Missions

January 25, 2014

It is 2:50 AM and I am at 36,000 feet with an airspeed of 581 miles per hour.  The Captain says there are strong winds and my thoughts drift to the beloved character of Mary Poppins.  And like her, I too am being carried to a place desperately in need of organization, discipline and love, though I am not headed to 22 Cherry Tree Lane.  My east wind is blowing me to Ghana.

What is it that inspires philanthropy?

What life experiences propel one’s desire to create a greater global good? I think about these questions as I stare out the window into the darkness, for here I am embarking on another Right To Sight medical mission.

Mary Poppins used a spoonful of sugar to make the medicine go down. If only it were that easy! The recipe fashioned for our medical outreach was quite a bit more involved and in need of many ingredients.   In the end, however, it went sweetly down as if it too were sugar coated.

Recipe For A Right to Sight Outreach

Ingredients:

2 cups enthusiasm

2 cups determination

1 cup commitment

large handful perseverance

1 bunch motivation

pinch of frustration

2 heaping tablespoons humility

diligence to taste

sprinkle with patience as needed

Directions:

Mix together enthusiasm and determination.  Add in commitment. In separate bowl, beat together a large handful of perseverance and bunch of motivation.  Blend into first mixture. Season with patience as needed and simmer with diligence. Add in a pinch of frustration and 2 tablespoons humility. Cover with cloth to keep out dust and mosquitoes.  Let mixture bake under the hot Ghana sun.

Serve with education, good intentions, and friendship.

Should keep fresh for one year without refrigeration.

Each of the above ingredients were necessary to make the outreach a success and yet none could stand alone, for it was the sum of all the parts that created the real magic.

Dr. Judith Simon led our team through her hard work, dedication and commitment. She attempted for months to pull together resources, contacts and organizations as she laid the ground work for outreach approval in the Northern region. It was a daunting task to piece the mission together and coordinate  the decisions from the many personalities needed for our approval…..Village Chiefs, hospital administrators, medical directors, district mayors, Tamale Teaching Hospital staff officials, Swiss Red Cross, Ghana Red Cross, interns, students, nurses, and friends. Long hours, inconveniences, misinformation, and bureaucratic run-around continually plagued her good intentions.  I felt her upbeat attitude beginning to waiver and her faith in accomplishing this mission wearing thin. With no clear answers, I flew to Ghana determined to keep pushing and working towards the outreach approval.

There is an old saying…”sticks in a bundle don’t break”.  I would add my fresh perspective and “energico” which I concluded were critically needed.  Judith had confided in me that if an outreach were to happen, we probably wouldn’t know until most likely the day before. I may be mistaken, but I sensed the “powers that be” just got tired of us asking and pushing, surprised we had not given up (does a Jersey Girl ever give up??). Then true to her prediction, we received our “go ahead” on a Wednesday night.  Within minutes, she contacted a new intern optometrist, Dr. Collins, and extended the invitation to join our outreach. He agreed with enthusiasm and was sent out to the rural community of Zabzugu and Tatale to begin prescreening some 24 hours later. Mr. Razak of the Swiss Red Cross helped coordinate transportation of patients, and Mr. Alidu arranged the meeting with the village Chief at his palace (Kola nuts the traditional gift and a must for formal introductions).

Our team functioned with mutual respect for each other, creating a deep sense of camaraderie.  With the help of the Tamale Teaching Hospital eye nurses, Lucianus, Imaculate, and Momed, we packed and loaded supplies from the clinic, hospital operating room, as well as including packing personal and donated supplies. We then traveled some 3 hours to the rural community of Zabzugu. There in the district hospital we unpacked and organized our pre op, post op, and operating room supplies…. gloves, drapes, dilating drops, steroidal drops, instrument sets, blades, microscopes, intraocular lenses,  IV fluids, cannulas, syringes, needles, sutures, antibiotics, q-tips, gauze, tape, sanitizer, cautery, basins, autoclave, eye charts, scanners, ophthalmoscopes, flashlights, antiseptic, alcohol, water, and don’t forget the duct tape! The hospital seemed much like a ghost town, with many empty rooms and wards. Though a fine looking facility (though it could have used running water) there are few to no doctors to fill this place (2 ophthalmologists for 2.5 million people in Northern Region). The setting provided the perfect conditions for me to educate the Ghanaese healthcare workers.  Sterile technique, infection control, patient processing, skills that enhance the safe delivery of care, and finally compassion…an often overlooked virtue necessary when taking care of the elderly.

It was an awesome outreach with a great learning curve. We accomplished so much in a short amount of time even though frustration and politics clung to our actions.  District’s medical directors refused to send prescreened patients to our location because they wanted the notoriety in their own village’s hospital. I must mention it was the owner of the A.B.M. Hotel we stayed at who aided our fledgling efforts by providing a vehicle to help transport those patients stranded in the outlying villages. We did 10’s of surgeries instead of 100’s, yet I am not disappointed.

