Saturday, January 27, 2007

The Final Weekend

After church today, we all went on a nice hike to Ruben’s (the optician's) village on the road towards Malawi. Then we headed to the Ang’s for dinner.

Todd really enjoyed the karaoke machine.

Yesterday was Todd’s 31st birthday, so we’ve managed to celebrate several times. Yesterday the Angs brought over a home-made cake.
Tomorrow we will have a joint birthday party at the Peduche’s for Todd and B-boy. It’s a weekend full of celebrations – before Todd and I have to say good-bye to Zambia. I can’t believe our time is coming to an end so quickly!

By the way, here is a photo of a hairy, scary tarantula that we found outside the Angs' house. Have I ever mentioned that I have arachnaphobia? Ewww!

Thursday, January 25, 2007

Blessings in the Midst of Blackouts

Another black out. Thursdays are our surgery days. We were just setting up to begin operating when the power went out again. There was not enough spare diesel to run the generator for all of our 10 scheduled cases, so we decided to wait it out. In the meantime, Mr. Limwanya entertained me with pictures from the various eye camps they had held in villages throughout the Eastern Province of Zambia. Although most of the pictures were faded or overexposed or underexposed, I could sense the joy and excitement of these once-blind patients who were granted the sight-restoring surgeries.

As we were enjoying the photos, Mr. Mwalle – the father of one of our patients (an 18 year old boy named Stephen) – came into the office to chat with Mr. Limwanya. He told us that he works closely with some non-governmental organizations abroad. He stated that he was quite impressed with the work we were doing at Mwami and wanted to assist us in finding outside donors.

The power outage being our excuse to occupy ourselves with something other than surgery, Chipo, Mr. Limwanya, and I began to brainstorm. We drafted a mission statement as well as a letter soliciting donations for our Eye Centre. We worked until 2 pm, at which point we broke for lunch, and then we finished the draft from 3:30 – 6:00 pm. I believe it was not by chance that Stephen required a lengthy stay at our hospital; I believe God intended to put us in contact with his father. Perhaps God also turned off the power so we would have the opportunity to hold this impromptu meeting. Whatever it is that God has planned for us, I am excited.

Just a side note: today I had my second hot shower during my stay in Africa! Yay! The hot water is fixed! What a luxury. =)

Wednesday, January 24, 2007

Kalichero Muleyi

This morning I was supposed to meet Mr. Limwanya at 8 am. I waited…and waited. He is normally very prompt. However, it was 9:30 am by the time he finally arrived. Apparently, the Eye Centre landcruiser had gotten a flat tire this morning, so he had to change it out for the spare. I’m surprised that with the horrible condition of all the roads the tires in Zambia last as long as they do. Nonetheless, when we got to Chipata we stopped at the autoshop to repair the original tire and take off the spare again.

Finally we were on our way to Kalichero Muleyi. Wednesdays are always “outreach days.” We arrived at the clinic close to noon, and there were about fifty patients waiting outside for us. What a scene! After a prayer, we began to see patients. Mr. Limwanya and I split up the work so we could be more efficient – I saw close to twenty patients and he saw more than thirty. Although English is the national language in Zambia, many people in the remote villages only speak their tribal tongue. Since I did not know Nyanja, I often had to ask for translation. Nonetheless, we worked non-stop until 4 pm, at which point we broke for lunch. The clinic staff had prepared for us a delicious meal of nshima.

We headed back to Chipata with five patients whom we had scheduled for surgery tomorrow. One of the patients – a blind, older lady – felt nauseated and vomited all over herself on the ride home. Poor thing.
Anyways, Candice and Sarah -- the two girls from Walla Walla College -- are supposed to arrive tonight from Lusaka! They are both pre-med and commited to serving in Mwami for six months as student missionaries. I am looking forward to meeting them.

