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.

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.

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.

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.

In fact this is our busiest time of year.  We are sending our ambulances out to the south lakeshore.  A 4 hour 300 kilometre drive to do Wednesday and Saturday mobile clinics.  There is a great number of blind and severely visually impaired people in this area.

Mr Nyadani, in the village before coming to Nkhoma

Mr Nyadani was not blind, but couldn’t see his family and was failing to do much of the work on his farm and at home for the past two years.

Our wonderful mobile clinic team, and Isabelle the fantastic optometrist volunteer from Luxembourg met Mr Nyadani a few weeks ago.  He was diagnosed with cataracts and came in the ambulance to Nkhoma.

Mr Kambewa, Nkhoma Cataract Surgeon, operated both his eyes successfully, and after 4 days he was taken back to his home and family, with a great improvement in his vision.

4 weeks later we went back to his village and met him again.

Mr Nyadani, happily back with his family

It is quite amazing to have had the chance to visit his family and village a few weeks after his operation to restore his sight.  He was very happy in the hospital just before going home, but seeing him with his family at his home showed us the great happiness that he felt.

The power of one operation to restore one man’s vision was in the faces of his children and grandchildren, and of course in Mr Nyadani’s smile.  The power lay in his ability to return to work, and his happiness in taking back his full role in the close family and community.

We are coming very close to the day when 10 million cataract operations would have been carried out by CBM over the past 100 years.  I find that incredible;  that so many people, and also their families and communities have been given back their right to sight.