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Rough Cut: Tibet: Eye Camp
Interview With Dr. Marc Lieberman

Lieberman talks about what he has discovered about Tibet in the 12 years he has been working there among its poorest residents.

Dr. Marc Lieberman says his 1995 decision to start a cataract treatment program in Tibet "came after 20 years of practicing Buddhist meditation and being confused about whether I was Jewish or whether I was Buddhist." After discussing this conflict with Jewish scholars and Tibetan teachers, including the Dalai Lama, Lieberman says he was steered toward his work in Tibet -- it seemed like the perfect integration of his professional and spiritual life. He now refers to himself as "a Jewish-Buddhist ophthalmic surgeon."

Lieberman lives and works in San Francisco where he has a successful medical practice. Before that, he taught ophthalmology in India for 10 years and at a number of teaching universities in the United States. In the 12 years he's been traveling to Tibet to run rural clinics and train local doctors, he's seen dramatic changes take place there. He's also learned how to navigate the tricky politics of a country many consider under Chinese occupation.

Dr. Marc Lieberman

Dr. Marc Lieberman sees patients at the eye camp in the northern Tibet town of Sok Xian.

Jackie Bennion: Let's begin with this dilemma over your religion. You met the Dalai Lama and other religious scholars. What did you discuss in those conversations?

Dr. Marc Lieberman: There was a general acknowledgment of the profound historical resonance of the plight of the Jewish people in the last 2,000 years -- being in exile before recovering their homeland and the plight of the Tibetans who are in their first generation of exile. The Tibetans explicitly wanted to know what the Jews did to survive. From this, I realized that I could make a contribution by going to Tibet and teaching eye surgery to help reduce cataract blindness, which is the most common form of preventable blindness in the world, and that I would be able to do this as a Jewish-Buddhist ophthalmic surgeon. It seemed like a perfect fit.

Most of the year you are running a busy practice in San Francisco, but you keep returning to Tibet every year. Why do you keep going back?

Somewhere along the line I must have gotten a tip from someone else working in the developing world that probably the easiest way to make a contribution is to keep going back to the same community until you've made your connections and have learned how to read the landscape. I have been doing that for the past 12 years. During two of those years, I started living in Tibet, so really I consider it a second home.

Somewhere along the line I must have gotten a tip that the easiest way to make a contribution is to keep going back to the same community until you've learned how to read the landscape.

When you are living in Tibet, are you practicing ophthalmology full-time?

All my time there is literally spent teaching the doctors and nurses a contemporary ophthalmology, meaning lectures or demonstrating surgery and then mostly supervising. I don't do surgery [there] anymore. I haven't done that there since the first two or three years when they needed to see how it was done. Now I bring over the supplies, troubleshoot microscopes, deal with politics, which means sitting in a lot of boring meetings and trying to negotiate with my Chinese counterparts, which is a very interesting exercise.

What makes it so interesting?

Trying to find common ground and dealing with two very different worldviews and set of values.

Can you elaborate?

Well, the Chinese presence in Tibet as most people know is fairly controversial. There are two fairly radically different perspectives -- the Chinese and the Tibetan. My experience comes without having to take any political stance, but the reality is, of course, that Tibet is part of the Chinese cultural community. And I need to find ways to creatively encourage the Chinese to allow me to come and teach and equip a Tibetan cataract team, which can then go and restore vision to the remote rural blind who need help. And at the same time, I have to meet their particular needs, where the altruistic dimensions that inspire me aren't their highest priorities.

Woman with cataract.

Tibetan women have a higher susceptibility to cataracts than do Tibetan men.

What are their priorities?

The Chinese are much more interested in mastering the technology and being up to date in surgical skills. They appreciate the donation of equipment. So we're able to find a common ground where they want me to bring them up to the highest level of proficiency, and in return, they allow me to use the eye camps we do in these remote settings as the arena where in fact I can enhance their proficiency.

How has your work and the place itself changed over the years?

There's been a remarkable amount of change. It was a very crude and primitive place to work for the first few years. Transportation access was very limited with few roads. Many communities had never even seen a white man. And our Chinese hosts were themselves many years behind in terms of current technology. Now with the high level of investment that the central government of Beijing has bee putting in the infrastructure in Tibet, the roads are much better. I get better cell phone connection in Tibet than I do in California and that is no joke. Hospitals have been rebuilt. Doctors there are more accustomed to not just our group but other groups coming in, teaching modern cataract surgery.

What's the impact of all this development on the Tibetan population?

The actual population of Tibetans I think has had their life quality enhanced in a dribble down fashion. And they do reap the benefits of better medical attention, better medical access.

It was a very crude and primitive place to work for the first few years. Transportation access was very limited with few roads. Many communities had never even seen a white man.

How much has the recent direct train route from mainland China to Lhasa changed things there?

It's a very complicated economy now in Tibet where many young, eager-to-work Chinese from the Western provinces of China have access with the new rail and roads, and they've come in to Tibet for the building boom. They need to make a living like anyone else in the world. They make their wealth and then they usually go back home to the lowlands where, quite honestly, it's much easier for them to have children.

Why is that?

The Chinese it seems have a great deal of difficulty carrying infants to term at the high altitude, which is an average of 15,000 feet.

That's very interesting.

Yes, it means that there are a lot of Chinese coming and going from Tibet, having an impact. Then there's this other large group of Tibetans that live away from the network of roads and cities, in the rural communities that are not nearly as directly impacted. They remain largely untouched by the flow of people.

Some might say it's a good thing these communities have been left untouched to maintain their cultural identity. What do you think?

