First I want to give credit for the ORBIS team for doing a tremendous job in organizing this trip. It is very impressive. Even while here in Nigeria, the two Orbis organizers, Amelia Chamberlin and Dr. Ahmed Gomaa, are absolutely phenomenal.
None of my previous trips to Africa have ever gone this smoothly. These two guys take care of everything for us. So that is one of the neat things about going on a mission trip with orbis. No worries about logistics at all thanks to these two. ORBIS also donated a tremendous amount of equipment, including a new slit lamp and indirect ophthalmoscope. There was also a laser given.
We have 2 pediatric ophthalmologists (Drs. Marilyn Miller and Linda Lawrence), one cornea specialist (Dr. Devin Harrison), one nurse (Sandy Burnet), one specialist in ultrasound (Alicia Montoya) who is from Bogota, Columbia. They are all very well-travelled and skilled in "third world" ophthalmology. They all are extremely generous and kind people as well. It is truly a privelege and joy to be working with them.
Yesterday I saw about 25 retina patients. I saw one Marfan's patient with bilateral chronic retinal detachments and lens dislocations who was completely blind in one eye. Unfortunately the ORBIS plane did not make it here so I don't have any way to take this very unfortunate 28 year old girl to the OR. There is one place in the private sector that does retinal surgeries here in Nigeria...yes, one retinal surgeon for about 200 million people! Unfortunately the cost will be too high for this young lady (~5000$). I got her phone number. Hopefully when the ORBIS team comes next time she can be contacted for surgery...hopefully before she is completely blind in her only remaining eye.
I saw one HIV pt who had complete whitening of all the vessels in both of her retinas and the whitest (i.e. "most dead") optic nerves I have ever seen. She is very depressed as she has three young kids to take care of her. Unfortunately there is nothing that can help her. The good news is that she is on highly active retroviral therapy. Apparently now (and this is different from two years ago when I was here) all pts who are HIV+ can receive such therapy thanks to many NGOs and the government.
I saw another 8 month old on referral from Drs. Miller and Lawrence with profound pigmentary changes throughout the retina and large areas of geographic atrophy in the macula. There was no history of maternal/child illness. It was probably a variant of a cone rod dystrophy; however it looked different than any of the numerous cases of cone rod dystrophy I saw in 8 years at KKESH in Saudi Arabia.
The retina had a white or silvery appearance that was very strking. Dr. Harrison pointed out that this might be Oguchi's disease. Although his retina seemed much "whiter" than what I would expect for that diagnosis. I wish there was a camera here so that I could take pictures of this pathology. Also saw quite a few endstage proliferative diabetic retinopathies. With all the pathology here, it was like I was back in KKESH in Saudi Arabia!
It was very enjoyable to teach the faculty and numerous residents how to use an indirect ophthalmoscope and how to do a slit lamp exam with a 90 diopter lens. They were all very enthusiastic and picked up these skills right away. I was really impressed with their knowledge of ophthalmology. They were able to rattle off differential diagnoses right away for most of the pathology we saw.
Tomorrow I will be giving lectures along with the ped ophthalmologists. I will also be trying to troubleshoot the diode laser and do some optical coherence tomography.
Sorry I can't upload any pics as the internet connection is a bit dodgy and very slow. In fact this is the first time in 24 hours that it has been working very well.
Hope to have more updates in the near future...
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1 comment:
You're my hero homey! You're out there doing what so many of us only think about doing, but don't translate it into action.
Harinder
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