to find my copy that I've had since it first came out and it was one of the first books I ever read about climbing. It caught my attention. I know you probably still have a few copies of that still, but I'd recommend anybody who wants a good climbing memoir that's exciting and fun and still has a lot of twists and turns, Blind Corners is a fantastic read.
Erik Weihenmayer:
The best part is definitely the pink kangaroo flying across the English Channel and he almost hits the steeple of a church. And he's throwing cases of beer out of the kangaroo pouch. And he just misses the steeple. He almost plows into the steeple and there's beer cans exploding on the lawn of a church, in the cemetery. Okay. Enough said.
Erik Weihenmayer:
All right. Well thank you, Geoff. Thank you Jeff Evans. Awesome. No Barriers to everyone.
Jeff Evans:
Thanks everybody. See you next time.
Diedrich Jonk:
The production team behind this podcast includes producer Diedrich Jonk, that's me, sound design, editing and mixing by Tyler Cottmnan, marketing and graphic support from Stone Ward and web support by Jamlo. Special thanks to the Dan Ryan Band for our intro song, Guidance. And thanks to all of you for listening. We know that you've got a lot of choices about how you can spend your time and we appreciate you spending it with us. If you enjoy this podcast, we encourage you to subscribe to it, share it and give us a review. Show notes can be found at nobarrierspodcast.com, that's no barriers podcast.com. There's also a link to shoot me an email with any suggestions for this show or any ideas you've got at all.
Diedrich Jonk:
Thanks so much and have a great day.
