First Outreach

Again, my darling father has been asking questions, this time about the weather. Well, we are currently in Ghana during the "rainy season" which lasts from about June to August. It seems like Ghana weather has two options 1 - hot, 2 - hot and rainy. In the sun, the heat is pretty much unbearable, and in the shade, it's a tolerable version of stifling. During our outreach today, it was hot and sunny up until half an hour before we left the village, and then it started to rain. The rain really cooled things down and felt incredibly nice. Also, rainy season doesn't seem to mean that it rains a lot, just that it rains sometimes. I imagine in "non rainy-season," it doesn't really rain at all.

Well, today was my first day on the job, and it was very interesting. We went to a village in the Volta Region, about three hours away, called Wute. Our van left around 9 AM, we were in the village a little before noon, we worked until about 4:30, and we were home around 8. I was warned ahead of time that a good portion of the workday is spent commuting, so I brought a book for the drive. We have to commute a good distance to get out of the city because the city is HUGE and traffic is insane. We probably spent much of the commute time just getting to the outskirts of Accra.

When we arrived in Wute, there were about 90 people sitting outside a small building waiting for us. They had been told we were coming and that if they had any problems with their eyes, they could come to be examined for free. We ended up seeing 84 patients in a little under 4 hours, and I'll try my best to explain how it all went.

Luckily, Jerome, who is a member of our team, spoke the local language called Ewe, so he did the introductory health talk. Since I couldn't understand what he was saying, another volunteer told me that he told the people about common eye conditions, about how to adopt good eye health habits, about the treatability and non-treatabilty of certain conditions, and about the falsity of many of the local myths surrounding eye surgery. It is very very important to dispel fear about surgery so that if some patients are referred for procedures, they actually show up. At this village, one man stood up and asked if it was true that for eye surgery, he must have his eye removed and then returned to its socket. It was so so so important that Jerome help him understand that eye surgery was far less invasive and terrifying than that!

There were six of us on the job in Wute, and we each had an assigned station. Ben ran registration, I did the preliminary visual acuity screening, Robert the ophthalmic nurse did the eye examination along with Andrew, a medical student, and Ashley dispensed eye glasses and medications with Jerome.

First, the patient would sit down with Ben and translator who knew English and Ewe. Ben would speak directly to the patient in English, and the translator would relay Ben's questions. He wrote down the patient's name, age, and chief complaints. It was very interesting to see that many of the patients did not know their ages, but many of them had IDs that told their birthdays, so Ben found himself doing a lot a math.

After the patients were registered, they came to me to get their vision screened. First, I introduced myself to the patients and found out if they could read letters. A good number of the people we saw were illiterate, so instead of using the traditional Snellen's chart we had to use the "tumbling E chart." Both of these can be seen at this link so you know what I'm talking about http://i1.allaboutvision.com/i/eye-charts-358x338.gif. If we used the tumbling E chart, we simply asked them to point in the direction that the tines of the E were pointing. I would progress down the chart until the patient couldn't read the letters, and then I would record their acuity. If the patient could not see the chart at all, I would ask them to count my fingers at progressively closer distance. Acuity could be recorded by the distance at which they could count fingers. If they couldn't count fingers at a distance of one meter, I would simply ask them if they could see my hand waving if I waved it slowly. Finally, if they could not see my hand waving, I would shine a pen light back and forth across the eye to see if they could perceive light. If they could not perceive light, there was a good chance that glaucoma had made the patient completely blind, and the blindness caused by glaucoma is due to damage of the optic nerve and is irreversible.

After the patients saw Ben and then me, they went to be examined by the ophthalmic nurse who would dilate their eyes and diagnose their pathologies. He would determine which prescriptions of glasses, which medications, or which surgical referrals each patient would need. Then he sent each patient to the referral station where they were given free eyeglasses and very inexpensive eye medication. The patients were asked to pay the equivalent of 2 USD for eye medications just to make the medication more valuable to them. Unite for Sight has found in the past that if the medication is given away for free, the people do not think that it will be effective, and they do not use it. Making them pay a small amount for the medicine makes them value it much more. Plus, 2 USD is about all they can afford.

We saw a number of patients today who had one eye in which they had no light perception, and quite a few who could only perceive hand-waving. We saw a congenital cataract in a 4-year-old, a cataract due to trauma in a teenager, and many cataracts in the elderly. There were quite a few people with damage due to glaucoma, and a good many who had simple refractive errors. A disease you've probably never heard of, but that is pretty common in Ghana is pterygium, seen at this link - http://www.eye.com.ph/images/Pterygium1_300.jpg - where tissue grows over the eye and impairs vision. Many patients with pterygium showed up at the outreach today. I think, in total, six patients were referred for surgery, most for cataracts and one for a large growth on the eyelid. Many patients were given eye glasses, sunglasses, or medication.

Then, we drove home. When we got back, it was already dark and four of us went out and bought some spicy steak from a cart on the street. Good food at the end of a good day.

Okay, this is another super-long post, but I figured I would write a lot because from tomorrow to Saturday, I will be away from my computer. Five of us are going to stay over-night in a village called Jasikan to do three days of outreach and one day of sight-seeing at the highest waterfall in Ghana. I'm sure I'll have lots to write about when I get back from that!

Good night!