Wednesday, April 27, 2016

"I want to see my doctor"

Here I sit, exhausted, but happy.  Sneezing, fatigued, with a runny nose, clearly coming down with something viral, but feeling ready to conquer the world.  It’s Friday afternoon, and we have just completed another eye camp at Kanye SDA Hospital in Botswana.  Our 3rd annual eye camp should have been easier, but ended up being more difficult.  The autoclaves weren’t working, which led to a situation where we had to borrow one from the lab (except this autoclave took at least 45 minutes per cycle, excluding the 2 hour time frame for a cold start), attempting to loan one from a government hospital 100 km away (the one we borrowed failed to work), and finally getting some two maintenance workers to stay up all night on Tuesday to get two nonfunctioning autoclaves up and working by Wednesday.  To say the least, this delayed our flow, causing us to work longer hours but operate on fewer patients.  By the end of the week, however, with the same great team that has always stepped up to the plate each year, a mix of government and church workers, we managed to successfully complete 104 operations – 102 cataracts and 2 entropion repairs. 

These 102 cataracts were some of the toughest, densest, trickiest cataracts I’ve ever had to deal with.  All the patients had LP (light perception), HM (hand motion), or CF (counting fingers) vision.  They ranged from rock-hard brunescent cataracts to Morgagnian white puffy cataracts with a smaller floating nucleus, to surprisingly dense PSC cataracts that ended up with more nuclear sclerosis that I had bargained for.  Wednesday was particularly exhausting, where back to back, pseudoexfolation patients seemed to appear on my table, and I suffered several vitreous losses for one reason or another (ICCE due to completely fibrotic lens/capsule complex, uncooperative patient, or IOL haptics breaking through a very weak posterior capsule).  Battling these with manual vitrectomy – or vannas scissors, since our portable vitrector is down – was a special challenge.  But on the other hand, it was greatly rewarding to see so many patients, especially those older Botswanans who are poor, weak, and vulnerable, going from blind to rejoicing at their newfound sight.  This particularly dramatic change is something that reminds me of why I went into ophthalmology in the first place.  Some comments to the nurses from the patients included, “Now I can see your eyes, your pupils!  Now I can go home and see my grandchildren’s faces and eyes clearly.” 

“Please tell me when my doctor is coming. I want to see my doctor, because I could not see her before the surgery.”
One patient, a 46 year old male, had travelled from more than 400 km away, and he was happy to have his sight restored as our very last patient of the eye camp.  It humbles me and brings me great joy to be a part of Jesus’ healing ministry.  So although I am physically and emotionally exhausted after a long week of surgery, my mind is filled with contentment and joy. 

After this long prelude, it brings me to the next part of this blog – our regular update from the last 3 months!  This quarter has been another busy one, indeed. 

1.  Jin tied the knot!  My brother-in-law, Dr. Jin Yoo, a once-highly eligible bachelor, finally got married to a beautiful girl from Seoul.  Juhee is a make-up artist by profession and owns her own business.  We had the opportunity to travel to Korea in December 2015 to attend the wedding and be a part of the festivities.  
Posing in front of the Burj Khalifa in Dubai, en route to Korea
Ice skating at the Dubai Mall, en route to Korea
The happy couple
Family photo
Yeo Jin did a great job MC'ing the wedding

