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This mission was organized in Senegal by the Peace Corps with close cooperation with Oumar Tall Kane, the the ophthalmic technician from the Department of Ophthalmology, Regional Hospital, Bakel, Senegal. We did a cataract mission in Bakel in 2007 with the help of the Peace Corps and Dr Kane, and have been planning to return there since.
From the US, five members of the nonprofit organization “Right to Sight and Health” participated: John Jefferies, RN, two students, Dezso Simon and Daniel Simon, and two ophthalmologists, Donald Macdonald MD and Judith Simon MD.
Bakel is a small town with 15 000 inhabitants, and a regional center for health care. It is the only hospital in several hours drive in each direction. The hospital director, Dr Balde warmly welcomed our group and assured an excellent working environment.
The Peace Corps volunteers, with the leadership of Brian Bartlett, who has superb organizational skills, took care of all the logistics: Relationship with hospital administration and workers, assuring patient flow, translation, preoperative and immediate postoperative care, vision check, biometry, eyeglasses and eye drops distribution, and working as circulating nurses. They also provided for all the needs of our group from the US, including transportation, lodging, food, and obtaining supplies. Brian and 7 other Peace Corps volunteers worked with us last year in Tambacounda, which made things much easier, as they were already familiar with the work and did not need to be trained.
Dr Kane and Brian had been doing cataract screening prior to our arrival in the surrounding villages for 3 months every Friday and Saturday and they scheduled 140 patients for us. Most of these patients showed up and most of them were good surgical candidates. Most of them needed the second eye to be operated on also. We scheduled the 2nd eye of most patients for the second week of our stay but unfortunately we had to cancel most of these surgeries, as new patients arrived who were bilaterally blind. Even that there was no advertisement for our mission; the news spread and patient were arriving from several hours drive, even from Mali and from Mauritania. The clinic became so crowded during the second week of our stay that we had to ask for the help of the police for crowd-control.
During our 10 surgical days performed the following surgeries:
156 cataract surgeries, 144 with PC IOL, and 11 with AC IOL – 2 were subluxated cataracts – and one with no IOL.
We also performed the following surgeries:
3 secondary IOLs
2 Gunderson flaps
1 pterygium removal affecting the visual axis
2 large conjunctival tumors
1 penetrating trauma, with suturing and gluing
1 corneal scraping for band keratopathy
1 large chalazion
There were also 2 reoperations, one for retained cortex and one for leaky wound repair after penetrating trauma.
Altogether we performed 170 surgeries.
We had 2 operating tables and 2 operating microscopes, that is how we could do that many cases.
We trained Dr Kane in the technique of small incision cataract surgery (SICS). He has been performing ECCE with corneal incision and sutures for 5 years. He made great progress but he still needs additional training to be able to perform SICS alone. We donated 2 surgical instrument sets to him, and also a direct ophthalmoscope, surgical supplies and eye drops. We also trained Amadou Fall, ophthalmic technician from Kedougou for 3 days in SICS, who recently completed his surgical training in Guinea. We have worked with Amadou Fall previously in Kedougou in 2009 and in 2010. We also trained both technicians in the use of intracameral Cefuroxime, to prevent endophthalmitis and in the use of intravitreal Vancomycin, to treat endophthalmitis.
We distributed about 200 pairs of glasses, mainly reading glasses and 16 pairs of aphakic glasses. We donated 800 pairs of glasses, mainly reading glasses and some myopic glasses to the hospital for further distribution. All postoperative patients received sunglasses for light protection.
We finished our work on Thursday and left Bakel for Tambacounda. On Friday morning we paid a visit to the Department of Ophthalmology of the Tambacounda hospital, where we worked for 2 weeks this February. We took some supplies to them and we wanted to check on the autoclave we donated. To our great disappointment, the autoclave was sitting in the OR without being used. We had a long discussion with the head of the department, dr Cisse and also with the hospital director, dr Babacar Mane, and after demonstrating how the autoclave worked, and showing them that the indicator turned, they promised to use it in the future. We also talked to Gallo Djallo, “cataract operator”, whom we trained in SICS in February of 2011. He has been doing only this technique since; this made us extremely happy and satisfied. We saw a few his postoperative patients, and they looked perfect. We were very proud of him.
Overall, this was our second most successful mission ever, regarding the number of surgeries and also the teaching aspect. It was also our most difficult mission: We were completely overwhelmed with patients with light-perception and hand-motion cataracts, and we could not help even half of those who were in need. It was also extremely difficult to train other surgeons in these circumstances. But we did our best.
We want to say a huge « THANK YOU » to the Department of Ophthalmology of the Bakel Regional Hospital, especially to dr Kane, to the and to the Peace Corps of Senegal for making this possible.