CEO Stories: Dr. Geoff Tabin, Himalayan Cataract Project

This Is Capitalism: Dr. Geoff Tabin

RH: This is Capitalism. I’m Ray Hoffman

How many lives has Geoff Tabin, Dr. Geoff Tabin, either saved or improved, often by his own hands? Well, let’s start with this figure: 35,000. That’s the approximate number of sight- restoring cataract surgeries that Dr. Tabin has performed in countries like Nepal, Bhutan, Myanmar, India, Ethiopia, Rwanda, and Ghana. And when you consider the totality of what he has done in partnership with Dr. Sanduk Ruit, as cofounders of the Himalayan Cataract Project, the number of lives saved or improved might be over 1 million.

As its website’s name, Cureblindness.org, suggests, the project provides high-quality eye care in some of the most remote and/or underserved 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.

In the economically poorest countries of the world, cataracts are responsible for half, right, half of all avoidable blindness?
GT: Yes. Half of all blindness. Eighty-five percent of the blindness is preventable or treatable and of all the blindness, half is from treatable cataracts.

RH: What you do with the Himalayan Cataract Project fits into a long line of medical humanitarian activities, going back to Project Hope and dermatologists who have gone into war zones, doing skin reconstructions, oral surgeons going in and fixing cleft palates. So I’m wondering if there was any particular act of humanitarian good work that you witnessed that got into the back of your mind and wouldn’t leave and influenced what you eventually did?
GT: Specifically I watched a Dutch ophthalmologist named and his team, they had a program called Foundation Eyecare Himalaya out of The Netherlands. And I watched them do cataract surgery with lens implants in Nepal. And it was the craziest thing, it was this miracle. People were totally blind, shriveled, waiting to die, and boom, the next day they were changed. It altered their life, their family’s life, they went from totally blind to seeing and it was really almost biblical, healing the blind.

That was a revelation. I was already a doctor then. The first thing that really altered my focus on medicine, Ray, is I was all set to go to medical school. My idea of what I wanted to do from the time I got to college — I played Division One college tennis, I played pretty much all sports growing up, I did a lot of rock climbing, a lot of skiing. And I met some very charismatic orthopedic surgeons. So by the time I was even in undergrad I had this idea I was going to do something orthopedic, in orthopedic sports medicine.

Then at the end of my time, I was an undergrad at Yale, I was given a scholarship to go for two years to Oxford University in England. And I was able to step back and I looked at comparative health systems. I did a master’s degree in philosophy, but I also opened my mind to a lot of international scope.

I was, as I mentioned, a keen climber and Oxford had these indigenous trust funds that were remnants of the time when Oxford students were supposed to enjoy civilizing other aspects of the world. And they had one scholarship in particular which was called the AC Irvine Grant for Oxford students to pursue strenuous holiday in mountains abroad. It was given in memory of Andy Irvine, who died on Everest.

And my climbing partner and I tapped into those grants and we began traveling to Asia and to Africa to climb. And I was looking at the moral imperative underpinning medical care and medical delivery. It gave me a chance to really see firsthand the disparity between the haves and the have nots in the world. So by the time I matriculated at Harvard Medical School I already knew I wanted to do something in global medicine.

So I already had this idea I wanted to do something that would make a difference in bridging the gap in care between the wealthy countries of the world and the poor countries. And I was searching around for where that might be and what form that might take.

I was climbing in 1988 and went to the top of Mt. Everest with the first two American women to climb Mt. Everest, and I was working as a general doctor in Nepal and really struggling to see where an individual doctor could really make a difference. And I was right on the cusp of coming back and applying to public health schools and I was thinking of getting a PhD in public health would be the best way I could contribute to global healthcare when, as I mentioned, I saw this Dutch team come in.

And in our village it was just accepted that you get old, your hair turns white, your eye turns white, and then you die. And people just got depressed and…and then I watched this miracle. And it was just crazy how it just changed lives. And I went back to Katmandu and I checked around and I found that there was no one in Nepal at that time doing modern cataract surgery with lens implants. And I thought, “Wow, this is a place I could make a difference.” I got so excited.

I came back, I got very lucky, I fell right into an ophthalmology residency, a position had just opened up [unintelligible] at Brown University. And I was incredibly fortunate to be able to come back to the states in the spring thinking, “Wow, I want to be an ophthalmologist and start my training that July first.”

