Update on Rita's house

We are finally making some progress on Rita's house!!! Remember Rita? For Christmas many of you readers gave to help construct Rita's house.  Well here we are, she  now has walls! Here is a picture from before Chistmas. It has taken her 5 years to get this far.

  Here is a picture from before Chistmas. It has taken her 5 years to get this far.

Here is a picture of Rita and her oldest son, Tadeo, when we used your dollars to buy cements.

 (and Roman)

Here is Tadeo in from on the house now! The walls are all up and now they are putting some iron support on top.

In order to same money, Rita's construction crew are making the cement blocks instead of buying them. We got to see how this is done. In front is the mold and behind are the blocks while they are drying.

Picture of the constuction crew from inside the house.





Dude wanted to pose, another construction worker.

Rita and her kids are so excited about the house. Since I've written about her, and we has the wonderful responce, Rita lost her last living sibling, her sister, and has inherited her three children. Row Rita has 6. Pictured above are two of Rita's youngest and her sisters two oldest. And of course Roman. She also now has a four year old.

Nela, her four-year-old



These kids will finally begin school because Rita knows the importance of it. They are 10 and 8 years old and have never been to school. With the new house they will all have beds and comfortable living space. We saw yesterday that the government has started puting in power lines to the neighborhood, and they are also working on puting in water. Very exciting.

So now we have use all the money that was donated so I told Rita that the rest depended on Rita. It's good for her to use her own money too. As you can see there is quite a ways to go, so if you do want to help out and have not yet, it will be very appreciated!

Thanks again for reading, and allowing me to be a vessle, transporting your love and generocity to Rita.

With Love From Angola,

Lori

This is Africa (TIA?)

I ( John) am just returning from a short 5 day visit to CapeTown, South Africa and Windhoek, Namibia. Before discussing the details of the trip, I must tell you what happened to Lori and Zeke as I was on the flight to South Africa. Zeke got a very high fever and had a seizure! The situation was actually very serious as he stopped breathing and Lori and to resuscitate him. I am thankful that he is making a good recovery now. We still don’t know exactly what it was, he has been checked for Malaria 3 times since and have all been negative. We are treating him for it anyway. Very odd timing since everybody has been very healthy up until now. I felt this illness was sent specifically to distract me from the upcoming meetings we had coming up with CBM (Christian Blind Mission). I really wanted to return to Angola immediately upon landing in Cape Town, and had trouble focusing on the presentation upcoming. However, we serve a God who is greater than any force of evil and he showed that to me by taking better care of Zeke than I could have if I would have been there physically. Before the presentation to CBM Africa, I got word from Lori that the fever had broke and Zeke was acting normally without any visible effects.  I am proud of the way Lori handled the situation, I really was blessed the day I married her.

Now, on to the Trip.

Here is a picture of the lead CBM consultant doctor, Dr. Collin Cook, myself and Dr Jean-Pierre Brechet (JPB) outside of their office in Cape Town.  JPB and I came to meet with CBM to discuss continued funding for Boa Vista and the possibility of CBM adding a doctor co-worker in Angola, essentially a CBM supported doctor position. Our project is a 3 year proposal designed to increase the volume of cataract surgery done at the Boa Vista project through the training of Angolan doctors to do cataract surgery.

This project is very important to me, I have a strong passion to train Angolan nationals and feel that God has equipped me to do so. In fact, training of nationals to do the work is included within Lori and my mission statement. In the 6 months we have been here, that mission has yet to be realized which has been frustrating. If the work here in Angola continued in this path, I would have had to reconsider our long term engagement here.

Currently a new opportunity to teach at least one Angolan doctor starting in July, with more on the horizon. This will be a new project located in the north of Angola.  CBM South Africa could see the potential in our project, and responded favorably to it. They feel this is a feasible goal, and were excited along with us concerning this opportunity. As a result of the meeting, there is the potential for staying on in Angola as a funded Co-worker. Nothing is final yet, as this position has to go through the CBM board in Europe, but it is possible that the funds for this position have already been allocated. So, we now wait and see. I am praying that God will open the doors as only He can do.