There are many voices that could be heard in response to your question. But my interest is deliberately medical and my concern is the welfare of the people. In a private agenda, I would like to see the Tibetan culture acknowledged and thrive there, but it's not in my purview. For example, if we could just eliminate so many unnecessary sources of human suffering in the Tibetan population. There's a pandemic of iodine deficiency that affects 20 percent of all Tibetans -- meaning that we have children who are literally near cretins in terms of intelligence because of impaired brain function caused when there was not enough iodine circulating in the mother during pregnancy. We have higher rates of spontaneous abortion among all mammals -- mothers of children and yaks and sheep and goats. It's just a profound drag on the whole welfare and wellbeing of the Tibetan people. We have high rates of infant deaths through poor maternal delivery customs. We have child malnutrition for several reasons, one of which is cultural attitudes that don't encourage children to snack when they are small and young. There may not have been enough food to give them necessarily. So we have a lot of stunted children.

Cataract is literally causing blindness in half of Tibetans over 70 and about 15 percent over 40. This is completely something we can take care of with a 20-minute operation and about $20 worth of goods.

What about the acute problems in your own field?

In my profession, cataract is literally causing blindness in half of Tibetans over 70 and about 15 percent over 40; and this is completely something we can take care of with a 20-minute operation and about $20 worth of goods.

Surgery can restore vision, but what can be done to prevent the cataracts in the first place?

That's an interesting question because we do suspect that the ultra violet radiation, which is so intense at that high altitude, and the exposure to these high levels of radiation over a lifetime, do cause the premature aging of the lens in the eye. It naturally gets a little more opaque as we get older but it seems to be more opaque more rapidly in those conditions. Theoretically, if every child born was given a great pair of sunglasses and could have them replaced every six weeks when they were lost, like my sunglasses or yours, and they were made to wear them all the time -- or at least wear hats all the time -- then in 60 years we would see a reduction in cataract formation. But it's not the sort of public health intervention that's going to happen. A preventative measure that won't have any payoff for 60 years is a hard sell to anybody.

In remote villages, what is there in terms of healthcare?

Not much. The healthcare situation there is complicated because we have persistence of many preferences in the community.

You mean traditional medicines?

No. Somewhere in the last 30 years, it's become common for people who become ill, with a cold or flu or a cough to not go to a doctor. Plus there aren't many medically trained people in the rural areas. Instead, they go to the equivalent of a pharmacist. There they pay for an IV, for an intravenous solution to be plugged into their arm. It may not be anymore than sugar water. What's appalling is that the needles are usually used between people without being replaced. This means we have very high rates of blood-born transmitted diseases like hepatitis and presumably HIV, though the evidence for that isn't available. Hepatitis there is considered a pandemic, affecting as many as 60 percent of the population.

Herder on plateau

Cataracts cause blindness in half of Tibetans over 70 and about 15 percent of those over 40, Dr. Lieberman reports.

I don't understand why IVs are considered the solution.

Neither do I! Let me first back up a little. The traditional Tibetan medical system has been a robust and fascinating one for hundreds and hundreds of years. It's one of the most interesting ones in the world because it combines really ancient traditions as nowhere else. It combines Chinese pulse diagnosis. It combines ayurvedic practice from India. It combines the remnants of the Greek and Roman tradition of the medical system that was in Galen's [ancient Greek physician] textbooks at the turn of the millennium in Rome. These were transmitted by the great civilizations of Afghanistan from Western Tibet into Central Tibet. And they still do things like urine diagnosis in Tibet, which is what you can read about in these Latin texts. And they have hundreds of years of tradition with Tibetan herbalists.

But practitioners can't make any headway in many villages unless they offer IV solutions. The Tibetans of course want Tibetan herbs as well, but in their mind, getting an IV is the proof they've seen that they are in touch with modern medicine. It's almost like it's a shamanic icon or something. I guess it's like going to a doctor in the West -- if he doesn't give you pills, then you don't feel like you've seen the doctor.

Where does Buddhism come into health practices in Tibet?

It's a little harder for me to address the religious issue, mainly because I don't speak Tibetan. And,as you can imagine Tibetan Buddhism is not publicly encouraged by the authorities so it's one of those areas where I don't have firsthand experience. Tibetan medicine is directly related to Buddhist practice. A practitioner here in the West, for example, who is trained in these traditional schools, is usually a monk or at least has some understanding that illness is not always just physical. It can have spiritual or karmic consequences. I guess this puts it at the intersection of religion and mental health and mind and body health. But in Tibet, religion truly is a closet affair; and it is practiced by families and communities, but away from the public eye. That is until the time comes for it to be allowed to be expressed publicly.

How difficult is it to raise the money to keep the operation going? And where does it come from?

We've been extraordinarily blessed by a few angels -- maybe four or five people have donated about 99 percent of the budget these last 10, 12 years. Literally, individuals who have been inspired by our work. In the beginning, one donor in particular was very generous and kept us going. Then he got the expected donor fatigue and someone else stepped up to the plate. We just feel so grateful because it means we don't have to spend a lot of time fundraising and writing grants.

What is your budget to run the operation?

Our budget is really quite small by international health standards. We get by easily on about $50,000 or $60,000 a year. That's probably a lot of money to you and me but there are people in the Silicon Valley community where that's a big dinner party. So I am always looking for a couple of angels who will be inspired to help us eliminate preventable blindness among Tibetans.

One reason I am so grateful for Isaac's beautiful documentary, which I think captures beautifully the quality of the Tibetan people and the everyday miracle of restoring vision, is that I am hoping it will lead to other angels waking up and coming to help.