Monday, September 03, 2007
The Waterfall
We had breakfast and said "Bye" to Alicia, who was planning to fly back early to Bogota.
Ahmad and I did a live television interview with Dr. Ezepue on the NT national television station about ORBIS and the symposium. We took calls as well--the first caller was an irate gentlemen, upset that live broadcasting of the under 17 soccer world cup had been interrupted. No more call were taken after that. The first call notwithstanding, the interview went fantastic with discussions centering on eyebanking, early ophthalmologic exams for new onset eye symptoms, and acknowledgement of the enthusiasm of the local ophthalmologists. Ahmad also did a great job informing everyone of the purpose and history of Orbis, leading into an overview of the success of this mission.
We then came back and changed out of our jackets and ties. Devin, Ahmad, Amelia and I went with a male resident and a female consultant, Dr. Ezegwui, and her three kids to a "waterfall." But before we left, I asked the front desk attendant why he had was wearing two ties. He explained that there was about to be a wedding and he was trying to help the best man get his tie on. He implored us to help. Feeling sympathetic and a bit of wonderment at the proximity of the tying of the tie to nuptialization, Ahmed and I went to work helping these chaps out. It was a nice exchange and we were happy to help the groom try and match the sartorial style and elegance of his bethrothed (who we saw later that day).
Back to the hike--described to Amelia and Ahmad in minimal terms as a half hour walk across flat terrain. It actually turned out to be much more than this.
As our vehicle turned and headed into the densely vegetated forest; Ahmed, after a period of silence, inexplicably to me brought up a random comment about the foilage at the Monastery being a great place for war! "The dense foilage would provide many hiding places," he elaborated.. in response to my gaze of puzzlement. My question was "But what brought war to your mind; we are in a monastery?" "Eventually to bring balance and hoping that the tears in Ahmed's eyes (as well as the rest of us) were those of laughter and not hurt, I thought a little levity and more gravitas was in order. Thus, I been enquiring of the male resident about the Biafran war and acknowledging (on Ahmad's behalf) this jungle would truly be a great place to have a war. After a quick review of the history of the Biafran war, Ahmed , not surprsingly I guess, gave a full account of the details of the war. Completely confused as to how Ahmed knew so much about the Biafran was, I was nonetheless quite impressed. We were still chuckling several minutes later as the bus came to a halt inside the monastery grounds, at which point Amelia promptly noted that she "had to go to the bathroom." I chivalrously pulled out a travel pack of mini Kleenex for her. Grasping it with great gratitude, she hurriedly headed into an unpopulated area to find a spot. The male resident accompanied her to scout out a place. As they disappeared into the distance, the resident asked her in a mattter-of -fact tone if she had to "pee or poo." As she related later, " I thought the question was a little personal. But after regaining my composure, I replied."Pee." A suitable spot was found. Business was accomplished and we began our nice "Sunday stroll."
Uh actually ...a bit different .... Though it started out like a scene out of the "Sound of Music" (in Africa) as originally envisioned, the nature of the terrain began changing. The path started getting steeper. Vines formed natural steps. The green bushes started getting closer on either side. The firm ground gave way a bit more...There were many Nigerians on all sides of us, engaged in purposeful walk and excited talk. They were moving at a rather rapid clip and a bit more focus than I would associate with a "relaxing stroll" Every once in awhile we would pass somebody drenched and excitingly shouting "The Water. The Water." I am thinking "Oh okay, it seems that you might actually be able to duck your head under the Fall." As we kept advancing we encountered increasing numbers people of all ages were singing and laughing and talking excitedly as we made our way down a muddy path. Enjoying the beautiful harmonies and polyrhythmic singing, we stopped suddenly. We had reached a 3 feet creek, with about 6 inches of water. The forward momentum of the Orbis group came to an abrupt halt. We glanced down at the stream and at everyone taking their shoes off in order to traverse it . Luckily for me, earlier the male resident had noticed my black leather dress shoes and had insisted on buying me a set on Nigerian flip-flops--this despite Amelia's protestations that I should have to "muddy my shoes to learn my lesson"--something about packing right.... We had even bought an extra pair of bright green (with design) slippers for Ahmad. But he was insistent on wearing his black leather shoes. Everyone else had appropriate hiking footwear.
