Mugabe the Madman

I read this article on the airplane ride back from Nigeria yesterday and found it on the web...Mugabe the madman starving the voters...
News

Guest Worker May Lose Digits, Toes After Being Tied Up in Bathroom for a Month

Guest Worker May Lose Digits, Toes After Being Tied Up in Bathroom for a Month: "a total of 2,000 housemaids have been repatriated to Indonesia so far this year, with many alleging maltreatment"

Wolfowitz Dating Muslim Woman Causes Stir

Wolfowitz Dating Muslim Woman Causes Stir

Baby with anterior staphyoma left eye and corneal opacity from measles seen in Jos, Nigeria last week 

ABC News: Anti-Vaccine Sentiment Plagues Nigeria

Measles already is a huge problem in subSaharan Africa--looks like it may get bigger...

Last year, incredibly, there was an outbreak of polio which spread to several surrounding coutries due to an identical accusation by Muslim Clerics in Nigeria regarding nefarious motivations behind vaccinations...

See picture above for a baby blinded by measles seen in Jos last week.The left eye was enucleated. Devin did an optical iridectomy in the hope of giving the baby even a slight bit of vision in the right eye.
(Thanks to Devin for the link below).

ABC News: Anti-Vaccine Sentiment Plagues Nigeria: "Accusations by Islamic preachers that vaccines are part of an American anti-Islamic plot are threatening efforts to combat a measles epidemic that has killed hundreds of Nigerian children, health workers say. "

Strangers in the Night

Like many other third world countries, one of the constants in Nigeria is the lack of reliable electricity. For example, Laurie tried to run her tiny European style washing machine over twenty times since the early am before there was finally enough electricity around 9pm to run this single load. Those who can afford it have backup systems, consisting of generators and/or a 12 volt truck battery. At other times there can be excessive voltage resulting in fans spinning wildly, appliances alarming loudly, and the everpresent risk of computer death.

I find it most disconcerting when the electricity goes out at night if I have not yet inventoried with which critters I am sharing my sleeping space...in the complete darkness. Thus, I like most Nigerian residents, keep a flashlight with me at all times. The possibilities for roommates include cockroaches, mice, lizards, and the ever present malaria bearing mosquitoes. As long as there are no scorpions, large spiders, or snakes I find I can drift off to sleep.

Such encounters with creepy critters are more prevalent in the bush. Several days earlier I went to Miango, a somewhat rural area, to do a retina exam on a Texan named Tim M. (last name withheld in case HIPPA's tentacles extend into the African bush). He described a series of unfortunate events with snakes and scorpions that I found quite remarkable.

A week earlier his two dachsunds had been attacked by a spitting cornea resulting in severe corneal edema and transient blindness. The spitting cobra was noted by the water cooler, and was about 8 feet long. They can throw their venom ten to twelve feet. (There is a patient in the Kano eye hospital who was permanently blinded from a spitting cobra). The dogs had just recovered their vision when they were attacked by a rabid dog several days ago. Tim had also spotted a 6 inch long scorpion in the bathroom the previous night. Further, he had seen a tree viper drop down onto his roof and then into his attic several days earlier. His encounter with such intruders was not unique as his neighbor had found a puff adder in his house yesterday as well.

These events did not seem to faze Tim and his family. (I am not sure about the dogs). Tim is no stranger to danger--ten years earlier he had been held hostage for ransom in El Salvador! His past history also includes eating off a cow carcass for a week in Zambia. The cow was slaughtered in his honor by a village chief and then left in the field (no refrigerators in the bush) where it was walked on by an assortment of birds and licked by wild dogs. (Yesterday, he had visited a Fulani village where he relished a traditional bowl of sour milk with millet).

Spitting Cobra

Tim, (with his wife) trying to smile and keep his eyes open in the midDay African sun after dilating his eyes for a retinal exam.

