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Friday, February 24, 2012

Divine Intervention

Many of you know that we have been praying for the arrival of our shipment of supplies for some time now. I was trusting in the Lord that it would come in December, January.... But as our supplies dwindled, and finally had to stop surgery yesterday I got really worried.. I scheduled an 8 yr old boy for surgery for this coming monday. I promised his mother that we would do surgery on Monday. But as the days progressed and it looked like I would have to cancel surgery for this little blind child, and the dozens of other blind that we would have to turn away.

So this morning in our weekly devotion at Boa Vista, we spent a special time in intercessory prayer. We all lifted our voices in prayer and asked for the shipment to be released from the customs officials today so we could continue to do the Lord's work with the blind.

  We got notice a few hours later that the shipment had been released. WOW! This is no small matter, the customs officials here are notorious for delaying and at times losing shipments all together. So we were all really excited to unload the container tonight.
Here is a picture of our administrator, David, helping unload the container this evening. He did so much work to get to this point, but I had to remind him that we had hired guys to unload this and he should let his back have a rest.
I'm so grateful to God for his faithfulness to me and to the work here in Angola. One of the privledges and challenges here is having to rely on God's power for so many things. We don't have control for the importation of supplies, our equipment is technologically challenged, the surgeries are difficult and the patients are inumberable. I have to rely on God's power here and it is teaching me that I can trust Him.
-John

Wednesday, February 15, 2012

I miss Grand Rounds

Everyday I'm surrounded by all of these really interesting cases. I try to explain how interesting these cases are to my nursing staff, but it's just every day problems for them. I think it loses something in my portuguese...
So once again I'll share some interesting cases from the last week.


1. Meet Isabel. She is 16 and has had to stop school because she can no longer see to read her books or the chalkboard.


 
These type of congenital cataracts are becoming commonplace for me. After I looked at her, I felt confident that I could help with surgery. But I'm never sure how much. Fortunately, I have some divine help here! She could see 20/40 the first day after surgery uncorrected. She will have the second eye operated on next week, then return to finish school in Luanda.

2.
7 yr old Eva can't see well out of her left eye. On closer inspection her facial symmetry is abnormal as well.

If you look closely at her left ear you will see an abnormality. Also the large growth on her cornea.


 She has Goldenhar's Syndrome. A congenital malformation of the left side of her face. I gave her glasses to try and treat the astigmatism while I wait for her mother to get a general medical evaluation of Eva. These children can have other internal organ malformations. If this corneal limbal dermoid continues to grow or her vision worsens I will excise it.

3.  19 yr old Maria has double vision when she tries to look to the right.
4 months previously she had some type of surgery by somebody in the capital. It sounds like it was either a pterygium or pingueguela. Something very small and likely un-needed surgery. Now she has pain and double vision. I'm calling this a psuedo-pterygium, an inflammatory growth following surgery. There is a large adhesion of the bulbar/palpebral conjunctiva and restriction of movement of the globe.
I took her to the operating room and did a modified ptyergium surgery with an autograft, and takedown of the adhesions. I placed a large contact lens to prevent recurrence of the adhesions. Post op week 1 she looks good, double vision is gone, she is happy (mostly) eye is still pretty red.

4. 23 yr old man has a red painful eye for the last 6 months. No previous medical history. Vision is Counting fingers. The anterior chamber is deep, but has near 360 degree cornea peripheral thinning, with heavy vascularization.

Those of you who read this blog regularly will recognize this as Mooren's ulcer. I did a systemic work up here, which was negative for every test I can run here. I'm treating him with systemic steroids/topical ointment and close observation. I'm hoping he doesn't perf, I really don't want to touch this with surgery.