After our meetings were concluded we got to see some of the sights of Cape Town, and enjoy some very nice food, pictured.

Table Mountain provides great views of the city and ocean below. Cape Town has quickly become one of my favorite cities in the world. The combination of mountain adventures, beautiful ocean coastline, and just the right amount of Africa mixed in was really fun to experience. 

It was really hard to believe that Angola and Cape Town exist in the same continent. They are worlds apart, and further highlight the disparity between the developed and developing world.

After 6 months of Angolan "funge" (corn meal mush) this steak seemed to be the best 20 oz ribeye steak in the world. In fact it was a great cut of meat, and to make the experience better we ate this in the shadow of Table Mountain on the waterfront in Cape Town. I recommend "Baltshazar" steakhouse to anyone in the area.

After this brief 2 day visit to Cape Town, we flew north to Windhoek, Namibia. This was also a brief visit, with time taken to conclude some importation business and meet with a local ophthalmologist who has a Private Practice in Windhoek. Great meeting, and good future contact for me.

Later that day, we drove 30km out of the city to a game park and got to witness Lions being fed. Wow, we got so close to them, never any real danger as there was an electric fence between us and them. But close enough to feel very small compared to that massive cat. Because Angola destroyed all the large animals (Lions, elephants, Giraffe, etc…) during the war, this was my first experience  where I felt I was in the Africa you see on National Geographic.  I am looking forward to bringing Oliver and Zeke back to this spot, they will love it.

Tommorow we will drive to the province of Uige. We are planning a new clinic there. Currently we are training 4 nurses that will work there. Hopefully in July we will begin training a doctor to perform cataract surgery there! There is hope yet to train doctors here in Angola.

-John

March interesting eye cases

Hey there readers, I'm going to show a couple of interesting cases that I've had this month. You should know by now if wierd pictures of the eyeball bothers you. If that is you, you have been warned.


1. A 32 year old woman presented with a 2 month complaint of blurry vision in her left eye. She had been punched in that eye by her husband a few weeks prior. Vision in the left eye was counting fingers at 3 meters. Anterior segment exam was normal. An exterior photo of her is posted below.  Do you know what she had? I bet most of my collegues studying for their board exams know this one. Scroll down to the end of the post for the diagnosis and classic exam finding.

 2. I'm blessed here with a collegue, whom, as far as I know, is the only Angolan ophthalmologist who actually does significant amounts of surgery. He works in the central hospital here in Benguela, and has access to general anesthesia, in which we need to operate on most children.
I am starting to take children there who need surgery, such as our next case.
This child has retinoblastoma, at least i'm pretty sure he does. No pathology results yet, but it looks like RB. This tumor is fatal for many children, and he had an advanced tumor. It had actually grown outside of the eye, which is a bad sign. However, I was growing very tired of simply telling the mothers that their child would die, so I arranged to takethis child over to the General Hospital and do his surgery there. I hope I have saved his life, but only time will tell. I'm praying to God that he lives. He is in the hands of the almighty now, I have done what I can. Pictured is the child and the eye after removal.

Same day, working on a different patient. At the head of the bed is Dr Salomao.

 I'm to the right, operating.

3. This patient came in to be seen at Boa Vista several times by the eye nurses that we have. She had complaints of headaches. My nurses gave her eye drops and told her that she had dry eyes ( on 2 seperate visits) 3 months later when she was blind, she came back to Boa Vista and the nurses showed the patient to me. She had bilateral swelling of the optic nerve. I sent her to get a CT scan. Pictured below.

 Its a really big brain tumor. It represents a probable fatal condition for her because access to Neurosurgery here is equally poor and chemotherapy is almost non existent.
This represents a larger problem however, because even my nurses who are probably the best trained nurses in Angola, still make rather poor efforts at diagnosing complex problems and do not show me all of the cases of the day. I'm struggling with that idea. I simply don't have time to see all 80 + patients of the day and do 10-12 surgeries in the morning. I sure could use some more doctors here.