There is another old saying…”to save one life is to save the world”.   It is a miracle to restore someone’s sight and be part of that process. I will never be able to put into words the look of joy you see flood in someone’s eyes the day after surgery when their eye patch is removed. I will never be able to explain the feeling of humility when someone bows to you or kneels at your feet or kisses your hand with pure unadulterated gratitude. I only know that at the exact moment when our eyes meet, we both see something wonderful…for it is not necessarily sight we have, but insight.  When you can see past color, race, religion, or culture…when everything disappears from sight except one human helping another, what you are left with is the best vision of all.

Eventually the winds changed and a west wind carried me back home again to New Jersey where I find myself dreaming of another Right To Sight outreach. I wish to personally express my deepest thanks to the 2014 Ghana team.  One at a time we really are changing the way the world sees.

Beth Weston Knotts, R.N.

February 2014

This year our group went to a small town in the Eastern part of Senegal called Ourossogie. Ivy, one of the Peace Corps Volunteers (PCV) who was with us last year, offered to organize a mission there. She said that to her knowledge, there had never been any cataract missions organized in this town (which turned out later to not be true) and the need was huge.

There was already a problem before we left home. One of the doctors in the group cancelled at the last minute and we had two hundred blind patients prescheduled, waiting for surgery. The local ophthalmologist, Dr. Diallo and two eye-nurses, Dr. Baa and Dr. Sall have been screening patients for cataract surgery during the past weeks with the help of the PCVs. It was doubtful that we would be able to handle all the patients but it was already too late to get another doctor.

The five members of our group arrived to Dakar with all of the twelve large bags, which is always a great joy and relief. The first time in six years we were asked for permission at the customs. We always request it months ahead from the health ministry and we usually receive it after we return to the US. I had a forged copy as usual from last year, I just changed the date.. But there was a change of government in the meantime and the custom officers were staring at the permission form very suspiciously. I quickly yanked it out of their hands and offered some reading glasses for their parents. After this everything went smoothly.

Next morning we left for Ourossogie, a mere twelve-hour drive from Dakar. It’s a small town in an underdeveloped Eastern area with 20,000 inhabitants, and a regional center for health care. It’s the only hospital providing eye-care for several hours drive in each direction. We arrived late and unloaded the bags in the hospital in total darkness. The next day we took some more bags from the hotel (a twenty minute walk) with a donkey-cart. (a twenty-five minute ride.) This was the local taxi, driven by young boys. The drivers were usually hitting the donkeys mercilessly and the more we protested the harder they hit them. They probably believed we wanted to go faster. After a couple of days we gave up on the carts and walked.

We unpacked on Sunday and set up the operating room, the consultation room and the postoperative care room. These tasks are never easy, fraught by hundreds of small problems common to developing countries, i.e. missing keys, non-functioning outlets, (the electrician is still on his way…) no operating tables/chairs/etc, no water, sink clogged, AC does not work and it is over 100 degrees, etc. But where there’s a will there’s a way, by the afternoon we were ready. The volunteers came to our hotel in the evening to discuss the logistics of the whole operation. Luckily a few of them were with us last year so they already had experience. Also, the main organizer, Meredith was an extremely strong, well organized and thorough person, she thought of nearly everything ahead of time and this made things go relatively smoothly.

Next morning we started to see the preoperative patients and in two hours we started surgery. Meredith called in only fifteen patients out of the twenty scheduled, and if a few didn’t show she called in more during the morning for the afternoon. All patients (or their relatives) had cell phones, which made the organization much easier. During previous missions this was not the case and frequently we had too few or too many patients for the day. About 15-20% of prescreened patients weren’t good surgical candidates so they had to be sent home. (We paid for everyone’s transportation.) I first believed this was due to the lack of training of the screening personnel but later we found out that none of them had the right instrument for cataract screening, a direct ophthalmoscope. This costs $400 in the US and developing countries just can’t afford it. There is one now invented for poor countries, it costs 10$ and functions with solar power. It’s questionable though whether it will ever be manufactured on a large scale.

The first surgical day went a bit slowly as usual. Dr. Diallo showed us his technique of cataract surgery. It took over an hour and used about six different sutures! I saw immediately that we could make a big impact in patient care if I taught him the so-called “sutureless small incision cataract surgery” technique. I started to train him the second day. He was an extremely talented surgeon and he picked up the steps relatively fast. He also knew when to stop and let me take over, which requires a lot of insight. I see it very rarely. Most doctors are either too aggressive or too timid surgically.