Tuesday, January 23, 2007

Wish List

I have been asking Mr. Limwanya to provide me with a “wish list” of things that he would like to see happen at the Mwami Eye Centre. Some of the urgent needs include:

1. Another landcruiser vehicle: Frequent trips into the villages to bring pre-op and post-op patients to and from the hospital and crossing muddy streams and unpaved dirt roads require that they have rock solid transportation. Also, when they do “eye camps,” going into villages for 2-3 weeks at a time to do 80-100 surgeries, they need a large vehicle to take all their personnel, equipment, and other supplies. Currently have one good car which was donated by CBM (Christoffelblinden mission) about two years ago. However, that is not large enough for their purposes. They are in desperate need of another vehicle.

2. A teaching microscope and video/computer monitor for the operating microscope: For teaching purposes it is essential to be able to see what I going on during surgery or even on slit lamp exam during clinic visits. A teaching scope is an integral piece of equipment. A monitor would be a treat.

3. A slit lamp for the Chipata Adventist Clinic: Every Monday and Friday we go to “town” (Chipata) to see patients. However, we do not even have a slit lamp there!

4. Other equipment: an indirect ophthalmoscope, video camera, computer, vitrectomy unit, phacoemulsifier, auto-keratometer, A-scan, B-scan, etc.

5. Additional funding for staff training, staff salaries, expansion of facilities, additional eye camps, additional medications, and more intraocular lenses

I am convinced that God sent me here to Mwami for a reason. He closed doors for me in Lusaka, but opened wide the doors for me to come to Mwami. Even Mr. Limwanya mentioned that perhaps this is the beginning of an answer to his prayers. Although I personally do not have access to the finances necessary to fulfill these needs, I know God can provide a way to get these resources to Zambia. Somehow. Some way. I am excited about this mission field and what lies ahead. And I know that if I follow faithfully in God’s path He will show Himself to be our mighty, omnipotent Lord.

Sunday, January 21, 2007

South Luangwa National Park

Yesterday we had a wonderful day in the wildlife. After a full breakfast, we embarked on a self-guided safari with Chipo as our designated driver. From 8 am – 2 pm we explored the South Luangwa National Park. It was captivating to see so many animals in their natural habitat. We even witnessed an elephant defecating as it nonchalantly walked down the road.

Here are some photos of the wildlife we encountered:

from impalas...

to buffalo...

to elephants...

to giraffes...

to hippos...

to wild birds...

to lizards...

to zebras...

Halfway through our morning on Chichele Drive our landcruiser got stuck in the soft mud. We ended up taking about 45 minutes to extricate the vehicle.

More than a few times during our daytime safari my heart pumped with adrenaline – especially when we were entrapped between two sets of elephants, and also when we were surrounded by an entire herd of buffalo (>100 animals in this particular herd) which was crossing the street. It was amusing to watch them all just stare at us as we stared at them.

We returned to our lodge for a short lunch break, then we headed out again on our night safari – from 4 to 8 pm. This time we were in a real safari car, the kind with no covered roof, making us feel very vulnerable to any animals that might come our way. The safari car was especially built for these extreme outdoor situations and we were literally able to forge through roads completely covered with water. It was a bumpy ride for us in the back row, but terribly exciting and adventurous at the same time.

We spotted many more hippos grazing outside the water. We even spotted a hyena. My only regret is that we were never able to find the wildcats, neither the lions nor the leopards. But at least now I can say I have come to the heart of Africa.

Friday, January 19, 2007

The Morula Lodge

Here I am sitting beneath a mosquito net in the middle of a game park here in South Luangwa, Zambia. Dr. Verna Peduche (an Ob/Gyn), her husband Gemini, her two kids Beth and “B-boy,” Chipo (our fearless driver), Todd, and I made the decision to venture forth to the game park despite the fact that we are in Rainy Season. Chipo is from the Luangwa area, so we visited his grandmother earlier today on the way to the game park.

