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Sunday, December 16, 2012

Merry Christmas

 
I baked yummy American style cakes for the Christmas party and they ate them all up.  I'm back for another personal update. My last one was after 6th months of being here, and I was having a tuff time. Now we've been here a year. And for me, Lori, things are much better. Conversations are flowing. We've made many good friends. We are helping with a church plant. The kids are involved in activities and ministry and inviting friends over. (Sigh) I am definately in a better place now. God brought me though, and I'm not saying life is easier now, but I am saying that I'm enjoying it more!
Oliver and Zeke have been taking Tennis lessons this whole year, and I started taking an early moring class everday, for the workout, and for anyone that knows me, I need regular excersize. So even that is so nice.
I've also gown fond of the visiting culture here. One must not wait for an invitation to someones house. Because inviting someone creates a lot of work. So they would prefere just pop in visits. That way if they don't have anything to serve, it's because they didn't know I was coming instead of that they didn't have the means to get something. If that makes sense. Anyway, I make visits to mainly the people in our blind assotiation. And I've been practicing reading Umbundo Bible passages by reading at our weekly blind association food distribution. So I have hopes of learning that difficult language in the coming year.
Anyway, here are two pictures from the Boa Vista Team Christmas party. First my handsome men and me, and next is the whole staff.


 
Next are picture from our blind association party. Finding donations from some stores and mainly churches and also from Boa Vista, we were able to give each person on our list, a large sack of goods to cook with and some clothes. This young man in the following picture is not on our list, but he came to read a Christmas devotion in brail for us. What an amazing man. He was able to attend and comlete his first year of, I guess it's our equivelent of college. And is looking for funds to return for another year. He is the one person we know that reads brail. We are so proud of him.
 
 
Below is a group of women called Project Ana, these women are always donating time and money to spread the Love of God. The were able to come up with many of our donations for the party.

 
Distributing sacks


A good friend of mine, Elvira, carring her very heavy sack on her head while being led by a guide. 

 
And finally are some pictures of a dinner party that I hosted, and I'm happy to say that having people over, has become a joy of mine, and I can also understand the conversations!! Yeay! One family we know from church and the other is the other is the only Angolan Opthalmologist in Benguela.
 
 

 
Anyway, thank you all for you prayers. And you can continue praying for John, his health has not been 100%, and it's taking a tole on him. So as we enter into a wonderful 4 week trip back to the States, we hope that he will regain his strength and be renewed for more hard work. We will be in Texas for Christmas and Nebraska for New Years, and stopping for a very short visit to our church in Somerville, Mass. Please contact me for a visit at loriclements@juno.com if I'm going to be in your city.
Below is our churches Nativity Scene.
God Bless you all and Merry Christmas!
 
With Love From Angola,
Lori


Saturday, December 1, 2012

Spiritual Blindness


During the course of this year we have spent a lot of time discussing our efforts to cure physical blindness. As terrible as the physical suffering is here from needless blindness there is a far more serious condition that afflicts Angolans and Americans alike—spiritual blindness.
Blind man being led by a young girl

I like Jesus’ perspective on spiritual blindness in His sermon on the mount as recorded in Matthew 6:19-23

19Do not store up for yourselves treasures on earth, where moth and rust destroy, and where thieves break in and steal.20But store up for yourselves treasures in heaven, where moth and rust do not destroy, and where thieves do not break in and steal. 21For where your treasure is, there your heart will be also. 22The eye is the lamp of the body. If your eyes are good, your whole body will be full of light. 23But if your eyes are bad, your whole body will be full of darkness. If then the light within you is darkness, how great is that darkness!


