Prime Time Replay:
Geoffrey Tabin
on Mountaineering and Cataract Surgery in the Himalayas
MsgId: *infinities(1)
Date: Wed May 28 22:42:26 EDT 1997
From: guest At: 207.94.249.101
MsgId: *infinities(2)
Date: Sun Jun 1 22:24:18 EDT 1997
From: melanie At: 204.164.64.200
Tonite's guest is Dr. Geoffrey Tabin, has climbed Mount Everest as well as every other of the highest peaks on every continent. A feat he chronicles in his book, Blind Corners, Adventures on the Peaks of Seven Continents (ICS Books). He is also an opthalmic surgeon who has traveled to Asia where he runs the Himalayan Cataract Project in Tibet. Welcome Dr. Tabin. Please tell us a little bit about the Himalayan Cataract Project and how did it get started.
MsgId: *infinities(4)
Date: Sun Jun 1 22:32:13 EDT 1997
From: Dr_Geoffrey_Tabin At: 204.164.64.200
The purpose is to eliminate preventable and treatable blindness in that region. This accounts for over 95% of blindness in those country. About 75% is from cataracts and the other 20% is from preventable corneal diseases. The Project began with an Australian opthemologist called Fred Hollows who a talented Nepalese doctor, Sanduk Ruit to Australia to train in modern cataract surgery.After I completed my residency in opthamology, I went to Australia to do a fellowship with with the Fred Hollows Foundation which has continued to support Dr. Ruit. I went to Nepal to work with Dr. Ruit during my fellowship, and he asked me to run an eye hospital in Biratnagar in southern Nepal. While there, teaching cataract surgery, Dr. Ruit and I decided to commit ourselves to eliminating blindness from the entire Himalayan region and we formed the Himalayan Cataract Project in 1995.
We've developed a technique of teaching cataract surgery and transferring the skills, technology needed to carry on the work in remote Himalayan areas. We bring a team approach which consists of doctors, nurses and opthalmic technicians to eliminating and treating blindness. We begin by bringing a local doctor/nurse/technician unit to Kathmandu where they spend two or three months observing and learning about eye diseases. they observe hundreds of cataract surgeries and practice under the microscope to develop hand-eye skills. They then return to their local area and pre-screen several hundred patients who are blind in both eyes from cataracts. Then doctor Ruit and I come with our team from Nepal and we restore sight to one eye in every patient with the local doctors assisting.
Then Dr. Ruit and I assist the Tibetan doctors as they operate on the second eye of each of these patients. We leave all of the equipment--microscopes and inter-ocular lenses necessary for the local doctors to continue their work. At our last session in Tibet we restored sight to 479 people and left two doctors who were performing excellent cataract surgery in both Lundgup County in Northwestern Tibet and two surgeons doing excellent surgery at Lhasa City Hospital. This year we will be starting a cataract surgery facility in Gantse in Eastern Tibet and also we'll begin working in the Baltoro region of Pakistan.
MsgId: *infinities(8)
Date: Sun Jun 1 22:43:04 EDT 1997
From: melanie At: 204.164.64.200
It sounds like there's a preponderance of cataracts in that region. Why is that?
MsgId: *infinities(9)
Date: Sun Jun 1 22:46:29 EDT 1997
From: Dr_Geoffrey_Tabin At: 204.164.64.200
The highest incident of cataract blindness is in the Indian subcontinent as a whole. The World Health Organization estimates that there are currently 38 million people in the world who are blind from treatable cataracts. And in India alone 3.8 million people become blind each year from cataracts. Most third world countries are unable to cope with the new cases, let alone the backlog. And whether it's due to intense UV light or a genetic predeliction, the highest incidence of people who go blind from early-age cataracts is in the Himalayas. Also there is an acute lack of doctors. Prior to our excursion to Tibet in 1994, no one had ever performed microscopic cataract surgery or used and inter-ocular lens implant to restore vision in that region.In Tibet we're working with several other organizations. We're combining efforts with the Seva Foundation who've done fantastic work with blindness in India and also the Tibet Development Fund and Foundation Eye Care Himalaya, and we're working together in addition to our outreach projects to develop a center of excellence for eye surgery in Lhasa. In the next five years, we're hoping to train surgeons in Bhutan, Sikkim, Hunza and other areas where currently there is no eyecare whatsoever.
