Sunday, July 20, 2014

#eyesandyoos #dental #swissfrance #jaycee

Please be forewarned that this may be the last blog entry before our lives change dramatically once again with a new addition to the family.  We head back on the long trek to the U.S. for our leave in just 2 weeks, and this update comes just before the whirlwind of activity, last-minute clinical care, and frantic packing.  

Since I have not shared too many eye cases lately (those who prefer not to see photos of eyes, you can take this as fair warning and scroll down to the bottom of the blog), here are a few interesting cases that I have encountered in the last few months.

1. A 4 year-old-female presented with a swollen, protruding left eye, shallow anterior chamber and white pupil.  
The mother mentioned that the child had been squeezing her left eye since early childhood.  The eye was enucleated, and this was what was removed.   
Unfortunately for the child, the pathology was positive for retinoblastoma, extending even beyond the globe.  She is being referred to the Cancer Center at the University Teaching Hospital for further treatment of this important cancer.

2. Speaking of enucleations, I was referred a case of a 4 year-old-male who had recently had an enucleation 2 months earlier at another hospital within Zambia.  He presented with complaints of discharging due to the presence of an extruding orbital implant.  I took him to the operating theatre, and this is what was removed, after great difficulty.  I’d never seen anything like this before.   
Because of all the holes in the device, the fibrosis had really set in, embracing the implant into the socket.  But finally, I managed to remove the implant, close the conjunctiva, and allow the healing process to begin once again, sans infected implant.  

3. I continue to do children’s surgeries, nearly on a weekly basis.  One of the more rewarding surgeries is strabismus surgery, in which a child’s eyes are dramatically straightened after years of being stigmatized as the one with crossed eyes.  This is a 6 year-old male who was measured to have 80 prism diopters of esotropia.   
After performing a bilateral medial rectus recession in both eyes (8 mm), he was very happy on postop day #1. 

4. In June, a random, kind-hearted woman dropped by Lusaka Eye Hospital to inform us that she wanted to make a donation.  The donation amounted to ZMW 1800 (~$300), and it was meant to help sponsor two cataract surgery operations for anyone who could not afford it.  We thanked her profusely and ensured her that the money would be utilized appropriately.  The very next day, we had a patient present with a very real need.  He was a 75-year-old man from Western Province.  He had somehow hitched a ride to Lusaka and was dropped off at the police station.  He insisted that he needed to come to Lusaka Eye Hospital for eye surgery, so the police paid his bus fare so that he could be transported to our eye hospital.  He showed up without any cash, completely blind in both eyes, with a walking stick in hand, and with the faith that we would help him.  After examining him, our staff diagnosed bilateral mature cataracts, remembered that a donation for the vulnerable was made, and decided that this man should be the beneficiary of that donation. 

I operated on one eye one day and the other eye the next day.  During that time, we offered him a free stay in our ward, as well as some simple meals during the day. His surgeries were both successful.  Three days after his arrival, we sent him on a bus back to Western Province, and we noticed that he had left his walking stick behind.  He could see!  He was so overjoyed that he did not know what to do with himself.  He also mentioned that he wanted to join our church.  Hallelujah!  

5.  I continue to do a number of glycerol preserved corneal transplants, mostly for therapeutic or tectonic purposes.  Below are some examples of cases in which these tissues are helpful.  This is a case of a severe corneal ulcer that developed a perforation.  By the time I met him, he had a full-on hole in his cornea, and what seemed to be vitreous was pooching forward.  
Fibrosis or a desmetocele was the only thing keeping this eye from expulsing all its contents outward.   
The glycerol-preserved corneal transplant was successful in allowing stabilization of the globe as well as reduction of inflammation and pain.

Thanks again to Global Sight Network and colleagues like Dr. Chris Croasdale who allow me to have access to these wonderful corneal tissues!

6.  This is another case in which a glycerol-preserved corneal transplant was used.  This poor 16-year-old boy was referred by another hospital in Lusaka.  He had undergone corneal transplantation in both eyes in India 3 years ago.  The left eye unfortunately developed endophthalmitis and was eventually eviscerated.  The right eye, now his only eye, was slowly dropping in vision.  Then, suddenly he developed pain and poor vision in that very eye.  He was diagnosed at the other hospital with a severe corneal ulcer within the graft and was admitted for frequent antibiotic administration.  
When about 10 days worth of antibiotics still failed to resolve the ulcer, he was referred to us for possible glycerol-preserved therapeutic graft.  His vision was HM in that right eye.  He underwent a successful transplant surgery.   
I am relieved to report that his vision has improved (CF@1m) and his eye is looking much more stable as of his postop week #2 visit.  Once the eye quiets down, he will hopefully be a candidate for a fresh corneal transplant in the future.  

