Sunday, August 31, 2008

Orbis Blog

Orbis has its own blog--which is a good reference to keep up with the latest "going ons" of the Flying Eye Hospital.

Farewell from Uganda

The Flying Eye Hospital program in Kampala, Uganda has ended and the ORBIS DC-10 is currently en route to its next destination of Harbin, China. ORBIS volunteer faculty and blogger ( Dr Hardeep Dhindsa sent a small collection of photos from the Uganda program containing an assortment of images of fellow volunteer faculty and patients. The album can be found here.

Saturday, August 30, 2008

Tortured, but Not Silenced

What an inspiring person...

In 10 days, Halima’s extraordinary memoir will be published in the United States, at considerable risk to herself. She writes in “Tears of the Desert” of growing up in a placid village in rural Darfur, of her wonder at seeing white people for the first time, of her brilliant performance in school.

Eventually Halima became a doctor, just as the genocide against black African tribes like her own began in 2003. Halima soon found herself treating heartbreaking cases, like that of a 6-year-old boy who suffered horrendous burns when the state-sponsored janjaweed militia threw him into a burning hut.

One day she gave an interview in which she delicately hinted that the Darfur reality was more complicated than the Sudanese government version. The authorities detained her, threatened her, warned her to keep silent and transferred her to a remote clinic where there were no journalists around to interview her.

Then the janjaweed attacked a girls’ school near Halima’s new clinic and raped dozens of the girls, aged 7 to 13. The first patient Halima tended to was 8 years old. Her face was bashed in and her insides torn apart. The girl was emitting a haunting sound: “a keening, empty wail kept coming from somewhere deep within her throat — over and over again,” she recalls in the book.
Halima found herself treating the girls with tears streaming down her own face. All she had to offer the girls for their pain was half a pill each of acetaminophen: “At no stage in my years of study had I been taught how to deal with 8-year-old victims of gang rape in a rural clinic without enough sutures to go around.”

Soon afterward, two United Nations officials showed up at the clinic to gather information about the attack. Halima told them the truth.

A few days later, the secret police kidnapped her. “You speak to the foreigners!” one man screamed at her. They told her that she had talked of rape but knew nothing about it — yet. For days they beat her, gang-raped her, cut her with knives, burned her with cigarettes, mocked her with racial epithets. One told her, “Now you know what rape is, you black dog.”

Nonprofit Hospitals

This is an important article to read in its entirety. This monopolistic behavior is limited not only to Roanoke, VA but is also readily apparent in Reno, NV---where the largest "non-profit" hospital refuses patients without insurance for surgery, does not buy updated surgical equipment, does not provide appropriate nursing staffing, does not pay doctors for taking call for its emergency room..yet continues to make real estate investments (including buying local competitive surgical centers), pay exorbitant salaries to its "suits," and even spent a rumored 10 million dollars on a name change for "branding purposes." What can one expect when doctors are excluded from the managerial hierarchy to a great extent.
ROANOKE, Va. -- In 1989, the U.S. Department of Justice tried but failed to prevent a merger between nonprofit Carilion Health System and this former railroad town's other hospital. The merger, it warned in an unsuccessful antitrust lawsuit, would create a monopoly over medical care in the area.

Nearly two decades later, the cost of health care in the Roanoke Valley -- a region in southwestern Virginia with a population of 300,000 -- is soaring. Health-insurance rates in Roanoke have gone from being the lowest in the state to the highest.

hat's partly a reflection of Carilion's prices. Carilion charges $4,727 for a colonoscopy, four to 10 times what a local endoscopy center charges for the procedure. Carilion bills $1,606 for a neck CT scan, compared with the $675 charged by a local imaging center.

Carilion's market clout is manifest in other ways. With eight hospitals, 11,000 employees and $1 billion in assets, the tax-exempt hospital system has become one of the dominant players in the Roanoke Valley's economy. Its dozens of subsidiaries include businesses ranging from athletic clubs to a venture-capital fund.

