(This is a running post about a nurse's journey on the Africa Mercy, a hospital ship that travels up and down the coast of Africa)
Moving along gently
Pam, one of my teammates, was gone for two weeks to attend her daughter's wedding. It didn't seem to me that she'd missed much...but she thought so, and it's the same two weeks since I last wrote. So, what did she miss?
Perhaps the main change has been the establishment of a routine, albeit a continually changing and interrupted one. Tuesdays and Wednesdays, we go to one of several sites around town to screen for potential patients. Mondays and Thursdays we are at the eye clinic giving a more complete eye exam to people who passed the first cut at screening. Fridays have been a potpourri, but will become clinic days starting this week. Our first eye surgeon arrives in two weeks. Until then, we do preparation and training, shifting people around so that as many people as possible can learn to do the different jobs.
What all happens in the clinic exam? First, we collect personal information, including phone numbers and languages spoken. It still amazes me how widespread cell phones are, even among people living in shacks with deficient diets. It is a way of life here, an essential tool that people really depend on. Well, we depend on them, too, in case our surgery schedule changes for any reason.
But getting an accurate phone number seems to be a challenge. Either they don't know it, or it gets transcribed wrong, or our western way of reading the numbers the translators write is sketchy, or some combination of factors.
To begin the eye exam itself, we use a Snellen chart to test visual acuity. If the person sees too well, we don't do cataract surgery, saving our limited surgery spots for people who are too blind to function without a caregiver. For those with somewhat better vision, we see if perhaps glasses would help, and we use a tonopen to check for glaucoma. Glaucoma is a major cause of blindness here, but if we catch it soon enough and send them for proper treatment, their vision can be saved.
Is their vision poor enough to qualify for surgery? The next step is to dilate their eyes. Then we use an auto-refractor to measure the curvature of the cornea, one of the measurements they need to choose the proper lens to implant in surgery. From there, they move to the slit lamp, where an ophthalmic provider or technician examines their eyes for a variety of diseases and conditions that would prevent a successful cataract surgery, including corneal scarring and retinal damage. We also test these patients for glaucoma, since cataracts and glaucoma are not mutually exclusive.
Is the patient still a good surgical candidate? Next comes the A-scan, an ultrasound device that measures the depth of the eyeball, another number needed for choosing the proper lens. Then we take a short medical history and take their blood pressure. Africans tend to run high blood pressures, but if it is above 200/120, the retina can bleed during surgery--not good. So, we send them to see a doctor and get their blood pressure under better control, and then we bring them back in a month for another try at qualifying for surgery.
Finally, about half the people who come for the eye exam are found to be qualified for surgery. We then enter their information into the computer, schedule the surgery, and fill out the necessary paperwork. Last stop--teaching. We need to explain the surgery and the risks and get a consent signed. We need to tell them when and where to go, what to bring, and how to prepare for the day of surgery.
It takes an hour or more to get each patient through the whole process, and we're seeing around 60 patients a day on clinic days. It becomes quite the assembly line, but each of the tasks require some skill and some practice to do them well. Of course, we also require translation for every step of the way-- communication is always the biggest challenge. Many of the machines and tasks can be done by our Congolese day crew once they have been trained, and indeed, we couldn't function without them filling many of the roles on the team. But, perhaps now you can understand why it takes so long to get each one properly trained in a variety of tasks and to get the whole operation running smoothly.
Today brought an unexpected treasure. It is our practice as a team to circle up to pray before we start our work day. This morning, however, the patients and caregivers who were lined up waiting for their appointments wanted to join our prayer circle! Some of them prayed in Kituba (I think it was Kituba, anyway), some in French, and some of us in English. Congo is 90% professing Christian, and they are passionate about it. When they pray, it is loud, long, and fervent. When they have a church service, it lasts two or three hours and includes much loud, passionate singing and loud, passionate preaching. So, our morning prayer time was energetic today!
It seems that Wednesday is market day in Pointe Noir. We were trying to reach a screening site fairly far across town yesterday, and the traffic was so dense it took an hour to get there. Thankfully, I did not have to drive! Do you ever find yourself squeezing your elbows to your sides when your vehicle is trying to navigate a narrow spot? Or squinching your eyes? Wednesday gave me plenty of opportunity to observe those reactions in myself! But we got there, and we got home again in due time.
Market day was interesting to observe from our slow-moving car. Hundreds of people swarming everywhere (mostly not watching for cars, either). Traders were sitting by their little patches of wares laid on a cloth on the ground, hoping for customers. I would have been bored out of my gourd to have to sit there all day in the sun hoping for an occasional sale, but these folks seemed content. They'd visit with the trader sitting next to them, or just sit doing nothing visible, but their faces were peaceful and their movements were placid. Little children flitted all around--who knows who they belonged to? They have a freedom of movement that our kids have lost. I would have been gripping mine tightly in the midst of such a crowd, I know, but these kids seemed to be able to play freely.
Speaking of screening day and of little kids, let me end by mentioning a special little boy. He was probably about seven or eight, and he came alone to our screening yesterday because his eyes were bothering him. Who knows if he has parents, or why they were not with him? If he has parents, did they send him to fend for himself, or did they perhaps not even know that he came? We had a crowd of several hundred people yesterday, and this little guy just waited at the end of the line for the crowd to clear so that he could make himself known and present his request. His eyes were itchy, probably allergies, so we gave him some soothing drops.
But how many eight year old kids do you know who can navigate to a destination, negotiate a crowd of hundreds of competing adults, wait patiently for hours by himself, and then present his medical situation and request in a clear and concise manner? Mark my words, that young man is destined to be a leader someday, if he can navigate the treacherous waters of childhood without capsizing.
Blessings to you all,Marilyn
Click here to learn more about the nurses and doctors on board the Africa Mercy.