MsgId: *infinities(12)
Date: Sun Jun 1 22:50:33 EDT 1997
From: melanie At: 204.164.64.200
As a physician and climber, what are your thoughts on the recent tragedies on Everest, and on what some people are calling the popularization of a once feared mountain?
MsgId: *infinities(13)
Date: Sun Jun 1 22:50:53 EDT 1997
From: melanie At: 204.164.64.200
MsgId: *infinities(14)
Date: Sun Jun 1 22:52:12 EDT 1997
From: Dr_Geoffrey_Tabin At: 204.164.64.200
I am much more a climber when I approach that question. I climbed full-time for seven years and supported myself by working as a mountain guide. And I think that it is a shame when people approach mountains simply wanting to get to the top rather than have the experience of really climbing.Everest in particular is a mountain that is impossible to guide in the sense of the guide being able to guarantee the client's safety. The problem is that the vast majority of guided clients going to Everest are grossly incompetent to be there. They have primarily been taken care of on their previous climbing excursions and have bypassed the long experiential learning curve that is necessary to safely climb a mountain like Mt. Everest. And in fact, even if they stand on the summit I do not think that following fixed ropes with mechanical ascenders from the base to the summit while breathing high amounts of bottled oxygen and having everything carried for them is actually climbing the mountain.
I think that last year's tragedy is very sad, but was completely the fault of incompetent people on the mountain and moving much too slowly. Even the most recent tragedy, again it was a guided expedition, they were getting to the summit around four in the afternoon. When I reached the summit of Everest in 1988, it was at 8 o'clock in the morning. I spent an hour on the summit and I was back at Camp 2 at 21,000 at 5 in the afternoon, and we were able to move that quickly because we were climbing unroped and all members of our party were top-flight professional climbers.
MsgId: *infinities(17)
Date: Sun Jun 1 23:01:06 EDT 1997
From: melanie At: 204.164.64.200
But isn't it true that anyone, even "top-flight" climbers can have some bad luck and run into poor weather conditions? Is fatality necessarily a measure of incompetence?
MsgId: *infinities(18)
Date: Sun Jun 1 23:02:28 EDT 1997
From: Dr_Geoffrey_Tabin At: 204.164.64.200
Yes and no. There are ways to minimize one's risk and avalanches, falling rocks or drunken drivers on the highway can occasionally not be avoided. However, the circumstances last year and again this year were certainly caused entirely by poor judgment and incompetence, not any unusual weather.
MsgId: *infinities(19)
Date: Sun Jun 1 23:03:36 EDT 1997
From: melanie At: 204.164.64.200
Is it only the climbers who are incompetent? What about the guides who have them up at the summit at 4 pm? Shouldn't they know better and turn back?
MsgId: *infinities(20)
Date: Sun Jun 1 23:06:00 EDT 1997
From: Dr_Geoffrey_Tabin At: 204.164.64.200
In hindsight, absolutely. I knew the guides on last year's trips very well and it is very difficult problem to turn someone back from the summit when they are very close and everything looks perfect. It is an easy mistake to make. In addition, even the strongest climber has impaired judgment at altitudes above 26,000 feet. It is hard enough to take care of yourself let alone a client when things begin to go wrong.All of the guides were superb climbers who previously had always shown great judgment. The leader of the New Zealand trip was the first to guide truly incompetent people to the summit of Everest and over the previous three seasons, he had brought a total of 39 people to the top. Twelve of whom were very inexperienced clients.
