The first OCT in the History of Enugu Hospital

Dr. Lawrence holding Grand Rounds

Drs. Harrison and Miller

Amelia helping patients

Optical Coherence Tomography (OCT)

We spent much time teaching ophthalmologists in how to use the OCT Machine.
This is one of our patients.

Dr. Alicia Montoya

I inadvertently neglected to mention a key member of our team in yesterday's posting:
Presenting the ocular imagist extraordinaire: Dr. Alicia Montoya.
She is teaching the ophthalmologists here how to image the eye through ultrasonography and optical coherence tomography.
She works at the Barraquer Institue in Bogota, Columbia.
Today she gave severral lectures with beautful images of not only ultrasounds but also pathology slides of enucleated eyes (hmmm...beautiful to an ophahlmologist perhaps)...:)

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.

ORBIS TRIP IN ENUGU

Well I just wanjted to give a quick update on the trip thus far.
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...

Scientists Induce Out-of-Body Sensation

Using virtual reality goggles, a camera and a stick, scientists have induced out-of-body experiences — the sensation of drifting outside of one’s own body — - in healthy people, according to experiments being published in the journal Science.

Another photo from the Lake Tahoe Shakespeare Festival

Shakespeare At Lake Tahoe

This Shakespeare lover had the opportunity to see a fantastic performance of"Romeo and Juliet" at an outdoor venue at Lake Tahoe last week:
The picture says it all...

Actor Dan Hoyle "bringing it home" to Nigeria

Go to the world.org and listen to today's broadcast to hear an excellent rendition of a Nigerian accent. BTW, I will be headed to Enugu, Nigeria in a few days so blogging will be light for a few weeks unless I get internet access there.


Actor Dan Hoyle

Actor Dan Hoyle traveled to Nigeria. He brought home stories about big oil, local warlords, and the people caught in between.

World Clock

This is cool!

China’s Trade in Africa Carries a Price Tag

This article reminded me of a conversation I had with a shopkeeper in Freetown, Sierra Leone last fall. He noted that although there was a great deal of rice grown upcountry in Sierra Leone, his shelves were stocked with rice imported from China. Due to the terrible road conditions in Sierra Leone it was very difficult for the farmers to get the rice to him. Instead he would go to Dubai on a regular basis to import foodstuffs such as rice...(Dubai is a huge intersection point for the Far East, Middle East, Africa and Europe).

To give an idea of how bad the roads are--it took 8 hours to go from Freetown to the hospital in the Bush at which I worked--the distance was about 100 miles.

From South Africa’s manganese mines to Niger’s uranium pits, from Sudan’s oil fields to Congo’s cobalt mines, China’s hunger for resources has been a shot in the arm, increasing revenues and helping push some of the world’s poorest countries further up the ladder of development.

But China is also exporting huge volumes of finished, manufactured goods — T-shirts, flashlights, radios and socks, just to name a few — to those same countries, hampering Africa’s ability to make its own products and develop healthy, diverse economies.

(..)

But China’s growing presence in global trade is wiping out thousands of jobs in countries with fledgling manufacturing sectors like Zambia and South Africa.

Despite relatively low wages in many countries, African manufacturers find it very hard to compete, arguing that China’s currency policies undervalue the yuan and give Chinese exporters a huge advantage.

Many industries in China also benefited at various points from subsidies and free or low-cost government financing, making their costs lower. Beyond that, there are major infrastructure problems in Africa, where industry struggles with inadequate roads and railways, and unreliable electricity and water supplies.

Looking Past Blood Sugar to Survive with Diabetes

Nearly 73,000 Americans die from diabetes annually, more than from any disease except heart disease, cancer, stroke and pulmonary disease.

Yet, largely because of a misunderstanding of the proper treatment, most patients are not doing even close to what they should to protect themselves. In fact, according to the federal Centers for Disease Control and Prevention, just 7 percent are getting all the treatments they need.

Rising Brand of Immigrant: Skilled and Welcome

This article captures well the dynamics of international migration--a phenomenon quite "foreign" to many citizens here..

An economist with a Louisiana doctorate and a Mississippi drawl, he shocked his friends when he left a tenured job in Virginia for the American University of Sharjah, a school conjured from nothing by a sheik in the suburbs of Dubai. But when he lists the benefits of working abroad, Mr. Mitias crows.

He has free housing and utilities. (“Sweet!”) He has international experience on his résumé. (“Huge!”) He has cheap household help, good schools for his children and a BMW and a Mercedes he was able to buy by paying no income tax. Not to mention plenty of American fast food.

“Papa John’s delivers to my house,” he said. “It’s all here!”

This is migrant work, Ph.D.-style — a lesson about labor, a comment on class, a window onto globalization and a phenomenon on the rise.

(..)

He describes life abroad as a successive discovery of freedoms: freedom from taxes, freedom from mortgages, freedom from crime, freedom from the sex and violence his daughters would see on American television. He and his wife have taken them to places as different as London and Vietnam, and to Thailand three times. “The world’s at your fingertips,” he said.

Lobes of Steel

Should I start prescribing exercise for my retinal patients?

Scientists have suspected for decades that exercise, particularly regular aerobic exercise, can affect the brain. But they could only speculate as to how. Now an expanding body of research shows that exercise can improve the performance of the brain by boosting memory and cognitive processing speed. Exercise can, in fact, create a stronger, faster brain.
(..)

Gage’s discovery hit the world of neurological research like a thunderclap. Since then, scientists have been finding more evidence that the human brain is not only capable of renewing itself but that exercise speeds the process.

“We’ve always known that our brains control our behavior,” Gage says, “but not that our behavior could control and change the structure of our brains.”

Emergency flashlight from a Pencil!

Turn A PENCIL Into A LIGHT ! - video powered by Metacafe

Bruce Cockburn Concert

I want to draw your attention to a fantastic artist, Bruce Cockburn, who played here in Reno two nights ago. He is a poet, who sets his lyrics of peace and social justice, to complex insistent, even hypnotic, guitar-based rhythms.

He played as a solo guitarist in the fantastic outdoor venue, Bartley Ranch, in front of a crowd of about 2000. We, the audience, shared an intimate evening with one of Canada's most appreciated musicians. For reasons unclear to me, heis not widely known here in the States.

As the beautifully percussive strumming draws you into his space, it as as though you are moving out of the surrounding darkness into the spotlight with him--to share his and the world's agonies...and beauty at the same time. His lyrics, poignant, passionate, and visually evocative, reverberate with his driving rhythm...in the mind and...the heart. One senses that as he himself gropes toward truth and justice in his music, he asks us to do the same--to brave the dark and mysterious, and to illuminate with love.

Here is a picture my son, Ryan, took at the concert



Here is concert footage from another venue:

How To Save a Live

Any fans of "The Fray" out there?
Here is an excellent mashup of one of my must see websites on a weekly basis (postsecret) with The Fray's "How to Save a Life."