Mission ophthalmology report 2011 Tambacounda, Senegal
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This mission was organized in Senegal by the Peace Corps with close cooperation from the Department of Ophthalmology, Regional Hospital, Tambacounda, Senegal.
From the US, five members of the nonprofit organization “Right to Sight and Health” participated: Christine Hedges PhD, RN, Dominga Villagomez RN, Richard Alsobrook, OD, optometrist, and two ophthalmologists, Donald Macdonald MD and Judith Simon MD.
Tambacounda is a large town with 80 000inhabitants, and a regional center for health care. It is the only fully functioning hospital in several hours drive in each direction.
The head of the department, Dr Bacisse Bassouri, (ophthalmic nurse) and the 2 other ophthalmic nurses of the department, Landing Sane and Assane Diatta prescreened many hundreds of patients for cataracts and scheduled 200 patients for cataract surgery. The Peace Corps volunteers with the leadership of Katy Sterba, who has excellent organizational skills, took care of all logistics aspects of the work : Relationship with department workers, patient flow, dealing with the health insurance and the hospital administration, translation, preoperative and immediate postoperative care, biometry, and working as circulating nurses. They also took care of all the needs of our group from the US, including transportation, lodging, food, and entertainment.
We performed 183 cataract surgeries, 172 with PC IOL, and 11 with ACIOL. (Out of these, 2 were subluxated cataracts.) There was one reoperation of a patient with prolapsed iris. We had 2 operating tables and 2 microscopes, that is how we could do that many cases.
We operated on the second eye of about 50 patients. These surgeries were scheduled only 4 days after the first, by the local nurses. We felt uncomfortable operating on the second eye so soon, but it was too late to mess up the schedule. Later we realized that this was due to practical considerations as most patients came from faraway villages and camped out in Tamba with family or friends for the 5 days.
We trained Gallo Djallo, a nurse and an « operator » (nurse trained to perform eye-surgery) in the technique of SICS. He was an excellent surgeon and learned it really quickly. After the 3rd day he was operating alone, faster and with better results than us. Previously he performed ECCE with corneal incision and sutures, and most of his postoperative patients had very high astigmatism, even after removing all the sutures. We donated 2 surgical instrument sets to him, and a small autoclave is being ordered for the department. (Presently they have only an extremely large one which takes hours to sterilize and the sterility is not complete.) We also trained him in the use of intracameral Cefuroxime, to prevent endophthalmitis.
We distributed about 500 pairs of glasses, mainly reading glasses and 21 pairs of aphakic glasses. All postoperative patients received sunglasses for light protection.
We donated 2 direct ophthalmoscopes, a 78 D diopter lens and an indirect ophthalmoscope with a 20 D lens to the department. (They had only battery-operated ophthalmoscopes which they have not been using as the cost of batteries is prohibitive.) We trained them in the use of these, which they were more or less familiar with already.
We also learned a lot from the local eye-nurses, mainly how one can still work with minimal instrumentation. They operate with only 2 people in the room, vs. 4 in the US. Also they showed us how to check eye-pressure without fluoresceine, even without anesthesia.
Overall, this was our most successful mission ever, regarding the number of surgeries and also the teaching aspect. We want to say a huge « THANK YOU » to the Department of Ophthalmology of the Tambacounda Regional Hospital and to the Peace Corps of Senegal for making this possible.