Thursday, June 12, 2008

Surgery in Yendi

Hey there!

Yesterday I traveled to Yendi with Dr. Wanye, Nurse Maggie, and CuRi to do seventeen cataract surgeries. The hour drive out to Yendi was a scary one because it was storming like crazy and our driver was driving way too fast! Apparently our car doesn't have a windshield defrost and I don't know how the drive could see anything. Even if it weren't all foggy, the solid sheet of rain alone made visibility next to none. There was another health care provider sitting in the passenger seat and CuRi and I in the backseat. After trying to watch the road for the first ten minutes I decided I ought to just close my eyes and go to sleep because it was scaring me wicked. I heard the passenger say every now and again, “child!” or “goat!” or “turn!”. I figured if I were asleep, at least I would be limp in the case of an accident :) We did finally make it to the hospital, which is a beautiful facility with running water and an operating “theater” at least twice the size of ours at the eye clinic. It was lots of fun because it was only us four in the operating room so CuRi and I got to help a lot and we all had a fun enjoying one anothers company. CuRi and my main job was to keep a sterile environment and clean the operating utensils. The last surgeries I watched were conducted at our clinic here in Tamale, so it was interested to see how they maintain (to the best of their ability) a sterile enviroment while traveling.

First and foremost, Dr. Wanye and Nurse Maggie are the sterile people and are not able to touch anything that is not sterile. The clinic has a huge duffel bag that is packed in advanced with all equipment needed. Every gauze, cotton swab, eye cloth, tool kit, gown, etc. is individually wrapped in clean wrapping paper with it's contents written on the outside. Upon arrival, CuRi and I disinfected two stainless steel table tops with alcohol. These were to be the two sterile surfaces that we were not allowed to touch from that point on with ANYTHING. Below each table top was another shelf where we were able to store extra supplies so we could unwrap them as needed throughout the day, and these were not considered sterile zones. To set up the stations, CuRi and I were in charge of unwrapping the marked packages in a certain order WITHOUT TOUCHING the actual contents (I messed this up the first time) while Nurse Maggie, all scrubbed in and gloved up, would take it out and place it where it was needed. After the stations were organized, we had to unwrap seventeen pairs of gloves with care. We were allowed to touch only the outermost wrapping, but nothing beyond that. To accomplish this, we pulled the tabs at the top and had to turn the envelope sideways, taking care not to let the outer paper touch the table top, and let the gloves fall onto the table top. Again, I messed this up the first time and accidentally let the packaging touch two of the sterile eye clothes so Nurse Maggie had to put those clothes in the laundry and we unwrapped two more.... oops! After the operating room was all set up, the surgeries began. After each surgery, CuRi and I traded off the task of taking the tools into the wash room to wash them with antibacterial soap, soak them in alcohol, then soak them in saline. Relatively speaking, it's a clean procedure. However, at the end of the day when we cleaned everything, my heart dropped to see Nurse Maggie had put the syringes and hollow needles in the bin to be cleaned. Clearly written on these objects is, “Discard after one use.” I realized not only had the few we have been reused through the patients of the day, but we were going to use them for at least one more day of surgeries ,and I have to assume many times beyond that. Of course, they have no choice about it. Ideally they would have new needles for each patient and throw them away, but it just isn't and option to them. They aren't giving the funds or availability to buy them. Despite this, Dr. Wanye said it is very, very rare to have anyone suffer from complications of infections and they do administer a heafty dose of antibiotics directy into the eye before bandaging. Still, I couldn't help but be saddened by the realization.

Every surgery yesterday was a difficult one, Dr. Wanye said. Because of this, each one last closer to 20-25 minutes, making for a long day. Dr. Wanye started a little before eleven and went straight through to 6:30 with a ten minute break to eat some banku. (He's a rockstar.) He loves to joke about how we should give him a break and take over for a while. CuRi and I enjoy playing into this game and say how it doesn't look too hard, anyway, we can handle it. A simple cut into the eye and *pop* the lens comes out. I am amazed out how the lens does seem to just pop right out after he scoops around for a little while, making sure it is fully detached, and scoops it out through the little incision. He thought it was hilarious that I say it just “pops out” and now uses this term to explain that what he does isn't too difficult. I got a perfect video of exactly what I am talking about and hope to load it onto my blog today we'll see how it goes. (Daddy, don't watch this. Mummy, enjoy it, it's wicked cool!!)