Realizing at this point that this hike might take on a different character than originally expected, we each made an individual calculation as to whether or not to take our shoes off and go on, or just turn around--to perhaps go past "the point of no return." The residents who were with us had never gone past this point, so really couldn't help in our decision either. As I was pondering the possibilites of schistosomiasis, onchocerciasis, and other parasites that might be residing the water, I looked up and saw that Devin and Amelia had made the decision for the group. Ahmad and I rolled off up our pants, took off our shoes, vanquished thoughts of tropical parasitemia as we crossed to join our barefoot buddies.
Sensing no acute signs of parasitic infection, we marched forward on the dirt path--passing large "trains" of people coming the other side. Some were carrying jugs of water, considered holy, on their heads as we passed their smiling faces. Others were excitedly telling us about the water. I couldn't really understand the details of these passing conversations, but started to realize that this hike could indeed be completely different than imagined.
We then came to a river bed at the mouth of a canyon. The canyon walls at least 100 feet high and insinuating did not allow a further look as to what lay ahead. Realizing this was our last chance to turn back...we hesitated. In the space of the hesitation, it was clear that we were surrounded by very, very happy Nigerians, singing, dancing and praying. No one seemed to be wretching, writhing, or showing other signs of sickness. Having "boldly"surmounted our first creek, we felt rather intrepid--ready to handle the river (and whatever lurked beneath). As we sloshed through the river of various depth from 6' to 3 feet, we started feeling a childhood sense of joy from doing something we weren't planning on doing. All around, behind, in front and on the side of us people were walking with us. Amelia, as usual, was making friends with many of the Igbo people around us.
Turning through dark caverns, with water sliding down the walls beside us, we were in communion with hundreds of Igbo Nigerians singing and laughing and dancing and praying and soaking up the water. The turns were rather abrupt and I lost sight of our fearless leader, Devin. Knowing he was leading the charge we kept marching forward, occasionally, okay more than occasionally, wincing with pain from stepping on the steep rocks invisible under the flowing water. The flowing water and the flowing people kept us moving forward in a near-hypnotic march, as we were focused on avoiding sharp rocks and not falling into the water en bloc,and intermittently looking up to see where the rest of the group was.
It was amazing--so much human African spirit rejoicing at the beauty of nature and the nature of God.
Amelia pointed out to me a spiderweb on the side of the cavern about 50 feet up-- with a ray of sunlight reflecting off and shining through the wet silk. Her only words were "This is one of those moments."-- a reference to discussions we have had in the past where one is totally opened to the Spirit, to God.It was truly transcendent moment. Everything stopped. I hope one day, Ahmad, will paint it. He is an accomplished oil painter. (But don't as ask him about his childhood violin lessons).
When we got to the end of the riverbed, the canyons which had varied between 2 and 6 feet wide, opened up into a natural amphitheater about 60 x 60 feet.
At the end of this was the waterfall-- rushing down a sheer rock face into the base of the river. The loud Fall was a great acoustic backdrop for all the pilgrims and celebrants in naturally harmonious praise, dancing, and laughing...
Some would say they were "catching the spirit." I stood there with Ahmed, Amelia, and transifixed--just took it all in.
At one point Amelia, in awe of the whole scene, asked someone how long they stayed here at the end of the journey to the Fall. In typical Nigerian fashion, the woman answered, "Not long. Once we get here, we turn around. Some people are coming. Some people are going."
That brought us back from our group fugue state and we started heading back.
We then navigated the rocky, and at times sandy, way back through the river bed, clutching the walls of the cavern to keep from falling. Luckily no one fell in the water and exposed themself to any seriously high titer of parasites. No river snakes were seen. No flash floods occurred, and we made it back to the mouth of the riverbed.