We were supposed to operate with two microscopes so we could perform more surgeries. The local hospital had one, and we brought one from the US. But it was close to impossible to operate with their microscope, as it was not made for ophthalmic but for ENT surgery. Dr. Diallo was aware of this but somehow never mentioned it to the hospital director. Probably he wouldn’t have been able to order a new one anyway. It was actually miraculous that he got relatively good results with this one. (I saw the OR log, that’s how I knew.) Also, after I found out about the problem with the local microscope it became obvious why more than half of the cases selected for our group were complicated cataracts: Dr. Diallo knew better than to operate on them with substandard equipment.
So we decided to use only our microscope and we had two beds, with the scope swinging back and forth between them. This way we had time to prepare the next patient on the second bed and it speeded up the surgeries. I saw this only in an article (in the US we never need to do this) but it worked.

There was also a huge problem with our autoclave. (The instrument used for sterilization.) It was leaking steam and the cycle took too long to complete. Sterilization became the rate-limiting step for the surgeries. We scouted around to see if there was a small autoclave we could use. (The large ones they use for their OR take several hours to sterilize.) In an abandoned room we discovered a brand new one, just perfect for eye-surgery, apparently never used. It was donated a year or two ago by a Spanish NGO. The locals had no idea how to use it. Not because they are stupid but because no one had ever explained it. In the developing world people are simply unable to figure out how to use instruments from manuals. Technology is completely alien to them. (Similarly, I wouldn’t be able to figure out how to herd cattle from a written description.) We asked for the manual, and were told they didn’t have it. It was sitting on top of the autoclave. We couldn’t make it work so I called the manufacturer in Germany. Next morning technical support called me back and with one sentence explained what to do. After this it worked perfectly and sterilized in forty-five minutes! Thanks to the autoclave we completed all the surgeries we had planned. Also, we trained the locals how to use it – it was quite simple. This was probably the biggest impact of our mission!

The following story happened not on this trip, but on the one last year, also in Senegal. (That mission was pretty much a nightmare so I decided not to write a diary about it.) I will include it here though, as it is worth mentioning.
On the weekend we decided to visit Bema, the same village we visited four years ago, during our first Senegal trip. Mark, the PCV who organized our first mission lived there for two years and created a large garden there. (See the diary from 2007: https://www.righttosightandhealth.org/bakel-senegal-2007/#more-139 ) We went with Brian, another PCV who has been working part-time in Bema, trying to develop the garden further with the help of a local farmer. To my disappointment, the garden was nearly completely dried out, sporting only a few cachectic plants, a miserable remnant of Mark’s earlier one. (Which didn’t impress me too much either at the time, but I guess I had nothing to compare it to.) Brian was working on having a well dug by manual labor. It seemed an extremely challenging task, and he was kind enough to familiarize us with the details of well-digging in Senegal. Who would have believed it was so complicated? The problem was that the well diggers – who were from Mali, as labor is cheaper there – were “too lazy” to dig with their picks after a few meters in the hard, rocky soil so they started to use dynamite much earlier than they were supposed to. This depleted the funds for the well. A few weeks later Brian obtained some more funds and these were once again spent quickly on dynamite sticks. As this area is extremely arid the well had to be at least thirty meters deep. We also donated a few hundred dollars for the well but never received any feedback about its completion.

On the way back we waved down a “cab” after an hour wait, as there’s no bus service back from Bema. There were already eight people sitting in the 7-seater, a very old and decrepit car making scary noises. To our great surprise, it stopped and we squeezed in, two of us to one seat, next to the driver. Later the car stopped twice more and took two more passengers. One of them sat next to the driver from the outside, making driving a bit of a challenge. Later we took one more man who sat on the roof. Then the car swerved into the desert where there was no road. No one seemed to mind. We crossed dry river-beds and the car made louder and more frightening noises, ready to fall apart at any second. I thought we were going to drop someone in a village but there was no village. It was getting late, the heat was unbearable and the hope of ever getting back to town seemed more and more remote. All of a sudden the car jerked to a stop and tilted to the side. The driver cursed loudly. All the passengers got out and we discovered one of the wheels about ten feet behind the car. It was immensely difficult not to laugh out aloud, as the locals did not find the situation funny. We thought we had better walk than wait as the wheel seemed irreversibly damaged, and climbing a small hill we discovered that actually we were only half a mile from the town! By the time we climbed down the car was already fixed–the passenger who sat on the roof happened to carry a wheel and this was put on the car. We never learned why the driver chose to drive through the desert instead of the asphalt road. On arrival we shared our adventure with the PCVs who were totally unimpressed–these things happen to them on a regular basis.

The second week of work went relatively smoothly. We operated on a blind ten-year-old using general anesthesia. We offered bilateral cataract surgery at the same time but the father did not consent. The child could see quite well the next day but didn’t show any emotion. (The father though seemed quite pleased.)

