Sambani is from Kalonga Village in Lilongwe District.  He lives with his parents and four siblings.  He had been blind for two years, and had stopped going to school last year.  He had been doing well at school, and told me “I was an intelligent boy!”  He was in standard 4 but his low vision “made me to be a useless boy” he said.  I couldn’t believe what he was saying.

Sambani in the Clinic

He lives with his father and mother and four siblings, and they were looking after him.

Sambani after his second cataract operation

Sambani told me and nurse Rose, that he is now going to continue his education because he is “still young”.  He wants to be a driver or a teacher.

Sambani

It will be great to take Sambani back home today, so he can be with his whole family again, and then start school again next week when school opens for the new year.  We will try and meet him again in a few months to see how he is doing.

Pieter, the South African missionary living near Monkey Bay phoned me yesterday.  There are many people he has met in the villages who would like to, or need to, come to Nkhoma for their eyes.  Lumbani will be heading down on Sunday with the ambulance to help collect them. We will try and meet with Mary who lives nearby, and see how she is doing, 4 months after her surgery!

Mary with white diabetic cataracts - Photo: Roger Loguarro

With the help of the doctors in the general hospital, she did extremely well.  She felt much better, less tired, but was still blind.   Eventually after 12 days it was her time for surgery.

I felt very sorry for Mary, as she is so young and was doing well at school until relatively quickly her sight was lost.  She can barely move around now, and constantly needs help.  Of course school has been out of the question for her for the past year.

I don’t really see that many people with Diabetes in Malawi.

Meeting Mary on the waiting line

I was a bit scared when operating, as I wan’t sure how far advanced the diabetes in the eye was, but after the first operation all was well.

Half way there, and happy

In the end a small miracle happened.  I was scared that the diabetes had not only resulted in cataracts, but had also affected the retina.  The surgery went very well, the Nkhoma team were awesome in their care, and Mary’s sight was totally restored.  I will try and visit her in her village near the south Lake Malawi lakeshore later this year, and we are helping her with her diabetic medications so she should be back at the hospital in a month or so for a check up as well.

I felt so thankful that Mary had found us, and we’d been able to help.  I really hope that her life carries on in the way she planned.  She was so excited to head home and celebrate.

Mary, ready to take go home to Lake Malawi, 3 hours drive away

I said goodbye to Mary on a Tuesday, and she travelled home with the Nkhoma ambulance early the next morning.  I’ll tell you, and I am so happy for her!

Nkhoma now has a modern ‘phaco’ cataract surgery service!  The first permanent such unit in Malawi.  Fantastic.

Although the technique we use for cataract surgery for thousands of operations each year is very very good, and we can perform an operation to treat blindness in 7-8 minutes; the availability of ‘phaco’ allows for a much smaller incision in the eye, and a faster visual recovery.  Also less astigmatism (and need for glasses) and glare after surgery.  Some of the really good artificial lenses we can use, have a built in UV filter to protect the retina from the sun!  Which is nice.

In the end, I am so happy to have had the chance to bring ‘phaco’ to rural Malawi.  And the big thing is we will now have the chance to earn a little money for the hospital, in order to continue to go into more villages and screen people with blindness, which is great.  It is thanks to CBM supporters that this initiative was even possible.

After 18 months of planning, redrafting the plan, seeking advice(from the clinical and business side of things), getting the equipment and consumables together; we are here!  Eesh, it was kind of a long haul, but very much worth it.

Newspaper Article

We had a bit opening ceremony at Nkhoma last Tuesday with singing and dancing and drums and speeches.  Very colourful and attracted a big crowd.

I’ll keep you posted on how it develops.

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

Jacaranda trees are in full bloom, and signify the start of the hot spell of October, before the amazing flame trees blaze across the countryside in November to announce the start of the heavy rains and spectacular electric thunderstorms in December.  The regular rains will only begin around Christmas time, but the next few months are among the most incredible in rural Africa.  I’ll get some shots of this remarkable change over the next few weeks to show.

We went into a village the other side of Lilongwe on Monday to see a couple of patients that had been to Nkhoma, and others that could come for help.  The picture Katrin took was amazing and it really stunned me.

The view is incredible.  A vast vista of space with fields and patches of trees, and real African beauty.  There is even two slices of fields in the distance that have already been raked in preparation for planting maize.  The house is however a simple mud hut, and the grass mat the only piece of furniture for the family.  The gentleman on the right is Mr John Round.  He had his cataracts operated by the Nkhoma team last month, and was very happy.

Mr John Round's stunning view

What stuck me is poverty.  It’s been nearly 3 years that I have been living in Malawi, and my house is on the edge of Nkhoma Mission village  with lots of mud huts around the valley.  We have had the chance to travel and see the Lake of course, as well as Zomba and the great metropolis of Blantyre.  But this comfort of my house with electricity only cutting out two to three nights a week, the tarred road to Lilongwe and the restaurants and fairly super markets there; and many of the comforts I see here hide the economic reality of the majority of the country; of people like Mr John Round.

We sometimes ask whether it is possible to ask people here to pay a little towards their cataract operations, or other treatment.  And the answer most of the time is simple.

There is a great definition of humanitarianism.  It is an attempt to honour the dignity of a person, who does not have a choice.

With CBM’s continued support of the work of the team at Nkhoma, this attempt can continue!  And the goal of eradicating avoidable blindness in Central Malawi can be achieved.

It’s a bold idea, and one that I and the team here don’t often get the chance to sit down and really consider.  We usually just get on with the work at hand!  But the photo of John Round and his family;  the great view, great happiness and also great poverty was a contrast that brought much of the realities of work and life here into sharp focus.