Mercy Ship Expedition - Pediatric Cataract Surgery: One Nurse's Story

 
My friend Marilyn is off on another 
Mercy Ship adventure in Africa. Those 
who followed her story before on the 
Africa Mercy know that Marilyn is a 
volunteer nurse on a hospital ship that 
sails the African coast in search of patients. 
She emails me and I share her post with you. 
I hope you enjoy!

"Pediatric cataract surgery"
3/22/2017 5:23 PM
 
We have begun our two weeks of children's cataract surgery. This is
quite a bit different from adult cataract surgery. For one thing, they
are under general anesthetic instead of a local block. That requires
admitting them to the ward the day before surgery and keeping them for a
second night, after surgery. As I understand it, the technique the
surgeon needs to use is different from what they use on adults and takes
a lot longer to do. Each eye takes 45 to 60 minutes, and we do both
eyes for each child. The net result is, three children per day is about
the maximum we can do.

From a nursing standpoint, the most critical thing is teaching the
parents how to care for the eyes after surgery. That, too, is more
complicated than what we ask adults to do. The kids have to wear eye
shields and have eye drops four times a day, and they shouldn't engage
in anything strenuous or touch the eyes for two weeks--which, if you
have a two-year old, requires hawk-like parental alertness. Teaching
them all that they need to know through a translator can be challenging.
We ask them to boil water to cleanse the eyes, for instance...and to
cool the water before use. It's not necessarily obvious to them what we
mean by "wash with clean water" unless we spell it out step by step.

Our first patient was Maurice, aged 5, who was completely blind. His
eyes rolled back and forth and twitched continually. The surgeons
weren't too sure if he would have a good outcome, both because he'd been
profoundly blind for so long and because of the eye movement. But--good
news--he can see. It's a little hard to measure acuity in young
children, but when we showed him a photograph of our ship, he remarked
on the teeny-tiny people he could see in the little canoe that was in
front of the ship. We were just hoping he could see the big ship! It
was fascinating to watch how the eye movement improved over the course
of a few hours. In the morning, the eyes would wander quite a bit, but
by noon, he could really focus and hold them steady. He'll be fine.

Our second patient was his sister Sophie, age 2. She had some huge
cataracts, blind since birth. Still, her eye movements were not as
pronounced as Maurice's, and she was younger, so we were optimistic.
Sadly, it appears that she is still quite blind despite a successful
surgery and healthy-looking retinas. I guess the neural connections to
the brain just didn't develop since she never had any sight to stimulate
them. The surgeon thinks that she may gradually learn to see, at least
to some extent, over the next couple of years. I imagine I'll wonder
about her, and hopefully pray for her, for a long time.

Our third, fourth, and fifth patients were siblings whose mother was
also born with cataracts. Pretty clearly a genetic component for that
family, I'd say. Since all of them had some sight in the early years, I
think that they'll do well. They were such sweet children, everybody
was wishing that they could take one home. Momma brought them to the
ship, but she had malaria, so we sent her home and asked Poppa to come
instead. He has been so attentive and gentle with his kids, it's been a
treat to watch them all interact.

Our sixth patient was Anna, age 2. I don't know the results from her
surgery yet, but we noticed that she seemed to be dragging her left leg.
An x-ray revealed a broken femur, which is a pretty large bone to
break. If I got the story straight, the husband's family threw her or
dropped her or something about four weeks ago. She refused to walk for
three weeks, but by now the bone had partially knit together, and she
was starting to use her leg again. It was too late for surgery, or even
for casting, but the doctor cautioned the mom not to let her walk for
three more weeks, lest she bend the bone even further out of alignment
as it finished healing. She'll probably always have a limp...but maybe
she won't be blind, too.

We have two surgeons at the moment. Dr. Bob has just recently retired.
He found out that there's a huge need for surgeons to do cataract
surgery on children in Africa, so he's here to learn the technique.
Hats off to him, being willing to pick up new skills at this stage in
his career! Dr. Dan is training him this week, but Dr. Bob will be
doing children's cataracts on his own next week. It was interesting to
hear how he "just happened" to hear about Mercy Ships at a ball game, as
he sat sandwiched between a major Mercy Ships donor on one side and Don
Stevens, our founder, on the other. Gotta love those "coincidences."
 
Maybe it was a set-up...

Marilyn