The primary goal of our mission wasn’t to perform cataract surgeries but to train Dr. Diallo in the small incision cataract surgery method. (“Give a man a fish and you feed him for a day, teach a man to fish and you feed him for a lifetime.”) By the end of the second week he could perform the surgery in fifteen minutes with good results! He was a truly talented surgeon. Seeing him doing well made me much happier than getting good surgical results myself – teaching someone else is the real challenge. He asked us to return next year, so I told him that by then he’d be the one to teach us new things! I really meant it–with the surgical volume they have in most places in Africa a talented surgeon can become excellent quickly.

On the way home we stopped in St Louis, which used to be the regional capital of whole Western Francophone Africa until 1902. It is wedged between two arms of the mouth of the Senegal river, with an orthogonal street grid and beautiful colonial architecture. It was declared a Unesco World Heritage Site in 2000. The city received several millions of dollars for restauration and maintenance. Unfortunately the money was not used wisely, the buildings are crumbling and the streets are covered with trash emanating a horrible stench. We went to the beach which has the potential of becoming a tourist paradise, but there was so much garbage on the sand and also in the ocean that it was impossible to enjoy it.

Finally, after twelve hours of driving, late at night our group arrived to Dakar. Next day we took a long flight back to the US, tired but exhilarated. We might return again next year – Insha’Allah!!!

Judith Simon

This mission was organized in Senegal by the Peace Corps with close cooperation with Dr Abdulaziz Diallo, ophthalmologist and dr Sall, the ophthalmic technician from the Department of Ophthalmology, Regional Hospital, Ourossogie, Senegal.

From the US, five members of the nonprofit organization “Right to Sight and Health” participated: Pamela Spranger, RN, Bethelena Weston-Knotts, RN, Patrick McCarthy, Silka Spranger and Judith Simon MD.

Ourossogie  is a small town in an underdeveloped Eastern area of Senegal with 20 000 inhabitants, and a regional center for health care. It is the only hospital providing eye-care in several hours drive in each direction. The hospital director, Dr Diouf warmly welcomed our group and assured an excellent working environment.

The Peace Corps volunteers, with the leadership of Meredith Hickson and Ivy Renfro took care of all the logistics: calling patients for their surgical appointment, 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. Ivy and 3 other Peace Corps volunteers worked with us last year in Bakel, which made things much easier, as they were already familiar with the work and did not need to be trained.

The pre-screening of the cataract patients was done by Dr Diallo, Dr Sall and Dr Baa, with the help of the Peace Corps Volunteers. They started to go out to the surrounding villages, mainly at the Ranerou region, 2 months prior to our arrival and they scheduled 200 patients for us. As one of our doctors cancelled and we had only one surgical microscope (the local one was not suited for eye-surgery), only 15 patients per day were called in for surgery. Most of these patients showed up and most of them were good surgical candidates. We also operated on a few patients who showed up and were not on the schedule, but only if they were bilaterally blind. We also operated on a 10 year old child in general anesthesia. We offered bilateral cataract surgery but the father did not consent. His other eye will be operated on by Dr Diallo after our departure, for free.

During our 10 surgical days performed the following surgeries:

115 cataract surgeries, 110 with PC IOL, 4 with AC IOL – 1 was   subluxated cataract – and one with no IOL.

The primary goal of the mission was not to perform cataract surgeries but to train dr Diallo in the technique of small incision cataract surgery (SICS).  He has been performing ECCE with sclero-corneal incision and sutures for 5 years. He is a very talented surgeon and he made great progress, at the end of our mission he could safely perform uncomplicated SICS in 15 minutes, with good results. He was also trained in performing complicated cataract surgeries. We donated an operating microscope “Endure” with excellent optics to the hospital which is portable, so he would be able to use it also on outreaches. We also donated 3 surgical instrument sets to him, and also a direct ophthalmoscope, a slit-lamp, other surgical supplies and eye drops. We also trained Dr Sall, an ophthalmic technician with excellent knowledge of ophthalmology in surgical assisting. We trained both Dr Diallo and Sall giving peribulbar anesthesia, in the use of intracameral Cefuroxime to prevent endophthalmitis, and in the use of intravitreal Vancomycin to treat endophthalmitis. We trained them and the hospital personnel in the use of a new autoclave which was donated to them a while back but have not been in use because of lack of in-service. The use of the new autoclave is a big advance as the one in use previously took over 2 hours to sterilize and this one took about 40 minutes.

We distributed about 300 pairs of glasses, mainly reading glasses. We donated 500 pairs of glasses, mainly reading glasses and some myopic glasses to the hospital for further distribution. All postoperative patients received sunglasses for light protection.