The power of nonprofit hospital systems like Carilion over their regional communities has increased in recent years as their incomes have surged. Critics charge this is creating untaxed local health-care monopolies that drive the costs of care higher for patients and businesses.

Originally set up to serve the poor, nonprofit hospitals account for the majority of U.S. hospitals. They are exempt from taxes and are supposed to channel income they generate back into operations, while providing benefits to their communities. But they have come under fire from patient advocates and members of Congress for stinting on charity care even as they amass large cash hoards, build new facilities and award big paychecks to their executives.

Fueled by large, untaxed investment gains, Carilion's profits have risen over the past five years, reaching $107 million last year. Over the same period, the total annual compensation of its chief executive, Dr. Murphy, nearly tripled to $2.07 million. His predecessor, Thomas Robertson, received a lump-sum pension from Carilion of $7.4 million in 2003, on top of more than $2 million in previous pension payouts.

Sunday, August 24, 2008

Video of Ndere Dance Troupe

Here is a video of the Ndere dance troupe from "loreeley" on You Tube:

Dancing with Balance

Posture and Balance

The female dancers progressively balanced more and more ceramic pots on their head and then kept dancing to the frenetic, syncopated drumming

Feel the Rhythm

Let's Make Some Noise

A dancing princess

The girls

The Musicians

Choreograph This!

Flying Ndere boys

Ndere drummers

Surreal Joy and Unity in Uganda

The ultimate surreal moment was reserved for the end of the night when Mr. Ndere gathered the audience into the center of the outdoor amphitheater nation by nation (with Orbis representing perhaps appropriately its own nation).
The 300 or so attendees filed down center-stage when their country was called: "Tanzania, Kenya, Sudan, Ethiopia, Germany, Tanzania, Democratic Republic of Congo etc..."
(The lone German representative, "Sebastian," was a German resident who had come to Kenya for superior surgical training compared to that available in Germany).

Once the audience was gathered in the center of the amphitheater, Mr. Ndere had us hold the hands of those next to us and form a circle, under the night sky. (He found it amusing how difficult it was for microsurgeons to form an accurate circle).

Then after a few moments of gathering silence, the initial notes of "Amazing Grace" arose and floated on the night breeze before the Ndere troupe broke out into a beautifully harmonized version of this classic. Swaying side to side, we all joined in the singing. The Spirit of Africa and its people was quite present indeed! (I had a similarly surreal experience when I was in West Africa a year ago--see The Waterfall.")

Holding Hunter's hand on one side and Bernadette's hand on the other, I soaked in the beautifying unity of the moment.

Within a few verses, the beat became increasingly insistent and vigorous...Before we knew it the Ndere dance troupe infilitrated the circle and started pulling people into the center to dance to the now uptempo version of "Amazing Grace." The drummers held a complex, syncopated back beat as we all started dancing. Even the normally reserved Dr. Warren Anderson and Dr. Justin Arbuckle started "breaking out!" Djalene, the Orbis communication rep. was breaking it down Ethiopian style. Amelia--lithe, lissome, and languid was in her dancing element. In fact, the Minister of Health complimented her on her skilled African styled moves, to which she replied, "Why thank you Your Honor!"

A great, great night indeed...
Somehow, I doubt I will experience anything resembling this experience at the American Academy of Ophthalmology in November....

Hunter presents Orbis donation to Uganda

The Ugandan Minister of Health

Dr. Stephen Malinga, the Ugandan Minister of Health

Uganda's 1st corneal transplant patient

Veronica--a beautiful 16 year old girl who received Uganda's first corneal transplant when Orbis came here two years ago was a Guest of Honor!

A Great Cultural Event in Uganda

As Orbis Medical Director, Hunter Cherwek, has said "One of the greatest things about working for Orbis is that every month one or more of three things happen:
"I see a heart-warming sight-saving surgery; I meet an amazing Volunteer Faculty; or I experience a great travel adventure/ cultural event."

