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 :)

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