Overall, this was one of our most successful missions ever, not so much regarding the number of surgeries we performed but because of the teaching aspect. Dr Diallo made a huge progress and after our departure he will be able to perform cataract surgeries much faster, cheaper and with significantly better results. With the  new microscope he will be able to tackle complicated cataracts and monocular patients. He was already on a relatively high level professionally which will make it possible to develop further on his own. He asked us to return next year, but we answered that then probably he will be the one who can teach us!

We want to say a huge « THANK YOU » to the Department of Ophthalmology of the Ourossogie Regional Hospital, especially to dr Diallo, Sall and Diouf, and  to the Peace Corps of Senegal for making our mission possible.

RAPPORT D’ACTIVITE

Dans le cadre de la coopération tripartite entre le Centre Hospitalier Régional de Ourossogie, l’équipe d’ophtalmologistes de l’ONG (Right to Sight and Health) des Etats-Unis  et les Volontaires de la Corps de la Paix s’est déroulées du 3 a 14 de septembre 2012.

Nous avons opérée 115 de cataractes :

EEC+ICP   110

EEC+ICA 4 (1 étaient cataractes subluxee)

EEC sin implant  1

Nous avons formée Dr Abdulaziz Diallo pour faire le technique « phacoalt » . Il est un chirurgien excellant, nous sommes très satisfait avec son progrès. Il a opéré’ tous les patients qui avait un cataracte incomplexe et un autre œil avec l’acuite’ visuelle satisfaisant.

L’hôpital a un microscope sans coaxial illumination avec quoi ce n’est pas possible d’opérer les cataractes compliquées. Notre ONG a donne’ un microscope de très bonne qualité « Endure » à l’hôpital qui est aussi portable. Nous espérons que Dr Diallo va l’utiliser pour faire les chirurgies plus complexes, avec moins de complications. Aussi on peut faire les camps de cataractes avec ce microscope.

Nous voudrons demander a’ vous et a’ Dr Diouf de supporter Dr Diallo pour être capable de opérer avec le nouveau technique sans fil. Les résultats son considérablement meilleur a’ cause de beaucoup moins de astigmatisme avec cette technique. Il a besoin un kit « phacoalt » ou les lames « Crescent » et « slit » pour ca. Nous avons montre’ a lui l’usage de intra caméral Cefuroxim a la fin de la chirurgie. Cette peut remplacer de les antibiotiques subconjunctival, pour la prévention d’endophtamite. Il est beaucoup plus efficace et moins cher : Il faut utiliser 1 mg per patient et une bouteille de 750mg (originalement pour usage intervenus) coute 4$ et bon pour 1 semaine après le dilution.

In addition nous avons forme’ Dr Diallo et Dr Sall (TSO) pour utiliser le anesthésie peribulbar en lieu de retrobulbar – moins risquée. Nous avons forme’ dr Sall pour être infermière stérile pour assister dr Diallo pendant la chirurgie. Nous avons eux enseigne’ de traiter l’endopthalmite postopératoire ou traumatique avec injection de Vancomycin intravitreal.

Nous avons donne’ 3 complète sets chirurgical a’ la département de ophtalmologie, aussi 1 ophtalmoscopes direct rechargeable, et une lampe a feinte.

Concernant les vices de réfraction, d’environ 300 verres correcteurs ont été distribuées pour les presbyties, myopes and hyperopes, et des verres de soleil pour tous les malades opérés.

Tous les malades opérés ont respecté leur rendez vous à J1 et presque tous a J4 et ont bénéficié gratuitement  des médicaments pour leur suivi.

Nous sommes très reconnaissant  a’ Dr Diallo , Dr Sall et Dr Baa pour nous accueillir, pour faire le dépistage des patients et pour travailler beaucoup d’heures tout les jours et très dur pendant le mission.

Nous remercions aussi a Dr Diouf et a’ le personnel de l’hôpital pour nous aider en tous les aspects de notre travail.

Judith Simon

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RAPPORT D’ACTIVITE’

Dans le cadre de la coopération tripartite entre le Centre Hospitalier Régional de Bakel, l’équipe d’ophtalmologistes de l’ONG (Right to Sight and Health) des Etats-Unis  et les Volontaires de la Corps de la Paix s’est déroulées du 5 a 15  décembre 2011.

Nous avons opérée 156 de cataractes,

EEC+ICP   144

EEC+ICA 11 (2 étaient cataractes subluxee)

EEC no IC 1

Nous avons aussi opérée :

3 ICA secondaire pour aphakes

2 Gunderson flap

1 pterygium affectant l’axis visuel

2 tumeurs de la conjonctive

1 trauma pénétrants

1 reoperation de trauma pénétrant

1 reoperation pour résiduel cortex

1 corneal scraping

1 gros chalazion

1 entropion

Le total des chirurgies fait est 170.