The first half of the way from Chipata to Luangwa was smooth sailing – the dirt roads were graded so we were literally flying down the road. The second half of the trip was another story althogether. We encountered even more potholes here than in Mwami! Fortunately it had not rained all day, so the roads were not completely flooded. About 1 km from our lodge, however, we encountered a “lake” crossing our path. “No, No! NO!” counseled Todd nervously, “We can NOT go through there.” At that moment on the right side of the road there was a sign pointing down another path that read out as if in warning, “Crocodile Lake.” The road was low-lying, and the surrounding water from the Luangwa River had literally flooded over the road. About a good 10 meter stretch was completely underwater, and there was no way to know how deep the water was or how muddy the underlying dirt would be. If we got stuck, there was a possibility that we could end up as bait for the crocodiles or even the hippopotamuses (or is it “hippopotami”?) that like to congregate in these waters. Chipo bravely forged ahead in our Eye Centre Landcruiser. We almost got stuck, but by the grace of God we arrived safely at the Morula Lodge. “Only in Africa.”

At the Lodge, we were delighted to encounter about a dozen monkeys just lounging around or playfully jumping atop one another. The Luangwa River flows right beside our site, and hippos can be spotted frequently from shore. There are about 8 to 10 chalets scattered around the campus. It is a beautiful, serene spot in the middle of the heart of Africa (locals often say that Zambia is the “real Africa”). The best part about this is that we are getting a huge discount on the lodge (since we’re with a local Zambian and also because it is Rainy Season when business is really low) – it only costs about 25,000 kwacha per person per night (about $6/night). That sure beats the exorbitant prices tourist-loving luxurious lodges like the Chichele Lodge, which can cost $500 for a one night stay.
As soon as we arrived at the Morula Lodge, we immediately prepared food and sat down to a surprisingly exquisite candlelight dinner under a wooden gazebo-like outdoor dining area. Afterwards, we gathered in my room for a short evening worship. The Peduche family is staying in one chalet, and Todd, Chipo, and I are in another. Our chalet has two rooms, so I get one room all to myself since I am the only girl. What a wonderful experience this is going to be. This is the first real safari of my life, and I am excited to see some amazing wildlife tomorrow.

Thursday, January 18, 2007

Operating in the Bush

Today was surgery day. We ended up doing 10 cases – five cataracts, two trabeculectomies, and three pterygium removals.

Mr. Limwanya actually let me get behind the microscope and do some basic, preliminary portions of the surgeries – clamping the superior rectus muscle, making an incision in the conjunctiva, removing the pterygium. Although I was only taking baby steps behind the operating scope, it was my first time actually “operating” on the eye, and it was so awesome! Of course, the power went out twice during our day, meaning that we had to sit and wait for the generator to kick in. Nonetheless, we were able to finish our surgeries successfully.

On surgery days, nshima is served. It is quite a tasty dish, made from ground maize or cassava. It is a true Zambian staple. In fact, the local people say that if they have not eaten nshima, they have not yet eaten. Reminds me of how Koreans need their rice. I had nshima today for the first time in my life; it was served with a green vegetable called rape. Mmmm….

Wednesday, January 17, 2007

Clinic in the Bush

Chanjowe is a very rural town fifty kilometers east of Mwami. It’s in the bush. Every Wednesday, Mr. Limwanya and the Eye Team goes on "outreach" to the rural villages, and the Chanjowe Health Post happened to be our destination today. We were quite busy, as we saw 56 patients from 10 am – 2:30 pm. From presbyopia to allergic conjunctivitis to senile mature catracts to post-operative follow-ups to corneal ulcers to optic neuropathy to retinal detachment to glaucoma – all examined and diagnosed with the naked eye, a flashlight, and an ophthalmoscope.
The toilet was an interesting experience – I had never before gone in a triangular hole surrounded by elevated foot markings.

When we returned to the Mwami Eye Centre, more patients were waiting for us. We have eight surgeries planned for tomorrow – four from today’s excursion and four from prior clinic appointments.

The Angs had us over for dinner again. Once again the power lines were malfunctioning – but only halfway this time – we were running on dim lights at 110 volts. Very strange. As we always say…”Only in Africa.”