As an eye doctor I must say that for the longest time I didn’t get the connection between verses 19-21 and 22-23. Why was Jesus being so hard on blind people? Didn’t they have enough problems without Jesus saying they were full of darkness?
I’d like to analyze Jesus’ words. A blind person is physically in darkness and as such will be unable to navigate their physical surroundings without specialized training or guidance. You have heard the expression about people groping around in the darkness; well this is precisely Jesus' point. Pretty terrifying. In fact, surveys show, fear of blindness ranked up there with fear of death.
As terrible as physical blindness is Jesus goes on further to talk about the light within being dark and bringing a kind of internal darkness to be feared more than physical blindness.
So what is this light within that Jesus talks about?

I think the light Jesus is referring to is what we call your worldview, or how you perceive and relate to the world around you. A type of vision that guides every aspect of your life. Your worldview guides you as you make small decisions about where to spend your free time, what movies to watch, books to read. And especially it guides large decisions, such as where to live, employment, relationships, and resource management.
So you can see that if your inner vision, or spiritual sight, is blind you really are in bad shape for your life. You will be groping about in the darkness about all of life’s decisions, big and small. This is truly tragic.
Jesus is providing us in this passage with examples of inner lights or worldviews.

“Do not store up treasure in the world” he says. This is not an indictment against persons with a bank savings account or personal property. As missionaries we rely on the fact that God has blessed some of his people with resources and they are faithful with that and support His work around the globe.
Treasure is something different than simple currency. It is something that you value highly above other things in your life. For one it could be a bank account or stock portfolio, or house, others it could be personal beauty, reputation, prestige or success.
But when you place these temporary things at the center of your life it will blind you. The belief that material things will bring you security, happiness or fulfillment is the inner darkness, or spiritual blindness. Running after these things will leave you blind for all decisions in life. That’s not to say some good things may not happen to you if you are living as such, every once in a while even a blind squirrel finds a nut. But on the whole, for all big important decisions you will be without direction. Groping in the dark. Feeling that you are lost and without hope, particularly when one of these treasures is taken from you.

In stark contrast to this, Jesus presents a better way; to store up treasures in heaven. This is the cure for spiritual blindness. With our treasure in Heaven we will make decisions with all the guidance God can provide and navigate through this life in the way it was truly meant to be lived.
And this starts by having a life transforming relationship with Jesus that transforms every aspect of your life. Because faith in Jesus not only provides eternal security, but also provides the vision or worldview necessary to live the human life as it was intended.
When Jesus says that we are storing up treasures in heaven He is not suggesting that we are merely stockpiling for the great beyond, a type of life insurance policy that is only collectable on death. Yes, it is true, there is an eternity to be spent with our Creator in Heaven, this is something to be desired. But, this treasure is available now, in this life.  In the form of God’s sovereign provision, fruits of the spirit, the Holy Spirit Himself.
So how do we go about storing up treasures in heaven and curing spiritual blindness? I believe Jesus provides us with clear directions on how to ensure that we are living with the proper worldview. It is recorded in the book of Mark 12:30-31 as the greatest commandment

“Love the Lord your God with all your heart, with all your soul, with all your mind and with all your strength. The second is this: Love your neighbor as yourself. There is no commandment greater than these.”

According to Dallas Willard we ought to “Invest your life in what God is doing, this treasure cannot be lost. Devote ourselves to the good of other people, all of whom God cares for deeply. Do your part to bring the love of Jesus to your world, wherever that may be.” In doing so, you can be assured that your inner light will be as bright as the heavens and will help bring light to the darkness of those suffering from spiritual blindness.

My good friend Dr Steve Collins in Angola tells this story of an elderly woman who he had performed a surgery on and frankly, it didn’t go very well, and she remained blind after the surgery. Dr Steve was very concerned about this and was apologizing profusely to the woman. She could tell that he was upset about this and said. “Doctor, you don’t need to worry about me. You see, I have a friend and His name is Jesus, do you know him? He tells me that everything is going to be ok and we can trust him”.  This is the type of attitude that we can have only when our worldview is aligned with the kingdom of heaven. The world may crash around us, but we are secure in His hands.

