Thursday, May 29, 2008

Cataract Surgery!!

Hey there!

So today Yue and I stayed at the clinic to watch cataract surgeries! Mike, Jess, Marielle, and Cu Ri went out to another village to perform eye screenings. The day at the clinic was pretty crazy. Our only “job” was to watch and learn... not too bad! We scrubbed in and had the whole gown, cap, and mask going on. The extent of our assisting was at the end of the surgery when we got to help tape the eye patch over the eye. We watched Dr. Wanye perform seven surgeries in three hours. Each one lasts only about fifteen minutes with the exception of one that took a little longer due to deep set, small eyes on one elderly man who required stitches through his eye lids to pull them far back. We got to be right at the table and lean over to take as close of looks as we wanted – it was sweet! I was completely enthralled and couldn't get enough detail, but after the first one, as he was covering up the eye, I realized I was sweating profusely and was very light headed. I hadn't felt like I was getting grossed out at all during the surgery, but apparently I had an adrenaline rush or something because I had to sit down and have some water before getting back to the operating table. I'm going to describe the surgery in moderate detail, so sorry if it's too much for you weak stomached to handle :)

The procedure starts in the pre-op room where you give a series of shots and eye drops that completely numb the eye and the surrounding area in addition to dilate the pupil. I assume they also give the patient something along the lines of Valium to calm their nerves (they are awake during the whole surgery) but I don't actually know if these patients get that luxury. The patient is then brought to the operating room and lies on the table, their head in a rest that positions it straight and tilted slightly back. Dr. Wanye sat at the head of the table with the surgical table to his right, where two nurses stood to hand him the tools, and the microscope/optical light to his left, where Yue and I stood with a medical student who has been shadowing Dr. Wanye. (On a quick side note, this lovely 22 year old woman is in her fourth year of medical school, attending the school here in Tamale, and the programs here are seven years!) Dr. Wanye started by first scrubbing the eye lids and surrounding area with swabs of iodine to sterilize the skin. He then put a sheet over the whole face with a cut out hole for the eye. He made the first incision in the cornea with a TINY pair of scissors just above the iris. He then cut a line across the top of the iris and pulled the cornea back. He controlled the bleeding with a small cauterizing tool (this part smelled nasty). During this whole time the nurse is irrigating the eye with a syringe to ensure it doesn't dry out. Then, using a small, triangular shaped scalpel, he cut into the sclera to be able to access the lens. At this point, the doctor is “inside” the eye and all wetting is done by the doctor with a small syringe that he puts into the incision. The lens is shaped like two bowls facing each other and it is the interior of this cavity that is damaged (cloudy) and needs to be replaced. This allows there to be no issue with the cilliary muscles still performing their job of stretching and relaxing the lens. (I thought the whole lens was replaced and was confused as to how they reattach in muscles.) With the incision now running behind the lens, the doctor is able to take a tiny scalpel bent at a 90 degree angle to cut the front portion of the lens away from the back portion. Dr. Wanye then bent a very thin, very sharp wire in the right shape (90 degrees down, flat, 90 degrees up, handle) that allows him to put it into the eye flat, turn it upright so the small tip points downward, and then run it along the lens. He uses this tool to cut around the inside of the perimeter of the lens, freeing it from the rest of the lens. Then it gets crazy!! If the cataract is still soft (only found in children and young adults who only have a cataract as a result of intense trauma, which we did see today in a twelve year old boy), then the lens can be suctioned out with a syringe. Otherwise, the lens is scooped out with a spoon-like instrument and popped out through the incision, which is mostly the case. It's pretty insane to see it popped out through the sclera!! The moment it is out the pupil changes fro the silvery solid to a clear, dark healthy pupil – it's amazing! The lens is about a millimeter or two in diameter and is hard and completely opaque if a mature cataract (as most are around here). Even to the untrained eye, you can tell it is diseased. (Cataracts is the clouding of the lens and, when mature, results in total loss of vision. It is the number one cause of preventable blindness in the world. You can tell when a person or animal has a full cataract because their pupils look silvery. They are most commonly caused by UV damage but can also result from trauma). More irrigation is done to wet the eye and also administer antibiotics to prevent infection. The prosthetic lens is then unwrapped from individual canisters. The lens is the same size but looks much more fluid and is entirely transparent. There are two little, arched blue threads across from one another that act to anchor the new lens into the existing capsule. Once in place (you can see it moving through the pupil, though barely because it is healthy and clear), the cornea is folded back down and a large injection of antibiotics is administered in this cavity. (In some cases, Dr. Wanye had to stitch the tiniest sutures I have ever seen. The knot of the stitch is pulled through to the anterior cavity (between the cornea and the lens) as to not irritate the inside of the eye lid. These sutures are remove on the post-op visit.) It creates a huge, very odd looking bubble beneath the cornea, but this will disperse and disappear within two days. The lid if closed over the eye, gauze is stacked on the lid, and a cupped disk is taped over to protect the eye. That's it! The patient returns to the clinic in the next two days and once the bandage is removed, they will have their sight completely back!! It's amazing!

