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Alan Crandall handles many of the complicated cases. They are mostly children who were born with cataracts or have suffered an injury to their eyes, from thornbushes, knives, and the numbing range of trauma that afflicts those living at the subsistence level. Crandall specializes in a surgical technique called phacoemulsification, breaking up an opaque diseased lens with ultrasound, suctioning it out, then inserting a new lens. Phaco, as it is called, is simply a different means to the same end as Ruit’s procedure, and Crandall is one of its most renowned practitioners. He has brought a scaled-down version of the machine he uses in the States. It’s the size and weight of a suitcase packed with books. While working with Tabin in Ghana two years earlier, Crandall was on a bus when it hit a pothole and lurched dramatically. His phaco machine shot off a rack over his head and slammed into him, fracturing his neck. Crandall completed his work in Ghana. Then he phoned home during a layover on his way back to Utah to schedule surgery for himself.

The titanium plate that stabilizes his neck now makes hunching forward on a surgical stool uncomfortable. But with Ann and Julie assisting, Crandall operates for 14 hours our second day, straightening up only to take a single bathroom break. First thing the third morning, he prepares to operate on a five-month-old named Gebreyesus, or “servant of Jesus.” Gebreyesus has a tuft of curly hair on top of her head, huge eyes, and congenital cataracts that render them useless. To complicate matters, she also has acute glaucoma, high pressure in her eyes that can harm the optic nerve. Crandall must not only remove the cataracts without creating scar tissue that will damage her growing eyes, but construct tiny vents to release the pressure. He presses his own eyes closed. His hands, in white latex gloves, rehearse the movements he will make, like a ski racer reviewing the contours of a course before heading to the starting gate. “I’ve never seen him this nervous before,” Julie says.

“It’s just that in the U.S., you have so many resources,” Crandall says. “Here, there’s no backup. If you screw up, this beautiful little girl is blind forever. Her life is in your hands.”

In this case, that’s a good thing. Crandall operates with the encouraging calm of a veteran pilot bringing a damaged 747 in for a safe landing. “That went fine,” he says after two and a half hours, his blue surgical gown striped with sweat, as the bandaged, unconscious Gebreyesus is placed in her mother’s arms. “I think we might have a small victory here.”

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