Tuesday, January 16, 2007

Congenital Cataracts

Another day has passed. The morning began with a six year-old girl with congenital cataracts on whom we performed bilateral cataract extractions. She required general anesthesia, so we took her to the main hospital OR for the surgery. She did surprisingly well. (Addendum: a few days later, she was running around playing with her friends – happy about her newfound vision but unable to comprehend the true magnitude and life-long impact of that sight-saving operation).

The baby that was delivered this morning breathed her last few breaths tonight. When we checked up on her at the end of the day, she was still in respiratory distress, bradycardic (heart rate in the sixties), and very limp. May God be with her mother and grandmother who will be grieving the death of this newborn baby.

It is hard to believe I’ve been in Africa only one week; for some reason it feels like I’ve been here much longer. And while a part of me wishes I could stay longer to serve in Zambia and get to know these people, another part of me is counting down the days until I can return to my family, my fiancé, a warm shower, my own bed, and even my hospital (despite its flaws, it is a wonderful hospital with modern equipment, accessible resources, a relatively efficient system, and new facilities – all worth millions of dollars that most third-world countries would not even dream of).

Each day that I am here I realize that there is still so much for me to learn before I return to Africa as a missionary. Firstly, I need to learn ophthalmology – not just ophthalmology as practiced in the U.S., but also “bush ophthalmology,” including extracapsular cataract extractions, examination and treatment of eye conditions in HIV/AIDS patients, etc. Perhaps I can also learn to do corneal transplants. I do not know if there is even a single corneal specialist in entire country of Zambia, which has a population of about 12 million people and of which only 12 are ophthalmologists.

Next, I need to learn how to bake bread. “Shoprite” is a supermarket where one can find food/supplies easily, but what it is really known for is its tasty bread. One loaf of bread costs about 1700 kwacha, equivalent to about $0.40, depending on the exchange rate for the day (it was approximately 4200 kwacha per dollar when I left Zambia). Interestingly, however, the people always cue for bread as they wait for it to be made in the oven. Instead of a straight line, however, there is consistently a large mob of people crowding around the bakery counter frantically grabbing loaves as they are distributed. It is an interesting sight. If I could learn how to bake bread, however, there would be no need to participate in the madness of waiting for Shoprite bread.

Other things that I have to learn before I return to Africa include: how to cut hair, how to grow my own fruits and vegetables, how to cook tasty meals with limited ingredients (maize, cassava, flour, potatoes, onions, and garlic), how to drive stick-shift, and how to speak Nyanja (the tribal language commonly spoken in the Eastern Province of Zambia).

Here’s a quick lesson in Nyanja:
Muli bwanji = How are you? (Morning greeting)
Machoma bwanji = How have you been? (Afternoon greeting)
Zikomo = Thank you.
Penya cu mwamba = Look up.
Penya panzi = Look down.
Penya cu manja = Look to the right.
Penya cu mazere = Look to the left.
Tika dye = Let's go eat.

Déjà Vu

Déjà vu. That is what I experienced today. Another newborn baby desperately needed resuscitation. At three am I was rudely awakened from a deep slumber by a knocking sound on my window and what seemed like a man’s voice. Half asleep and alarmed by the strange noise, I timidly called out, “Yes?” This last week for three nights in a row there had been houses in our immediate vicinity that were known to have gotten robbed, so Todd and I were especially paranoid about having an unwanted visitor. “Yes?” I said again, this time a little more loudly. No one responded to my call, so I simply laid my head back down on my pillow, wondering if I had dreamt up the entire scene. However, five minutes later, I heard a distinct, urgent knocking on my window and voice saying, “Doctor, a c-section! The patient is waiting!” I then realized that Dr. Ang was on call and that the watchman had come to awaken us to join him for en emergency c-section. By that time, Todd had awakened to see what was going on. He and I quickly got dressed and walked over to the hospital. The night was dark, but the clouds had cleared, so the stars were unbelievably bright and beautiful.