Jaycee and Zachariah enjoyed many things about Korea – taking the subway, eating nice food...
Swimming at the hotel
Christmas tree
Yummy ice cream in the shape of a fish!
Hitting the town
Yes, ALL that hot sauce goes in...
One of the spiciest dishes I've ever eaten
 and, especially, getting to stay at and visit Lotte World (hotel, Adventure, Aquarium, etc.).  
Lotte World Aquarium
Lotte World Adventure
Lotte World Folk Museum
Live Cinderella show at the end of the day!
We even got to visit a few special people during our time in Korea.
My friend, Yeo Jin, who is a news anchor for YTN, her husband, a reporter for KBS, and their son
The church my uncle pastors
An ophthalmologist that my aunt knows
Pastor Kwon from the Northern Asia-Pacific Divison
2.   Just before we hailed in the New Year, thanks to Dr. Colquhoun and Buxton with International Vision Volunteers and Eversight, we got a consignment of 15 corneal tissues!  
Because some of them were soon to expire (remember, harvested corneas have a shelf-life of only 2 weeks from the date of a patient’s death), we decided to organize a day (New Year’s Eve) to perform 8 cornea transplants.  It was a personal record to do that many PKPs back to back, but by God’s grace they all went smoothly.  We transplanted another 4 of the viable tissues the following Monday. 

One of the patients was a middle aged male who had corneal scarring in both eyes from a terrible motor vehicle accident he had suffered more than 20 years earlier.  His exam was interesting in that he had tiny shards of glass in bilateral corneas and under the conjunctiva of both eyes.  
Preop: corneal scarring with glass shards embedded in cornea and conjunctiva
Immediate postop photo with new graft
This patient has very limited English, and it touched my heart when he brought a translator with him to his 2 month post op visit to expressly thank me for giving him the gift of sight once again.  His graft is healing well, and I am excited that he is able to see through a fresh cornea which is not littered with the remnants of his horrible accident of the past. 

In February, we had another shipment of 5 corneas come in.   
Most of the cases done were straightforward keratoconus patients, but one patient in particular was a special one.  She is a two year old girl with history of bilateral congenital glaucoma and resultant corneal scarring, status post trabeculectomy in both eyes.  Her intraocular pressures were stable, but her sight was poor due to the horrible corneal scars.   
Preop: congenital glaucoma s/p trabs with bilateral corneal scars
Immediate postop: with a new graft
After her transplant, the mother reported that the child’s vision has improved significantly and she is now able to watch TV!  This week, I saw the child again for her 6 week post-op visit, and her cornea is clear as can be.  Since children have a higher tendency to reject and fail their graft, please pray with me that her transplant holds!

3.  For my ophthalmology colleagues, here are a few other eye cases below. 

One of most grateful strabismus patients is a 40-something year old female from West Africa.  I had done her corneal transplant in Zambia more than a year prior, but after she had returned to West Africa she wanted to have her strabismus taken care of.  Thus, on her trip back to Zambia, I had the honor of correcting her large exotropia.  She’s doing great and “got [her] self-confidence back.”

Preop: large exotropia (and left hyperopia)
Several months postop: doing well
Also, I had the opportunity in February to go to Dr. Agarwal’s Eye Hospital to do a case of riboflavin corneal crosslinking on the fellow eye of a keratoconus patient that I had transplanted a few years back.  Dr. Geetha was so helpful in guiding me through her protocol of epithelial off, contact-lens assisted cross-linking. 

One last interesting case was that of another Mooren’s ulcer patient.  He had developed a deep temporal ulcer and perforated (self-sealed), which resulted in a peaked pupil.  By the time I saw him, the nasal aspect of the cornea had a very deep (>90% thinned) crescentic peripheral ulcer, ready to perforate at any moment.  I decided to use glycerol-preserved corneal tissue to create a crescent-shaped partial thickness graft in order to reinforce the unstable nasal ulcer.  The surgery went well, and his 6 week post-op visit showed a very strong, stable graft.  
Immediate postop
6 weeks postop
4.  New Year & New Volunteers. The New Year seemed to bring a whole host of new volunteers to Zambia!  The first to arrive on 30 December 2015 were the Sandefurs – Travis is a lawyer and Lauren is a pediatrician, and they are the newest missionary family to move to Lusaka.  Travis is spearheading the Chalala hospital project, and Lauren is working as a pediatrician at Lusaka Adventist Clinic.  They are a very gifted and special couple, and we are so happy to have them join our team in Lusaka!  Although we don't have any fabulous photos of this couple, you will certainly see much of them in the months to come. 