Nous avons commencer de formée Oumar Tal Kane technicien supérieur de ophtalmologie  pour faire le technique « phacoalt ». Nous sommes satisfait avec son progrès mais il a besoin plus de formation de cette technique pour être capable de le performer seul. Il a fait de dépistage pour 140 patients pour chirurgie de cataracte pendant les 3 mois précédant de notre visite. Il a travaille’ extrêmement dur, de 8 heur de matin a 8 de nuit chaque jour pendant le mission.

Amadou Fall a passe’ 3 jours avec nous et nous avons commencer de le formée aussi pour faire le technique « Phaco-alt ». Il est un chirurgien avec beaucoup de talent mais il a besoin beaucoup plus de formation – pendant son formation en Gambie il a fait seulement 17 ECCE et 1 Phaco-alt.

Nous avons montre’ a Dr Kane et Dr Fall l’usage de intra caméral Cefuroxim a la fin de la chirurgie. Cette peut remplacer de les antibiotiques subconjunctival, pour la prévention d’endophtamite. Il est beaucoup plus efficace et moins cher : Il faut utiliser 1 mg per patient et une bouteille de 750mg (originalement pour usage intervenus) coute 4$ et bon pour 1 semaine après le dilution.

Nous avons donne’ 2 complète sets chirurgical a’ Dr Kane,  aussi 1 ophtalmoscopes direct rechargeable, et quelques ICPs et ICAs, Ocucoat, fils de 10-0 et 4-0, beaucoup collyres des antibiotiques et stéroïdes.

Concernant les vices de réfraction, d’environ 200 verres correcteurs ont été distribuées pour les presbyties, myopes and hyperopes, 16 verres pour les aphakies et des verres de soleil pour tous les malades opérés.

Nous avons donné 800 de lunettes pour les presbyties a l’hôpital pour distribuer a les patients qui l’ont besoin gratuitement.

Tous les malades opérés ont respecté leur rendez vous à J1 et presque tous a J4 et ont bénéficié gratuitement  des médicaments pour leur suivi.

Vendredi nous avons visité le département d’ophtalmologie de Tambacounda hôpital et avons rencontré Dr Cisse, Dr Assan et Gallo Diallo. Nous étions très satisfait et heureux de savoir que Gallo Diallo fait seulement le technique « Phaco-alt »  maintenant. Nous avons vu quelques patients postopératoires de lui et les résultats étaient excellents!

Nous étions déçu parce que on n’utilise pas l’autoclave que nous avons leur donné. Nous avons expliqué l’usage et nous avons démontré comme il marche. Nous avons donné l’indicateurs. Dr Cisse a promis de commencer de l’utiliser-il est beaucoup plus vite que le autoclave avec chaleur sec et peut stériliser aussi les plastics.

Nous sommes très reconnaissant  a’ Dr Kane et Gaussa Diallo, l’assistant de Dr Kane pour nous accueillir, pour faire le dépistage des patients et pour travailler beaucoup d’heures tout les jours et très dur pendant le mission.

Nous remercions aussi à Dr Balde et au personnel de L’hôpital pour nous aider en tous les aspects de notre travail.

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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 2^nd 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

1 entropion

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.

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Last year when we were in Ghana, our group was asked by Dr. Jacques Kemabia to do an eye mission in Cameroon. He is originally from there but has been working in Ghana for the past 20 years and is one of the most highly respected eye surgeons in West Africa. He did many outreach programs in remote areas in Ghana and in the neighbouring countries, and now he wanted to help his own people. In his words: “I have been in so many bushes, I finally wanted to be in my own bush.”

So we agreed, and he worked arduously on organizing this mission for nearly a year. He suggested that we should go to Tonga, where his family originated from. He used his own vacation time and money to travel there twice so that everything would be in order by the time we arrived.

Cameroon is a country slightly larger than California on the West coast of Africa, with 22 million inhabitants. It is called “Africa in miniature” as it contains much from elsewhere on the continent, from every type of African people to every form of landscape. It has over 275 ethnic groups. Its GDP per capita is $2300, comparable to Ghana, and 1/20^th of the USA. Its healthcare is worse than Ghana’s, as there is no national health insurance. It used to be a French colony and became independent in 1960. It had only 2 presidents since, and even that it is officially a democracy, it has many features of a dictatorship, including suppression of opposition parties and widespread human rights abuses. It is also one of the most corrupt countries on the world.

We flew into Duala, a bustling port city of about 4 million inhabitants, the largest in Cameroon.  All of our 15 bags miraculously arrived. We were greeted at the airport by Dr Kemabia and his friend, and two self-appointed “helpers” who soon became twenty. There was a pandemonium, everybody screaming, running around, grabbing bags haphazardly and demanding money brazenly. We Americans were upset, confused and intimidated by this scene, but our African friends were laughing: “Welcome to Cameroon!”  It was truly incredible that all our bags made it to the car.

