Hi. Another interesting post from Marilyn in the Congo, my longtime friend serving as a nurse on the Africa Mercy. Her posts are a treasure trove for those considering a similar journey, and a window in for those who never will. I love her story of the little boy at the end, how one small life can make such a difference. It gives hope for those in the future....Sharon
(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)
9/26/13
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.
Hi......Cataract surgery is something we take for granted here in the United States. All of us can probably think of at least one person who has benefited from this life-changing surgery, and there are few if any complications. Imagine the joy of being able to see again, after waiting for months (maybe longer) for the Africa Mercy to arrive. Marilyn shares the excitement of one such day in the following post. How I wish I could have been there! Sharon