Kaleb Williams, an AHI (Adventist Health International) volunteer, arrived on 2 January 2016.  Travis Sandefur recruited him from Walla Walla University’s Business Department to come serve in Lusaka, helping with the accounts at Lusaka Eye Hospital as well as for the Chalala project.  Kaleb served for 3 months in Lusaka and was an amazing help to our finance team.  It was during his term of service that Lusaka Eye Hospital’s books got truly up to date and significantly more organized.  Thanks, Kaleb, for your dedication and help!

5.  MMED Ophthalmology Students.  On 29 January 2016, we celebrated the end of a short Ocular Pathology course that I was teaching for the MMED students in ophthalmology at the University Teaching Hospital/University of Zambia.  Sandy’s Creation was the choice location of our grand finale.  I was impressed with the knowledge base and dedication of this first year class, especially with Dr. Chimozi Tembo (far left), who was the winner of the final Pathology quiz.

6.  Riverside Farms.  This self-supporting SDA institution is one that we love to visit.  It’s proximity to Lusaka (only 1 hour’s drive) as well as the amazing friends we’ve made in the Busl family are enough of an excuse to lure us there at least 8-10 times in the last half year.  It's been especially lovely getting to know Michelle's brother, Paul, and his new wife, Katie, who are serving as volunteers at Riverside Farms for 5 months.
Jaycee and Zach particularly love any excuse to play with Hudson, William, Makena, and baby Anderson.

Eating watermelon together, individually
Going for a hike
Best friends
Baking in the "kitchen"
One memorable Sabbath occurred 30 January 2016, when we visited Riverside Farms with the Minor family.  The Minors had brought boxes full of clothes, shoes, and children’s Chrisitan magazines to donate and distribute to a local village school.  We sized up each child and picked out articles of clothing or shoes that would fit him/her.  What a blessing it was to see the smiles on their faces. 

7. Chalala project.  One of the sub-projects within the overall Chalala hospital project is to erect a house on the property.  We started building the house back in 2014, and it was supposed to be completed within 3 months.  For one reason or another, the building project delayed, and it’s only now, two years later, that we are finally finishing the house.  Thanks to Travis, who has been going to the site almost on a daily basis to check up on the progress, we finally have a completed house!  Kaleb can also be given credit for helping with getting the water tank built.   
Even a very nice underground water tank storage housing compartment was built as well.  
 By the way, this water tank is being funded generously by Loma Linda University’s(LLU) medical school class of 2017.  They have taken on the Chalala project as their pet project, and have not only raised funds for the water tank, but are also working toward funding the construction of and supply of medical equipment for one wing of the future hospital!  

8.  Lusaka Eye Hospital Bus.  Another wonderful thing that happened as the New Year turned the corner was that Lusaka Eye Hospital was able to purchase a new bus.  For the last year, we had been on the hunt for a good used bus to replace our aging, well-worn bus that had traversed the country transporting blind patients from their remote villages and returning them to their homes with newfound sight.  However, with the sudden Zambian kwacha devaluation in mid-2015, combined with the dearth of reliable used vehicles within the country, we found it impossible to find a used vehicle that suited our needs.  We looked into purchasing a new Chinese brand bus but were hesitant to go that route for quality control issues.  It was sort of a distant dream to think about getting a brand new Toyota Coaster bus, but we thought, “How can we afford a $100,000 vehicle?”  We decided to go to Toyota Zambia for a meeting to ask for a discount, and after a few weeks they replied that they would give us a $20,000 discount.  Well, we could only afford about $40,000 for a bus, especially if we sold our old one.  So we only needed another $40,000 to reach our goal! 