RH: And what I’m assuming you couldn’t have known anything about is how at the very same time your future cofounder was halfway around the world, moving toward the same goal.
GT: My partner, Sanduk Ruit, who has been my elder brother and leader and the genius behind everything we’ve been able to accomplish, was at that time finishing the final leg of his training in Australia. And Sanduk was this incredibly brilliant young boy from a hill village, very remote, in far northeastern Nepal, no running water, no electricity, no schools, three days walk from the nearest road.

And he was involved in a house fire and his parents took him to a monastery and the monks said, “Wow, this boy is exceptional, he needs an education.” And his father walked him 11 days to get to Darjeeling, India where at the time he spoke no English, he spoke no Hindi, and his father left him in an English-language Jesuit school.

And he emerged from that to gain his education, get a full scholarship to one of the best medical schools in India, scored at the top of the Indian Medical Boards, trained as an ophthalmologist at the All India Institute of Medical Sciences in Delhi, do a fellowship with the Ear and Eye? Hospital System, which at the time was the highest-volume cataract program in India. And then he came back to Nepal and was noted by the same Dutch ophthalmologist that I witnessed, and he went back to the Netherlands for training in microsurgery, and then to Australia for a two- year fellowship with Fred Hollows.

So he was finishing all that training and he came back as an absolutely world-class ophthalmologist, looking at “how can I bring the same highest-quality care I’ve been participating in, in the Netherlands and Australia, to the people of Nepal at a cost that’s affordable.” And he started doing that the same year that I started my residency at Brown. Then when I finished my residency at Brown, I went and did my fellowship in Australia under the mentorship of Professor Hugh Taylor, who had been one of Fred Hollows’ mentees. And during my fellowship, they sent me over to work with Dr. Ruit.

And I came over thinking I had the high-end education of the west, I’d be coming over to teach something, and I was absolutely blown away by what he had already started to establish in a system where…with locally sourced material starting an interocular lens factory in Katmandu and doing very high volume but very quality care delivery, and in a system where no one does anything that anyone with lesser skills can possibly do. He was just doing this amazing work.

And I spent a couple of weeks during my fellowship working with him and then said, “Wow, this is amazing. When I finish my fellowship, I want to work with you.” And I finished my fellowship in Australia and moved to Nepal to work with Dr. Ruit.

RH: So in reading your bio and hearing from you here I assume then that this particular project wouldn’t have come to pass had it not been for your passion for mountain climbing and I guess the mountain range around Oxford was not challenging enough for you.
GT: I actually love the rock climbing around England. You learn to climb in very inclement weather because if you don’t, you don’t go out. In America, if you’re in Yosemite and it’s raining, you go to the bar and get a beer. In England if it’s raining you just climb a few grades easier because if you don’t go out in the rain you never go out.

But no, it was really serendipity, being in the right place at the right time, and then being willing to follow up on this excitement. I had issues at my local medical school with taking time off to climb but had that not happened, I would not have gone back to climb Everest. And if I hadn’t gone to climb Everest I wouldn’t have ended up working as a doctor in Nepal and then I wouldn’t have met Dr. Ruit. So it’s a lot of serendipity. I’ve had some really, really great mentors and really great partners.

RH: How far back in your life do we have to go to explain this passion for mountain climbing?
GT: I started hiking with my dad. My dad was a nuclear physicist. He actually did his doctorate at the University of Chicago under Enrico Fermi. And Fermi brought him to Los Alamos during World War II to work on the Manhattan Project. And Fermi had been very passionate about the mountains in his native Italy and he had been a hiker and a skier and got my dad enthused about hiking and skiing.

And so my dad started taking me hiking and skiing from almost the time I could walk in New Mexico. And I began hiking up mountains in New Mexico to ski down and learning a little bit of basic mountaineering techniques from a few of my dad’s friends when I was an early teenager. And I became very fanatical about reading mountaineering literature and reading the adventures of the great explorers and mountaineering heroes.

And then I was fairly focused on tennis though my later teenage years and I was recruited to come play tennis at Yale. But when I got to Yale I met—he’s still one of my best friends—a guy named Henry Lester, who had grown up as a rock climber the way I had been a tennis player. I had done a little bit of rock climbing prior to getting to college but became progressively more fanatic about rock climbing as college went on.

RH: Now before we talk about your recent trip to Africa and societal problems and various outreach programs, I’d like to know how this organization was formed in terms of the nuts and bolts of it.
GT: Well it started out when I moved to Nepal and began working with Dr. Ruit and began teaching his method of cataract surgery delivery but also training. And our whole focus of our program from the very beginning has been in transferring skills. Dr. Ruit had the brilliance to, while we were training doctors, also starting programs to train ophthalmic nurses, started a program for ophthalmic technicians in three years after high school, ophthalmic assistants one year after eighth grade, helping primary healthcare workers gain basic understanding of eye diseases to screen, and creating this whole system.