Grateful Cataract Patient

Cataract Surgery in Nigeria

This is from Devin's blog:

This photo tells why Hardeep misses the practice of medicine overseas. In America we are fortunate to have excellent medical care. Patients rightly expect good care, and have easy access to physicians. This is not so in many areas of the developing world. This man had cataract surgery in Kano, and when we removed his dressing the next day he was very happy and immediately knelt down to pray. Another reason why we do not see this in America is that patients have cataract surgery done much earlier than they do here. In the US, many patients will have the surgery done when their vision drops down to 20/40 (legal cutoff for getting a drivers licence), but here in Nigeria we usually wait until the patient is 20/200 (legally blind). So the patients in America usually do not have the same dramatic changes the patients in Nigeria see.

Back in Jos

Devin and I made the four hour ride back to Jos today without incident... Gave out plastic bags of water to the policemen at the roadchecks. They were very appreciative as it is quite hot here!

Had a great time at ECWA eye hospital in Kano the past two days. Saw alot of interesting pathology. I will post about this later with pictures. I even got in two scleral buckles. Unfortunately the cryo unit wasn't working so I don't know what the eventual success will be. I am bringing it back to the States for repair. One of my patients was an albino. I also had an albino with a retinal detachment last year in Kano. If anyone knows of any condition in which albinism is associted with retinal detachment, please let me know.

The cataract patients are so grateful that they can see. One patient who has been blind (count fingers vision) fell to his knees in prayer in front of the entire team (about 8 of us). Saw another huge tumor in a 20 year old.

In discussions with various people here about how to improve healthcare in Nigeria, the number one answer is to decrease the corruption. However, no one has any ideas, or even hope, it seems in this vein. Apparently it is quite frequent for strikes to occur at the general hospitals, even by the doctors. The patients are left to die....It is quite sad.
But at the same time there are people and doctors who are incredibly devoted to the patients, which gives some sense of hope.

Devin and Laurie continue to be wonderful hosts...

VVF Clinic

VVF Clinic-what is it?
It stands for vesiculo-vaginal fistula clinic. Young women often develop these fistulas here after prolonged labor. These are commonly childbrides... Due to the malodorous sequelae, they are then often released by their husband back to their parents. However, even there they may be shunned by the villagers. They are essentially outcasts of society. Nigeria has 9 vvf clinics, the most successful one is in Jos. After the corrective surgery they can stay at the hospital for as long as three months, during which time they undergo physical therapy. Laurie volunteers much of her time to help in the PT for these patients. They are very grateful to have this treatment. At the hospital in Jos they are also given vocational training, in areas such as sewing. There was apparently a big reunion of VVf patients along with their doctors and physical therapists the week before I came. I heard it was quite a celebration, replete with dancing and drumming. There were even financial sponsors who flew in from the States for the celebration!

I wish I could upload photos from here to show you the smiles of these grateful young women!

Today I did rounds in the 200 bed ECWA eye hospital in Kano and was in clinic thereafter. I saw incredibly advanced disease in all but 2 patients--many of these were kids. Tomorrow is a surgical day....Will write more about the eye disease later....

Update from Nigeria

Hello from an internet cafe in Kano Nigeria! Just arrived in Kano with Devin today after a four hour ride from Jos.

First, internet access is nearly impossible. (Noter to self: Need to learn where Nigerian internet scammers are going for access). I am having a great time, seeing patients with severe disease who are very appreciate. For ex, today there was a patient who went from Hand motion vision to count finger vision after cataract surgery. She was just laughing and nearly dancing with joy at her new-found vision...hard to imagine similar scenario back home.

Of course seeing lots of tragic unnecessary blindness as well, e.g. 6 month old baby with measles and anterior staphyloma in one eye and dense leukoma (corneal scar) of the other eye. He underwent evisceration of the staphylomatous eye, and optical iridectomy in the other eye. This was all done under ketamine--no intubation. By the way the mother was advised to throw the baby from the bus and leave it to die as the father had died shortly after the baby's birth. But she related that "it was the fear of God" that made her keep the baby.