Todd scrubbed in with Dr. Ang, and I posted myself by the “crib” (a metal tray on wheels covered with a thin sheet) as I reminisced back on my days on Newborn Nursery calls during my Pediatrics rotation. The mother was dark-skinned, petite, and very tired. The c-section was called for PROM (premature rupture of membrane), polyhydramnios (too much amniotic fluid), and fetal distress. When the baby was removed from the mother’s womb, it was limp and blue. Flashbacks of my experience with difficult babies on Pediatrics came rushing back. We bulb suctioned and deleed the baby and gave her oxygen by nasal cannula, but the baby remained limp, did not cry, did not even breathe. I felt for her pulse her umbilical cord, and it was less than sixty. We started to administer positive pressure oxygen, and I began two-finger chest compressions on her. Apgars at 1 and 5 minutes were a pathetic 1 and 1. After extensive resuscitation and some dextrose into the umbilical vein, the baby began to take a few, feeble, faltering breaths. Nonetheless, it was not enough. The anesthetist intubated the baby, and we continued to bag her. By about 30 minutes, she was finally able to sustain her heart rate greater than 100, breathe spontaneously, and her color had improved slightly. I had never prayed so hard for a baby before, and God seemed to answer our prayers as we desperately fought for life. Thank God for his deliverance!

Yesterday, I went to the Chipata Adventist Clinica again with the Eye Team. It was pouring rain (it had rained for twelve hours straight through the night), and we suspected the clinic would be slow. Nonetheless, we had a great turnout with many interesting cases – several severe corneal ulcers, a bad case of herpes zoster ophthalmicus, uveitis, glaucoma, diabetic retinopathy, foreign body, a few manual refractions, etc. I had never before seen such a severe case of herpes zoster ophthalmicus (the re-emerging chicken pox virus that affects the V1 branch of Cranial Nerve V on one side, often affecting the ipsilateral eye) – it covered her entire left forehead and eyelid area with contagious blisters, and it had only begun 5 days ago. Many of these severe cases can occur with immunocompromised states, so we encouraged her to get testing.

Herpes zoster ophthalmicus:

Corneal ulcer:

One mother came in with complaints that her one year-old son had been tearing for the last few days, right eye greater than left. We assumed it could be allergic conjunctivitis. We projected that it would be difficult to invert his lids, but we attempted it anyway. Lo and behold, a 2 mm black foreign body was embedded in his upper eyelid. We successfully removed it and at the same time learned an important lesson: ALWAYS invert the eyelids if you suspect anything fishy might be going on.

Sunday, January 14, 2007

Indian Zambians

Today I met Moosa. His mother is African. His father is Indian. They never married, and Moosa was raised solly by his mother for the first twenty-six years of his life. Then, his mother suddenly passed away while Moosa was in Lusaka studying at the university there. It was at that time two years ago that Moosa finally sought out his father, who lives in Chipata. His father is a medical doctor by training, who turned to business when his own father, a businessman (as most Indian Zambians are), passed away and needed someone to take over the lucrative family business. Now, Moosa’s father has moved on to the farming industry – to be precise, the tobacco farming industry. Moosa’s father eventually married two women – the first is of Indian heritage, the second is African. They are both legally married to Moosa’s father. Their two families do not ever interact; in fact, they live in separate houses on opposite sides of Chipata. Moosa was at the Katuta lodge, a sort of park or resort area on the outskirts of Chipata, with his three half-brothers, the sons of his father’s second (African) wife.

Polygamy is still prevalent in Zambia. In the Eastern Province where I was staying, those men who choose to live polygamous lives will have only two or perhaps three wives. In the Southern Province, however, the Tongan tribe is known for the great number of wives the men often have – six, eight, even ten women – depending on your wealth and status.