Two funny things that happened today in surgery: 1) Dr. Wanye requested that music be put on. I was shocked when Johnny Cash is what come out of the speakers! It wasn't his fun Ring of Fire, A Boy Name Sue, Folsom Prison Blue, etc but his slow, gospel-like music. The nurse leaned over to me and asked if I knew this music and I said, yes, I enjoy Johnny Cash but I really, really enjoy their music with the upbeat baselines and fun singing. Later, they put on some local music. 2) One man was having a hell of a time standing still. He kept bringing his hand to his face to try to scratch it (God knows why he had the desire to get near his eye while being operated on!) and Dr. Wanye would yell, pretty sternly, at him. He also was having a hard time not touching himself. It was awkward! Yue and I didn't really know how to respond so we just tried really, really hard to not take our eyes of his eye. Again, Dr. Wanye had to yell at him because, not only was it inappropriate, but it was also causing him to move which is NOT a good idea when you have sharp objects cutting open your eye.

Our day was completed around 1 o'clock, which was convenient because the rest of the group returned about the same time. We came home and I finished Slaughterhouse-Five. Very good book, very sad story. Fried rice, again, for dinner. I am dying for a huge, fresh salad filled with lots and lots of veggies and fruits that don't need to be peeled!! (You know it's bad when you are craving food from home a week into the trip.) When I get home, I am eating fresh veggies, lobster and fish for a loooong time. NO meat (at least none on bones) and NO rice!! I think I'm going to have to get over my weirdness with meat, but it's so hard and I haven't done it yet!! All the meat is served on the bones and I don't know what they do with the chicken breasts because it is all legggggs! I mean, sure the chicken was probably clucking around this morning, but echhhh. At least I have gotten to the point where I am able to pull off the white(r) meat from the bone. But the second it gets dark or I can see veins or cartilage, I'm out. Luckily, the rest of the group (with the exception of Yue who is a vegetarian) is ok with this and will take the rest of my chicken – otherwise TONS of meat would go to waste. Yeah, bottom line, salads and seafood when I get home. And Mum's mac and cheese, mmmmmm....

Oh yea! We met a group of guys who are working with the Carter Club to eradicate guinea worm. I don't know if you all remember learning about this gnarly creature in bio class but the eggs are ingested when stagnent water is consumed. The eggs hatch in the stomach and the nearly-microscopic worm leaves the stomach and enters the muscle/flesh. The worm can grow up to a meter in your body!! They move around your body as they please until they leave through your skin to lay more eggs in water. Apparently, this process is wicked, wicked painful. Steve said that some of these women have virtually no pain through childbirth but will cry and scream while dealing with the exiting of the worm. Crazy!! The Carter Club have recruited Miss. Ghana to work as their PR person. They've been here for a few months and have a car so now we can see things without bothering our driver.

Alright, well until next time take care!! Love and miss everyone tons, but not too much because I'm really freaking loving it here! Talk to you soon!!

