#willseye

Addis Ababa, Ethiopia

My last journey of the year: Ethiopia.  The WHO recommends that sub-Saharan Africa has approximately one ophthalmologist for every 250,000 people.  Unfortunately, Ethiopia falls far below this recommendation, with only one ophthalmologist for every 1,500,000 people.  This grossly underserved area of the world is not alone in its fight against blindness, though.  One of the most exciting parts of this year was the chance to get to work with the Himalayan Cataract Project (HCP).  Started by Geoffrey Tabin and Sanduk Ruit, the organization has been traveling to the farthest corners of the world to combat reversible blindness.  HCP has been working tirelessly for decades to make Ethiopia an example of how even the deepest pockets of blindness can be reversed.  The first week I arrived, I was amazed to see that 41 residents were able to sit for the International Council of Ophthalmology’s annual standardized exam.  Talented faculty, knowledge hungry residents, and the support of organizations like HCP make me optimistic about the future of eye care in Ethiopia.  For the time being, however, it will take many more years and many more people to dedicate themselves to improving education and eye care in Ethiopia before blindness can be eradicated in this corner of the world.  

Kigali, Rwanda

When most people hear the name "Rwanda", they immediately think about the dark past and aren’t familiar with its bright future. The country has, indeed, endured tremendous struggles and the scars are still very visible if you take a close look. However, the nation has found a way to persevere and slowly heal its wounds. Since then, Rwanda has been steadily increasing its influence as an island of stability in Africa.

NGOs have taken notice of its relative lack of corruption and heavy investment in infrastructure.  Rwanda is an ideal place for Wills Eye and other global eye specialists to dedicate time and effort. Although there are talented ophthalmologists in the country, they have all been trained outside of Rwanda and are in serious shortage.

I spent three weeks in Kigali working alongside Drs. John Nkurikiye and Ciku Mathenge. Together, we reviewed and updated the College of Ophthalmology of Eastern Central and Southern Africa (COECSA) accreditation guidelines.  Additionally, I did an analysis of the human and physical resources in Kigali to identify any gaps in education that might arise during our efforts to start Rwanda's first residency program.

I also toured a local diabetic clinic in Kigali that sees younger type I diabetics and many type II diabetics. We started laying the groundwork for Rwanda's first teleretinal screening program. Telemedicine has been used in the USA for years to screen patients for diabetic retinopathy. Our VA hospital system does an exceptionally effective job of this. Many countries around the world have also undertaken initiatives to use telemedicine for eye health. This exciting chapter in Rwandan eye care will give us valuable information about the state of diabetic retinopathy in the country and allow Rwandans to get early intervention before irreversible blindness sets in.

I recently returned from my trip abroad to Haiti. It was quite different from my other CAGO experiences thus far in several ways. Particularly, it resembled a surgical mission trip much more than any other ventures in which I have participated this year. We set off at 5am from Wills Eye, flanked with the ten bags containing hundreds of pounds of medical supplies we had packed over the preceding weeks. The team consisted of my CAGO mentor, Brad Feldman, Donnae, our top notch surgical scrub nurse, Brynn,  one of the Wills’ surgically gifted third year  residents, and my sister Brianna, who is currently enrolled in the pre-medicine track at JMU. After navigating through customs at the airport in Port-au-Prince, we were finally on our way toward Fond-des-Blancs, a remote village nestled in the mountains about 70 miles from the capital. The journey took over four hours on narrow dirt roads that hugged the mountain side. We journeyed in total darkness, as much of the country still lives without electricity; we relied on the headlights rather than streetlamps to guide our way.  Abruptly, amid the darkness there was an island of light. As we drove closer, scattered street lights lit the road, which had just as suddenly become paved.  And then, before us was a small city of lights encompassed by a gate; we had arrived at St. Bonafice hospital. It was quite literally, a beacon of light in the darkness: the only source of medical treatment for miles.  We were greeted with much excitement, and quickly whisked away on an impromptu tour by the incorrigibly optimistic, tirelessly hardworking Anshu Chandra, who the founder of the department of Ophthalmology at St. Boniface hospital.

Our first day in clinic opened our eyes to the massive task at hand and the impressive strides made by Anshu, alone in this remote place with her vision of what it could be. Trained as an optometrist in the U.S., she made Haiti her home just under a year ago. Within that time she has single-handedly secured space within the hospital, trained local villagers to serve as ophthalmic techs, and initiated a weekly educational session to improve the medical fund of knowledge of those working in the clinic in order to medically manage as much ophthalmic pathology as she can. Moreover, she has secured an impressive amount of equipment donations and has outfitted her home-grown clinic with 4 slit lamps, a YAG laser, SLT laser, visual field machine, and an OCT. Having screened the patients for potential surgical intervention prior to our arrival, the pathology we saw was extreme and advanced. Nearly everyone we saw needed our attention but with just 4 surgical days available, advanced cases were prioritized, and the rest were turned away with regret.

The next few days were a blur of complex surgical cases on wide-awake patients staring rock-steady into our wobbly microscope with only a local anesthetic block on board. They ranged from 12 to 94 years and they all showed stoicism long put out of practice in our society. The OR staff had been similarly plucked from the village and taught to navigate an operating room by the residing surgeon. Ophthalmic surgery was a new experience for them, and they took the intrusion of our surgical team in stride. They stood dutifully by Donnae, learning the names of the instruments and steps of the surgeries. We continued our case load until past midnight on some evenings, only to leave the OR staff turning over the room for an emergency C-section. It goes without saying that the needs of the community were many and the number of men and women with the expertise to help were few.

Despite our busy week, we found one night to explore the village. We wandered down the lane under a sky so intense with stars our necks ached from staring up at them. We followed Anshu down to the only watering hole in town. As we neared the gathering we noticed that the “bar” was an  immense  metal cargo shipping container that, once emptied, had been filled with a small fryer, a freezer, and stools. A plastic sheet had been draped from the container’s edge to poles about 6 feet away to create a covered outdoor space, which had been filled with tables and hanging lights. Though it did not lack in creativity, the meager set up felt striking compared to the fine restaurants and swanky bars of Center City. This was “going out on the town”, here in Fond-des Blancs.

We looked terribly out of place.  A large speaker had been set up outside and a young man was thumbing through his phone, looking for the next song to play. Once selected, the crowd erupted into animation. There were fancy steps, and swiveling hips. There were cheers and whoops and laughing. Their joy was obvious. Their joy was infectious. Among us at first, it was an imperceptible sway, and a tapping of the foot. And then, in an instant, the locals traversed space between our group and theirs, reached into the depths of our foreign crew, and pulled us into their movement. It was like water bursting through a dam. The next 20 minutes were a blur of motion and laughter. I stilled for a moment to take in the joyful chaos around me:  a group of strangers entangled in an alcove of merriment carved out by villagers who lived a life worlds apart from our own. And yet, in that moment, we all shared in this contagious delight brought about by music and movement, a commonality of humankind that transcends language and culture and status.

As on my other ventures abroad, I learned a great deal about the medical system in Haiti, and enjoyed the challenges I met both surgically and personally while spending time there—bucket showers and goat meat and all. But, as always, what I carry away with me in my mind are the moments when the shared human experience reveals itself to me. I tuck them away, and revel in them later. And then, I place it amongst the trove of other moments gleamed from across the cultures I’ve been fortunate enough to briefly become a part of, and marvel at the threads that tie us all together.