4. I think I posted this photo before. But I wanted to show the results of surgery. Briefly for review, she had some type of small growth removed by a nurse. She had lots of scarring, pain and double vision because of this growth afterward.

Below I am taking out some nylon sutures about 1 month post surgery. Her double vision and pain are completely gone. The symplepharon has been lysed and her conj autograft looks great, not a sign of recurrence yet. Will keep watching her.

5. Posterior Capsule Opacity - Capsulotomy with needle

With doing so many cataracts comes the usual complications; long term that includes clouding of the lens capsule behind the now clear lens implant. I had only ever used a LASER to clear this in the USA. But here I don't have that expensive piece of machinery.

SO I took the advice of Rainald Deurkson in Paraguay and cut it with a needle! I entered the eye 3mm behind the limbus with a 25 g needle. I used my very little experience with retina surgery to help with the placement of the needle, visualized the needle engaging the posterior capsule and then intentionally broke the bag! The patient could see well the next day, no infection and importantly a happy patient.

6. Answer to above unknown. Angioid streaks, with choroidal neovascular membrane in a patient with Pseudoxanthoma Elasticum.

-I'm presuming that the trauma she had from the domestic abuse (despicably common here), caused a break in Bruchs membrane and subsequent CNV. Other eye had same picture minus CNV.

Day in and Day out

After living in Angola for 6 months life has finally settled in and I can say that the "honeymoon" stage on being a missionary is wearing off. Not that I don't love being here, but now I don't love all the sacrifices. Like when I got here, after every meal I would hand wash every dish and think how easy it was, and that I don't know why I ever thought I needed a washing machine. (I know our Boston friends can relate here) Then I'd go clean a used cloth diaper, and fill up our water filter. And every time I swept the mound of dust that comes in the house, I would just smile and think how satifying it was to sweep a lot of things out of the door. Ha, you know how it was when you first got married, and you thought you loved the quarky things about your spouse that turned out to be the things you despised after a few years. That kind of thing, I even thought I loved studying a new language at the begining. But now, after six months and I still get whole sentences in conversations that I totally don't understand, I'm getting fed up with it. This must be why my relationship with God is deepening, because I really need to rely on Him right now in these frustrating times. I just want to have a couple over for dinner and sit back and laugh about life. But I'm too focused on understanding every word that even when it's funny, I don't have the energy to laugh.
The kids on the other hand are really getting comfortable. They have a few friends on the street, and they love to play together. Oliver and Zeke are attending a daily tennis class taught by our neighbor. And Oliver is actully liking school a little bit. We are very happy about this. He goes to a Portuguese speaking school in the morning and I teach him and Zeke together in English in the afternoons.
Roman is very comfortable with people and I'm sure he will be communicating in both languages here someday.
John is starting to feel the weight on his sholders as being one of a very few eye surgeons in the country. People are always traveling hours to be seen at the Boa Vista  eye clinic and the types of complicted eye problems are numerous. It's a releif to know that God wants to carry this burdon for John, and John knows that God is pleased when he is giving his best, but at the same time it is overwhelming.
Yesterday, I was at the blind association and even though I tell them all the time that I'm not a doctor they continue to call me Dr. Lori, so this poor woman brought her three year old son, that is clearly mentally handicapped, to me to see what I can do to help him get better. And of course in my limited knowlede of medicine I don't think anything can be done,, so I told her what I know, then refered her to the general hospital. Unfortunately, they will not have good news for her. So this was my glimpse into John's day to day life. Everyday, he sees blind people that the Lord allows him to bring sight, but at the same time he has to tell many others that their particular problem cannot be fixed; and send them back on their 2 day journey home. Since the Lord cares more about our love for him than the things of the world, we can rest asurred that people who come to Boa Vista and don't get the result that they want, they at least heard the Gospel and know that the love of Jesus even reaches them.
It is a tremendous honor to be somewhere where we are so needed and appreciated. So please pray with us that we always remember that. We really miss everybody and are so thankful for this ability to stay in touch. Thanks again for reading.

From Angola with Love,
Lori

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

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

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