Faith and Linds – Sorry I haven't responded to the e-mails yet! I finally checked my e-mail yesterday but was about to run out of minutes. I'll respond very soon. Thank you so much for the messages, though, it meant a lot and they both made me laugh a lot! Oh, and Faith, I am still using that blue stretched out hair elastic you let me borrow a few days before I left :) Reminds me of you every time I put my hair up!
Mum and Dad – Good luck on both of your recoveries! Take is easy but do everything you are supposed to – hip precautions included! Remember, PT sucks, it hurts, is boring, and is monotonous, but it is the most important thing to do right now! (Really saying that for my benefit, too. I'm trying really hard to keep up with mine but ewww I hate it!)
Elizabeth and Tom – I'm happy to hear you are keeping up with the blog! There are tons of Dutchies here. I always see them in the internet cafe. I was kinda proud of myself because I recognized their speech as Dutch :) I'm the only one with a blog, but thanks for asking!
Gina – Gosh I miss you!! Thanks for the post, I can't wait to talk to you when I get back to the states! Love you so much and the good vibes are wonderful :)

Tuesday, May 27, 2008

First Day of Work


Today was our first day of work. We did an outreach program in the school house of a small village called Dungu. Marielle, Jessica, and Mark determined acuity by hanging three Snell charts around the trunk of a large tree that provided a lot of shade. They marked six meters back from the tree and had the patients stand there while pointing which way the E was directed. (Because not everyone is literate, rather than having letters, our Snell charts have E's oriented either up, down, left, or right.) We brought along lots of cards to record the date, village, name, age, sex, vision right eye, vision left eye, and diagnosis. This was filled out at the time of acuity testing and the patients were then sent in to the school house with their card to be screened for eye disease by the optometric nurse, Lydia. (Patients in need of a full exam from Dr Wanye or who needed cataract surgery scheduled a time to come into the clinic.) Cu Ri and myself were in charge of determining refraction and dispensing glasses. It was wicked enjoyable and all went very smoothly. The kids were so excited to have us there and really had fun with us. When we left, we high-fived them all and shook their hands and they very sincerely thanked us for coming to their village. They cheered and eagerly waved goodbye when we left. They made us feel special, it was nice :) Tomorrow, four people will go on another outreach program while myself and another group member will stay in the clinic to help with the cataract surgeries. I am WICKED excited for that!! My understanding is we will help organize the patients and bring them from the pre-op room to the operating room to the post-op room. Like all aspect of this trip, I don't know exactly what to expect but I do know that I get to watch a lot of the surgeries and even get to "assist" - what that consists of, I don't know!

Last night I went for a jog around the area. Mazes of dirt roads make up the “neighborhood” where we live. Running around, it was clear to me that we are in a more affluent part of town. Every house had multiple rooms and had a car, garden, and farm animals. It was so hot it was nearly unbearable, but I trucked on for a pathetic (yet still good for me) 25 minutes. I had my iPod with me and was in the zone when, nearing the end of my jog, I saw something out of the corner of my eye. I looked behind me, prepared to move aside for a scooter, when I realized I had acquired a track team along the way!! Running with me was at least ten of the local kiddos. At first I thought they may be making fun of me (they were keeping their shoulders back with bent arms and controlling their breathing) until I realized, no, they are just having a wicked fun time! It was a precious moment and I couldn't help but laugh. I turned off my music and asked them if they liked to run. They said they did and were excited to see me running by their homes. The kids ranged in age from about 4 to 14. They were all wearing flip-flops, most of which were too big, yet that didn't stop them from keeping up, some even beating me by a long shot. I hollered to the ones in front that I was heading home, so hang a right and they were thrilled to do so. It was funny when I came up to the house because the roommates were all on the front porch and got a good laugh at my trail of runners. I gave them some water and went inside to take a shower and Mark threw around the frisbee with them.

Last night Tina made us delicious local food for dinner! We had fried plantains with a red sauce, fried rice (the best I have had here so far), and, of course, fried chicken. I'm still amazed that they eat hot meals when it's so hot outside, but so it goes. For dessert, we cut up two huge mangoes that Dr. Wanye brought over from his house. He also brought us fresh eggs that we hard boiled for lunch tomorrow.

I did my first load of laundry yesterday, which was an experience! I have never washed a full load of clothes by hand! I filled the basin with water, soaked the clothes, put in two fist-fulls of soap, scrubbed the clothes with themselves to get out stains and dirt, rinsed them, and then hung them up to dry. It was a work out! And it was really gross to see how much dirt was in the water when I dumped out the basin!

