10 Questions with Mary Roach, Author of Replaceable You

Orbis sat down with Mary to talk about what inspired her to dedicate an entire chapter of her book to cataracts (a clouding of the eye’s lens that is the world’s leading cause of avoidable blindness) and to highlight the sight-saving work we do in a chapter of the book titled “The Mongolian Eyeball.”

Orbis: What initially sparked the idea for the book—to focus on parts of the body that can be replaced through medicine? And what drew you to dedicate a chapter to cataracts specifically?

Mary: Anytime that I have an opportunity to dive into some new piece of the human body, I'm pretty excited because, for me, the human body is kind of a foreign place. It's as interesting and bizarre as the outskirts of Mongolia. I don't have a background in biology, so it's all new to me, and I enjoy learning and understanding how my body works and what it does. So, to dive into the eyeball—literally at one point—was pretty cool.

I find eyeballs fascinating. I'm a high myope, meaning I’m severely near-sighted. I can't even read the large “E” on the eye chart, so I have a built-in fascination with eyes since mine are not great. Plus, cataract is something that we all, if we live long enough, will have to deal with. Most people know that cataract surgery is in their future, so it was a universal interest because of that and a good thing to include.

Orbis: How and why did you pick Orbis to focus on in the book? What do you wish more people knew about our organization?

Mary: When I started writing the book, cataracts were something that I thought about, partly because I'm 66 and I'm certainly going to need that kind of surgery. But I had not heard of Orbis. I was poking around on social media, and I contacted Dr. Malik Kahook, the chair of your Medical Advisory Committee. I'm always looking for a setting and a place to go and people doing interesting things for my chapters, so when he mentioned Orbis International, and I later learned you were heading to Mongolia, I knew that was an opportunity for a great combination of interesting material.

What most people don't realize about Orbis is that it's not a program wherein surgeons fly into a remote area and treat people for a few days. That's a model that the public is familiar with, and that's what I assumed Orbis and the Flying Eye Hospital were all about. But in fact, it's not. Orbis’s work is about teaching the local doctors to be able to do the surgeries themselves.

Orbis: If you were sitting down at a dinner table with some friends, what would you tell them about chapter 11, “The Mongolian Eyeball”?

Mary: That chapter of the book looks at the benefits of simpler technology. In other words, you can get the latest technology and the very high-tech version of cataract surgery, known as phacoemulsification, here in the United States, but that's not available to everybody around the world, and certainly not available when we reached more remote parts of Mongolia. So, the fact that a simpler technique is available is a bonus because, if you look at the greater good, how many more people are going to be helped?

If you can train a few surgeons to do this simpler technique that doesn't require the same kind of technology—the operating room with all this fancy phacoemulsification equipment—if you can do it in a simpler way, that's still very effective. That's what you should do if you want to help the most people to be able to see. There's a lot of focus in our culture on having the most high-tech, the fanciest, but what I was seeing was the best thing for that region of the world.

Orbis: You've traveled far and wide on your writing projects, going to unique and remote places many people haven't heard of or thought to travel to. How does the trip to rural Mongolia compare among all the places you've gone?

Mary: Mongolia was just so interesting and fun. We'd been scheduled to fly from the capital of Ulaanbaatar to Mörön, a distance not entirely across Mongolia, but a big chunk of it, but something happened with the flight, and we ended up driving. A bunch of ophthalmologists and myself piled into a 4x4 to drive across Mongolia. There is a road all the way, but the road is often washed out, and you're going through these offshoots that go into other offshoots. You might have to use your car snorkel and cross a stream. There may be some people up on a hill who are having an impromptu horse race. The food was amazing. I became a big fan of kneecap soup (a traditional Mongolian soup made with beef or mutton). And I just loved the country because the Mongolian people are so hospitable.

At one point, I expressed an interest in what it might be like to live in a ger—which some people are more familiar with as a “yurt,” but the word “ger” is used in Mongolia. So, the driver, an ophthalmologist named Uno, says, “Well, let's go see,” and just turns the wheel, and we drive off over the landscape toward a cluster of gers. Uno just goes up, knocks on the door, and says, “We're a bunch of ophthalmologists and want to see what it's like for you living here.” So, the guy is like, “Come on in.” We all sat around, and they gave us some delicious dairy and fermented cheese products, and it was amazing.

Orbis: What was it like getting to spend a week with Orbis in Mongolia and see our programs firsthand? And later to visit the Flying Eye Hospital?

Mary: To spend a week with the people from Orbis was such a treat and a privilege—just because your commitment and enthusiasm is so obvious, and you so believe in what you do. It's incredible. When people hear you have a Flying Eye Hospital, people think, “Oh, surgeons go around, and they operate for a day or two on people who have cataracts or other forms of preventable blindness.” But in fact, no, what you’re doing is so much more helpful because you're training surgeons so that they can now treat the whole community. In terms of the greater good, how much better is it to train the surgeons locally to do this work, rather than just come in for a few days and only do operations?

Also, when I was in Ulaanbaatar, there was a virtual reality headset, which would enable students to practice a very tricky part of cataract surgery called capsulorhexis, which we don't need to get into here, but it is very difficult to do. The residents used to practice on cherry tomatoes, so now they don't have to sacrifice all the cherry tomatoes. They can do it over and over again using the headset. I tried it. I wasn’t very good at it, but I did try, and it’s very realistic. It's all about teaching and making local surgeons proficient at these techniques so they can help the greatest number of people possible.