And when I began working with Dr. Ruit, we began taking our best young cataract surgeons and sending them at the time initially to Australia because they could participate surgically to do some specialty fellowships in pediatric ophthalmology, glaucoma, retinal surgery, all of the subspecialties. And once we had the full component of subspecialties we started a full, world- class residency program.

Meanwhile, I wasn’t getting much funding. I was finding it was difficult to engender any support from industry, coming from Nepal with no track record in America. And we began to expand into other countries, particularly when we went to work in Bhutan, the health minister said “So do you teach doctors in your country as well?” And I never have.

So Dr. Ruit and I discussed things, decided that we, that it would be best if I went back, started an academic practice in the United States. And I took my first job as an assistant professor at the University of Vermont Medical School in Burlington, Vermont. And so people could support the work, pay for needed equipment and outreach surgery, we decided to incorporate as a 501c3, which initially we called the Himalayan Cataract Project because there was still this enormous backlog of cataract blind in Nepal.

We were just beginning to move into Tibet and Bhutan, where there was almost no cataract surgery and a huge burden of cataract blindness. So we called it the Himalayan Cataract Project. Fortunately, we ended up getting our website as www.cureblindness.org. And we began trying to raise a little bit of funds, or I began trying to raise a little bit of funds to support the work initially with my friends and acquaintances.

And then after about two years, I had been using a few student volunteers and interns to help me. I ended up hiring my first full-time employee, Emily Newick, who is still with me, and then shortly thereafter Job Heintz, and they are currently our CEO and COO and we began a little bit of a more formal organization.

And we continue mainly just raising money and working in Asia. We started in Nepal but then began taking Bhutanese doctors into our training program. We started developing a shorter-term training that we began bringing in doctors from Tibet and began spreading in initially mountainous Asia but then a little bit further afield in Asia and Indonesia.

And then in 2006—we incorporated in 1996—and 10 years later I was recruited for a professorship at the University of Utah.  And by that time things were running so well in Nepal in the cornea and cataract surgery—the things that I specialize in—were going so well and the surgeons there were all better than me, I really didn’t have that much to teach. And things were really running fairly well.

And when I came to the University of Utah, one of my partners, Alan Crandall, was already the highest-volume cataract surgeon in Ghana. He had been going just a couple times a year on a mission trip. And I began going with him and there was just so much need in Africa that I began trying to see how we could transpose the success we had had in Asia into Africa.

RH: And I see the growth, just from looking at your website. In fiscal year 2014, the organization had $8 million in assets and did 78,000 sight-restoring surgeries. Fiscal year 2015, 83,000 surgeries; fiscal 2016, 97,000 surgeries.

And you went over a million total patients for the first time that year. 2017, 115,000 surgeries, fiscal 2018, 123,000 surgeries. So your asset base, which is now about 12 million, has risen by 50% and the number of surgeries has increased by close to 60%.
GT: Yup! And I’m also proud to say that those numbers are just the ones that we are directly providing. And we are…our whole focus really is on training and empowering. So while we’re doing these high-volume cataract outreaches, we’re training local doctors, local nurses, local technicians, and at the same time as we are doing a hundred some thousand surgeries, doctors who we have trained are doing another several hundred thousand. So it’s really expanding more exponentially than just linearly.

RH: Looking back over all this growth, are you surprised by it in retrospect?
GT: Looking forward, I would have been shocked. If you had asked me in 1996 when we started as a $100,000 organization doing 3,000 to 5,000 surgeries, I would have said “no, that’ll never happen.” I never would have thought…Nepal went from (.88%?) blindness, now there was a survey done about five years ago that showed that blindness went down to 0.35. And I believe it’s down around 0.2%.

So Nepal is the large poor country that has actually reversed its rate of blindness. And if you would’ve asked me if that was possible when we were picking the name Himalayan Cataract Project I would’ve said “not in my wildest dreams.” So we are so far ahead of where I thought it would be there. But each small incremental step puts this at a little bit level higher and now looking down and saying, “yeah I can see how we got here.” But starting at the bottom I would never have seen the root all the way up.

RH: Yeah. I look on your website and I see the long lists of names of participating surgeons and surgeons your organization has trained.
GT: Yeah. And one of the things that Dr. Ruit… In some ways I’m kind of the fat boy who plays because I helped arrange to bring the ball. And Dr. Ruit is kind of the star player and the genius behind everything. But one of the things that he really instilled in me is to really look for who are the next young superstars and really to try and… It’s become a nice full circle because I started out being mentored by people like Professor Hugh Taylor.