Happily, we finally have electricity back. Now we can recharge out computers, cameras, and phones. But most importantly, we can now sleep because we have fans again!! We are all looking forward to a nice night's rest that doesn't involve being soaked in sweat :) On that note, I'm out and will be in touch soon. Take care!! Love you all!!

(Please disregard any spelling errors... I don't think the spellcheck is working and, unfortunately, I rely too heavily on it. Also, pay no mind to poor grammar, I don't write papers in school anymore and I'm calling that excuse valid!)

P.S. Two things came to mind that I wanted to share: 1) It is SO impressive how the children and women all carry the oddest shaped, heaviest objects on their head, effortlessly!! Shapes range from small baskets to huge, asymmetrical boards carrying anything and everything - sticks, cloth, food, sandels, bread... Their posture is impeccable. 2) The local greeting here is "Kawaaba" and you shake hands, press your thumbs together, then snap your middle fingers out. I've finally gotten the hang of it. It's fun!

P.P.S. I am still trying to post pictures!! For some reason, the firewall in the internet cafe is preventing me from doing so. I am going to try it for the fourth time tomorrow on my roommate's computer and hopefully that works. If not, you will all just have to wait for my return :) I hope I can post them, though, because I've taken some really great pictures thus far and no words can describe everything perfectly!


Monday, May 26, 2008

Africa Day/Memorial Day

Hey hey!

So I've now been here six days, but it definitely feels like longer. We haven't had power for three days and it is hotter than hell. (At least it is better than having no water.) The lack of fans are starting to really wear on us, though. We start work tomorrow and I am wicked excited to do so!

Yesterday a beautiful woman came to our house and made out lives complete. Her name is Tina and she explained to us that she is available to cook for us, if we would like. Would we ever!! She will come for breakfast and dinner and prepare box lunches for us to take to work. She's absolutely lovely and an awesome cook. Last night we got fried chicken, homemade french fries, and a pasta and veggie dish. To be honest, the local food here isn't so great. The one thing it has going for it is that they use a lot of peppers so the dishes are all hot. (For this reason, Mummy, you would hate the food. Everyone else in my life, you guys would love this.) For some odd reason, they have a LOT of Chinese food, but (believe it or not) it is not the best Chinese food I've ever had. The main local food enjoyed here is TZ. TZ is maize meal that is boiled through water to make a ball of gelatenous matter that they serve with peanut soup. The texture is very bizzare and it is pretty bland. The soup wasn't so banging, either. They eat a LOT of meat here, which was a relief to Mark but a bummer for Yue and myself. It's nearly impossible to order vegetarian dishes here. It's also nearly impossible to find a good source of protein that isn't meat. Tina is taking us to the market today so we can buy breakfast fixing, beans, soap to wash our clothes with, and whatever other food we would like. It's really great to have someone who can cook us delicious local food that we have some say in (ie. chicken on the side, please).

In Ghana, the rainy season spans from May to September. This means it rains nearly ever day, typically at night (for whatever reason). Later in the season it will start raining all day, all night, and possibly all the next day. Again, coming from Maine I thought I was rather experienced with gnarly storms. Apparently the sub-Sahara climate makes for much, much crazier storms. Every night we have been awoken by INTENSE winds, rains, and thunder. I'm talking wind so strong i was convinced out cement house was going to blow over. Rain so strong I thought the tin roof was going to fall in. No joke, the thunder was so close and so strong that I felt the vibrations. All this combined makes for a really loud storm that is impossible to sleep through. Luckily, I love storms and was thoroughly enjoying myself. Jess, however, was kinda frightened. What we are all wondering is what happens to the mud huts we've seen all over the place with thatch roofs. I have to assume the strong rains wear on the walls of the houses and cause them to melt and the winds HAVE to blow the roofs off. It's a mystery to us, maybe we'll figure it out before we leave. The strangest thing is when morning comes and we go outside to greet the day, the land is dried than ever as if no storm was ever experienced. Silly desert.