We were taken to the house of Jacques’ brother, who was a retired customs officer. It was massive and beautiful, with a guesthouse, servant’s quarters, a large garden and a swimming pool. We were served a delicious dinner by a liveried waitress, with French wine; it was quite an unexpected welcome.

The next morning we drove up to Tonga, a 200-mile drive, which took us six hours. Tonga is a small but lively town of the Bamileke people, with 16,000 inhabitants. The climate is relatively mild, with temperatures in the 90s during the day and in the 70s at night, and there are no mosquitoes or malaria. The Bamilekes are considered hard working and thrifty; they are excellent businessmen and value education highly. In general they are more prosperous than the other tribes.

The Mayor of Tonga, Monsigneur Ola Didier, generously offered us his weekend house to stay in. It was an enormous building with wrought iron gates and fence, a well-kept garden, its own well, and a multitude of rooms with luxurious leather furniture. It was quite absurd and pathetic to have such a house in a town where the majority of the population lives in mud huts, in abject poverty. It is a status symbol in Africa to build a large house in one’s birth village, even though the owner usually doesn’t spend much time there. But the house was rotting from the inside: water was leaking into it from many places and the repairmen could not fix the leak. The air was damp inside with a terrible odor, the walls and beds moldy, cockroaches scurrying in every direction. But this was still the best place we have ever stayed in Africa. The caretaker was a somewhat mentally challenged, friendly, and lonely man called Alinu, who had an elaborate and absurd ceremony of opening the house and the rooms for us, involving several keys hidden in different places. Usually it took us at least 15 minutes to get in. Sometimes we had to climb over the spiked gates, which was a bit nerve-racking at the end of a tiring day.

We arrived Saturday and immediately started to set up the clinic and the operating room (OR). First we had to decide on a location. There are two “hospitals” in Tonga, a Catholic Mission Hospital with three nurses and two midwives but no doctor, and a government hospital, with a new doctor who had arrived recently—there had been no doctor there before. We chose the Catholic Mission Hospital for our work, as it was in a somewhat better condition and they had running water and a generator, both of which the Government Hospital lacked. Around 9 P.M. Jacques suddenly remembered that we had been so busy with the organization that we had forgotten to visit the Chief! He hastily called him and arranged a meeting. It is customary in Africa for visitors to see the local chief upon their arrival, tell him about the purpose of their visit and ask permission to work. So we went, and even though the chief seemed upset about the late notice, he, few of his wives and the village elders welcomed us. In Cameroon the function of local chiefs is more limited than in Ghana.  They preside mainly over land disputes. The government provides for the rest of the municipal functions.

On Sunday we finished unpacking and setting up the clinic and OR. It was challenging as always, but after so much experience with so many missions, it went smoothly.  We had to deal with the usual broken taps, refrigerators, doors, as well as a cramped working space with very few electrical outlets, missing bulbs, etc. We purchased two fans for the OR as it was hot during the day, but the electric currant could not accommodate these together with the autoclave, which we had to run constantly as we had two microscopes and operating tables. It heated the room up like a steam bath. It was not easy to work in these conditions but we had no other choice. We hadn’t completely unpacked when the patients started to arrive a day early, so we started our examinations then.

Our meals were provided by Jacques’ sister Olga, and the cook, Patrick. We often had to wait an hour or two for our dinner, as Patrick was in town making matches on the internet or playing soccer instead of preparing our meals. But his employers never got upset with him. He was a decent cook, and anyway, what’s the rush? The local vegetables and fruits were excellent: tomato, avocado, plantains, potatoes, mango, pineapple, and banana. But the meat was a bit strange: chicken consisted of mainly bones and skin, and we never got a taste for bush-meat (different kind of animals hunted down in the forest, the main source of protein besides fish for most Africans).

On Sunday we had a chance to meet Jacques’ father who was 93 and nearly completely blind from glaucoma, but mentally intact. He used to be a meteorologist. He once had three wives simultaneously but two were now deceased. Together they raised 19 children and the whole family lived peacefully together.

Monday we started work. Two volunteers, Paul, an eye-nurse, and his nephew, Vincent, who was an optician, screened the patients. They were decent and hard-working people. They were building an eye clinic in Tonga and were hoping to get future patients this way. Jacques examined those who had problems, usually over a hundred people daily, and we saw only the ones he deemed to be candidates for cataract or eye plastic  surgeries. Communicating with the patients was a major problem. Most of them spoke Tonga and some French, and we had only one translator, who spoke their language but minimal English. Even the two members of our group who spoke French had trouble understanding the local accent. As a result communication was limited. We never knew how much of the explanation got through to the patients. When I complained about this to Jacques, he said that patients hardly ever get so much explanation (i.e. 2-3 sentences) about their medical conditions in Africa! We had several patients with languages nobody else spoke (in Cameroon there are 160 different dialects), and we usually let a family member come in and hold their hand during surgery to calm them.

