- Clinic space
- Our own manpower
- Number of clinic patients
- Surgical space
- Surgical volume
- Our supplies : Medications/ Glasses
- Time for set up, for repacking, and for goodbyes
1. Scout the clinic area carefully and decide on the best use of available space.
2. Ask for sufficient interpreters who are to stay with us. At least two will usually be required at all times. These folks should have no other responsibilities. We will ask first for our hosts to find these interpreters and then, if necessary, we will recruit our own.
3. Our teams will usually have 5-6 members. The first day we will all be in the clinic. Starting day 2 it may be that 3 will go to the OR and 2-3 will stay in the clinic. Those clinic folks make the efforts truly maximal, and we could not accomplish what we do without their continual presence in the clinic.
4. The number of clinic patients can be overwhelming. It seems difficult to handle them all if each patient is seen one at a time, one after the other. We need a system to help us work faster, find the surgical patients, and still give each patient care and compassion. The following is a possibility:
Several times each day a “scout team”, consisting of one of us and an interpreter, is sent into the crowd with index cards of 4 colors. The scout team will ask each patient to describe his or her main problem. These could be:
a. Significant visual loss in general – one or both eyes
b. The need for help with close work
c. Irritated, uncomfortable eyes
d. All others – miscellaneous
The scouts give the appropriate color index card with notes written so we soon have identified groups of people which we can then handle much faster. We would try to see folks in the above order since our main goal is to find the surgical candidates – mainly the cataract blind. This also helps us know how high to set the “bar” – who can get surgery on that particular trip. It also helps us know what kind of exam to perform as each group will have its own particular requirements. Vision checking and pupil function and possible dilation would be required for group A, for example, not necessarily everyone else. Reading glasses could even be given “en masse” with collective explanation unless we have the luxury of a “dedicated” reading glass team member. Ways to improve eye comfort could be taught to several people at the same time – perhaps even more thoroughly as this is a particularly difficult problem. The miscellaneous group could be restudied and dealt with even if one at a time. If we take time to walk around and greet the folks in any group individually, give them a smile, a handshake, a warm touch, we will let them know we care.
5. We will determine early on where the surgery will take place and clean this area thoroughly. We will require two areas – preop and OR. Our hosts will make this work well for us and may even have the area prepared prior to our arrival.
6. We can usually perform 6-8 operations on the first OR day and up to 10-12 per day after. This volume may have to be rethought depending on how many clinic patients are sent for my evaluation between surgeries. The clinic team should feel free to send me patients about whom they have questions. This means that there will be a defined number of operations we can perform. Our hope is to help the ones most in need and this requires “triage”. This will disappoint some but we have no other choice.
I encourage each of us to visit the postop patients in their room after surgery – that same day. They and their families appreciate this more than I can describe. It is also nice for us all to gather together with the patients the morning after surgery for the unpatching to celebrate their new beginning. Our encouragement and joy adds to their own. Many of these people are so stoic – from years of hardship. They do not always know how to respond to dramatic improvement. We can give them “permission” to smile, to laugh, to show the joy they feel. Remember, too, that the first postop day is just the beginning of their new eyesight. Just think what it will be like three weeks later!
7. There is one undeniable fact: each person we see will want something to take home with them. We can all understand this as we would feel the same way. They have come some distance, waited some time, and their expectation is that we will have something to give them – perhaps something “magical”. Our advice is good but a physical object (glasses, drops, pills, etc) is their true goal. How do we handle this when we can take a limited quantity of supplies and when sometimes giving something is not medically wise?
Distribution of glasses: See separate sheet
Eyedrops require special care. Any drop we give carries some risk. Think of the possibilities: The patient uses the drops, gets some benefit, and then the drops are gone – what to do then? Or the patient likes the drops, goes to a pharmacy in hopes of getting more but does not take our bottle. The pharmacist thinks maybe we gave cortisone and dispenses those drops! Or the drops did not help – what does the patient think about all his effort to see us? Or the patient is unable to purchase drops we have asked him to get (glaucoma) and the family feels guilty. Or the patient uses the supply of glaucoma drops we gave but does not get more, then goes blind from glaucoma and blames our drops for his blindness. The point is that we must either not give drops but rather explain alternative solutions (boiled water for example) – or we must thoroughly explain the drops we are giving, their uses, limitations, and what to do when the bottle is empty. Education is the key.
8. We will always need relaxed time for setup (clinic and OR) and takedown. This time has to be built into our schedule and is a top priority. We also need time to see the last day’s surgical patients the morning after surgery and to mingle with the clinic and OR staff. It is good if this time is unhurried. Everyone, including the staff, will want to tell us goodbye, and we need to give them our undivided attention. We Americans like to rush about, but this does not adequately convey our love. Part of our purpose is to become a part of the culture while we are there – slowing down a bit, reaching out to the people and giving them time.