The neighborhood kids finally got the courage to come over and play with us. They are so curious about us, it's funny. They have great senses of humor and are very polite. The girls started singing “Hips Don't Lie” by Shakira and dancing, I just about died. The boys loved playing frisbee with Mark. We gave them some gum and they thought it was the neatest stuff ever. Their names are Josephine, Richmond, Antoinette, Gloria, William, Genevieve, and Judy. When the kids had to go home for dinner, William stayed behind and got to play computer games on Mark's laptop. It was so cool to watch because he was enjoying himself so much!!

That's about all that's new at this point. I'm still having very vivid dreams that alternate between being disturbing nightmares and very realistic, but pleasant, everyday events back home. I've been told it's the Malarone (malaria medication) that is making my dreams go crazy. Whatever it is, it's a trip.

I hope everyone is doing well back home!! Until next time, take care!

Saturday, May 24, 2008


(I'm not always able to make it to the internet cafe, such as today, but I am still going to be writing “blog entries” that I will just post my next time to town.)

Hello, everybody!

The journey up here was an adventure, as to be expected. About 70% of the roads were paved, making for large portions of VERY bumpy streches. So bumpy, in fact, that we blew a tire two hours into the trip. Though it seemed like forever, we did eventually complete the 12 hour drive up to Tamale and are very happy to be here. While it is still humid, it is much more tolerable than Accra. Tamale is the capital of Northern Ghana and though it is a city, it is much cleaner with much better roads and friendlier people. Goats and sheep are all over the place!! I am irrationally taken by the goats and have made a special friend with one... His name is Winston. He's wicked small and has adorable grey/silver coloring with black hooves, main, and horns. I'm pretty sure customs would be chill with me bringing him home... :) Sadly, Dr. Wanye was honest with me when I asked if they are food. They are. Also rampant around Tamale are really neat lizards of all sizes and colors – very cool!

Dr. Seth Wanye is the ophthalmologists who we will be working with. There are only 49 ophthalmologists in the country and only one in the Northern Region, of course being Dr. Wanye. He is extremely nice and very smart – I really, really look forward to working with him! When we arrived late on Thursday he insisted on taking us out to dinner, which was very generous. He takes great care of us, checking up on us to make sure we are comfortable and happy. He has a great sense of humor and seems to really enjoy our group.

I was mistaken when I said it would be six girls. When the sixth group member arrived, we found out he is a guy (lucky him is probably going to be allergic to estragen for a while after this trip). The six of us have a guest house to ourselves, which is great. The house is surrounded by a gate and there is a guard on duty 24 hours a day. It is a very comfortable home. There are three bathrooms, four bedrooms, a living room, dining room, and kitchen. We all set up mosquito nets around our beds, but thankfully the bugs aren't so bad here. Though there is no AC, each room has numerous fans. There is running water, but no hot water. (It's so bloody hot that this does not bother us.) The group gets along great together. Jessica, Yue, Cu Ri, and Marielle are all going into their junior year as pre-med students. Jessica and Yue go to Wellesley, Cu Ri is at Mount Holyoke, and Marielle is at Holy Cross. Mark graduated this year from UC Denver and is applying to medical schools while here (he's here for six months!).

Our home is just outside the city center in a nice nieghborhood of sorts. We walked around the area for a bit today. There are little shacks/huts lining the main road that sell everything from snacks to water to phone cards to clothes to tools. Walking around, we made a spectacle for the children. I don't think they see many fair skined people, thus making us wicked novelties! Kids from all around will run up to us to greet us and ask what our names are. They are very sweet.

Monday is a holiday in Africa, as well. It is Africa Day, meaning we get a long weekend (not that we've even worked yet). We all look forward to our first day on Tuesday. That's about all that is new now, so I'll be in touch best I can as soon as I can. I love and miss everyone back home, take care!!

Thursday, May 22, 2008

My first few days

Hello everybody!!

It's been impossible to get online since I've gotten here, even though there is an internet cafe connected to the guest housing in which I am staying. Finally, the internet is up for the first time since I've been here and I've never had to exercise patience so well (it's like going back to the days of dial up). But here I am!