Even though I didn't get to fly on the Flying Eye Hospital, I did get to tour it while it was in California hosting training for eye care teams from Latin America. I saw it is not just an operating room—again, it's a classroom. It's a place where local surgeons can come in and learn techniques. The teaching element was amazing. It's also just very cool to see and to understand how it's done, knowing the Flying Eye Hospital was a real challenge and an amazing technological feat to create.

Orbis: What was it like seeing your first cataract surgery in Mongolia with the Orbis-trained ophthalmologist?

Mary: I spent some time watching cataracts being taken out of eyes and replaced with new lenses in an operating room in Mörön, which is a small city in north-central Mongolia. Having already visited an operating room in northern California, where I live, this was a very different scene. There was a wooden table. I'm not even sure if there was any padding on it. The only thing plugged in, I think, were those high-tech goggles so they can see what they're doing—the super magnifying glasses. I don't know the actual term. Anyway, I think that's the only thing you needed to plug into a wall. So, it was very basic.

But one of the things about that procedure that they're doing, which is simpler—it’s not phacoemulsification, which is done here in the United States and uses ultrasonic waves to break up the cataract into tiny pieces—the cataract is coming out in one piece. In other words, the whole lens is coming out intact, and it comes out quickly. It's almost like a birth, and it was very exciting, for me anyway, to see this little thing come out.

Orbis: Were you disappointed you couldn't keep the cataract from the surgery. Do you plan to save your own cataract?

Mary: After I watched the surgery, the surgeon casually parked it on a piece of gauze, and I was like, whoa, “That's a human eye lens right there.” And I just wanted to marvel at it. So, I folded over the gauze and stuck it in my pocket. And then very quickly, Hunter Cherwek, who is the Vice President of Clinical Services and Technologies at Orbis, informed me that if I took that cataract out of the country, I could be arrested for human trafficking and cause the hospital to be shut down. So, I gave back the cataract.

When I have my own removed—which I'm sure I will, because I've got starter cataracts right now, little tiny ones, just part of my lens is getting dirty in there—because of phacoemulsification, it's going to be reduced to this kind of chowder, so I won't be able to save it. If I could, I'd put it in a little glass jar and on the shelf along with some of my other weird memorabilia, or maybe I'd get it bronzed and make a little necklace because it’s nice, perfect disc. It's a pretty shape. It's just not a pretty consistency or look. It looks like a big, dirty lentil. You'd want it gold-plated or bronzed or something.

Orbis: In one part of the Orbis chapter, you talk about “the reveal” moment, when the bandages came off the patients’ eyes after surgery. What was it like meeting those patients and witnessing their transformations?

Mary: I was there for their surgeries, and then the next day, the bandages came off, which is kind of akin to the reveal in a reality television show. I expected more of, “Oh, my God, I can see you,” but these are nomadic herders. Their lives are tough. They're not expressive in the way we are used to. They're very stoic. So, we didn't get a lot of that, except there was one guy who kept just looking around the room, looking up at the lights, and he said, “It's like HDTV.” That was very cool.

There was a woman who had what's locally called a “full set” of livestock: sheep, goats, cows, camels, yaks. She had so many grandchildren that she wasn't quite sure of the exact number, and she took care of them a lot of the time. So, the fact that she can now contribute to this household was huge. And even though she wasn't going, “Oh, my God,” you knew that this was making a tremendous difference in her life and her ability to keep the family going and make everything work, and it was amazing.

Orbis: You've aligned yourself at the crossroads of science and humour, and you bring a quirky sense of fun to facts. Is this a skill you were born with, or how did you develop this craft?

Mary: I've always written the way I write now. I didn't make a conscious effort to have a persona or be funny. I think it's just how I see the world and how I enjoy writing about it. I remember looking back to one of the first pieces I ever wrote, which was for the San Francisco Examiner Sunday Magazine, and it really does read much the way my stuff reads now. I would say it's fun for me to write that way, and I assume that if something’s fun for me to write, it's going to be fun for people to read.

As a writer, you always want people to be entertained. I want people to learn, and I am glad that they're learning about Orbis International and they're learning about their own eyes. That's great, but the only way I can get them to do that is to keep them entertained. Otherwise, it's just too easy to put a book down and go.

Orbis: Replaceable You has been over three years in the making. What are you most excited about now that it’s out in the world?

Mary: After a book launch, I do a lot of appearances, and that is always really fun for me to finally talk to people about the experience and the book. As an author, you spend a lot of time in your head, in your little office, putting it all down on the page, and now you get to interact with people who've actually read your words. That's a real privilege, and it's fun. My readers are the coolest. I have a great time at my events, in the signing lines afterward. So yes, it's super fun. It's almost as fun as driving across Mongolia with Orbis International!

Replaceable You: Adventures in Human Anatomy by Mary Roach is available now at all major booksellers. Check out her book tour schedule here.

Header image: The Orbis Mongolia team encouraged Mary to try on a deel, a traditional Mongolian clothing item, while visiting Lake Khövsgöl.