I did see two really neat cases in the day of surgery. First, a woman with no left eye ball! After completing the surgery, Dr. Wanye made a quick comment of how she had no eye. Her eyelids had been shut tightly since coming into the room, but I didn't think much of it. In disbelief, I asked him to clarify, “You mean NO eyeball in the socket?? Nothing there??” He smiled at my amazement and said, no, nothing there and then pulled open her eye lids. She didn't have an eyeball!! I never really thought of what a socket with no eye would look like, but if I had to guess it wasn't actually as gross as I would've thought. It looked like two little pillows the same texture as the inside of the eyelid with a small button pinching it in the middle (the remains of the optic nerve). I then realized that this woman must have been completely blind for quite some time, due to the mature cataract in her one eye. Dr. Wanye said he guesses she has had no vision for at least five years, based on the maturity of the cataract. Today (the day after her surgery), when she goes to her post-op visit, they will take off her bandage and she will have nearly perfect vision! It's amazing! A woman who has been completely blind for years upon years has been given back the gift of her sight. It was a pretty moving story and a really cool sight. Second, I saw the doctor fix a case of pterigiym. This is a case unique to the tropics where UV damage cases intense scaring of the cornea, starting from the corner of the eye and moving inward. Once the scaring covers the pupil, sight is affected and eventually lost. To fix this, the doctor simply used his scalpel to cut the scar tissue loose from the cornea and then cut it off. So simple! So neat!

After our day of surgery, the ride home was fun. Dr. Wanye asked CuRi and I about our views of our politics which, honestly, I hate to get into because I could go on forever. This one was a good one, though! He said he found it interesting that Bush has ended up being one of the most notorious presidents and I explained why I thought it made pretty perfect sense. It was funny to hear Dr. Wanye speak so eloquently about US politics and I realized he undoubtedly knew significantly more than most all US citizens, myself included. The real kicker was when he asked what we thought about Hillary being out... oh my gosh I am so embarrassed to say we didn't know she was out of the runnings!!!! We don't have tv, haven't come across a paper yet, and the internet is so slow I am on just long enough to check my blog, Tom and Liz's blog, and my e-mail if I'm lucky! Later that night we were hanging out with the Canadians and I was even more embaressed to find that they have all known for well over a week! They asked how they could have all known without us knowing and I told them they seem more interested in our politics than us, anyway, probably because it's a form of entertainment and they don't actually have to live with it to the extent that we do. Oh gosh, soooo embarrassing!

That's about all for my day of surgeries. Lots of fun, new exciting cases, always a fun time with such a fun crew. Now we are on our way to go to an open mic pool party just outside of town, yay! Before I go, I have two quick little stories I find really funny: 1) We were at a community the other day and there were tons of little tykes all around. After a while of “being in the way” they were all put into one room near our screening stations, kind of like a daycare. All of a sudden, they all starting screaming REALLY LOUDLY, crying and running away. Turned out Ali, one of our coworkers, had told them that they were all getting injections that day, so they freaked out. It was pretty humerus, but a little mean of him :) 2) Jessica, a fellow volunteer, had something huge click in her head the other day. She actually saw a yam for the first time ever and was SHOCKED to see it was a root! She thought yams were an animal!! Mind you, we eat yams at nearly every meal here. For the past three weeks, she thought she was eating animal and was really confused as to why Yue, a vegetarian, would eat them. Wicked funny, she will never live that one down!

Ok, I didn't get around to uploading the pictures and video onto CuRi's computer yet, so I'll do that tomorrow and get them up onto WebShots early next week! Sorry, Dad, I know you're excited to see them.

Everyone take care and I hope you are all doing well!! Lots of love and missing!!


P.S. Can anyone explain to me why the children have extremely swollen, enlarged bellybuttons? I am assuming it has to do with malnutrition, but why does it seem to cure itself? (The adults do have these kind of belly buttons.) Also, why do the bellies get swollen? We have all been sharing theories, but none of us can remember the actually cause.

P.P.S. Marielle and I just found out we are encouraged to leave a day or two early to Accra and have the driver available to us to take us to a sight or two before taking off! We are so stoked because we didn't know we would have this opportunity and now are going to go to Cape Coast to see some amazing historical sights that date back to the 1600's and be able to spend a few relaxing days on the tropical beaches. More on that later!

Tony – Darling!! I keep thinking about you and thinking how you would love it here! I foolishly lost your e-mail address and haven't been able to send you a message. If you read this, please drop me an e-mail and let me know what's new in your life!! (At this point you could just as well wait until I'm back in the states...)

Beth – Thank you so much for your note! I would love to talk to you about your experience in Africa when I get back to the island. I am certaily staying safe but am being sure to take in every moment possible. Thanks for the birthday wishes and thoughtful note!

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