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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.

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