Moosa told me of his life adventures – he studied Arabic in Libya and completed a two-year diploma there. Originally, he had wanted to study science and become a physician or an engineer, but the scholarship funding promised him did not arrive on time and he was essentially forced to withdraw from the university. He plans to study public administration in Uganda so he can return to Zambia to help his people. It was refreshing to meet Moosa, a 29 year-old Zambian who has experienced many life struggles yet who is ambitiously aspiring to better himself and his people.

After spending the entire day at the Katuta Lodge, Todd and I accompanied Dr. Ang while he made some house calls. Both families we visited were Indian patients of Dr. Ang’s. Initially, it was surprising for me to see how many Indians have settled in Zambia, but now I have realized that this is the reality in Zambia. Since the late 1800s and early 1900s the Indians colonized the area and set up business. Today, it is the Indian population that owns almost every business on the streets of Chipata. Hence, they are quite well-to-do. I found that these Indians were also very kind, hospitable, and generous.

By the end of the day, Todd and I were tired. Nonetheless, we still had to make the 30 km trip from town to Mwami. Today, the trip took more than an hour because of the heavy rains from the day, which had eroded the dirt road and created an even bumpier ride back to Mwami. I really would like to speak with the Chief about paving the roads around Mwami – this is ridiculous!

Here are pictures from the beautiful Katuta Lodge:

Friday, January 12, 2007

Chipata Adventist Clinic

Another exhausting day! But finally the Sabbath is here. This morning was Day #4 to endure a cold shower. It is actually not too bad. Although it is currently the “Rainy Season” the weather is always between 60 – 80 degrees Fahrenheit. A cold shower anywhere else in the world would be absolute torture, but here in Zambia it is quite refreshing. Every Friday and Monday mornings, the entire staff at Mwami Adventist Hospital meets together for morning worship. After some beautiful a capella singing (Africans can really sing with soul), a short message was given by the hospital chaplain.

At about 8:30 am, Mr. Limwanya and a van full of people headed off to the Adventist Clinic in Chipata, about 30 kilometres away from Mwami. A heavy rain had fallen last night so the roads were in incredibly horrible condition. As I rocked back and forth in my seat up front on the left (Zambia was colonized by the British until October 24, 1964, so according to the British way Zambians also drive on the left side of the road and have their drivers’ seat on the right), I was reminded of the rocky ride called Indiana Jones at Disneyland.

When we arrived at the clinic, we proceeded to say patients. There was no slit lamp available, so diagnoses were arrived at by using a flashlight and direct ophthalmoscopy. Mr. Limwanya said he had no access to an indirect ophthalmoscope, but the budget allowed recent approval for one to be purchased next year. Refractions were all performed using a case of trial spectacles and lenses. Intraocular pressures were obtained using a Schioetz tonometer.

I also spent some time with Ruben, the optician, who actually made the glasses while patients waited. Using a large standard lens, Ruben took pre-made frames chosen by the patient and traced the shape of the frame onto the standard lens. He then chipped away portions of the lens with a crude metal mini wrench-like apparatus. Then, using a spinning wheel, he proceeded to grin the perimeter of the lens until it was smooth. Finally, comparing the lens to the shape of the selected frames, he proceeded to match the two perfectly. I was perfectly amazed at his skill and at the relative simplicity of making spectacles in less than one hour.

After clinic – which was only a half-day clinic due to the upcoming Sabbath – we ran errands (went grocery shopping, checked email, etc.). When I got back to Mwami, it was already time for vespers. After vespers, I ate dinner and I’m now finally winding down. What a day!

Thursday, January 11, 2007

"Bush Opthalmology"

Today I was welcomed into the world of bush medicine – and more specifically bush ophthalmology. In a small town called Mwami where surrounding villagers are very poor, there exists a fully functioning mission hospital called Mwami Adventist Hospital. This morning, Dr. Ang gave us a tour of the facility.

