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.

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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.

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 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

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.



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

Blind Association Video

This blind Association consists of 80 people that receive food every week. Two to three kilos of corn flour and three pieces of bread. As we continue to find donations we hope to add the 83 people that are waiting to get on the list, and Lord willing, I would love to give them something with nutrients.

I've heard that each city within our provence has their own blind association (totaling 450 blind), so in the near future, I plan on getting out and meeting each of the leaders of the other associations and find out their conditions. 

I plan on searching for help buying more canes and raising money to take care of the least of these. 

On another note, I'd like to pass on a testamony from Rita, the widow who's house we are trying to help build.

So the other day she was looking for a ride home, taxi busses or motorcycles are her usual way home. On this particular day, the motorcyclist wanted a dollar and she was trying to talk him down to eighty cents. She said a foreigner was near-by and told Rita she would give her a ride to where she needed to go. So Rita went with her. Later that day she saw a child sleeping in the dirt, where others were trying to walk, and Rita asked what he was doing, all he said was that he was hungry. So she took him and found him a humble meal for a dollar.

Rita said, that God gave her a free ride home so that she would have the dollar to buy this child a meal.

What a beautiful moment! I'm reminded of the passage in Luke 21: 1-4

 "While Jesus was in the Temple, he watched the rich people dropping their gifts in the collection box. Then a poor widow came by and dropped in two small coins. I tell you the truth, Jesus said, "this poor widow has given more than all the rest of them. For they have given a tiny part of thier surplus, but she, poor as she is, has given eveything she has."

From Angola With Love,
Lori

Stories of Survival

Lori and I have been in Angola nearly 10 months now. People have started opening up to us and sharing some of the painful stories about the brutal civil war. How humbling it is to hear their experiences. I'll share just a few of them.

Justinho lives in a city within the Benguela province called Ganda. During the war opposition forces accused him of being a spy. To ensure that he could not hurt there cause in any way and to send a message to others, the soldiers cut off his hands. Now, 20 years later, he was blind in both eyes from cataracts until we restored his vision. I was so happy for him that we were able to help in this small way.

One of my surgical nurses was living in his home in Caluquembe when opposition forces began advancing on the city. Word spread that this man was a ranking official in the ruling party. The opposition forces began looking to kill him. So he fled for the woods, where he lived for two years. Two years away from his family, moving about as a fugitive, never spending more than a few days in any location. During this time he had  help from his brother-in-law. Somehow they successfully reported his death, so that he could be free under a new identity. With a new name and a new beard, he was able to live in the house with this brother in law safely.

Another nurse at Boa Vista was working at the Caluquembe Mission hospital during the height of the war. This church based mission hospital had an unfortunate location and was held by opposition forces. When the government forces moved in to seize the province the hospital was viewed as sympathizers to the opposition and was bombed on a regular basis. During the bombings this nurse would always go to this one particular hole in the ground for shelter. He did this for several weeks as the bombings continued. One day as a raid started, he decided to help a patient who was struggleing to get to the shelter. By the time they both finally got to the shelter they found that it had been hit directly and everybody in the shelter had died. 

These kinds of personal stories of heroism and tradgedy are common. I feel humbled that as we get to know people, they open up and share their painful memories. War is terrible, the more direct contact I have with survivors the more I know of it's cost. 

Thanks for reading,

John

Eye glasses video

I'm not sure what Justinho was happier about the new reading glasses, or the plastic box to keep his stuff out of the rain. But all the same, we want to thank everyone who participated in gathering glasses for us. What a huge blessing. And for that matter, if you are still waiting to send them to us, just send me and e-mail and we will get that organized. Anyway, here are some photos of others who received glasses.

From Angola with Love,
Lori

Home is where the Heart is

Although I miss family and long to live closer to everyone, my heart resides in Angola. It is hard to really explain my feelings, but while I was visiting the U.S. for the past three weeks it felt like I was walking in a newly opened toy on Christmas morning; with yet a few more buildings and bridges to peel off the plastic. It seemed like I was in a dream, where everything was brand new. And the people were just as perfectly made up like Barbie and Ken dolls.
Then when we woke up the first morning back in Angola and got on the road for an 8 hour drive to our home, it was like relaxing into my favorite old pair of sweats' in which I feel the most comfortable. All the smells and traffic jams and people on the streets were surprisingly endearing. I was ensured, in my heart, that I am living exactly where the Lord would have us live. Thank you Lord for the conformation!
Thank you also, Lord, for the lesson in humility yesterday in our travels. For I had begun to believe that I was a good parent. Before yesterday, I had always had the good, quiet kids on the plane and it was getting to my ego. But with the blessing of a screaming one-year-old and a vomiting 6-year-old, I was quickly reminded that every other easy, comfortable trip before now was given to me by Your abundant grace. You helped me know what it's like to be the scum of the airplane that receives all the "over the shoulder" dirty looks. May I too show grace to others that don't seem as good as me, when I think I have it together. You, Lord, always know how to put life back into Your perspective. Thank You.
 And in our weakness, He is strong!
As I was growing quite weary of my screaming one-year-old and vomiting 6-year-old, so were the Angolan officials. They could take our chaotic family no more and showed us out the door, by-passing customs!!!! (we were afraid they would either take some of our luggage or charge us a whole lot to get it through) Thank You, Thank You God of the universe. Nothing is too difficult for You. Now 80 blind people will have a fancy new walking stick. And more than 200 people will be able to read again with their new glasses. And John's clinic will benefit from all the surgical materials in out luggage. We didn't know how we would get them through customs, but God did!
 My best friend, Mirjam, asked what it was like experiencing miracles. But just like the Israelites, I could easily forget or explain it away the very next day. Or  I could overlook it all together as  I angrily clean up vomit off the airport floor. Don't overlook the miracles in your own lives! Don't let life be so busy and selfish that you can't see the Lord moving. I know he is moving in the lives of all of you who pray. The Lord hears, and He acts.
I was afraid that our visit to the U.S. would make us want to return and not sign our new 2-year contract. But as much as we enjoyed climbing Mt. Olympus in Salt Lake City with its incomparable views, and as much as I love roaming through the isles and isles of the endless choices that Wal-Mart and Target have to offer; I am quite content with our unreliable electricity and the growling generator that covers us, and the constant need to pour water into the purifier, and the dear ladies who cry "peixe!" outside our house as they try to sell their dried, salted fish.
I am content with our one baby hill in Benguela, that the Angolans call a Mountain. I am content with the greatly reduced menu options that my kitchen has to offer, (I cannot speak for John on that one). But we are content and delighted to be here.
I don't know what the future has to offer us on a 10 year scheme, but as for now, me and my house will serve the Lord (Joshua 24:15), where ever that may be.

Congratulations James and Jamie Clements on your beautiful marrage, may the Lord be with you.

From Angola With Love,
Lori