I have been in Accra, the capital of Ghana, since arriving. Being from Maine and all, I thought I knew a thing or two about unbearable humidity. Well, I am now eating my words! Being on the coast and in a jungle, the humidity is a whole new extreme that I am experiencing. The temperature is a steady 30 degrees celsius through the day and night. I'm starting to get used to it, but it is kinda unreal.

I've woken up every morning to monkeys howling in the nearby forest and lots of different birds singing. I have yet to actually see any crazy wildlife except for some really cute lizards and the cutest little goats walking all around the streets. Mother hens and the little chicks also dart in and out of the cars on the uneven, partially paved roads. It makes me nervous, but I have yet to see anything get hit, person or animal! The trees are beautiful and lush green. I had my first taste of local food - fried rice sold on the street - it was different, but yummy.

It didn't take long for my first proposal of marriage from a local. Walking out of the airport I was approached by a million and five taxi drivers asking if I needed a ride. I politely declined and stood nearby waiting for my driver to show up with his "Katherine, UFS" sign. While waiting, a nice man and his friend explained they wanted me to be safe so they would stand with me and call Seth's phone (my pickup). The wait turned into about an hour and a half, and it was an experience! The man explained that he was an Akin prince and went through the history of the conflict between the Ashanti and Akin tribes in Ghana. His friend then asked if I was a "blonde" and complimented me on my "blue eyes." I told them I had brown hair and eyes and they asked what blonde meant. Looking around I realized I wouldn't see a blonde so I pointed to a yellow sign and said it was hair that color. They then asked me about the Bronx and asked if people are really held up at gun point to get out of their cars. I said "Could be, hasn't happened to me." I was also asked if I was a trained soldier because I was strong enough to carry my pack. My response, "hell no, just a tough cookie." It was kind of funny. By the end our conversation, the guy said he had fallen madly in love with me and wanted to be my husband because he desperately wanted to marry a white girl. He told me I could visit him in his beautiful palace and he would make me delicious local dishes. I told him I wasn't getting married for at least ten years, but thank you for the offer. He gave me his name and number, but I don't think I'll be calling him :)

The rest of the Tamale volunteers arrived today. It is six of us girls who will be departing tomorrow morning for a 10 hour drive through the country up to Tamale, the capital of Northern Ghana. The climate will be very different there because it is a desert. I'm looking forward to the dry heat (Utah has spoiled me these past four years). Three of the girls go to Wellsley, one to Holy Cross, one to Mount Holyoke, and then myself from the U. All six of us will be in Tamale until July 1 and I am really excited, they are all very nice. I'm really excited for the drive, though it will be a bumpy and long one, because we get to see the whole country and the change from jungle to desert!

I've finished my first book, Under the Banner of Heaven, and damn is that a crazy one!! It's looking at the Lafferty boy murders in 1985 where they killed a 15 month old baby and her mother because it was "God's will." It looks at Mormonism from the begining and tries to explain FLDS (Fundamentalist Mormons). Particularly interesting in the wake of the raiding of the compound in Texas. Now I've started Slaughterhouse-Five. After this it is strictly studying for the OATS, mehhhh.

Well I can't believe I am here, but here I am! I'll hopefully be posting more regularly once in Tamale and there will definitely be pictures!! I miss everyone back home wicked and am eager to be in touch! E-mail me:

P.S. I've been having really gnarly dreams since leaving and have recurring nightmares about Maxwell's wellbeing. Could someone in Utah please post here or e-mail me letting me know the pup is better than ever, perhaps just missing him Mum a little? I'd appreciate it. (I know I'm a little bit crazy but, well, that's not news...)

Due to the slow nature of this internet, I am going to respond to my two e-mails on here rather than with an e-mail:
Mummy - thanks for the heads up on the frequent flyer miles, I will take care of it when I get back to Maine. Sorry it took so long to post on the blog, hope you and Daddy weren't too concerned. Send my love to Dad and tell him I hope the recovery is going well. I miss you and love you both tons!
Gina - you are such a doll! Thanks for the e-mail, it totally made my day! I love you so much and miss living near you. Just get it over with and come back to Salt Lake!! I hear there are wicked high paying internships for lawyers there!! (So I might be making that up and being selfish, but all is good and just do it!) Please give your parents my blog address, I meant to before I left but spaced it. Talk to you soon!