Fair warning, there are graphic medical pictures shown here. If you don't like gross eyeballs you should probably stop reading this.
I wanted to give the reader an acurate snapshot of a typical week in the office here in Angola. These are just a few of the difficult cases I've had to deal with here (we see 80 patients daily, and I don't have time to take pictures of all of them). I'll give a brief summary of each case.
Case #1- 35 yr old woman has had this growth for the last 2 years. It appears to be squamous cell cancer of the conjunctiva. I elected to treat this with a topical chemotherapeutic agent (5-FU). I don't easily have access to pathology here in Angola and I don't have the standard equipment to treat these with surgery. So, I elect to treat these small tumors topically. I see at least one of these every day in clinic.
Case #2- This is what happens to the eye in case #1 in 10 years if left untreated. This eye was removed entirely and sent away to the capital for examination. If I'm lucky they will send me the results of the exam.
Case #3 - Cataract, lots and lots of cataracts. This man had a trauma to the left eye. I've done almost 100 surgeries at this point, and on review of my records 90% of the surgeries have been for patients that can only see shadows because their cataract is so dense. Really crazy, because in 4 years of surgical training in the USA I did maybe 6 of this type of cataract.
Case #4 - Many people suffer from trauma here. This man had a rock fly up and hit his eye causing a cut in the cornea and the sclera (white part). His iris (brown part) was sticking out of his eye. He came to me a week after his injury. I debated on what to do for him, the eye looked pretty good but his eye pressure was very low and on inspection there was fluid still leaking from the wound. I took him to the OR today and sutured the wound closed. I may not have done this surgery except for the child I had seen the day previously with the same story, except they waited 2 weeks to come and in that time he developed a terrible infection of the eye causing him to lose his eye.
Case #5- Cornea scars. These are all too frequent here. This man had a central infection, leaving a nasty scar. It is more than 50% deep so I need some good cornea tissue to do a transplant. Cornea transplants are complicated, first I need fresh tissue which I don't have here. Next I would need a patient who good get medication reliably for 1 year. Since most of the patients we see here are well below the poverty line, the chances of them paying for medicine for 1 year is low. If they stop taking medications the transplant will likely reject, now they have a blind AND painful eye. That being said, I took a picture of this man and took his cell phone number. Maybe one of my US collegues can lend me some fresh tissue one day...
Case # 6 - orbital cellulitis in children. While I don't love the over-use of antibiotics that exists in the Pediatric medicine culture of the US, it does prevent things like this from happening. I was wanting to admit to the hospital, start IV antibiotics..... oh wait, I'm in Africa and I am the hospital and I don't have IV antibiotics to give the child. This child did very well with oral Amoxicillin only, made a full recovery. That is the benefit of people not having good access to health care, the bacteria have not seen antibiotics.
Case #7 - Presumed retinoblastoma. A deadly tumor. Sorry to disturb you with this one, but I see a couple of these a month. With a population of 20 million people all of whom have no access to easy eye care, I have a huge referral source and people take buses with their children; faces taped or wrapped to hide the gruesome sight of their bulging eye. The white on this childs face is actually adhesive from the tape used to hide the eye.
I have no good solution for these tumors currently. I do not have general anesthesia for a 3 year old child. I do not have chemotherapy. In fact there is little access to this in the entire country. Sadly, even with a surgery this child is likely to die soon from the metastasis. I referred them to the children's oncology unit in the capital city 8 hours away at the Government hospital.
So, while there are some tragic cases here, I'm really enjoying the practice of medicine in Angola. I'm seeing things here in less than 2 months time that US physicians may go their entire careers and not see. Plus I'm at a place that shares the Gospel message of Jesus Christ to every patient that walks through our sacred doors. I don't get to choose who I can help physically. I wish to God that I could fix everyone's problems, but I simply can't. I don't know why God allows some people to suffer, and others to live in comfort. I don't have answers to many things. But I do know that for those patients I can't help physically, there is hope in Jesus Christ. To Him be the Glory, forever, Amen.
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