February 26 2015
On Wednesday, the 3 teenagers operated on last week returned for follow-up from Wa. All 3 claimed to see better. Mohammed, age 17, who had vision of light perception, improved to count fingers 2 meters, but he has an extremely small eye (called microphthalmos) so we did not expect that much more improvement. Bayiiri, age 12, had the same improvement in both of his eyes. He has been blind since birth, from cataracts, so his prognosis is not too good, as his brain never learned how to see. But he was very happy and his teacher told me he saw him reading the Bible alone! I was a bit sceptical, as he knows only Braille, but the teacher assured me all blind children still know how letters look like.
The third youth, Richard (age 22) could see nearly normally, he could read 2/3 of the distance eye chart and also medium-sized letters! He had been blind for 12 years! He told me the story of his blindness: (A quite common story in the blind school). When he was 10 years old, he went to fetch water, and he experienced a severe headache. He returned home and complained to his mother, who admonished him. Later he became very sick, developed a fever, was taken to the hospital, and when he was discharged, he could see just minimally. Later he was taken to a different hospital, got eye-drops, but his sight did not improve. Then he was taken to a third hospital, he received treatment, after which his remaining vision was also lost. He started to attend the Blind School at age 13. Now he can walk around alone, can read and can do everything a sighted person can do! He was helping out a lot with the other blind children who came for surgery. He was very excited about returning to his village sighted. I wish I had the time to go with him to see his family’s reaction. (Though people in developing countries are quite stoic in general, over the years I saw only a handful of patients who showed their emotions upon regaining their sight.)
I asked Richard about his plans. He said he would probably finish school in Wa, as he is in his last year. The teacher said he can be “mainstreamed” now, meaning he can go to regular school. One of my fears upon embarking on this project was that children will not want to see: They have a safe place in Wa, it is free, they are getting fed (even if it is only rice), get clothing (even if it is torn), have a bed, they go to school, have caring teachers, they have friends, a community. They also receive vocational training. Life is probably much worse in the village even if someone is sighted: No schooling, hard farm work, scarce food, no hope of ever leaving from there, of ever getting a profession…. Well, we will see what happens long-term.
Thursday we did surgery on 3 more children, all three of them bilaterally blind. They were from age 9-12, so they needed general anaesthesia. We also operated on Richard’s other eye – initially I deemed his prognosis so poor that I suggested to operate only on one eye first. Thank God, I was wrong!
The surgeries went well, though we had the usual problems: Patients arrive half hour late from floor, no anesthetist, (finally, after extensive begging one came) no oxygen, no anaesthetic drugs, no gloves. The power went out during surgery, no one to turn generator on, so I had to break sterility and run outside to do it…but by now I am used to these difficulties and they do not phase me the least bit.
Rosemary, the teacher who came with the children, was excellent, calmed them, fed and bathed them, and took really good care of them. David, a 10-year-old cried horribly for over an hour after surgery, wanted to tear his patches off, it was heartbreaking to listen to it. Finally, we gave him some sedatives. At the end of the day everyone left, the children were taken up to the hospital ward. As I am leaving the clinic (I am always the last one to leave), I discover one of our patients, 12-year-old Lovia, sleeping peacefully on a bed in front of the OR, with both eyes padded. She did not wake up from anesthesia yet. This is Ghanaian postop care – just leave the patient alone till she wakes. I imagined how it would be – waking up totally blind, with two eye pads, alone, not knowing where one is….luckily she did not wake. A little while later the teacher and the house officer came to pick her up.
Next day we saw the 4 postops, gave them eye drops and instructions. It was too early to see any improvement, but I could see the back of their eyes, which is a good sign, it means eventually they should be able to see. They returned to Wa with the noon bus, getting there around 7 pm. The last batch will come next week.