As we emerged from the riverbed, shook ourselves dry, and regained our bearings on solid ground, we were surrounded by many others who had just completed the pilgrimmage. Ahmed, perhaps still inhaling the air of exhiliration, greeted everyone around us with great sincerity with the unwritten message that we have shared something fantastic with you. Shaking his head alternately left and right while walking forward as though on a great diplomatic stage, he beamed out "Anisha! Anisha!" He must have uttered this word about 15 times. Later on the path we learned that the word, "Anisha" does not mean "Hello," but "white person." Upon learning that this was the meaning, Ahmend's first response was "But this is very bad."
Onward we walked and were pleasantly surprised by seeing the rest of the Orbis staff who had driven here, after a surgery for congenital ectropion.
It was one of the most incredible experiences I have ever had.
I was very fortunate to share it with my friends.
Ahmad and I did a live television interview with Dr. Ezepue on the NT national television station about ORBIS and the symposium. We took calls as well--the first caller was an irate gentlemen, upset that live broadcasting of the under 17 soccer world cup had been interrupted. No more call were taken after that. The first call notwithstanding, the interview went fantastic with discussions centering on eyebanking, early ophthalmologic exams for new onset eye symptoms, and acknowledgement of the enthusiasm of the local ophthalmologists. Ahmad also did a great job informing everyone of the purpose and history of Orbis, leading into an overview of the success of this mission.
We then came back and changed out of our jackets and ties. Devin, Ahmad, Amelia and I went with a male resident and a female consultant, Dr. Ezegwui, and her three kids to a "waterfall." But before we left, I asked the front desk attendant why he had was wearing two ties. He explained that there was about to be a wedding and he was trying to help the best man get his tie on. He implored us to help. Feeling sympathetic and a bit of wonderment at the proximity of the tying of the tie to nuptialization, Ahmed and I went to work helping these chaps out. It was a nice exchange and we were happy to help the groom try and match the sartorial style and elegance of his bethrothed (who we saw later that day).
Back to the hike--described to Amelia and Ahmad in minimal terms as a half hour walk across flat terrain. It actually turned out to be much more than this.
As our vehicle turned and headed into the densely vegetated forest; Ahmed, after a period of silence, inexplicably to me brought up a random comment about the foilage at the Monastery being a great place for war! "The dense foilage would provide many hiding places," he elaborated.. in response to my gaze of puzzlement. My question was "But what brought war to your mind; we are in a monastery?" "Eventually to bring balance and hoping that the tears in Ahmed's eyes (as well as the rest of us) were those of laughter and not hurt, I thought a little levity and more gravitas was in order. Thus, I been enquiring of the male resident about the Biafran war and acknowledging (on Ahmad's behalf) this jungle would truly be a great place to have a war. After a quick review of the history of the Biafran war, Ahmed , not surprsingly I guess, gave a full account of the details of the war. Completely confused as to how Ahmed knew so much about the Biafran was, I was nonetheless quite impressed. We were still chuckling several minutes later as the bus came to a halt inside the monastery grounds, at which point Amelia promptly noted that she "had to go to the bathroom." I chivalrously pulled out a travel pack of mini Kleenex for her. Grasping it with great gratitude, she hurriedly headed into an unpopulated area to find a spot. The male resident accompanied her to scout out a place. As they disappeared into the distance, the resident asked her in a mattter-of -fact tone if she had to "pee or poo." As she related later, " I thought the question was a little personal. But after regaining my composure, I replied."Pee." A suitable spot was found. Business was accomplished and we began our nice "Sunday stroll."