At Boa Vista I’m faced with physical blindness every day. Some I can cure. Many I cannot. However, for every person who is sitting in my exam chair I can offer hope. While it is certainly sad when a person loses their physical vision, we can offer them something of much greater value, hope in Jesus Christ. Saving knowledge of a life transforming relationship that will strip away the darkness from inside of their soul and replace it with the brilliance that is Jesus.

 

As you enter this Christmas season make sure that you are celebrating it with a clear spiritual vision.

 

God Bless you

John

 

 

Monday, October 29, 2012

M'banza Kongo

We've just returned from a two days journey north to a small town called M'banza Kongo. They are proud to claim that they used to be the capitol of the Congo Kingdom. We had a beautiful time, met some wonderful people and John did lots of surguries.
First of all I have to comment on a few new culture shocks that I encountered.

-As we were eating on the patio of a restaurant, I honestly was past by a couple cats, a large pig, a dog, a chicken and a monkey! Could somebody call sanitation control!!! (the monkey was on leash)

-I'll never complain about a cold shower again as long as it's a shower and not a tiny bucket that was brought up to me by the poor worker guy, who not only had to haul our bathing water, but also our toilet flushing water! (Thank you, God for flushing toilets!)

-I actually did like the carrying our dinner up to the dorm rooms on our heads, and then returning the dishes in the same fashion. I need to work on my neck muscles a little more.

-I cannot wait to be invited to peoples house. It won't happen. I've waited for a year. I'm realizing that they just want us to pop in. Or call and say that we are coming over! I love it and they do too. (I'll try not to let this one effect my visits back to the US.)

-I finally discovered the beauty of a washboard, and I'm not talking about my abs.


Above is the poarch were I learned a few dishes about cooking in Northern Angola

Above is Katerina, before her eye surgery and below is her afterwards! I just love her.

Patients waiting to see the doctor.
Translation: Cemetary of the Kings of the Congo

The kings burrial sights

My impromptu English class

The students who didn't want to leave

Minus the power lines, this is what I picture when I think of when Jesus lived. So simple and so wonderful

 
John in action

Post Surgury


Yum!

Quick stop on the trip back home for some fast food!
 
Thanks for reading.
 
With Love From Angola,
Lori
 

Wednesday, September 19, 2012

Year in Review

I am happy to announce that we have completed our first year here in Angola! I'm humbled by your continued support of our work and ministry. Following, I will give a brief description of a few clinical cases that highlight the medical experience I've had over the last year, and demonstrate some of the outstanding needs.

 Equipping Angolan Doctors for Cataract Surgery
First and foremost, my biggest passion when coming to Angola was to teach Angolan doctors. Equiping Angolans is our mission, and for the first time I can say that we are fulfilling that mission! Dr. Mavitidi (pictured in the middle) has completed his first month of the cataract surgery training course and is progressing nicely. He removed his first cataract earlier this week and told me afterward it was one of the most exciting experiences of his life.
Through this training we hope to multiply the numbers of patients we are able to reach annually.

 
 Cataract Surgery
 Pediatric cataracts are something that I never attempted in the USA, but here, it is necesary.  I do a lot of them now, and they keep me very busy. Boa Vista is now the only center in Angola performing pediatric cataract surgery. We have children coming from all over Angola.

Below you can see Helder, a fun loving 6-year-old boy. He was born with congenital cataracts. After surgery on his left eye, the results were great. He really wanted a photo, and when he struck this pose I had to try to match his charisma (I know, I know, he pulled this off much better than me.)


Above is Milton. an 8-year-old boy who also was born with cataracts. I did surgery on both of his eyes as well. But his vision did not respond well because of Amblyopia (his brain never learned to see well because of his cataracts). He is a reminder to me that I want to grow our service to provide surgeries to infants. Currently children must be able to undergo local anesthesia, which disqualifies almost all babies. This is a critical time for surgery, if not operated on in a timely fashion, dense amblyopia may develop and nothing can fix it.

