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Thursday, April 25, 2013


After almost two years of living here, I've finally jumped into church leadership. yikes! So far, we have been attending regularly and helping with the teaching, but I was so afraid of changing their culture into my American standards that I needed to just observe. And because the people are so reserved and stand offish, I'm still learning cultural things even now.
But I'm attending a church, where as far as I'm aware, the pastor and one young woman, John, Oliver and me are the only ones that read!!! I went to the Wednesday night worship meeting and the poor young man of 25 year was preaching and using text that had nothing to do with his topics. He would have one of us read and then talk about it, but when the words didn't match up he just kept right on like they did. And our people are all just listening and I have no idea why they are coming back, but they are! So I started a womens bible study, we met at 5:30pm, and it starts getting dark at 6pm and I didn't even think about this. I'm reading the Bible with the light of my cell phone! The women were receptive, but I still have so much to learn.
But taking the American out of me has been harder than I ever thought. I'm sooo thankful that I've was lucky enough to be born an such an amazing country, I have a new and profound kind of American pride that I didn't know I could.  Just the ideas that I had and the concept that people know how how to read and study the Bible at home on their own. I'm totally back in the Bible days, where people need to gather at the church to hear the word of God. And I don't mean my opinion of the Word, I mean just to have someone sit in the church and read, people will come and listen!
And to want to have a Bible study after work doesn't work unless the church can afford a generator, but then you have the obnoxious sound of a generator. Then when we gather, the older women want to hear the Bible in Umbundu, and the younger generation want Portuguese, so in this culture, even when there are not foreigners, there needs to be translations.

 Oh, and bathrooms, just remember not to drink to much coffee on days you go to church, because the "bathroom" is a tent that is only a 3 quarter enclosure. Not even a hole! They do have a giant hole waiting for the finaces to build a batheroom around it, or I should just say walls around it, but so far, it's not happened. Very few of our members have jobs, and when I say jobs, I mean buying and selling vegitables. Or getting picked up for the day to help lay concrete or something. Nothing regular or secure.
The picture below, is the landmark that I remember, so I know where to turn to find our church. The walls of the "building" are made of patched together t-shirts, a very common way to have shelter from the sun.

I love my church, but there is so much work to do. I am now teaching reading once a week in the mornings. The pastor teaches everday, and I help in on Mondays. He teaches 6 am women, 8am children, 10 youth. None go to school, just our church for education. Then I lead Sunday school and Wednesday night ladies Bible study. I'm praying that I start noticing leaders within the group to start training and helping this church be sustainable without me, but we have a long way to go. I mean it will go with or without me, but I do think the Lord has placed me at this church in this new neighborhood for a reason. And I'm very excited and overwhelmed by the responcability.

So this is what's is happening for now. Thanks for reading.

From Angola With Love,

Saturday, April 13, 2013

Sending out Dr. Sebastiao!

What an exciting day for the Clements family!!! We came to Angola for John to train doctors in Ophthalmology, and today we had the graduation of his first prodigy! Dr. Sabastiao Mavatiti has gone through John's fast cataract surgery course, he has completed 100 cataract surgeries with good results and this evening we commissioned him to one of the northern provinces of Angola. Angolans caring for Angolans, it is so wonderful.

We are so proud of  Dr. Sebastiao, he has shown himself to be a compassionate, careful, and a compitent doctor.  May the Lord continue to flood our doors with people like Dr. Sebastiao, who have a heart to learn and help others.
                                                       Dr Sebastiao and His beautiful family
 Then, pictured below,  the tear jerking part of the ceremony, when John had one of Sabastiao's patients stand up. And he said that before sugery he couldn't see, now because of doctor Sabatiao, he can see. Wow! So beautiful.

                                           The Boa Vista team makes it all happen!

The rugrats, that interrupt ceremonies.
Congratulations Dr. Sebastiao Mavatiti!!!
We are so proud of you.

Thursday, April 4, 2013

Fun with trauma repair

Fun with traumatic repair

Ok, so it's been a while since I (John) posted some cool ophthalmology cases. For those that don't like eye ball pictures, I promise these aren't too bad....

1. A 24-year-old male reported decreased vision in the right eye for 2 years. After some questioning he admited that the eye had been struck by a soccer ball, and that is when the decrease in vision began. His vision was found to be hand motions olny. The pupil was irregular, and appeared to have a traumatic iris coloboma. There was no afferent pupillary defect and a sonagraphy (B-Scan) was done showing a normal appearing retina and optic nerve. IOP was normal. *Disclaimer, this photo is not my actual patient but, you get the idea

I was very concerned about potential zonular pathology in the area of iris defect, but agreed to attempt a surgical correction. I spent more time than usual pre-operatively explaining that the vision result of surgery may not be good.
At the start of surgery I was pleasantly surprised to find the lens stable and no obvious zonular loss. I was able to complete a linear capsulotomy ( was worried about CCC causing troubles here and still worried about long term zonular stability for in the bag placement of IOL).
For the lens implant I placed a 1 piece PMMA lens with haptics in sulcus and optic beneath linear flaps of capsule.
I then turned attention to the iris coloboma. It had been a few years since I performed iris suturing, but figured this was a great case to get some practice. I only had one error, the first pass I attempted with the long CIF-4 needle was completely wrong, and had to redo it. However, the second pass was much better, and I tied it with a McCannell knot. Couldn't quite remember the siepser slip knot. The result is shown below at 1 week. The vision result was a pleasant surprise, 20/40 un-corrected, resulting in happy patient and even happier doctor. 

2. A 32-year-old man had been involved in a motorcycle accident one day before coming to the clinic. The only injury he suffered was to the left eye. Vision was perception of light, no APD. He had a corneal laceration and traumatic cataract, (This picture is actually from a different patient, but very similar presentation)
I performed urgent surgical repair. During surgery it became apparent that the posterior capsule had been violated from the perforation. I performed a lensectomy, vitrectomy and sutured the corneal wound. I left him aphakic. Fortunately, the eye did well post repair, as shown. 


With a +10.00 lens he was seeing 6/36 in our clinic. The problem was his other eye is a perfect 6/5 and the imbalance prevented glasses correction. You eye people out there may be wondering about contact lens correction, but frankly it doesn't exist in Angola. So my options were leave him afakic (he declined this), anterior chamber lens (surgeon was hesitant for this because ascan showed a 22D lens would be best and I only have 19D ACIOL) or iris sutured lens. All of these options have pluses and minuses. I elected to place an iris sutured IOL. I think it was a good enough option for him and plus I was really wanting a case to practice this technique on. Surgery went well, only had a little trouble positioning the lens with haptics behind iris with optic capture anteriorly. I used a monarch injector to place a 3 piece MA60-AC acrylic lens (which I now have with our phaco supplies).
Here is his appearance at one week. Vision has improved to 20/60, which I am pleasantly surprised with, given the cornea scar and astigmatism. 


Please, for any anterior segment surgeons who may be reading, send me your comments, tips or other feedback.

Acknowledgments: Thank you for showing me the technique Dr Pineda and a big thanks to Dr Croasdale for supplies.