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.

He’s had a busy week on his motorbike, driving around ten villages in the rural district around the capital.  The ambulance brought back 12 patients, 10 of whom were offered surgery.

Mrs Kalembo had come to Nkhoma a few weeks earlier.

Mrs Kalembo in the village, before coming to Nkhoma

Mrs Kalembo stays with one of her 5 grandchildren, and she said her main job was looking after her grandchild.  She told Isabelle that she had nine children, only 6 of whom are still alive.

Luckily her grandchild could stay with friends while Mrs Kalembo came to Nkhoma for the 4 days she was with us.  She said she had low vision since last year.

Meanwhile back in the village some 5 weeks after both her cataracts were operated, she was back with her friends and grandchild.

And the whole family of village friends

John Kapakasa is in the back, on the right.  Mrs Kalembo’s grandson has a lot of young friends!  She said after the surgery she is now completely mobile again, and doesn’t need a walking stick anymore.

The smile says it all

I need to get out more often.  I don’t really get out of the hospital much during the day.  Mr Kambewa and I are in theatre for the day after we and the staff finish the clinic in the mornings.  Sure John and the other cataract case-finders live on their motorbikes riding around the villages looking for people like Mrs Kalembo who need assistance.  Some of the staff at Nkhoma head out on mobile clinics to screen people in villages during the week.  But I generally stay around Nkhoma Hospital, seeing people that are brought in.

It is really great to see Mrs Kalembo back in her village, with her friends and family; happy after surgery.  Rather than just picture her in the hospital.

Her smile says it all

Glaucoma is the second main cause of global blindness, after cataract.  It is a condition that slowly affects the optic nerve at the back of the eye, and is often associated with high pressure in the eye.  Untreated, the high pressure destroys vision causing tunnel vision, and perhaps eventual blindness.  People here in Africa tend to be affected by a more aggressive form of the potentially blinding condition than say for example in USA or Europe.  Sadly though, because it is so slow to progress, people often become blind before they seek help here.  At Nkhoma last year I looked at all the glaucoma operations we did, and two-thirds of patients who we operated on were already blind in the other eye.  We are trying to start a screening program to detect glaucoma in the early stages, when we can treat it and stop the loss of vision.

All the same, what I basically do is to treat the high pressure, and thereby stop the loss of vision.  Here we do this with an operation called a trabeculectomy, which adds a little drainage outlet at the top of the eye to continuously relive the pressure.  It’s a lot more tricky than cataract surgery, but we get good results.  Another tricky thing is that I need to keep a close watch on the eye after the operation, for weeks and months.  We ask people who have this operation to stay at Nkhoma for a full two weeks after surgery, and then when they go home, we ask them to come back after a month, then after another couple of months.  But Nkhoma is far from some peoples’ villages; and less than half actually do come back.

Mr Edward Richard did come back.  In fact he kept coming back every month for the past 6 months since I did both of his trabeculectomy operations at Nkhoma in September and October 2009.  Mr Richard is a businnesman, and importer and shopkeeper in Lilongwe.  At 35 he is married with 3 children.

Mr Edward Richard

When I saw Mr Richard last year, he said the vision in his Left eye had been deteriorating over the past 3 years.  In fact he was nearly blind in this eye.  His right eye also showed signs of glaucoma.  Without any warning or pain, glaucoma had been robbing him of his vision.

Both operations went well, and when I saw him last week, World Glaucoma Week, the pressure in his eyes were well down, and his vision was stable, and in fact actually improved a little (which is unusual).

We had carefully explained to Mr Richard, as we do to all people who need a glaucoma operation, that the surgery will not give them back their vision, like cataract surgery; but will prevent their vision from getting worse.

I had 4 patients for glaucoma operation on the list for World Glaucoma Day.  Nkhoma Ophthalmic Nurse (and Nkhoma Eye Hospital employee of the month for February !) Vincent Saka counselled them, answered their questions, and put their minds at rest, that although we may not be able to restore what sight they may have lost; we could offer an operation to prevent blindness.  They all accepted and the operations went well.  I will be heading into the hospital this morning to see them all, as they are staying in for a couple of weeks.

Glaucoma patients at Nkhoma on World Glaucoma Day

Finding people with the early stages of glaucoma, and then treating them before they lose their sight is a huge challenge in rural Africa.

We are training medical staff in primary health centres in surrounding districts & villages as far as 100 miles away, to perform vision screening on people over the age of 40.  We hope to be able to reach many more people with glaucoma, before, for them it is too late.

Happy World Glaucoma Day from all at Nkhoma!