Yoos and Eyes in Zambia: 2014

I was welcomed back to Zambia just after the terrible news that our president, Mr. Michael Sata, had passed away (28 October 2014). This is an interesting time in Zambia’s history, in which former Vice President, Guy Scott, has been thrown into the position of Acting President for the next 90 days until the presidential election is held. This is the first time on the continent of Africa that a white man has held the position of head of state since Nelson Mandela’s predecessor, Frederik de Klerk, in South Africa in 1996. These next few months should be interesting, to see how the former ruling party, Patriotic Front (PF), unravels as each political leader clamors to become president, and to see if Mr. Sata’s wife, Christine Kaseba, will venture out and run for president against her step-son (Michael Sata’s son from another wife), Mulenga Sata.

On to other, non-political topics.

1. Welcome, baby Zachariah! On 1 September 2014, we were thrilled to welcome our precious new baby boy into the world.

Sweet baby Zachariah, the newest missionary

Zachariah, or “Zach” for short, was born at Loma Linda University Medical Center. NSVD. Healthy. And of course slightly jaundiced, being an Asian child.

Newborn nursery with the double bili lights

After the usual round of bili lights, we were told that his biliruben levels had come down nicely, and we were able to go home from the hospital on time. His big sister was anxious to smother him with kisses; love mixed with jealousy was the theme of that relationship.

No, look again, he doesn't have polydactyly

Admiring the newborn baby

We make sure that Jaycee does not get too close to Zach, lest he get attacked with her surprise sweep of fingernails. Nonetheless, everyone is thrilled to have this new addition to the family.

Jaycee with 1 month old Zach

Spending quality time with the grandparents

Jaycee with 2 month old Zach and Auntie Helen

2. Jaycee thoroughly enjoyed her three months in California. It was a lot of firsts for her. She got her first perm.

Ummm...what did we just do to our toddler?

What a trooper

She got her first violin lesson (by yours truly) on a real violin.

Beethoven

Great form!

She also enjoyed playing her Dora guitar.

One day we'll get her a real ukelele

She had many opportunities for playdates, which she rarely partook of while in Zambia. Alex & Andi, Andrew & Ethan, Ryann & Dylan, Nathan & Joshua & Elle, Joshua, Lyla, Yuna, Joshua & Caleb & Noah, even baby Mikko.

Great seeing you, Kelly!

Love the twins' twins!

Selina, your sons' got my daughter on a choke-hold.

Janine & Curtis, thanks for coming out.

Sunah & Curtis, your daughter's a hoot! Jaycee loves Lyla!

Hanging out with Lyla & Yuna in Loma Linda's hidden park

Jane & Fred, great seeing you.

Seeing Sonia after 7 years

She especially loved hanging out with her cousin, Oliver.

Shake it

Jaycee's favorite cousin, "Ollie oppa"

She loved attending church, getting the peer interaction that she so craved. On Wednesdays we would sometimes attend “story time” at the local library, during which Jaycee would sing songs, listen to a book being read, having craft time, and choosing a few books to take home and read during the week.

Singing songs at the library

Craft time!

We celebrated her 2^nd birthday in California, and she got to experience Chuck E. Cheese’s for the first time.

TWO!

She had a blast at Chuck E. Cheese's

It was only during the last week or two in California that Jaycee began to perseverate on Zambia, repeatedly saying, “I wanna go back to Zambia.” “Why?” we would ask. “I wanna see papa…and Cino [our dog]!”

3. During my leave, I had the chance to speak to several audiences regarding the work at Lusaka Eye Hospital. First was for the English Ministry at the Loma Linda Korean SDA Church on 16 August 2014. Being 38 weeks pregnant seemed to make speaking in front of a large audience more difficult, but by God’s grace I somehow managed. Three weeks after the birth of Zachariah, I was on the go again. I had the opportunity to speak to the Claremont International Church, then two weeks later for vespers at the Loma Linda Korean SDA Church. On 15 October 2014 I spoke at Grand Rounds for a group of ophthalmologists at Loma Linda University’s Department of Ophthalmology, and a week later at a vespers for young medical and dental students at Loma Linda University. Finally on 1 November 2014, a day before I returned to the U.S., I spoke at a benefit concert that the Inland Korean Ladies’ Choir put on to raise funds for Lusaka Eye Hospital.

Inland Korean Ladies' Choir, my mom's choir for 23 years

What a blessing it was to share my experiences with the different groups of people, to see their response and excitement about the work, and to see the response that came out of their desire to help our little institution and to somehow be a part of the work going on in Zambia. I praise God for the fundraising efforts and for each individual who gave something to the cause. Each dollar will certainly go a long ways!

4. Because of the timing of Zach’s birth (which was very similar to that of Jaycee’s birth 2 years ago), and because of the every 2 yearly cycle of conferences that are held in certain locations, Paul and I were able to attend some conferences in the U.S. In August, Paul went to Chicago for a dental conference. We also got to attend the the Global Healthcare Conference in Loma Linda in October. I was delighted to be able to attend the AAO (American Academy of Ophthalmology) in Chicago and the AMEN (Adventist Missionary Evangelism Network) Conference in San Diego, both held in October. All the conferences were a blessing to attend, with great networking, reunions, and opportunities for learning. In Chicago, the AAO was a great chance to catch up with ophthalmology colleagues.

Three generations of Lusaka Eye Hospital medical directorship - Drs. Boateng Wiafe and Eustace Penniecook

Kristen and I, posing with our cornea fellowship director, Dr. Jim Chodosh

With Dr. Dohlman, now 92!

Love you, Sandy & Dr. Kathy Colby.

Co-fellows

Yummy vegan dinner at Karyn's Cooked

One highlight of the Loma Linda Health conference was hearing Drs. Gillian Seton and James Appel share about their experiences in Monrovia, Liberia, in the midst of the ebola epidemic.

Dr. James Appel

Finally, seeing old friends was a treat at the AMEN conference, especially our mini reunion of medical school classmates!

LLUSM Class of 2006

5. Since Paul came back to Zambia alone before the rest of the family, he had some free time to take some students camping at the Lower Zambezi National Park. He had an amazing adventure in the wild.

Student missionaries' tent - close encounters with elephants during the day and hippos at night

Hanging out with the elephants

Zambian car wash

Elephant skull minus the ivory

Someone didn't get a lawn chair

My long trip back to Zambia was not easy to make with a toddler and infant, but the fact that my parents came along to help made a world of difference. They will be hanging out in Zambia with us for the next 2 months. After a few days of the entire family struggling with jet lag and trying to get back into our routine, we’re now back to life as normal in Zambia!

Hang loose

Lovin' the noodles

Stay tuned for more Zambian adventures to come.

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 décor, 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

Before: Op 2

After: Op 2

Before: Op 3

After: Op 3

Before: Bathroom 1

After: Bathroom 1

Some dental therapy students currently on rotation at the dental clinic

10. From 7 – 12 July 2014, the 2^nd 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!