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 

Mercy Ship Expedition - Stop in Ouidah - 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!




March 18, 2017

Ouidah was a major departure point for the slave trade--several million
slaves were shipped out of here during those years. The Portuguese had a
big compound, a fort, with a moat filled with crocodiles, and gun
turrets on the four corners. Slaves were kept in the courtyard in the
back, thousands at a time, with no shelter and only a bit of bread to
eat. Many were chained, and many died. From the fort, they were taken
to "cha cha square" where they were sold and branded, then to "the dark
house", another very cramped, airless, sunless place used to "acclimate"
them to life on the ship, which was more of the same. Many died there,
too, of course. None of this was new information, really, but it was
sad to see the actual places where it took place.

Another fact that I've known, but it got more vivid today, is that the
Europeans didn't really go "slave-hunting." The Africans did that.
Instead of killing their enemies from other tribes, they conquered and
sold them to the Europeans. The African kings got quite rich off the
slave trade, so they encouraged it. Plenty of heartlessness all around,
it seems to me.

The trip to and from Ouidah was interesting in itself. It was a good
divided double-lane highway between the cities of Contonou and Ouidah,
about an hour's drive each way. It might have been two lanes, but there
were often three lanes of traffic weaving in and out, not to mention the
swarms of motorbikes. I'd guess there were ten times as many motorbikes
as cars, and a fair number of large trucks also rumbling along. I
figured out that honking the horn was a polite way of saying "I'm coming
up behind you and I plan to pass you, so don't do anything stupid like
swerving into my intended path." There was a lot of horn-blowing...

Buying gas was interesting. There are petrol stations somewhere, I
guess, but gas is cheaper if you buy it from vendors along the roadside,
who sell it in big jugs. Our van just pulled up onto the sidewalk, and
the guy poured about ten gallons of gas into the tank from his jug.
Sometimes they water it down, of course, but quality control isn't high
on the list of requirements. Avoiding the tax at petrol stations is.

There were eleven of us from Mercy Ships on this expedition, and we had
a hired guide who explained things to us in English as we went along.
He had a lot to say about the country, its history, and its politics.
After about 30 years of revolutions, with some presidents lasting only a
day or a week, it finally settled down to presidents lasting for five
year terms, and even getting re-elected. There are about 200 political
parties, the guide said. They aren't really representative of the
people. They are established by rich businessmen, who then use their
influence and their wealth to control elections. The current president
is the richest man in the country and owns the cotton industry. The
second richest man helped him to get elected a year ago, but they have
since had a falling out, so that may be where the next challenge comes
from. Since the richest man controls the port, and since a container of
gold and money "disappeared" from the port before the election, rumor
has it that perhaps that's how the election was purchased... That's the
perspective of our guide, anyway. But maybe it just makes a good story
for the tourists... 

Next week we plan to do cataract surgery on children. Kids get
cataracts for a number of reasons: genetic is a big one, but trauma can
cause it, or rubella during pregnancy, or malnutrition. When we do
children, we do both eyes, because if you don't do both together, the
non-operative eye nerve pathways don't develop properly, so the eye goes
blind even if you remove the cataract later. Children also need to be
done under general anesthesia, so they are admitted to the ward the
night before, a whole different process. I've never been here for
children's cataracts before, so I'm in for new experiences the next two
weeks. Looking forward to it. I'll probably have more to say about
that next time.

Meanwhile, blessings to you all
Marilyn

Sharon M. Himsl

Writer/Author. Blogging since 2011. 
Published with Evernight Teen: 
~~The Shells of Mersing