The ICU in the hospital is quite interesting--no running water and no ventilators! Saw a teen in ICU with probable cavernous sinus thrombosis--severly obtunded. No CT or MRI scanner available to confirm diagnosis. Abcess drained at bedside and on iv antibitics. (Thankfully iv antibiotics are available).

Saw another kid with massive hydrocephalus of unknown cause.

Overall, I am having a great time, with the only concern being for security.--Especially when driving and having to stop at numerous police checkpoints. Some of these are actually decoys for the bad guys to get you to stop so they can rob you.
Here is a link to an article about a boy who was shot on the compound last month and is now recovering in Minnesota...

http://wcco.com/localnews/local_story_069111604.html

Have to go--next time will try to post on great results from vesiculvaginal clinic....

UN Millenium Project

If you are not able to access the Time magazine on poverty mentioned below, go to http://www.unmillenniumproject.org/. On the right side of the page you will see a graphic of the Time magazine cover on The End of Poverty. Click on it...you will need Adobe Reader. There is more from Jeffrey Sachs at http://www.earthinstitute.columbia.edu/endofpoverty/
(Thanks to Daniel Drezner)

Democracy Activists on Trial in Saudi Arabia

Democracy Activists on Trial in Saudi Arabia
The three Saudi Arabian democracy activists held in prison the past year for leading calls for a constitutional monarchy were sent back to jail today as their closed court trial was suspended for another three weeks so that prosecuting attorneys could gain more evidence against the defendants. The three were to be tried in August of last year, the date was pushed back to December when 9 journalists and family members were arrested for attempting to attend the trial. The trial was then postponed until February and then again pushed back to this weekend (Saturday, March 12th): Reformists Ali al-Demaini, Abdullah al-Hamed and Matruk al-Faleh are also accused of "using Western terminology" in demanding political reforms. They also allegedly questioned the king's role as head of the judiciary. Only two members of the seven-strong defense team continue to attend hearings as four were dismissed by the judge and another was arrested. The crackdown on constitutional reformists has cast doubt on the government's attempts to introduce limited reforms, claimed to fit Saudi specifications rather than following a Western pattern.

BONO

THE WORLD'S BIGGEST ROCK STAR IS ALSO AFRICA'S BIGGEST ADVOCATE. BUT BONO KNOWS HE HAS TO MAKE THE CASE FOR AID WITH HIS HEAD, NOT HIS HEART
Rock stars tend to cast themselves as emotional savants, folks who feel the plight of vanishing rain forests and anguished Tibetans more acutely than the rest of humanity. Bono's involvement with Africa began in typical celebrity-dilettante fashion...But then Bono and his wife traveled to Wello, Ethiopia, and spent six weeks working at an orphanage. "You'd wake up in the morning, and mist would be lifting," Bono recalls. "You'd walk out of your tent, and you'd count bodies of dead and abandoned children. Or worse, the father of a child would walk up to you and try to give you his living child and say, 'You take it, because if this is your child, it won't die.'"...
The experience remained with him through 1999, when he joined the Jubilee 2000 movement. Jubilee 2000's aim was to get the U.S. and other wealthy nations, as well as the World Bank and the International Monetary Fund, to erase the public debt of 52 of the world's poorest countries, most of them in Africa. By wiping $350 billion from their books, these countries would be free to spend money on health care and education, rather than pay down the principal on loans floated by corrupt and sometimes long-gone governments. ...
"I know how absurd it is to have a rock star talk about the World Health Organization or debt relief or HIV/AIDS in Africa," Bono says. But he also knows that no one else with his kind of access to media and money has taken on the job. In an effort to keep the discussion serious and avoid the appearance of being just another rocker against bad things, he refrains from treating Africa as an emotional issue. "We don't argue compassion," he says. His argument is pragmatic, not preachy. "We put it in the most crass terms possible; we argue it as a financial and security issue for America...There are potentially another 10 Afghanistans in Africa, and it is cheaper by a factor of 100 to prevent the fires from happening than to put them out." ...
"What we're all on about is: Africa. Seventy percent of the problem of HIV/AIDS is in Africa. We're talking about the continent bursting into flames while we stand around with watering cans. That's our one idea. But the closer you get to the policymakers, you need specificity, and you need to know what you're talking about. I'd go in and talk about debt relief, debt relief, debt relief, and people would say, 'But that's only part of the picture here.'"
At 41, Bono says, he has given up on music as a political force. He believes his work negotiating in political back rooms is more vital and effective than singing in sold-out stadiums...
Music does make a difference in one way; it sways people emotionally. But for Bono that is no longer enough: "When you sing, you make people vulnerable to change in their lives. You make yourself vulnerable to change in your life. But in the end, you've got to become the change you want to see in the world.(italics mine).I'm actually not a very good example of that--I'm too selfish, and the right to be ridiculous is something I hold too dear--but still, I know it's true."
Link: http://www.time.com/time/archive/preview/0,10987,1001931,00.html?promoid=AM2 (subscription required)