The location of the OR was not ideal; the blind patients as well as our group had to pass through the maternity ward each time we entered, where women were breastfeeding their babies, surrounded by their families who were busy cooking and caring for them.  Adjacent to the OR was the birthing suite were the fridge stood, and we had to enter several times daily to access it. This did not bother the mothers giving birth, or at least they did not show it. Interestingly, we did not hear a single moan or scream ever from them, only the newborn’s cry.  We were told it is frowned upon for women to scream when giving birth.

On the weekend we went to visit the grave of Jacques’ and Olga’s mother. It was in a little sepulcher about 20 miles from Tonga, with the second’s wife’s grave right next to it. We entered, and Olga told her mother about us, what we were doing here, that her son brought the Americans here to help the people of Tonga. Then we just stood there silently for a few minutes before leaving.

Then we paid a visit to the Chief again, this time in his palace in Bandunga. We arrived unannounced, and we found him alone watching TV. His palace was a 1-floor medium-sized house filled with artifacts, mainly presents to the previous chiefs and to him: statues, masks, plates, paintings, leopard-skin, and a large throne. He offered us beer and soft drinks. He told us the story of his chiefdom: He was in his 40s, an established engineer, when his father passed away. His father willed that he became the new chief. The office of the chief is inherited and the chief in power appoints the next chief, usually the son whom he considers the most apt for the job. He absolutely didn’t want to become chief, but tradition forced him to accept the position. In the beginning he performed the functions reluctantly, but with time he got used to it. He had four wives but married only the first one in the Catholic Church, as the church doesn’t recognise polygamy. As a chief he is expected to have many wives; this is a sign of power and affluence in Africa (much like a fancy car or a yacht in the US).

During colonialism the tribal societies were superimposed with centralized governments, but in some instances they have retained or regained partial self-government. The function of a local chief is somewhat different depending on the country, the area and the tribe. Generally it involves decision making in land disputes, judging personal disputes, helping people in need, organizing political gatherings, keeping contact with the government, etc.

On Saturday night we decided to visit the local nightclub of Tonga. It was an unforgettable experience. Young men and women—usually arriving separately—were lined up at the entrance in their best outfits, hair beautifully made up. Inside there was deafening music, a growing crowd was dancing amid mirrors, flashing coloured lights, on an uneven floor which posed quite a challenge. No one seemed really drunk. The heat and the consequent odour of sweat were nearly unbearable at first but we soon got used to it. There were mostly men dancing, the women sitting shyly at tables. The whole place was just brimming with life and energy.

In the second week we continued to screen and operate on patients.

As word got out to the surrounding villages about our work, more people arrived early each morning.  First we would see our post-operative patients while preparing the new patients for surgery.  In order to maintain a peaceful and quiet environment, all the new arrivals were seated under a tent and entertained by a few of our group singing a few African-American spirituals and any songs that the people wanted to share with us.  This is always a great way to “break the ice” and produce smiles in those who had to wait long hours to see us. Later we added a small comedy skit with wrestling, which was even more successful than the songs, and had to be repeated frequently.

Each day we walked through the village of Tonga several times on the way to work or to our meals.  We always passed the two town wells, constantly in use, being pumped usually by children. The villagers waited to fill large buckets with water.  We also passed by the adobe houses nestled in the surrounding heavily vegetated hillsides.  No matter what time of the day or night we walked through town there were always multitudes of people on the streets busy carrying things, hurrying somewhere, selling all kinds of stuff, cooking, eating, drinking, talking, shouting, laughing. There was loud music coming from many stores. It was truly a village teeming with life.

On our last day in Tonga we packed up and bid farewell to everyone we had worked with.  On our way to back to Duala we stopped in Bafoussam, a large town to tour the eye hospital and once in Duala we toured the eye hospital there, both of which were superbly run and staffed. It was quite a surprise to see these facilities; we didn’t understand why we had had so many patients if there was good quality and relatively affordable eye-care nearby. We were told that even though cataract surgery costs “only” 100$, many patients can’t afford it, and many don’t trust their own healthcare because of previously poor outcomes.

On our last day we did manage to visit the beach in spite of a sizeable thunderstorm. We decided to take a swim in the ocean, but ran in panic to the shore as a lightning bolt struck right next to us. At the airport we learned that our flight had been delayed by 12 hours so we happily spent one more night in Cameroon.

Judith Simon