WE WERE IN PHAPLU as part of the Sight-to-Summit Expedition, a hybrid of altruism and adventure that brought a group of climbers, sponsored by The North Face (TNF), to volunteer for two weeks at two of the Tilganga Eye Centre's mobile surgery camps, in the villages of Jiri and Phaplu—and then spend two more weeks climbing a 21,129-foot peak called Cholatse. If that seems like an unusual pairing of missions, it was. But it was also a new way to publicize one of the boldest public-health initiatives of the past quarter-century: the restoration of vision to tens of thousands of Himalayan villagers.

Cataracts are the world's leading cause of blindness, typically forming after the age of 50 when protein cells in the eyes' lenses start to harden, creating an expanding occlusion,

A few days before we arrived, two Russian climbers on their way to Everest had been ambushed by Maoist soldiers, who lobbed three pipe bombs toward their taxi. One detonated on the floor of the backseat, tearing off one climber's left heel.

like fog on a windshield. According to the Geneva, Switzerland–based World Health Organization (WHO), some 20 million people suffer from cataracts severe enough that they can see only light and dark; another 160 million are visually impaired. Even in the United States, more than 50 percent of people between the ages of 75 and 85 will experience some vision loss from cataracts, making cataract surgery the single most common major operation in America. In the developing world, cataracts develop unchecked and with greater frequency, due to factors that include higher-than-average genetic predisposition, disease, poor nutrition, and, particularly in mountainous areas like Nepal, intense ultraviolet radiation.

"There's just so much need," Geoff had told me when I met him in Kathmandu a week earlier. "The first time I came here, to climb Everest in 1983, I couldn't believe the disparity between health care in the developed and developing worlds."

Most families in rural Nepal scrape out a living farming small plots of near-vertical topography, getting around on foot over rough trails. Because even the oldest family members contribute to a household's welfare, blindness takes a huge toll. The afflicted can be neglected and malnourished, and depression often sets in. One 1993 study of cataract sufferers in India and Africa by John Javitt, a Georgetown University ophthalmology professor, revealed that, once a person goes blind from the condition, his or her remaining life expectancy shrinks to barely a third that of otherwise healthy adults.

"I've seen patients treated like animals—worse than animals," says Dr. Sanduk Ruit, the 52-year-old Nepalese ophthalmologist who cofounded Tilganga. "They'll just get put in a corner and left there to die, some with no help whatsoever."

Dr. Ruit grew up in a small trading village in northeastern Nepal, in the shadow of 28,169-foot Kanchenjunga. In 1968, when he was 17, he watched his older sister, Wangla, die of tuberculosis. There were no doctors in the area, and his family was too poor to get her to a hospital. It was a preventable and tragic loss, even then, and it propelled him into a life devoted to improving health care in his country. After graduating from King George's Medical College, in Lucknow, India, in 1977, he went on to residencies at some of the finest medical programs n the world, including the University of Michigan School of Medicine and the All India Institute for Medical Sciences, where he specialized in eye care.

"What struck me about ophthalmology," he says, "was how, in a short time, you could make such a difference in the lives of so many people."

As recently as 1993, most cataract cases in Nepal were treated with an old-school procedure called intracapsular extraction, in which the surgeon simply cut out the lens and fitted the patient—now completely blind—with Coke-bottle lenses, essentially relocating the lens to the outside of the eye to restore limited sight. Of course, many patients lost or broke their new specs, leaving them worse off than before. Returning to Nepal in 1984, Ruit was apoplectic to see that his peers tolerated, even championed, such an inadequate solution. But they argued that establishing the IOL system would mean endless complications and exorbitant costs.

"They thought I was mad," he says. "They thought I was just serving my own interests, that I was seeking my own fame and fortune. But that wasn't it at all."

Ruit teamed up with a brash and unorthodox Australian ophthalmologist and mountaineer named Fred Hollows, who'd come to Nepal in 1985 to research the bacterial eye disease trachoma for the WHO. Like Ruit, Dr. Hollows was outraged at the prevalence of outdated intracapsular surgeries—and famous for his explosive candor. Ruit recounted one legendary outburst, at a 1986 Kathmandu meeting of the International Agency for the Prevention of Blindness, that had become a favorite story of Geoff's as well. Ater denouncing the assembled medical VIPs as heartless imperialists clinging to a clearly second-rate method, Hollows finished with a hearty "Fuck you all!" and dragged Ruit off to the bar.

Ruit and Hollows dreamed up the idea of an eye hospital based in Kathmandu, one that could provide treatment for anyone who needed it. But there was a big hurdle: Interocular lenses from multinational suppliers cost at least $100 apiece—far too much for mass application among the poor. And another, graver problem soon presented itself: In January 1989, Hollows learned that he had kidney cancer. The prognosis wasn't good.

Before Hollows's death five years later, at age 63, he gave his friend a final gift: He established the nonprofit Fred Hollows Foundation, which helped fund construction of a lens-manufacturing facility that could provide IOLs for about $4 each. Factoring in labor, a procedure carrying a $3,000 price tag in the West could cost as little as $20 in Nepal. By 1994, Tilganga and the adjacent Fred Hollows Interocular Lens Laboratory were up and running—building lenses, treating eye problems, training physicians, and, four or five times a year, staging high-quality surgical camps in outlying areas. If the blind couldn't come to Tilganga, Tilganga would come to them.