And I also started in 2007-2008, I started the first global ophthalmology fellowship in American Academic Ophthalmology. I’m proud to say there are now eight global ophthalmology fellowships at various university programs in the States. But my former fellows, I am just so proud of. And I have some amazing young superstars who are former fellows of mine who are really taking it and pushing things forward.

And again, as I said, I have a couple of really great young African and Asian early-career ophthalmologists who we’re mentoring who I’m really expecting to really be game changers.

RH: And how much bigger should the project be in your mind and how much bigger can the project be and still be as effective?
GT: That’s a hard one to say because I wouldn’t have—I would not have expected that we would be able to expand as well as we had. We had Dr. Ruit, who is really the person who made things happen and change in Nepal. We had Dr. Kunzang Getshen the person who really made things happen in Bhutan. And as long as we have great local partners there are an awful lot of places we can still expand. And one of the key things is just keeping the focus on the quality.

In terms of how much bigger, Ethiopia still has a backlog of 600,000 people blind from cataracts. And I would love to have the financial resources—we estimate it would be somewhere around $100 million to completely reverse blindness in both Ethiopia and in Ghana, which are our two main programs in Africa right now.

But there’s and incredible need for similar type changes in a lot of other African countries. And as long as we have these incredible, devoted superstars, and I’ve got one of my…he actually began working with me as a medical student, Matt Oliva, has really stepped up, he is an incredible superstar and he is taking on the mantle of being the country coordinator for Ethiopia. One of my former fellows, John Welling, is assuming that role again in Ghana, and I have a couple of other amazing young fellows who are looking where they can make a difference.

And so I feel like we can keep on expanding. And to me it’s a realistic goal now that we can, as far as we have come, that we can actually begin to turn the tide on needless blindness. To me it’s just a travesty that 85% of the blindness and low vision on our planet could have been prevented or could be easily treated. And of blindness, half of the blindness is from cataracts.

And we can bring the material cost of a cataract surgery now down under $25. And to think that there are 12 million people who can’t do the tasks of daily living, who for $25 could have their life and their family’s life completely changed.

And I’m kind of excited about the future. I hope that maybe Priscilla Chan or Mark Zuckerberg will listen to this broadcast. They have publicly stated they want to cure disease and there really isn’t any lower-hanging fruit. Blindness is one of the few things that we really know how to cure.

RH: It’s so absolutely doable. Tell me about your role though as a fundraiser.
GT: My role really is…I’ve been very fortunate in the people I’ve been able to meet. A couple of our largest donors have been former patients of mine who were excited about how cataract surgery changed their vision and were fortunately in financial ability to contribute. And I’m always kind of on the eyes open to think of who might be able to help us.

Now that I shifted three years ago from the University of Utah to take an endowed chair for ophthalmology in global medicine at Stanford University and being in being in Silicon Valley, there’s a lot of people who would be in a position to make a huge impact in global blindness. So my role as a fundraiser is really to spread the word and try to share my excitement of how much we can do with how little and hope that I meet more people who are as excited about the possibility of having that kind of impact with their money and that we can begin to talk to them about how things are possible and what they can do.

RH: Can you share with me a bit of the arc of how successful the fundraising has been over the last few years?
GT: It’s been I think extremely successful. We have always basically spent just a little bit less than we’ve been able to secure. We have been very successful with U.S. aid. Grants has been one of our main funders for big capital projects. And we’re now around an $11 million a year charity but I would love to see it expand in the next couple of years to being a $20-$30 million a year program to really change the arc of blindness in Ethiopia and Ghana.

Right now we’re a little over half private philanthropy and about…the other half is split between government grants and foundation grants that we apply for. I’m excited about what we’re doing. I feel like we’re one of the most cost-effective and impactful interventions in global medicine. And there have been a couple of studies that have shown that restoring sight gives a direct impact of four to one to the local economy.

So one of the other things I’d love to have change in the next several years is a little bit more direct investment from some of the government and also from the global funds from both the  United States government and also things like the World Health Organization.