Well, my last night in Uganda we experienced one of the best cultural events one could imagine--seeing (and participating in) the great art of the Ndere Dance Troupe-- an event for the Ophthalmologic Society of Eastern Africa (OSEA) annual meeting.

Amelia (Orbis program manager), Hunter (Orbis medical director), staff ophthalmologists Warren Anderson and Bernadette Martinez, 3rd year resident Justin Arbuckle, Ethiopian country program director Djalene Temesgen and myself attended this event. Earlier in the day, Dr. Dave and myself had spoken at the OSEA meeting, which was attended by over 300 ophthalmologists from countries as diverse as Tanzania, Kenya, Democratic Republic of Congo, Ethiopia, Sudan, and Uganda.

This dinner at the Ndere Cultural Event Center was part of the OSEA program and featured spell-binding Ugandan drumming, singing, and dancing with side-splitting comedy from Mr. Ndere, a former school teacher turned comedian--all under a beautiful, summer night sky.

Featured guests included the Minister of Health and Veronica--a 16 year old girl who was Uganda's first recipient of a corneal transplant when Orbis came here 2 years ago. (You can read more about her on the Orbis blog.) Hunter and Amelia also used the evening to present the Ugandan Society of Ophthalmology with a large donation from Orbis.

Saturday, August 16, 2008

A Son Goes Off To War

A touching essay by retired U.S. Marine Colonel, James Zumwalt...

For three years, I knew this day would come. I thought I would be prepared. Coming from a family whose proud military heritage dates to this country's founding, and having served in the Marines for a quarter-century and lost a brother to war-related causes, I felt ready for any challenge military life might bring.

I was not.

Thursday, August 14, 2008

What You looking At?

The King of the Savannah. We got a nice shot here as the lion was staking out an area of burnt savannah. She later ambled into the tall grasses and disappeared nearly completely as her coat was the same color as the savannah grass.


Genius Leo

Communications is such an important part of having an Orbis program be successful. When the Orbis team lands in a given country, everyone gets local SIM cards placed in their phones so the whole team can be in constant contact. Luckily, this trip there is also an internet node that has been rigged up for the Flying Eye Hospital.

Yesterday morning I, Leo, and Jin Sook (pictured above) spent a fair amount of time "jerry-rigging" the parts from three different vitrectomy units at Mengo Hospital. We got it to work, mainly thanks to the genius of Leo. Leo was also the "trouubleshooter" for many years at King Khaled Eye Specialist Hospital, where we worked together for many years.

Erwin and Estelle

Here is a photo of Erwin and Estelle in the Flying Eye Hospital. This is unfortunately Estelle's final program with Orbis. She is going to join a retina surgeon in South Africa and be his full time scrub nurse....unless I can convice her to come to Reno!

Erwin Temmerman

One of the most interesting aspects of working with the Orbis team is finding out how each person life journey brought them here. Two nights ago I met Erwin Temmerman, Director of the Flying Hospital. He is a very kind and enthusiastic Belgian gentleman who took some of the Orbis team to a local Belgian restaurant for dinner. In addition to enjoying Belgian food for the first time, I had the opportunity to learn how Erwin's prior decade of NGO work led to his involvement with Orbis.

His involvement with NGO work started in Jordan, where he was part of the operations team for Jordanian Air. One night there was a flight delay in Amman and, in his official capacity,he made arrangements for all the delayed passengers to stay at local hotels.
However, he noted two young African boys were not moving from the airport lounge. After talking with them he learned that they did not even have money to take a taxi to get to the local hotel. So Erwin took them to his house and had them stay with him overnight, and brought them back to the airport the next day to catch their flight.

Several months later he received a letter of invitation to their home in Guinea, West Africa. Touched by the invitation, he decided to take them up on their invitation. He had a great time with their family, including their Belgian father--who was working with Doctors without Borders. After going out to the field and visiting the various field projects, Erwin realized that this was his professional calling. Additionally, he really loved the warm, sunny days he experienced in Guinea, contrasted with the cold, rainy weather of Belgium.