Above is a before and after of Higino. He was one of the very first cataract surgeries that I did here. He told me later that after his first surgery he was so happy because he could go home and dance with his wife. Before surgery his vision was so bad that he had to be led by hand in order to use the bathroom. Now he may return to work.

At Boa Vista we aim to decrease preventable blindness caused by cataracts by increasing our volume of surgeries performed. Our strategy, as mentioned above, is to train more Angolan doctors to do cataract surgery. We are making progress with Dr Mavitidi, but have a long way to go.

Cornea Transplants
This man had a bacterial conjunctivitis that raged out of control until he suffered a cornea perforation. I did lab tests and diagnosed HIV infection, accounting for his prolonged course and corneal perforation. His vision here was counting fingers at 3 meters.

 After 1 month his peripheral corneal transplant looks good and his vision has improved to 6/18.

I like doing these peripheral grafts and thanks to Global Sight Network, I have access to glycerol perserved corneas for non-visual uses.
However, one of the future dreams I have for Angola is to establish a program for corneal transplantation for restoration of vision. This will require lots of work and more funding, but I'm confident it can become a reality.

Eye tumors

Here is a 40-year-old man who came in with a spot on his eye. I ran some tests and diagnosed him for the first time with HIV.


 
 This type of tumor in Africa is often associated with HIV, series range from 51% to 92% of patients presenting with this tumor being HIV positive. For this reason I test all of my patients prior to treatment. I am currently collecting cases and rates of HIV positivity in order to help me learn a little more about the rates of HIV in our population.

I treated the tumor with a topical chemotherapy drop, 5-Fluorouracil, and it responded well, after 2 months his eye looked nearly normal(pictured below). I will continue to follow this over time to watch for recurrence and to give him encouragement to continue with his new medications for HIV.


Ocular Trauma
Unfortunately, Angola has a large number of violent crimes and accidents. A favorite weapon is the glass beer bottle, see example below. I perform 2-3 of these emergency surgeries every week. We have become the major referal center in the country for eye trauma. I guess that is a good thing, but it means lots of work.
,
Many children lack adult supervision in their play here and become victims of accidental injury. Sticks and stones can break your eyeball too... Below is an 8-year-old boy that was hit in the eye by a stone thrown by another child. I did surgery on him today actually. I will keep you posted on the result, the surgery today went well, except for the lack of general anesthesia. It is difficult to do these surgeries in children with only local anesthesia.

You are seeing the brown part of his eye (iris) protruding out of a cut in the cornea. I repositioned the iris back into the eye and sutured the cut closed. He should do well.
Congenital glaucoma
Look at the size of the baby's right eye. Do you see how much larger it is than the left eye? Also the front clear part (cornea) is cloudy. He has congenital glaucoma, his eye pressure is high and so the eye stretches in response to the force.


  Unfortunately, we cannot treat him, because we dont have an anesthesia machine.

Retinoblastoma
This child has a tumor inside of the right eye. Look at the ultrasound report, it shows the eye is full of tumor, as you see the left eye is clear.

.
 Without surgery this child has a very high chance of death. We need to get a pediatric oncology service together  in order to  increase the chance for this child to live. But again, we need more funding to pay for general anesthesia.




In summary,
1) 1 doctor is in the process of training.
2) we have done 1,800 individual cataract surgeries
3) Boa Vista provides a long list of potential treatments
4) Surgery for young children presents a challenge that requires new equipment

Wish list
1) General anesthesia provided by an anesthesia team
2) Phacoemulsification cataract surgery (Another machine)
3) Purchase of new equipment to upgrade operating room for teaching cataract surgery.
4.)More nursing staff
5)Implement cornea transplantation for visual restoration

Thank you for your support during this year, we have unofficially agreed to stay in Angola for another two years, we are waiting to sign the contract. God Bless

John

Sunday, August 19, 2012

Angolan vs. American Women's Retreat

We both (American and Angolan women) look forward to the event with excitment! We both plan on meeting God in a new way. We both spend the weekend together, bunking, eating, laughing and singing. I think, though, they enjoying singing more.