The pediatric ward, the largest ward of the hospital, was filled primarily with PMC (protein malnutrition) cases. As we walked into the unit, the charge nurse there cheerfully greeted us. “How is everything?” inquired Dr. Ang. “Oh, everything’s fine,” he replied. Almost as an afterthought, he added, “Besides the fact that two children died last night of PMC, everything is fine.” We entered a room where six malnutritioned children sat, accompanied by their concerned mothers. Signs of kwashiokor included a distended abdomen, edematous extremities, desquamating skin, anemia, and lethargy. Several of the children looked quite sickly. “This one looks infected,” commented Dr. Ang. The “infection” was in reference to the all-too-prevalent HIV/AIDS epidemic so rampant in sub-Saharan Africa, particularly in Zambia.

Statistics show that one in every four Zambians (especially women) in urban settings is infected – and 16% nationwide. This figure is likely grossly underestimated due to the taboo nature of the disease, denial, refusal to undergo testing, etc. Having heard these statistics in the comfort of the United States is so different from encountering the actual individuals here who are suffering the consequences of this deadly disease. One of the contributing factors to the spread of AIDS is the promiscuity and prevalence of prostitution in the cities. Driving around Lusaka at night, I remember we would hear cat calls from almost every street corner – from street walkers dressed up in hip-hugging outfits. Edward Martin – a tall, African-American bachelor – told me, “It’s difficult to be a single male out here. Sometimes I have to be very direct with the women who approach me. I definitely need a wife.” He mentioned that many Africans believe the myth that if an HIV-infected individual were to have sex with a virgin, he would automatically or miraculously be cured from his disease. Hence, there are an increasing number of rapes that have occurred at local elementary schools, sometimes by HIV-infected male school teachers. This news definitely saddens me.

Continuing on with my tour of the hospital, the other pediatric beds were filled with malaria patients, orthopedic fractures, etc. One boy had been in a coma for two days, but regained consciousness by the time with sam him this morning. His malaria smear was positive (2+), and he had presented to the hospital with seizures. Todd commented, “In the U.S. that boy would have been in the PICU – intubated and monitored closely. This is wild.” I agreed; this indeed was wild.

We continued to tour the male and female ward, the Ob/gyn ward, the HIV/AIDS clinic. Afterwards, Dr. Ang took us to the Eye Care Centre, about a ten minute walk away from the main hospital. Spending the day with Mr. Limwanya, the cataract surgeon, was a fantastic, eye-opening experience (no pun intended)!

There are two main buildings to the Eye Hospital – the first houses the reception area, a diagnostic room, a female ward, and a male ward; the second holds the operating theatre and the accountant’s office. There were about ten patients lined up, awaiting surgeries. Mr. Limwanya had brought these patients from a village 50 kilometres away. This morning’s line-up in pre-op clinic included: a presumed squamous cell carcinoma of the conjunctiva, several senile mature cataracts, a painful blind eye (s/p trauma two years prior), two glaucoma patients needing trabeculectomies, one pseudoexfolation syndrome case, a pterygium, and a six-year old female with congenital cataracts. After assessing their vision and examining them with the slit lamp we prepared to go into the operating theatre.

In the OR, Mr Limwanya and his assistant proceeded to set up everything – they assembled the operating microscope onto an old rickety operating table. The sterile linens and instruments were laid out methodically. A purple-tinted alcohol solution was poured out into the stainless steel basins.

Two autoclaving machines were conveniently situated near the entrance of the OR – both of which were used repeatedly to sterilize instruments immediately after each case so they could be used for subsequent patients.
The resources were indeed limited. The venue was primitive. There was no phacoemulsifier. There was no bovie for cautery. Instead, we used “fire” – a small bottle of fuel with a wick, lit with a match – to heat up a small metal tool, which was lightly touched to the bleeding vessels in the conjunctiva. Irrigation and aspiration was done manually with a bottle of normal saline hung from a metal stand with the tubing attached to a special cannula and syringe. The capsulorrhexis was performed with the “can opener” method. The lens was dislodged by hydrodissection and manually removed. Although in a primitive setting, the sight-saving surgeries were performed successfully and in a timely fashion. It was quite incredible.