MsgId: *infinities(22)
Date: Sun Jun 1 23:08:51 EDT 1997
From: melanie At: 204.164.64.200
What would be your suggestion? Should there be restrictions on who can climb the mountain? How would that work, some sort of demonstration of competence? Now it's more or less who can pay for it, not who can do it.
MsgId: *infinities(23)
Date: Sun Jun 1 23:11:31 EDT 1997
From: Dr_Geoffrey_Tabin At: 204.164.64.200
I don't think it will ever be possible to make restrictions and the costs are escalating which serves the poor governments of Nepal and China. They are certainly not about to reverse their policies. This is a huge money maker for them. The government of Nepal charges about $15,000 per person who tries. If several hundred climbers attempt the mountain at those fees, that's a huge sum to a country who's gross per capita income is currently $160 per year.Personally, people should have the freedom to do what they want in the mountains. I just think it's a pity that people want to risk and pay so much to try and stand on the top of Mount Everest where they would certainly have a much greater adventure attempting to climb the much smaller peak on their own. It's like saying you want to play doubles at Wimbledon. And you're paying $65,000 for the privilege, you still probably won't do well--but you won't die from it.
MsgId: *infinities(26)
Date: Sun Jun 1 23:17:48 EDT 1997
From: melanie At: 204.164.64.200
China is also presently in the news about renewing Most Favored Nation status, allowing it the best possible trading terms with America. Many people feel that human rights abuses in the PRC should preclude it's receiving MFN again. Human rights abuses are said to be particularly acute in Tibet, what do you think about the situation there?
MsgId: *infinities(27)
Date: Sun Jun 1 23:19:57 EDT 1997
From: Dr_Geoffrey_Tabin At: 204.164.64.200
I take the Fifth Amendment. Our program is completely non-political, we're only concerned with restoring eyesight to poor people, and I recently met with the Dalai Lama and showed him pictures of our Tibetan eye camps. He fully endorses our project, and I must work with the Tibetan infrastructure which is currently a communist Chinese government to accomplish our goals. We are working with the Tibet Development Fund which is a non-government organization in Tibet that is tolerated by the Chinese government.
MsgId: *infinities(29)
Date: Sun Jun 1 23:21:53 EDT 1997
From: melanie At: 204.164.64.200
You obviously have had a lot to teach the local health care people about medicine. What have the Himalayan medical practitioners taught you?
MsgId: *infinities(30)
Date: Sun Jun 1 23:25:38 EDT 1997
From: Dr_Geoffrey_Tabin At: 204.164.64.200
I assume you're referring to Tibetan traditional doctors. (In Nepal, most of the doctors are trained in India and practice a lower-level of what would be considered Western medicine.) The Tibetan traditional doctors are excellent at treating a large number of chronic diseases, like helping people that are plagued by depression, neuroses and other non-neurologic psychiatric problems. They are very good at controlling chronic gastro-intestinal and respiratory diseases as well as controlling headaches and muscle pains with herbal remedies, meditation techniques and dietary changes.The Tibetan traditional healers spend a larger amount of time with their patients, and do a very in-depth examination of the person as a whole, rather than simply as a diseased organ system. The laying on of the healer's hands, combined with massage techniques and personalized attention may provide additional relief to some of the people who have emotionally triggered ailments. I wish I could incorporate this considerations in my practice to a larger extent. Unfortunately, I have a sub-specialized practice at the University of Vermont as a referral corneal surgeon, and I find that I spend less time with each patient than I would like.
It's difficult in American medicine because the volume of patients is so high. In Tibet, people see doctors to keep them well. There used to be a system there where you only paid the doctor if you were well.
MsgId: *infinities(33)
Date: Sun Jun 1 23:32:14 EDT 1997
From: melanie At: 204.164.64.200
That does it for my questions. Thank you so much Dr. Tabin for joining us, and especially for staying on when we had our technical problems. Good night to you and to our audience.
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