One day, near the end of 2015, I received an email from a dear friend – she’s an ophthalmologist, an old medical school classmate, and, in fact, an old residency classmate.  She said that she and her husband felt compelled to give a donation to Lusaka Eye Hospital.  When I found out the amount that she had donated, my jaw dropped!  I could not believe my eyes!  She and her husband had generously donated the $40,000 needed for us to buy a new bus.  She agreed that we use the funds for that purpose, and our staff at Lusaka Eye Hospital immediately started the process of purchasing our dream vehicle, our Toyota Coaster.  By the end of January, we had the new bus in our possession, which is another miracle in and of itself, because it usually takes 6 months from the time of order to process, build, and transport a bus from the Toyota manufacturing plant in Japan.  But God had arranged for the brand new Coaster (wrongly ordered for another institution) to be in-country and ready, just waiting for us to make the payment.  
Supervising the "branding" of our new bus
The finished product
We give our heartfelt thanks to the Wagner family and Toyota Zambia for partnering with us in this endeavor.

9.  An Huynh rotation.  From 8 – 26 February 2016, we had another senior ophthalmology resident from LLU come rotate with us at Lusaka Eye Hospital.  An is a wonderful girl with a good heart.  Congratulations on your soon-coming graduation!

An at the microscope
Mandatory couch photo

10.  Cameron Lee rotation.  During that similar time frame, from 4 Feb – 9 Mar 2016, we had a 4th year medical student from LLU come to do a student elective in Lusaka.  He is a kind young man with a passion for missions and hopes to become a missionary ophthalmologist.  It is so rewarding to see young people with an interest in missions.  I just hope that these young students are able to keep that fire burning throughout the long years of residency/fellowship. 

Cameron, far right
11. Carla’s farewell.  One of the great blessings during our time in Zambia has been our friendship with the Minor family – Patrick and Carla, Kayla and PJ.  They are a God-fearing family who arrived in Zambia from the U.S. just 3 months after we did.   Over the last 5 years, we have enjoyed many special occasions filled with food, fellowship, and friendship.  Now that their children, Kayla and PJ, are now both in the U.S. for school, their hearts have been tugging at them to move closer to their children.  Carla was able to snag a great job with Adventist Risk Management at the General Conference Headquarters, so we bid her farewell on 28 February 2016 at a luncheon at Sandy’s Creation.  Fortunately for us (although unfortunately for Carla), we still have Patrick with us in Lusaka for another few months before he moves back to the U.S.

12. Lilayi Lodge.  Since we had quite a few visitors, including Rachel Pratt, who is a student missionary and a nurse at Riverside Farms, who came to volunteer at Lusaka Eye Hospital for a week, 
Rachel Pratt
we decided to celebrate National Women’s Day (8 March 2016) at Lilayi Lodge.  Everyone enjoyed swimming at the pool, a nice lunch, and a chance to enjoy the cozy loft upstairs. 

13.  Food.  Especially as we have been living in Zambia where it is rare for us eat out, home-cooked, home-grown food has become an important part of our lives.  We are thankful for a garden which provides our greens and the papaya trees that are slowly ripening their first season of fruits.   
We are so thankful for Annie, my mother-in-law, who loves to cook, to grow alfalfa and other sprouts, 
and to pickle various Korean foods.   
We are also thankful that Satipha, our helper, has become an expert tofu-maker.   And Mom certainly makes amazing dishes with the fresh tofu. 

Boiling the ground soybeans
Gathering and straining the curdled tofu
Fried tofu
With seasoning
Tofu soup
14. Ocularist visit.  From 14-16 March 2016, we had the honor of hosting Jorgen Cieslik, an ocularist from South Africa, as well as his wife, at Lusaka Eye Hospital.  
Jorgen is a very talented ocularist who is able to fit and modify stock eyes, create custom eyes, as well as make facial prostheses from silicone.  During this inaugural visit, we lined up at least 20 patients in need of artificial eyes and got them fit with their new prosthetic eyes. 

One man, Jorgen said, was cantankerous and grumpy.  He had been without a left eye for some time. 