Uh actually ...a bit different .... Though it started out like a scene out of the "Sound of Music" (in Africa) as originally envisioned, the nature of the terrain began changing. The path started getting steeper. Vines formed natural steps. The green bushes started getting closer on either side. The firm ground gave way a bit more...There were many Nigerians on all sides of us, engaged in purposeful walk and excited talk. They were moving at a rather rapid clip and a bit more focus than I would associate with a "relaxing stroll" Every once in awhile we would pass somebody drenched and excitingly shouting "The Water. The Water." I am thinking "Oh okay, it seems that you might actually be able to duck your head under the Fall." As we kept advancing we encountered increasing numbers people of all ages were singing and laughing and talking excitedly as we made our way down a muddy path. Enjoying the beautiful harmonies and polyrhythmic singing, we stopped suddenly. We had reached a 3 feet creek, with about 6 inches of water. The forward momentum of the Orbis group came to an abrupt halt. We glanced down at the stream and at everyone taking their shoes off in order to traverse it . Luckily for me, earlier the male resident had noticed my black leather dress shoes and had insisted on buying me a set on Nigerian flip-flops--this despite Amelia's protestations that I should have to "muddy my shoes to learn my lesson"--something about packing right.... We had even bought an extra pair of bright green (with design) slippers for Ahmad. But he was insistent on wearing his black leather shoes. Everyone else had appropriate hiking footwear.
Realizing at this point that this hike might take on a different character than originally expected, we each made an individual calculation as to whether or not to take our shoes off and go on, or just turn around--to perhaps go past "the point of no return." The residents who were with us had never gone past this point, so really couldn't help in our decision either. As I was pondering the possibilites of schistosomiasis, onchocerciasis, and other parasites that might be residing the water, I looked up and saw that Devin and Amelia had made the decision for the group. Ahmad and I rolled off up our pants, took off our shoes, vanquished thoughts of tropical parasitemia as we crossed to join our barefoot buddies.
Sensing no acute signs of parasitic infection, we marched forward on the dirt path--passing large "trains" of people coming the other side. Some were carrying jugs of water, considered holy, on their heads as we passed their smiling faces. Others were excitedly telling us about the water. I couldn't really understand the details of these passing conversations, but started to realize that this hike could indeed be completely different than imagined.
We then came to a river bed at the mouth of a canyon. The canyon walls at least 100 feet high and insinuating did not allow a further look as to what lay ahead. Realizing this was our last chance to turn back...we hesitated. In the space of the hesitation, it was clear that we were surrounded by very, very happy Nigerians, singing, dancing and praying. No one seemed to be wretching, writhing, or showing other signs of sickness. Having "boldly"surmounted our first creek, we felt rather intrepid--ready to handle the river (and whatever lurked beneath). As we sloshed through the river of various depth from 6' to 3 feet, we started feeling a childhood sense of joy from doing something we weren't planning on doing. All around, behind, in front and on the side of us people were walking with us. Amelia, as usual, was making friends with many of the Igbo people around us.
Turning through dark caverns, with water sliding down the walls beside us, we were in communion with hundreds of Igbo Nigerians singing and laughing and dancing and praying and soaking up the water. The turns were rather abrupt and I lost sight of our fearless leader, Devin. Knowing he was leading the charge we kept marching forward, occasionally, okay more than occasionally, wincing with pain from stepping on the steep rocks invisible under the flowing water. The flowing water and the flowing people kept us moving forward in a near-hypnotic march, as we were focused on avoiding sharp rocks and not falling into the water en bloc,and intermittently looking up to see where the rest of the group was.
It was amazing--so much human African spirit rejoicing at the beauty of nature and the nature of God.
Amelia pointed out to me a spiderweb on the side of the cavern about 50 feet up-- with a ray of sunlight reflecting off and shining through the wet silk. Her only words were "This is one of those moments."-- a reference to discussions we have had in the past where one is totally opened to the Spirit, to God.It was truly transcendent moment. Everything stopped. I hope one day, Ahmad, will paint it. He is an accomplished oil painter. (But don't as ask him about his childhood violin lessons).
When we got to the end of the riverbed, the canyons which had varied between 2 and 6 feet wide, opened up into a natural amphitheater about 60 x 60 feet.