RH: I’m assuming that you would be on the list – somebody’s list anyway—of most efficient/most effective charities. I can’t help but notice how 88% of the money you take in goes into programs, not administration or fundraising. Do you have any sense of how much larger you can grow and still be that philanthropically pure?
GT: It’s hard for me to say, Ray, because I never thought…20 years ago I didn’t think we’d be this big. But now that we’re this big and I see how well we’re working, I can see easily how we could double in our size and more than double in our impact without losing any of our effectiveness. We have the infrastructure in place where we can very quickly and very well scale up, and we have enough young doctors we’re training that we would like to support in a larger way. I don’t really want to expand to being a $20 million a year foundation by spending $5 million a year to advertise, direct mail, and raise money.

We’ve been very lucky in that a lot of the way we’ve attracted some of our biggest donors has all really been through word of mouth and through happy patients of mine. One of my close friends, who is a phenomenal eye surgeon also in California named David Chang has had a couple of his grateful patients help with funding. And my hope is that being out in the Silicon Valley now at Stanford I’ll run into somebody, meet somebody, or meet somebody who knows somebody and things may really scale up in the next few years.

But meanwhile we really are making incredible progress. In the last five weeks we did over 5,000 cataract surgeries in Ethiopia, and we had kind of an exciting outreach into Eritrea. The Prime Minister of Ethiopia just won the Nobel Peace Prize for normalizing relations with Eritrea and we followed up on that.

The chairman of our ophthalmology department, one of the really great young superstars of Ethiopian ophthalmology, Dr. Sadik Taju Sherief, did a fellowship in pediatric ophthalmology at Sick Children’s Hospital in Toronto. And he has family in Eritrea and he helped bring things together and we did a 1500 patient sight restoring first outreach into Eritrea. And we’re beginning to take Eritrean doctors to train our Ethiopia training program, similar to what we did from Nepal to Bhutan.

And that just started and then I came the next week and we did 3,702 cataract surgeries in three weeks, which is kind of our record output for three weeks in Africa, and a lot of really great training. And I really feel like we’re reaching that point with the quality and the really good young local doctors, nurses, optometrists, that we really are going to be able to change things, even if we continue going the way we are in Ethiopia and Ghana.

And I’m hopeful that someone will step in with some bigger funding and we’ll be able to expand it and really change the whole arc of blindness for the whole African subcontinent.

RH: I know you’re just back from Africa—Ghana and Ethiopia and Eritrea. So with one week to go in 2019, when we’re recording this, where have you been this year?
GT: [Laughs.] Well I’ve been to Ethiopia three times; to South Sudan; to Bhutan, where we just opened a new, state-of-the-art eye hospital, a few times to Nepal. And then I’m working about six months of the year at Stanford and then about six months of the year between Asia and Africa.

RH: I’m going to have you put your strategic hat on for a second. What economic circumstances and what political circumstances here in the U.S. would be of the most benefit to the goals of the project?
GT: That’s a tough one. But the way you phrased your question of “what is it in American society that will help us reach our global goals?” it’s really a matter of just our realizing that we’re all one world and we’re one human race. And it does matter what happens in Africa and it does matter what happens in Asia in both the short term but also in the long term.

One of the things that helps me keep a little bit of my focus, even though these numbers seem so overwhelming of millions of people blind, the nice thing about cataract surgery is once we operate on someone they are no longer a statistic. They are cured 100% and you’ve changed their life forever.

RH: I want you to look out six years because in six years you will be celebrating the 30th anniversary of the project. What do you expect it to look like six years from now?
GT: My hope right now, which I think is realistic, is that in six years, Ethiopia and Ghana will have gone the way of Nepal and Bhutan in really reversing their backlog of blindness and having sustaining, high-quality care for all their people. And that we will be expanding our program into other countries that really are in great need in Africa – places like Tanzania, like Nigeria, like Congo.

And that we’ll be getting closer to a solution, working in conjunction with other organizations, to really reverse the blindness in the two places where the largest burden till exists, which are China and in India. And there are a couple of really fantastic programs we work closely with in both countries. And their economic issues, as the quality has gotten so good, particularly in India and people are seeking care earlier, the poorest of the poor and the blind are still getting left behind. And doctors have an unlimited amount of people who are willing to pay for services before they go blind and the destitute who are blind are getting left behind.

And so I’m really hopeful that in six years there will be really a marked change in the whole tapestry of world blindness. And that we’ll be able to look back the way we do with something like polio now and say cataract blindness was a scourge of the past.

RH: It’s nice to know that you found your calling and you found your calling early on in life to really be impactful in it.
GT: As I said, I was just so lucky and just serendipity, being in the right place at the right time and having some incredible, incredible mentors.

RH: The website for Dr. Geoff Tabin and the Himalayan Cataract Project is Cureblindness.org.

This is Capitalism. I’m Ray Hoffman.