However, after Jorgen was able to fit him with a well-fitting artificial eye, this old man stood up and gave him a hug!   

We even got to start a facial prosthesis for one patient who had history of exenteration.   
Making the wax mold
Mixing and matching the pigmentation to the patient's skin tone
We are so thankful that Jorgen is committed to helping the underserved in Zambia.  We know that his artificial eye ministry will help so many in this country, as it is not readily available at the moment.  His commitment to helping train our staff to become competent in modifying the stock eyes will be an invaluable transfer of skills that will benefit so many in the future.  We look forward to his next visit in a few months!

15.  Staff pictures.  Every several years, we think about taking the time to organize a group photo for our staff.  Here is the wonderful LADS team, which is growing each year.   
And, of course, our amazing LEH team with our new bus!

16.  Renovations.  This last quarter has been full of changes, purchase of new equipment, and renovations at both LEH and LADS.  One of the more apparent accomplishments was the breaking down of the wall between the two institutions.  It signified a “reunification” of sorts, not in our management or books, but in the spirit of working together as church institutions.  

We also got the wall outside the dental clinic plastered and painted with our respective logos.  

LEH is doing quite a few renovations at the moment, thanks to another donation from Drs. Enoch & Diana Nam in addition to our budgeted funds for special projects.  In the last 2 months, we have been able to put new porcelain tiles down in the outpatient department (OPD), repaint the entire OPD, and we’re currently working on creating a new larger optical shop to display and sell our glasses. 

Before: PVC tiles, old paint
During: putting down porcelain tiles
Completing the tiling
Putting up the frame for the new optical shop
Installing cabinets for the optical shop
A new paint job in the OPD
Finally, LADS was able to purchase a new digital panoramic x-ray, which is impressive and keeps their institution cutting-edge. 

17. Music at church.  For the first time in nearly 5 years, my mother-in-law and I were asked to sing/play music for our church in Zambia.  I dusted off my violin and after a few Friday evening practice sessions, we had mastered renditions of “Precious Lord,” “Day by Day,” and “Don’t Forget to Pray.”  It is always a joy to use music to glorify God.  Since I don’t like speaking or preaching in public, music is a way to share Christ with others without having to preach a sermon. 

18.  India trip.  Another big event that occurred this quarter was a colorful trip to the beautiful land of India.  From 19 Mar – 2 Apr 2016, we visited the incredible country.  My primary objective was to learn from Dr. Jacob, medical director of Ruby Nelson Memorial Hospital and “the fastest ophthalmologist in the world,” as another old residency classmate had described him after his recent visit to India in January.  Indeed, this humble man of God is truly amazing.  Working with It is Written as well as CBM, he hosts massive eye camps on a weekly basis, performing anywhere between 100 – 465 cataracts per day!  His day often starts at 3:30 or 4:30 am, and he is able to complete 75 – 200 cataract surgeries (manual small incision cataract surgery using a fish hook) before the official day starts.  This is possible because each cataract surgery only takes 1-2 minutes.  8:30 am is morning worship, and then the regular outpatient department and clinic services start.  Post-op rounds occurs the following day, going from patient to patient with a flashlight.  The results are amazing with great vision, clear corneas, intact wounds, and minimal inflammation.  Sometimes, Dr. Jacob operates on the charity patients in the evenings or goes on evening pre-op rounds (one day, pre-op rounds finished at midnight!).  This man has gifted hands, a dedicated spirit, and a well-oiled machine of a team.   

Mom learning how they make chipati
Going to the supermarket on an auto-rickshaw
Of course, since we were in India, we took a few days to explore the Punjab region.  Before boarding our flight from Amritsar to Delhi on Easter Sunday, we visited the famous Golden Temple, a holy Sikh temple that is well-visited by thousands of fervent, religious individuals on a daily basis.  It was astounding to see the number of people coming to take a holy dip or to enter into the Temple itself. 

