Finally Stephen and Katie are allowing me access to the laptop to write a few words on our trip. This whole adventure was Stephen and Katie's brainchild. We started over six months ago and after a lot of work and advice, guidance and support from many people and groups. We are grateful to the outpouring generosity and kind support from various groups, especially from SEVA Canada and SEVA Nepal (international vision care charity organization), the University Eye Foundation, Lumbini Eye Institute (LEI), Bausch and Lomb Canada and Alcon. We would also like to thank the staff at the Holy Cross Center. Minister Diane Ablonczy (Minister of State of Foreign Affairs) and her staff, the Morphew brothers and their peers from their schools, Burt Church High and Ralph McCall, my brothers Ian and John and son Paul.
We landed in Bhairahawa in a wind storm followed by a monsoon-like rain storm. Fitting beginning. The reception at the LEI next morning was very warm and welcoming. We met the administrators and Dr.Byanju, the medical director a retina specialist. After being introduced to the staf,f we took a tour of the facility. Lines of patients wait in cues in the outside heat to registered and be triaged. From there they are quickly assessed by technicians and residents and channeled to various specialties. The facility is basic but the system is very efficient. It needs to be as this center sees 1300 patients a day during the high season and does 350 cataract surgeries a day amongst many other surgeries. The numbers are staggering and they do it all with 11 ophthalmologists and 8 residents.
We are quickly put to work. The kids are sent off to help with the pediatric optometrist Dr. Hari and I am taken to the cornea clinic with Dr. Kobita and her junior, Dr. Patel. These doctors, with good humor and camaraderie, see a large number of complex cases. There are so many
patients here with terrible eye diseases. In one hour we see five fungal corneal ulcers amongst many other serious problems. Patients
file into the exam room, quickly sit in front of the microscope, are examined, treated and the next patient brought in. When we finish we head up to the operating rooms.
The heat in the hallway is stifling as the temperature outside reaches 42 C. The two pre-operative rooms are filled with patients as is the anesthetic area where there are twenty or so beds. The anesthetic technician freezes the eyes. We walk around with a flash light to examine the eyes of patients and select those appropriate for phaco emulsification, a form of cataract surgery.
I begin to worry about my ability to do surgery in this heat as I am drenched in sweat. Thank goodness the operating theatres are
air-conditioned, albeit the electricity cuts in and out with alarming frequency. The lady doctors don't stand on ceremony and I begin to do
surgery. Patients come in and out. They sit beside the OR bed and as soon as one case is done, the next patient lies down. Staff and
doctors come in and out to observe and at one point there are 10 to 15 people. I lose count as I'm doing my best to concentrate.
Concentration is a challenge as everyone chats, laughs and joke around, completely foreign to when I am in surgery at home.
I quickly learn that my role here is to demonstrate different techniques and help train two junior ophthalmologists phacoemulsification. It's fortunate that we had brought a lot of lenses and supplies for this type of surgery as it is quite expensive
to perform. The people here generally cannot afford this, or even the SICS (small incision cataract surgery) that is done here with minimal equipment and instrumentation. Many of of the surgeries are done gratis as this is a
charitable hospital. I am pleasantly surprised how quickly the two doctors, Dr. Singh and Dr. Patel, pick up the techniques. I learn later that these doctors do 2000 to 3000 cataract surgeries as residents and have done that many in their three year career. That's as much surgery as many ophthalmologist in Canada might do in a career. Needless to say, they are superb surgeons.
The next six days follow the same pattern. I give a lecture for an hour, we head to the busy cornea clinic, and then go up to surgery. They have two large cataract surgery rooms, each with 8 beds and 4 microscopes. Each of the four surgeons use one microscope and have two beds. He or she operate on one patient while the nurses set up the patient on the adjacent bed. When the surgery is done, the surgeon swings his scope over the next patient and starts surgery while the patient he just finished is taken away.. On and on it goes. These docs are efficient, slick and highly skilled. It's back breaking work too as in the busy season they each do over 50 surgeries a day. When they finish they do the many emergencies that come in.
There were so many things to see and observe here that I can only give the highlights. What I first notices is that the patients are uncomplaining and patient. Up to 80% of them walk across the nearby border from India. This town is ideally located and is at many cross roads. They will wait for days in the heat to receive care. The other thing I observed was the closeness and friendliness of the doctors and staff. They are like a family and even all live in the hospital compound. I noted earlier the chatting and noise in the OR but learned that this is what they do. They teach each other and help each other through cases. They sit beside each other and operate day in and day out. I also found it remarkable how much they care about their patients and maintain their humor and respect despite the huge volume of people they serve.
Even though we had been here for only a week, it was tough to say good-bye. We have quickly grown to like and respect the doctors and the work they do. Dr. Byanju, the kind and soft spoken leader of LEI, was grateful for the little contributions we made and requested for Calgary to help train their junior ophthalmologists. They are certainly a well trained and educated group. Dr. Salma Rai, the pediatric person, did her one year fellowship at the Children's Hospital in Vancouver. Dr. Kobita, the cornea specialist, did her fellowship at the Moran Eye Institute in
Salt Lake City. They currently have one staff training at the Will's Eye Hospital in Philadelphia. Their second pediatric person, Dr. Anju is soon off to Portland to do a 6 month fellowship. I hope we can help train these excellent people.
Lastly and not least, having worked with their somewhat temperamental 25 year old phaco machine, we decided to ship one of our machines to LEI. Stephen, Katie and I also decided to donate funds for much needed surgical supplies.
This was a tremendous experience, one that the kids and I hope to do
again and soon and come back to visit the many new friends we have made.
Besides, Mount Everest beckons.