 This was my experience. I asked what I should bring, and they just said to bring my Bible and a notebook. I decided to bring some changes of clothes too though, and soap and toothpast. I only paid $20 for the weekend, for food and lodging.



                        Food                                                                                             Lodging

You will notice the right picture is a huge tent with lots of sleeping mats and cushions. A stark difference from the fancey hotel experiences I've had at ladies retreats in the U.S. But I really did enjoy myself except for the caffein headache that I experienced durring our manditory morning fast, ha.
The thing I enjoyed the most, and will enjoy even more, in the future, when I know some of the Umbundu worship songs, is that they sing for everything. We awoke at 5 am and I heard the women singing out in front of the church. Then we sing to enter the church, then we sing to worship in the church, then we sing to exit the church. Then we sing as we walk to the dining tent, they love to march and sing. And I liked it too.



Thursday, August 2, 2012

Let the training begin!

You may congradulate me, I passed my final board exam and am now fully board certified as of June 2012. It feels great, it is essentially the final test after 12 years of higher education. I feel blessed to be able to call myself the only American Board Certified Opthalmologist in Angola. This step was important as it paves the way for me to become a fully qualified trainer/educator for Angolan doctors to learn the art of cataract surgery.

 On that note, I, and my Boa Vista team are preparing to start training our first Angolan cataract surgeon. We feel highly optimistic about this opportunity and can sense God's leading in this direction. Through a cooperative agreement with an Ophthalmology Residency Program in Paraguay (South America) we are so happy to have received Dr. Manuel (Peruvuin), a 3rd year resident. He has agreed to come for 3 months to help take the surgical load off of my shoulders while we have a surgical student.
Dr Mavitidi is the Angolan doctor who will arrive on August 10th for the start of the cataract training. He will be here for 6 months. I am praying that God will bless this opportunity. The need for cataract surgeons here in Angola is massive. Imagine this: Angola has a rate of blindness that is 10x higher than the USA, however, the rate of cataract surgery in the USA is 65x higher than Angola's. I simply can not put a dent in this level of cataract blindness by myself. However, by multiplication of cataract surgeons we can make a difference!!

 Congential cataracts

This boy is blind from cataracts. He needed a surgery when he was a baby, but didn't get it. I operated on both of his eyes with good surgical technical results, but his brain and eyes never learned to communicate well, so his vision is still limited. I will still continue to try to rehabilitate his vision.

 Fun with corneal perforations (and medical jargon)
This 23-year-old male was seen by the most well equipped clinic in the country. He was treated for allergic conjunctivitis and sent away, he returned to them with this peripheral cornea perforation of at least 2 weeks duration. He was promptly referred to Boa Vista.  I think he actually had a bad scleral/corneal inflammatory condition. I treated him with a gram of azithromycin, topical antibiotics and ointments for two days along with oral steroids. This picture is the appearance after medical treatment.



After thinking about surgical options to restore integrity of his eyeball, I decided to do a peripheral patch graft with my supply of glycerol preserved corneas ( thank you Global Sight Network).



Here is the first operative day #1 appearance. I could not get all of the old fibrotic iris tissue out of the wound/angle, so the iris is still peaked (after doing many of these old perfs, I know why in the USA we do this surgeries in the first 24 hrs). However, the chamber is nicely reformed, his vision has improved from counting fingers to 6/18. I did a partial conj flap to cover the peripheral portion of the graft. I'm highly optimistic about his chances to retain good vision.

The same story here for another 20 something male. The only difference is the location of the perforation. Here we have a pericentral ulcer. I treated him  much the same as the previous case. Here is the before and after photos.






 
Thanks for reading,
John