5. 62 yr old man had cataract surgery a couple of weeks ago elsewhere. His cornea is swollen. What is not pictured here is the complete Descemet's detachment into the anterior chamber.
I attempted to place an air bubble into the anterior chamber,and even used vent incisions to try and get the fluid to come out, but it just wouldn't. This is actually post op photo.
I'm debating trying some full thickness cornea sutures in an attempt to force DM to get closer to the posterior stroma. What I'm not sure of, is whether he has epithelium growing on descemets preventing attachement.


6. 35 yr old woman with bilateral eyelid lesions (Kaposi's?). These looked very atypical, so I got an HIV test. It was positive. I'm always very suspicous of any atypical anything here for HIV. We are getting her treatment with HAART.  HIV is actually not as prevalent here as I thought it would be. But, I do make the diagnosis with frequency here.

7. Subluxated, Dislocated, Luxated.... Call it what you will, but the picture is just beautiful. This type of cataract surgery here is actually somewhat easy, crude, but effective. Some of my happiest patients had Intracapsular cataract surgery with SICS, and an ACIOL placed. I have an automated vitrectomy machine, so that helps.
These are just some of the interesting things that I was able to take pictures of this week. Thanks for reading.

John

Thursday, February 9, 2012

Blind Assotiation

So I get to spend time with the Blind Assotiation every Thursday morning. This is when their weekly food supply is distributed as well as a small Bible study and social time. This population is very often forgotten in this culture and to get together weekly and talk about life is a treat. I enjoy it too, although it can be tiresome because there are so many needs and they are always asking for things, like last Thurday, a young women asked me to buy her some expensive hair. This was one of the many requests that I decided to say "no" to, but sometimes there are legitamate requests that need to be heard.
 Worship
 Receiving their corn flour in bags
 Outside
 This gentlemen received his bag of food, plus for two other blind and has hailed a taxi to take him home.

This Assotiation has enough funding to feed 81 blind. (with a waiting list) That means they get just enough corn flour to survive, no vegetables or fruit or nutrition. But they do recieve a portion of corn four which they cook with hot water and it turns into a sort of grits type food, but make no mistake, it has no flavor like our grits, but they seem to like it that way, when possible they serve it with greens and that is where the flavor comes. Anyway, they receive the corn flour and two small peices of bread for the week. This is down because they lost funding for three peices a week like they got last year. Which is a matter of $10 a week. $10 buys 100 peices of bread. This week I will buy the extra bread, but I'm putting the request out there for you to consider a donation to the blind assotiation.
Everytime I want to give I hear people saying it's not good to give, you are only creating dependancy, but let's remember that the blind are dependant in a culture like this, and the Bible says in Matthew 31-46 when it is talking about the end and Jesus is evaluating if we did or did not feed the hungry and cloth the naked, it says, "And the King will say, 'I tell you the truth, when you did it to one of the least of these my brothers and sisters, you were doing it to me."
Besides the bread issue, this week the president (also blind) came to me with another valid request. They are asking for folding walking sticks. I have looked into it and they are nowhere to be found here in Angola. I mean, the president does have one, but it was brought in from Europe some time ago. So I realize that as a reader of our blog we have lot's of disturbing images, and lot's of requests. I really don't want to lose anyone as a reader, so please if you do not feel the Spirit leading you to help with any of our request, just read and move on with your life. Or you can commit to pray for the needs. We appreciate you reading, I don't want to weigh anyone down. But if you are moved by the Spirit to contrubute, then listen and follow through.  
I know nothing about folding walking sticks, except what I've googled, so I'm searching for those who know more, and if you feel like sending over a box or two of folding walking sticks I know at least 81 poeple, whose lives will be changes for the better. I've watched many of you collect hundreds of glasses for our ministry! We are amazed, how sending out one blog can change the lives of Angolan. So thank you and continue with me in our grand pursuit of emulating the heart of God.

On a lighter note, Oliver has started school here at a private Portuguese speaking school. He is still really struggling with the Language, so please pray for him.
 Roman playing with Brother Justinho (our guard)
And finally Zekie, with his buzz cut because he got gum in his hair last week.

From Angola with Love,
Lori