He still cares for individuals

I find it easy to get caught up in the big picture of trying to fix all of Angola's eye problems, train future ophthalmologists, and lead the Boa Vista project, instead of appreciating the individuals that we treat. However, from time to time God sends patients with stories so memorable that I cannot help but thank God for allowing me to be a part of this good work.
Today I will share two stories from surgeries that were done yesterday at Boa Vista that touched my heart deeply. This work would not be possible without the generous support of readers like you. So read, reflect and give thanks to God because He is still in the business of performing miracles and transforming lives of individuals.

1. Joaquina is 45 years old and lives in Luanda. She is blind in both eyes from cataracts and she has severe leg deformities from the polio she suffered as a child.

 In the neighborhood she lives in there are no side walks or roads that a wheelchair could access. She crawls on her hand and knees using flip flop sandals as "shoes" for her hands. She entered the consultation room with some difficulty, feeling her way across the room using her hands to guide her blind eyes. Her eyes had a type of cataract called posterior subcapsular cataract. Previous to my arrival at Boa Vista this type of cataract surgery was not being done, because it is more difficult to perform than a "normal" white cataract. She would have been told to return in 6 months when the cataracts were "ripe".
However, thanks to a generous donation of a modern cataract surgery machine (thank you Chris and Steve) I said yes we can help!
I performed a perfect phacoemulsification surgery on her right eye yesterday and this is the sight I was greeted with today as I entered Boa Vista.

One very happy patient and one very grateful doctor who can't believe how good God has been. We were able to restore her sight and help her navigate through her world. I can only imagine the troubles she had navigating blindly on her hands and knees through the dirty streets of Luanda (which is a third world version of New York). Now, if only I had a friend who did orthopedic surgery....

We are now running a successful phacoemulsification program in addition to our manual cataract surgery. Effectively expanding our capacity to help the greatest numbers of people and blessing me with the ability to stay current in cataract surgery technology. When I left for Angola there was no modern cataract surgery being done here and I was worried that I would forget how to do the surgery and be unable to return to the United States because of my diminished surgical skills. Those worries proved (as most are) to be lies. Through the generous provision of donated equipment and materials my surgical skills have multiplied and I am a far better surgeon and capable of performing a wide variety of surgeries well.

2. Our next patient is Lorenzo,  a 31-year-old man, who was led into the clinic by his brother. For the last 16 years he has been blind. Imagine that. A young healthy man unable to work, study, play soccer because of blindness. They said his eyes always looked a little funny since birth; but only after the "white spots" came was he completely blind.

 

 

For the non-eye doctor I will briefly describe the pictures. First his iris (the brown part) has a congenital abnormality, the pupil is not in the center of the iris but rater displaced up and out. Actually this is as big as the pupil would get as it refused to dilate with eye drops. There is the white spot, or cataract as I like to call them. The pupils slightly reacted to light, but he could point to the direction from where my light was coming from so I thought he could see if only we could do a cataract surgery. I performed an ultrasound of the eye and discovered that it was a very small eye only 18 mm in diameter (normal is 22-24mm). He would also need a lens implant that was very high in power (33 diopters), which I discovered we actually had here!. I did surgery on friday. It was one of the most challenging surgeries I have done in a long time. The orbit/eye is very small and had difficult access surgically. The anterior chamber was extremely shallow. The pupil was indeed only this big after multiple rounds of eye drops. I was saved by another donation of flexible iris hooks (Thank you Chris) which allowed me to mechanically retract the iris and open a pupil to give me access to the cataract. When I opened the iris for the first time I saw a perfectly white nucleus surrounded by darkness, I was worried that the lens would be dislocated. However, after proceeding it was only the very clear cortex I was seeing and the lens was actually not dislocated. The case went well.

Pupil is round, still displaced after surgery, but minimally traumatized.

 His vision was 6/24 today 1 day after surgery. I expect that to improve in the next few days. But today we had a good time shaking hands and hugging as the man who was blind, now sees.









There are so many stories like these at Boa Vista. I admit with some shame that at times I forget about these precious individual lives and their stories as I strive to change an entire country's eye health care system (and become jaded in the process). Thank you God for sending me gentle reminders about your love and care for individuals and for using a selfish creature like me to bless others.
-John

Calling All Adventurers and Ministry Teams

Many have asked if we could use a ministry team, or missions group. The answer is YES! I will tell you what is going on, and if anything strikes a chord with you, then please come.

OPTHALMOLOGISTS
If you are willing to come do surgery for a couple weeks that's great, if you want to stay for a month or even a year. You are welcome and wanted. Opthalmology nurses and techs would be very useful too.

READING
Teaching how to read. It would probably help if you knew Portuguese, but I'm no teacher, if there are ways of teaching how to read without knowing the language, I"m not aware of it. But the language is much more phonetic than English is.

ENGLISH
Teaching English, anyone who wants to come do an English class as an Evangelical tool, that would be so great. You would teach in the church, and we would advertise in the community, so all are welcome, then we would have our members come and be your helpers, that way they can meet the "prechristians" and show them the love and acceptance of the Lord.

CONSTRUCTION
There are always opportunities for construction, but the construction here is mainly brick making, brick laying and then pouring concrete. Actually if you could teach people this trade, that would be even better. People do it here without worrying about being really flat or perfectly done. The art of precision is lost.

PREACHING AND TEACHING THE WORD OF GOD
Again it would be best if one spoke Portuguese in this area, but we can and will find translators.

INVENTORY ORGANIZATION
Organizing our inventory is a new thing to me, and I could use all the help that I can get.

PHOTO AND VIDEO JOURNALISM
Someone who come and document the work that is being done here in a professional manner.

BLIND ASSOCIATION
The Lord has place me in a wonderful and intimidating position. Working with a blind association, with a building that is way too small and not enough resources to feed everyone on the list. For now, we can only feed half, and the half cannot fit into our "building" more like an office. The government has promised to build a bigger location, they have been waiting for a couple years. After the building is built, then what? We have ideas of Braille classes, training the blind in a trade or a craft, and opening a store front to sell the crafts. Big dreams right? But I'm not equipped to teach Braille, nor do I have a trade to teach, or a craft. Ha, I write! So I'm doing what I know how to do best. I'm writing to implore all of you out there that know anything about blind associations.

Thanks for reading, I can't wait to hear from you all, we will plan on receiving you all as soon as you are ready!!

From Angola With Love,
Lori

Church

 

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,
Lori

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.

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.

John