Mr Kambewa, the fantastic Clinical Officer and Cataract Surgeon here at Nkhoma, does a large amount of the work in theatre.  Operating patients cataracts with high quality and high volume!

One of the jobs that falls on me however is operating all glaucoma patients (the surgery is a bit longer… around 30 minutes instead of 8 minutes for cataract surgery, and a bit more tricky with all the small stitches); and also all the patients who need cataract surgery, but have only ‘one eye’, in that the other is blind from a cause that we cannot treat.

A number of patients come to Nkhoma blind.  That is they can perhaps see a finger or two at 3 metres from them.  Sometimes even less, only able to see a hand waving in front of them, or even just able to see light and dark but no detail at all.  A number of these patients are blind in one eye because of something that we can do nothing about.  A large scar on their cornea, very high pressure in the eye and end-stage glaucoma, trauma, previous infection or severe problems at the retina at the back of the eye.  It often happens that then the other eye (which in effect is their only ‘good’ eye) is severely visually impaired because of cataract.

It falls on me to have a chat with them about surgery, and then go ahead and do the operation if they agree and consent.  In the operating theatre, you take a deep breath, relax and go ahead and perform the cataract surgery calmly as you would any eye (trying not to think that this is their ‘only eye’, and that you kind of have only one shot).

Mr Jamison was untreatably blind in his left eye

Mr Jamison is 83 years, and came to Nkhoma from Mchinji, near the Zambian border, with one of our mobile clinics.  He has been blind in his left eye for 50 years from trauma, since a thorn went into the eye.  He can’t even see light from his left eye.  He had over the past 11 years been finding it increasingly difficult to see with his right eye.  In fact he said he has been blind for around 5 years.  He couldn’t see his maize or other food, and some children sometimes would come and take his meat.

I operated his right cataract and thankfully it was a great success, and he was thrilled.  He said he is going to celebrate by buying many fish!

I have operated cataracts on over 60 patients with ‘only one eye’ so far this year, and it fills me with joy and considerable relief to see them happy the next day!

Kuona kwa tsopano, Moyo wa tsopano

I had a busy day on Tuesday getting all the initial surgical supplies together for the modern phaco cataract surgery machine.  I and the staff are very excited about the prospect of introducing this to Nkhoma! Imagine… the country’s first ever permanent modern phaco cataract surgery unit.

On Wednesday I met a wonderful group of CBM supporters from Canada, and we showed them the work here.

On Thursday I saw a boy who had been hit in the eye with a stick some two months ago, accidentally while playing with friends.  The stick had gone into the eye initially, and it took him 6 days to get to the hospital. I cleaned it up and stitched the eye back together.  By now, two months later, his eye had healed well, but he couldn’t see anything as his iris, the coloured part of the eye, was stuck.  So I took him back to theatre to make a new pupil for his eye.  I hope he will be able to see even just a bit now.

I went to Lilongwe for a clinic on Friday morning.  Nearly hit a baby goat 20 seconds after starting on the road, and a huge 10 metre wide tree branch came metres away from falling on me and 4 patients in the hospital in a freak wind.  I then got a call around lunchtime that I may have to go all the way up north to Nkhata Bay on Monday for a cataract session.  There are 100 patients waiting to be operated on Monday and Tuesday, and they didn’t want to cancel.  In the end one of the other 7 eye docs in Malawi, who is a bit closer than here, was happy to go and cover.   Otherwise I would have been starting a 7 hour drive around now.

Finished the week with a long power cut on Friday night, so some candles and an early night as totally exhausted.

5 Speed ECCE

So anyway, the next two months. We really want to end the year on a high note, it’s been a tough year. And the best thing we can do is to go to as many villages, screen as many people, and try and reach as many as we can to offer cataract surgery or other assistance. We have a finite amount of money left till the end of the year, and pretty much will spend it all on diesel for the clinic ambulances and food for the patients. All the medicines and lenses and staff are already here!

And this is what it comes down to for the bulk of the work. I hope that link above ‘5 Speed ECCE’ works. It’s a normal cataract operation, at 5 times speed; which is why it is just under a minute long.

With the help of the staff here at Nkhoma and in the field, and the great team at Malawi Council for the Handicapped (MACOHA), Mr Kambewa and I are going to try our best to perform as many of these surgeries as we possibly can in the next two months. Except at normal, rather than 5 times speed. It’s the Nkhoma team’s real strength… high volume high quality surgery. And it’s our hope that as many individuals as possible, who are now struggling with the burden of blindness, will be able to see by Christmas.

Malawi Council for the Handicapped (MACOHA) has a team of field workers in their community based rehabilitation programme.  They have spent weeks and months travelling through the Salima District villages screening people, and then bringing them to Nkhoma Eye Hospital throughout this fortnight.

Over a hundred cataract operations have been performed, and after a day or two for each patient in the hospital, a lot of people have left happy.

A satisfied crowd from Salima, waiting for the car home

MACOHA refer around 30% of all of our patients to us.

We will be heading back into the villages around Salima in a month or so to follow-up a few dozen people.  Usually it’s too far and expensive for people to travel back to the hospital for a check up after surgery, so we are going to travel to them.

It is very cold and windy at Nkhoma right now.  As most of the people in the villages don’t have electricity, there is only open fires to keep warm.  Sadly that also means a lot of burn injuries, and we recently had a 15 year old girl who had an epileptic seizure, and fell into a fire face first.  It was a while before anyone could help her, and unfortunately too late for the third degree burns she sustained over her eyelids, face and neck.

Dr John Sandford-Smith was visiting and luckily could successfully help her with her eyelids.  We are sending an ambulance into her village near Kasina to bring her to hospital for review today.  I hope we can find her.

At 8am we had the big staff meeting/indaba to discuss the year ahead, tell everyone an update on Nick’s condition, and tackle any concerns that anyone might have.  Was a great time to have everyone together in the same place, and closed with a nice prayer by Church elder Mr Banda.

We saw a few patients, and then lept into a series of meetings with senior staff, tax consultants, drivers, and cataract case finders.  Finally we met with Stefan, CBM National Coordinator for Malawi and Dr Ter Haar the Nkhoma General Hospital Medical Director.  It was a very productive day  and we got a massive amount of issues sorted.  I’m not a fan of having meetings for meetings sake, but find it a pleasure to sit down with all the staff and people involved with Nkhoma Eye Hospital, to really hammer out and resolve important issues.  A real blessing to be able to do this now, as in 2 weeks time we will start to screen patients in the villages and bring them to Nkhoma for surgery or other help; and that is when we start to get very busy.  Looking forward to it.

It is great to have to weekend ahead to try and find my prodigal dog, and sort through some more work.  What astounds me always is the view from the hill here of the valley beyond.  Just to give an idea about the changing seasons:

Dry season

This is a photo last August in dry season, after the maize has been harvested.

And this is the exact same view from the house yesterday morning, some two months into the rain season.

Rainy season

The landscape now is a real garden of Eden.  The great thing is that the rains have been good over the past two months, interspersed with sunshine, and the maize crops are flourishing.  Crucial really as this one harvest will sustain villagers for the entire year.

I’m off to go and find that prodigal dog.