Surgery at Zimba Eye Clinic
We were all exhausted after Kilamanjaro- I'll just say that he and Katie encouraged and cajoled me up that mountain. After the descent we had a few hours of rest and then caught a 4 am flight to Nairobi, Kenya where we met up with Cynthia Mardinger, another member of the team. Cynthia is a second year medical student from U. of Calgary and joined us to help Stephen and Katie with their projects in Zambia and carry out a research project. We flew together to Livingston, Zambia where we met Westone Mukuka, the administrator for the International Vision Volunteers (IVV) Eye Hospital in Zimba.
THE TEAM
Westone is a warm, engaging fellow who is also a pastor for his church in Zimba. We learned, to our surprise, that almost all Zambians are christian. We had a day to rest and recover in Livingston and see Victoria Falls, one of the true natural wonders of Africa. The next day the rest of the medical team arrived and we convoyed together to Zimba. The team was comprised of:
Dr. Sue Wallace from New Westminster. Sue and I trained together many years ago in Vancouver and she had invited us to join this mission. She's a board member of IVV.
Dr. Yenjean Hwang (Infectious disease specialist and chairman of IVV) and her husband
Dr. Ivan Hwang (oculoplastic surgeon and IVV board member) are from the Bay area and partners with Dr. Bud Tysinger, the man who started the eye hospital in Zimba many years ago. Dr. Mark Cichowski, an ophthalmologist from Whitby Island , Washington and his wife
Jan (a nurse who does global missions with Mark) rounded up the team.
We were joined by Dr. Brighton Samoyo an ophthalmologist from Zimbabwe who trained in Russia. Our goals were to deliver eye care to as many Zambians as we could and teach Brighton cataract and other surgeries.
SETTING UP
The road to Zimba was well built and immaculate. We learned companies from China built most of the main roads in Zambia. Unfortunately the small side roads are a different ball game and are dirt roads often washed out by heavy rains. The kids went out to rural schools during their teaching and often there were no roads at all. Our first day was to sort out the supplies we had brought. Special thanks to Bausch and Lomb who donated a lot of supplies to us for this mission. Allergan and Alcon also contributed.
We met the local support staff and got acquainted with the instruments and equipment. Unfortunately, we learned the full time scrub nurse was ill and likely wasn't able to work the entire time. Jan was to be conscripted to be the scrub nurse while the doctors would take turns assisting each other. The challenge for us was to get used to unfamiliar staff, equipment and how things worked in rural Africa. We all adapted as well as we could and made things work. The night before we started work, patients started to arrive. Some came as far as 300 to 400 kilometers. It's quite amazing and humbling as many are elderly and had poor vision or are outright blind. They came by bus, car and many walked a long, long ways. Some patients and their loved ones will often camp out in the open by the clinic until they receive their care and sometimes for days after their care for follow-up. Since we came during the rainy season a lot of the roads were washed out and made travel impossible. Sadly, many people couldn't make it.
EYE HEALTH IN ZAMBIA
EYE DISEASES AND HIV
The clinic was very busy and the eye diseases were mostly quite severe. We saw more advanced and bilateral pathology time and again. The remarkable thing was that very poorly sighted people were not just the elderly. We saw large numbers of blind young people. There were many patients with terrible cornea scars from infections and solar exposure. We saw 6 young patients with squamous cell carcinoma of the conjunctiva which is very rare in Canada. It is rampant because of HIV. The virus attacks the immune system and young people develop unusual cancers and infections. We remove as much of the cancer as we can and put them on mitomycin-c drops, an anti- neoplastic drug. Brighton told me the official HIV incidence is 10% but given so many of our patients are HIV positive I would think it's much higher than that. Anti-HIV drugs are provided free by the government but many people don't get tested and many stop treatment due to various reasons. This is compounded by the fact in some tribes men would have many wives, up to twelve in some families. If the man has HIV then likely all the wives do too. It's a huge problem.