7.  Speaking of corneal transplants, a major breakthrough has occurred in the last few months!  After three years of meetings with officials, letters to the Ministry of Health, and other correspondence - requiring on my part some serious patience - we were finally given a letter from the Ministry of Health and the Ministry of Justice giving us official permission to import corneal tissue into Zambia!  Not only was this victory won, but Lusaka Eye Hospital has also been named by the main University Teaching Hospital's Ad Hoc committee on keratoplasty as the facility to which all referrals for corneal transplants under government sponsorship will come.  No longer will patients need to be referred outside the country (i.e. to South Africa or India) for corneal transplant procedures that can be done in Zambia.  Praise God for this important decision, and we hope that Lusaka Eye Hospital will be able to serve and help many patients with corneal conditions as possible.  

8.  Komboni radio is a local radio station “for the people.”  
Lusaka Eye Hospital, in conjunction with one of our partners, Sightsavers, took it upon ourselves to book three 30 minute slots on this radio station to be interviewed with the goal of educating the general public in Zambia about eye conditions.  The topics included: cataracts, pediatric eye diseases and surgery, and myths about eye care.  Lizzy, one of our ophthalmic nurses, joined me during one of the 30 minute sessions so that we could discuss children’s eye care in English + one of the local dialects (Nyanja).   
At the end of the session there was a chance for people to call in with their questions, and apparently the phones were ringing off the hook by the end; it’s unfortunate that we ran out of time and couldn’t entertain everyone’s questions.  We hope that this small effort made an impact in the general public’s awareness of eye diseases and the importance of following up on eye care.  And we hope that this type of activity can continue in the future.

9.  On the dental side, Paul has been involved in major, ongoing renovations at the dental clinic for the last year.  Thanks to the Beit Trust, 2 brand new dental chairs were donated to the clinic.  In addition...they have gotten new toilets, a new paint job, new blinds, a new d├ęcor, and a completely new look to the office!  Paul should really consider a second career as an interior designer!  
Before: Main waiting area

After: Main waiting area

After: Main reception window

Before: Op 1

After: Op 1

After: Op 1

Before: Op 2
After: Op 2
Before: Op 3
After: Op 3
After: Op 3
Before: Bathroom 1
After: Bathroom 1
After: Bathroom 1
Some dental therapy students currently on rotation at the dental clinic
10. From 7 – 12 July 2014, the 2nd Global Conference on Health & Lifestyle was held in Geneva, Switzerland.  Paul, Jaycee, and I had the opportunity to attend this important conference, as well as to participate in one of the plenary session in an interview-style presentation with Dr. Richard Hart.  The meetings were great, and it was also a lot of fun to get to know Geneva and several wonderful little cities in France!
Old Town, Geneva
Reformation Wall
Playing chess at the University of Geneva
Just relaxing
Jaycee, preparing for the presentation with Dr. Hart
Uni-Mail: the University of Geneva tram stop for the conference
Listening attentively at the conference

Crossing the bridge
The majestic Geneva Water Fountain
Boat cruise on Lake Geneva

Playing in front of the United Nations
Maybe one day she'll work there?
A little timid

Very majestic entranceway to the original UN Headquarters, before it was moved to NY

Under the broken chair
Cable car up to Mont Blanc, the French Alps
At Mont Blanc

Exploring the quaint town of Chamonix, France

Inside the ice cave of the glacier at Mont Blanc

Exploring the town of Annecy, France
Jaycee, enjoying her ice cream

Such a beautiful little city

Annecy, aka the Venice of France

Paul kept saying he wanted to live there.

Jaycee, getting to ride trains, planes, and automobiles
At the Chateau de Chillon, Switzerland
The majestic Alps in the background of the castle
Jaycee, pretending the beach in front of the castle belongs to her

Enjoying lunch by the Chateau de Chillon
Looking out to Lake Geneva from the train station
Chillon train stop
Exploring Montreux, Switzerland, before heading back to Geneva, and ultimately, back to Lusaka