The Golden Temple

Delhi, Agra, and Jaipur were our next stops, and my parents were able to join us in India en route to Korea.   

Jamma Mosque, Delhi
Humayan's tomb
Qutub Minar
We were told the cows meandering on the highways were strays, with no owners!  The colorful, confusing hustle of ricksaws (bicycle rickshaws as well as auto rickshaws), donkey carts, and automobiles spun around in delightful cacophony.  The mighty fortresses and powerful palaces were a sight to behold.   
Amber Fort, Jaipur
Elephant ride up to Amber Fort
And the Taj Mahal was a beauty that can only truly be appreciated in person. 
The beautiful Taj Mahal
India is a special country that I would love to go back to explore one day.

19. Wesley & Brianna Arnold.  From 3 – 9 April 2016, we had another wonderful couple visit us from LLU.  Wesley, a 4th year dental student, and Brianna, his teacher wife, came to Lusaka to check out the dental clinic on a mission to explore whether or not they would like to spend the next 5 years of their life here.   
To our joy, they emailed us after their visit stating they have made the decision to serve in Zambia!  Their expected date of arrival will be September 2016, and we thrilled that yet another missionary couple will be joining us in Lusaka. 

20.  Tiffany’s Canyon.  On 10 April 2016, we decided to explore a new recreational site that has opened, about 30 minutes south of Lusaka.  Tiffany’s Canyon is supposedly a large lake that was created after miners digging struck water, which flooded and filled up an entire canyon with water.  A beautiful surrounding recreational site was created, with a restaurant, tables for picnics, grills for barbeque (braai), a play area for kids, an artificial beach area, and kayaks for rent.   
The twins going for a spin in the lake
Having a blast in the play area
We were happy to spend time with the Sandefurs as well as the Gowers (Eve is currently the medical attaché for the U.S. Embassy, Mike works for USAID, and their two boys, twins, are full of energy). 

21. Linden Doss rotation.  Since 12 April 2016, Linden Doss, a 4th year medical student from LLU, has been with us on his rotation.   
He is in the Deferred Missions Appointee program (as I am), and I am so excited that he is committed to long-term missions service.  He had the opportunity to travel with me to Botswana last week and was super helpful (by the second surgical day, he was able to do all my retrobulbar blocks without any assistance). 

Our hard-working Operating Theatre team

One highlight of our trip to Botswana was a short visit to the home of Drs. Marlize and Eric Verryne, two veterinary surgeons from S. Africa who have lived in Botswana for the last 13 years.  I had met Dr. Marlize via email a few months earlier, and she invited me to visit her lion and leopard.  Yes, they have a pet lion and leopard living in their backyard!  They were entrusted with Kelele, the lion, when she was just 1 day old, and Kali, the leopard, when she was just 5 weeks old.  The two little ones, in addition to their puppy, Buttons, grew up together as a threesome.  The Verrynes were eventually given permission by the president of Botswana to keep the lion and leopard in captivity (since releasing them into the wild would mean a sure death for them), but apparently even now it is still a political issue.  It is cute to see that the three animals (lion, leopard, and dog) still live together in the same enclosure; they are truly a wonder to behold.  I fell in love with Kelele and hope to visit her again one day. 

Kelele, 4 year old lion
Kali, 4 year old leopard
Kelele perched on high (pc: Linden Doss)

22.  Jaycee & Zach.  As usual, this blog is not complete without some photos of our two precious children.  Jaycee never ceases to amaze me with her ability to memorize songs and scriptures.  

Zachariah is developing his own vocabulary at a fast pace and currently loves to put two words together (“papa’s room,” “auntie playground,” “drink milk,” etc.).  One of my favorite things: upon my arrival home from work Zach will run into my arms so I can hold him; he will then proceed to pound me firmly on my shoulder or chest and pronounce proudly, “Mommy, mommy,” as if to affirm to the world that I am his mommy.  Pure joy.