GLAUCOMA
Glaucoma is the other devastating disease and difficult to treat in rural Africa. People have very little eye care, so when they are seen their disease is very advanced and they have either lost most vision or on the verge of losing all vision. Glaucoma drops are the best treatment but access to care and medication is very difficult. Surgery is an option but the lack of consistent follow-up means lots of potential complications. I showed Brighton how to do a trabeculectomy in hopes he will stay in Zimba. We both hope this straightforward inexpensive procedure could save vision for a lot of people.
CATARACTS
Cataracts are the major cause of blindness in Zimba, and I presume in Africa. Patients come in with stone hard advanced cataracts and are usually blind. Surgery is much more difficult than in North America because the cataracts are too hardened to remove with our conventional techniques. Mark is an expert with small incision cataract surgery and showed Brighton, Ivan and myself this technique. I was able to show Brighton our phaco-emulisifcation technique and we did a number of surgeries with this. Thanks to years of donations and different surgeons volunteering in Zimba, the eye clinic and OR is well equipped and supplied. I was pleasantly surprised with the quality of the clinic, given the setting and was even more impressed with the local staff.
The Zambian staff are well educated and trained, pleasant to work with, and eager to learn. I'm sure that over the years they have helped and saved sight for many, many Zambians.
Our days were busy and well structured. We would start seeing post-op patients around 7:30 am and get the OR going around 8. Sue would continue to see patients throughout the day. She would ask one of us to see patients that need surgery or difficult cornea cases. Many of the patients have had little or no past care and have severe diseases. We did our best and give them free medications and try to get them to follow-up. Since most are farmers and travel a long ways, follow-ups are hit and miss.
OVERALL IMPRESSIONS
There were no shortage of surgical cases of all types. Given the circumstances , the surgeries are decisive and of tremendous benefit to the patients. Patients with severe painful blind eyes are grateful to have their eye removed. Cataract patients are extremely pleased to see after, for many, years of blindness. I was surprised on the number of young people with bad cataracts. One especially gratifying case was an old man brought in by his son. He'd been blind for many years. After his cataract surgery he was ecstatic that he could see his son's face and he walked around the waiting room peering into people's faces and looking at and naming the objects.
I felt very fortunate to meet and work with wonderful colleagues who donate huge amount of their time, expertise and heart really to people who have very little. Sue goes to Zimba twice a year and spends countless hours planning and organizing the clinics. She is also incredibly effective in recruiting surgeons to join her. Mark and his wife Jan are amazing people.
They spend two months a year doing mission work. Their work has taken them to far flung places in the world. They are the epitome of selfless people who truly believe in giving themselves to others who are less fortunate. Yenjean and Ivan are also amazingly giving people who have taken on the huge and daunting task of running the clinic and surgery. Finally, Brighton is the hope for the future for local clinics and symbolically the future of medical care in third world countries. He is smart, eager to learn, thoughtful and hopefully what little knowledge and skills we can teach him will benefit his world for a long time.
Personally, the best gift of our trip was the opportunity for my kids to see these dedicated people giving of themselves and for them to be able to give and teach in the best way they can. Stephen and Katie have written about their experiences. I can only say that, as a parent, how proud I was of them and what they did. Zambians were extremely grateful for their efforts. And of all the moments of gratitude, from people, from the children, from the Minister of Education, my favourite was this older woman who, upon receiving her certificate of attending Katie's seminar, gave this ululating African cry of joy.
I found the Zambians to be happy, genuine and pleasant people. They were truly grateful for what help they received. The parents love their children and education is clearly a priority to them. The kiddies are happy and joyful . When we pass people on the streets they give us a smile and a hand to their heart to thank us. And the kiddies, well they love to high five us and laugh.
Sue told us that when she started coming to Zambia 7 years ago there were mostly mud houses and cattle carts. Over time things have slowly progressed. Houses are going up, highways are being built and trucks are zooming by. The last day we were there I went for a run on the highway. People were happy, friendly and greeted me. After a while I came upon a young fellow walking. He looked over, gave me a happy laugh, and shouted " Slow but sure, slow but sure!" I thought about what I've seen in the short time we've been there and yah baby, slow but sure.