Who's Zooming Who?

I am currently in England at London Heathrow. I am nearing the end of an 8 hour layover before the 6 hour flight to Abuja. On my way to England I attended a meeting sponsored by a pharmaceutical company. Having never been to such a meeting, I expected it to essentially consist of aggressive, biased presentations in favor of the company's products. However, much to my surprise, there was actually more science here than at the supposedly neutral society meetings.With the increasingly intricate involvement between academic centers and big pharma drug trials, many presentations at e.g., the AAO and ASER have turned into blatant advertisements for various drugs. This trend seems to have markedly accelerated over the past 5 years. (I have been going to such meetings for the past 15 years). Note:I am not necessarily blaming academic centers for jumping into partnerships with various pharm. companies, but some of the presentations are so over the top it is rather embarassing...

However, at the meeting I attended yesterday there was really very little "fluff." Instead detailed analyses of various treatment options for macular degeneration were reviewed in minute detail. Future treatment options were thoughtfully debated. I was thoroughly impressed. It was probably one of the best meetings I have attended in the last few years.

But it sure makes my head spin to see more biased presentations at society meetings than at a drug company sponsored meeting...

Going to Nigeria

Well, I am about to head off to a one day meeting in Atlanta followed by a loooong flight to Nigeria. I am not sure how much internet access I will have. But I will try to keep you updated from there if possible.

Please make sure you check out the Time magazine article on global poverty. I found it quite interesting.

Also, Elizabeth Vargas, co-anchor of the TV show "20/20" will have a compelling feature on Cambodian refugees and orphans March 18th. I won't be in the States, but hopefully you will get a chance to watch it.


Cheers....

James Nachtwey, an incredible photographer, also has a photo essay accompanying the Time magazine article 

TIME Magazine: The End of Poverty (6)

Excellent Book Excerpt in this week's Time magazine...written by someone who knows what they are talking about. If you can't get the magazine, let me know and I will try and email you the article on my return to the States.
TIME Magazine: The End of Poverty (6): "The outside world has pat answers concerning extremely impoverished countries, especially those in Africa. Everything comes back, again and again, to corruption and misrule. Western officials argue that Africa simply needs to behave itself better, to allow market forces to operate without interference by corrupt rulers. Yet the critics of African governance have it wrong. Politics simply can't explain Africa's prolonged economic crisis. The claim that Africa's corruption is the basic source of the problem does not withstand serious scrutiny. During the past decade I witnessed how relatively well-governed countries in Africa, such as Ghana, Malawi, Mali and Senegal, failed to prosper, whereas societies in Asia perceived to have extensive corruption, such as Bangladesh, Indonesia and Pakistan, enjoyed rapid economic growth. "