Day 3 Enugu

Yesterday morning started with a 3 way mind meld between Drs. Harrison, Lawrence and myself followed by a prayer of supplication--- to get the dedicated Nidek laser that had been donated to the hospital to work. To make a long story short, Dr. Harrison alighted on the idea of plugging a nonfunctional transmitter into the back of the laser box; I then had a flashback to my jacuzzi in which a random combination of buttons are required to reset it, and Dr. Lawrence came up with this totally non-intuitive combination of simultaneously pushing 3 buttons on the front laser panel-- after a short prayer (accompanied by the a chorus of live, beautifully harmonized gospel singing; the singers consisting of the staff and patients in the main waiting area----which is the way every morning starts at the Enugu General Hospital). Voila', the laser began counting down to set itself and then the panel alit with the welcoming display of "ready to treat" paramaters. This laser, which cost at least 30K had not been used for many months as no one could figure out how to use it. I will now be able to teach the staff and residents how to do laser for diabetes, vein occlusions, retinal tears etc....Very exciting indeed!

Well this epiphanic start was followed by a marathon session of lectures. The audience of about 30 was stuffed into a small, non air condtioned room, but they were so hungry for knowledge that I ended up lecturing with few breaks from 9:30am to 5:00 pm. The impact of technology is evident in that many people carry usb flash drives. At the end of each lecture I would see many flash drives in front of me with their owners asking for the lecture just given to be downloaded on their drive. Given the lack of readily available teaching material here, it seems like quite a reasonable request.

Drs. Lawrence and Miller also had good attendance at their ped ophth. lectures, while Devin had a full day of clinic consisting of patients with severe corneal disease.

Dr. Harrison saw several patients with bullous keratopathy and severe corneal clouding due to non-state of the art cataract surgery. In many places the highly inflammatory and grossly large 5-0 silk sutures are being used to close cataract wounds (as opposed to 10-0 nylon sutures that are used in most of the world). Unfortunately without an eyebank to procure corneas for transplantation these patients will be blind for life. I don't think there is an eyebank anywhere in sub Saharan Africa. Unfortunately there are many patients who would benefit from corneal transplantation here as the incidence of corneal scarring is so high, from diseases such as measles, trachoma, onchocerciasis, and sometimes post cataract surgery.

Dr. Lawrence has done many courses here on small incision cataract surgery, which hopefully will reduce the incidence of corneal complications after cataract surgery.

Drs. Miller and Lawrence are also doing alot of great work on the rehabilitation of blind children. They also had an unusual patient--a 3 week old with bilateral congenital ectropion--where the eyelids were turned out and were so swollen that the baby's eyes were completely occluded.

Well after a busy day it was back to the hotel bar for some surprsingly good Spanish red wine ("Baron de Villa") consumed with granola bars and trail mix.

During "dinner" Dr. Miller spoke very highly of an ophthalmologist named Larry Schwab, who spent 25 years in Eastern Africa, noting that his motivation was solely wanting "to do the right thing."
Another living example of the maxim that the greatest truths are the most simple. It seems that if "do the right thing" can maintain status as the governor of one's conscience, not only "right things" but "great things" can be done, as in this case...as the obstacles of e.g. physical discomfort/inconvenience etc...fade away....and one raised in the luxurious lifestyle of America can go on to spend most of one's life in Africa.

Our team leader, Amelia Chamberlin, is another person who I find very enigmatic and delightful. Although only 29 years old she has the savvy and moxie, perhaps related to being raised in New York in an extended family of around 20, most of whom consisted of adopted children, to take complete command and control of not only our team but of organizing our hosts as well. She was even called into the Governor's mansion today to meet with him regarding security issues.

"Nurse Sandy" is doing a great job keeping patient flow moving along briskly...

Finally, I also want to recognize the lead ophthalmologist, Ahmed Gomaa, from Egpyt is the consumate diplomat with not only a very pleasant demeanor, but a great work ethic, and much experience in ophthalmology despite being only in his mid 30s.