He thus applied to Doctors without Borders. Unfortunately, his first assignment was in Albania. However, much to his relief, all of his subsequent assignments were in Africa.

For six years with Doctors without Borders he was country director of operations for various countries This was followed by 5 years as director of operations for Air Serve--which provides air transport for other relief agencies such as Doctors without Borders among others. He has been with Orbis over the last year.

I suppose it is only fitting that a person with his background initially in commercial air flight, followed by NGO work, would end up at the Flying Eye Hospital!

Tuesday, August 12, 2008

In Broken Economy, Burmese Improvise or Flee

RANGOON, Burma -- For the crowds of young Burmese outside the Immigration and Customs Office here, the commodity of choice is a shiny, tomato-red, cardboard-stiff new passport.

One recent morning, hundreds of men and women flooded in and out of the office, located on a rickshaw-crammed boulevard, or camped under umbrellas along the sidewalk to wait for their passport applications to be processed. Some scoured billboards that listed openings in garment factories, shipyards and other workplaces in Singapore, Thailand and Malaysia. The run on the passport office reflects a social crisis at the heart of an economy in free fall.

Sixty years ago, Burma, also known as Myanmar, was among the wealthiest countries in Southeast Asia, outshining its neighbors with higher standards of living and greater social mobility. Its universities attracted students from across the region, and its rich stock of natural resources promised steady growth.
Today, more than a third of children are malnourished, the average household spends up to 70 percent of its budget on food, and more than 30 percent of the population lives under the poverty line, according to United Nations estimates.

The Orbis team

It feels so GREAT to be back with the Orbis team--meeting old friends and meeting some new people as well!
This place feels like home. Right now Justin Arbuckle, a resident from Medical University of South Carolina, is teaching phacoemulsification cataract surgery on a very cool surgical virtual reality machine. I will be using the same machine later to teach vitrectomy surgery in a different module.

Meanwhile, live surgery is going on in the back of the plane and is being broadcast to the classroom in the front. Dr. Rishi Mohan from New Delhi is doing a corneal transplant with a local Ugandan doctor. Interspersed with the live feed, Dr.Gogate from Poona, India is giving lectures on phacoemulsification to the classroom.

Other members of the Orbis team are on the internet planning the logistics of flying hospital programs to follow this one.

Tomorrow, I, Dr. Warren Anderson, and two nurses, Leo and Jin Sook, will go to a local hospital to assess their vitreoretinal surgery setup.


These elephants at Queen Elizabeth Park were about 30 feet away! For someone who doesn't think she can shoot photos, I think my friend, Amelia, did a pretty good job here!

Monday, August 11, 2008

African Ingenuity

Yesterday as I was walking having lunch at a local pizza place in Kampala with my good friends from Orbis, Amelia and Troy,
we noticed an ingenious gentleman on a bicycle with a small petrol tank on the crossbar and a small engine on the seat bar below.
He was able to travel at quite a clip!
Other examples of African ingenuity can be found at a recent PRI interview with Erik Herzog, the founder of the blog..

Untying a Genetic Knot

In an intriguing piece of research, scientists have found that an ancient genetic variation that once protected people of African descent against a certain type of malaria may also make these individuals 40% more susceptible to infection by HIV, the virus that causes AIDS.
"It helps in part to explain why HIV is so prevalent in Africa," says Robin Weiss, a virologist specializing in HIV at University College London and a co-author of the paper.

According to the study, about 90% of people in Africa and some 60% of African-Americans carry the variant gene. In Africa, the scientists estimate, roughly 11% of the HIV burden may be linked to this genetic variation.

Friday, August 08, 2008


This is the Silverback of Group 13--we were within about 20 feet of him at this point--when we first stumbled upon him

Mother with Baby

This baby is about 3 weeks old...

Baby Gorilla

Here is a picture of a baby gorilla we saw who was tumbling about and beating his chest..

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