At the end of this was the waterfall-- rushing down a sheer rock face into the base of the river. The loud Fall was a great acoustic backdrop for all the pilgrims and celebrants in naturally harmonious praise, dancing, and laughing...
Some would say they were "catching the spirit." I stood there with Ahmed, Amelia, and transifixed--just took it all in.
At one point Amelia, in awe of the whole scene, asked someone how long they stayed here at the end of the journey to the Fall. In typical Nigerian fashion, the woman answered, "Not long. Once we get here, we turn around. Some people are coming. Some people are going."
That brought us back from our group fugue state and we started heading back.
We then navigated the rocky, and at times sandy, way back through the river bed, clutching the walls of the cavern to keep from falling. Luckily no one fell in the water and exposed themself to any seriously high titer of parasites. No river snakes were seen. No flash floods occurred, and we made it back to the mouth of the riverbed.
As we emerged from the riverbed, shook ourselves dry, and regained our bearings on solid ground, we were surrounded by many others who had just completed the pilgrimmage. Ahmed, perhaps still inhaling the air of exhiliration, greeted everyone around us with great sincerity with the unwritten message that we have shared something fantastic with you. Shaking his head alternately left and right while walking forward as though on a great diplomatic stage, he beamed out "Anisha! Anisha!" He must have uttered this word about 15 times. Later on the path we learned that the word, "Anisha" does not mean "Hello," but "white person." Upon learning that this was the meaning, Ahmend's first response was "But this is very bad."
Onward we walked and were pleasantly surprised by seeing the rest of the Orbis staff who had driven here, after a surgery for congenital ectropion.
It was one of the most incredible experiences I have ever had.
I was very fortunate to share it with my friends.
The weekend
We had a busy, culturally enriching weekend and made many further connections with our hosts here. I don't have time at the moment to detail them all as I need to refine a uveitis talk to be given later today. Today is the opening of the Nigerian Opthalmologic Society. Several hundred ophthalmologists from all over Nigeria are expected to attend.
Anyway, I can't wait to share a "walk to a waterfall," which turned out to be much more than that--in fact it was one of the most amazing experiences I have had in all my travels to Africa.
Meanwhile here is a quote (sorry--I can't remember the author at the moment) which rings true:
"Africa's not an issue. It's not a cause or a problem. It's a continent - a complicated, confusing, beautiful continent, with wealth and poverty, peace and strife, success and tragedy. When Africa becomes a cause, we tend to see only one side of the continent - a helpless, dependent, starving side that "needs our help"."
I think that anyone who has been to Africa would certainly agree that this continent is so rich in so many ways, and it does it unjustice to reduce it to a cause...
Anyway, I can't wait to share a "walk to a waterfall," which turned out to be much more than that--in fact it was one of the most amazing experiences I have had in all my travels to Africa.
Meanwhile here is a quote (sorry--I can't remember the author at the moment) which rings true:
"Africa's not an issue. It's not a cause or a problem. It's a continent - a complicated, confusing, beautiful continent, with wealth and poverty, peace and strife, success and tragedy. When Africa becomes a cause, we tend to see only one side of the continent - a helpless, dependent, starving side that "needs our help"."
I think that anyone who has been to Africa would certainly agree that this continent is so rich in so many ways, and it does it unjustice to reduce it to a cause...
Thursday, August 30, 2007
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)...:)
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)...:)
Tuesday, August 28, 2007
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.
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.
Monday, August 27, 2007
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...
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...
Friday, August 24, 2007
Thursday, August 23, 2007
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...
Wednesday, August 22, 2007
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.
Actor Dan Hoyle
Actor Dan Hoyle traveled to Nigeria. He brought home stories about big oil, local warlords, and the people caught in between.
Tuesday, August 21, 2007
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.
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.
Monday, August 20, 2007
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.
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.
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.
Sunday, August 19, 2007
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.”
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.”
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