Africa: First Days on the Job

Our first full day started with chapel at 8 A.M.  The chapel was just beside the clinic, it was a new building constructed only a couple of years ago.  Both staff, hospital and eye clinic, and patients attended.  The eye clinic director was today's minster.  The sermon was given in both Tonga and English, Tonga is the most commonly spoken language in the area but English is the official language.  Patients from different parts of the country are more likely to speak English than they are Tonga so the translation is not being given just for our benefit.  At the end of the sermon we are introduced to everyone and given a round of applause.  It's hard for me to make a comparison about the differences other than the language, in addition to being my first African sermon this is my first Protestant one, having never attended anything but a Catholic mass before.

After chapel we walk next door to the clinic.  We are introduced to the staff who are much more numerous and more experienced than we had expected.  I won't be doing screening, they already have someone that does that.  They also have someone that can do refractions using an autorefractor so glasses can be issued, someone that can do lens calculations for cataract surgeries (and perhaps other things, I don't really know anything about that particular machine) as well as help out in the surgical prep room, technicians for the surgical room, and translators to help us see patients.

It's decided that I'll be helping with the surgical prep.  I spend the day with Anubis, who is our lens calculation guy and usually does the surgical prep.  It's slow, this isn't really a two person job.  I learn to do some lens calculations and how to put drops in but I don't really do much work for most of the day.  We basically just shoot the shit.

Some time after lunch I go looking for something else to do.  I end up taking notes for one of the doctors giving the exams, this ends up being my primary job for the rest of the trip.  I also fetch stuff and take pictures.  This helps the doctors to see the patients a little bit faster and means that the next team will have more extensive, more legible notes on any follow up patients.  And we have a lot of patients who will need follow up, glaucoma is extremely prevalent out here and that requires eye pressure to be carefully monitored.  We see plenty of other problems that will require follow-up as well, such as squamous cell carcinoma treatments and surgical and laser procedures.  It also means that I'm learning a lot more than I would doing other tasks, which I like as well.

In addition to glaucoma we see a lot of HIV patients.  This causes a number of eye problems which we can treat, like squamous cell.  Most of the patients we see with HIV are on treatment, ARV drugs are available for free through the Zambian health system.  While they're being treated HIV remains a major problem out here, as does tuberculosis (and of course malaria).  With the mission hospital next door we are able to send HIV suspects next door for testing, which is our little part in dealing with this particular problem.

What does surprise me is that we don't see that many infections.  We see some, of course, but I had been expecting to see a fairly large number of parasites and other infectious diseases.  We see some, including some parasitic diseases that we wouldn't in the US, but this is a minority of patients.  The majority of problems are the same as in the US, cataracts and glaucoma.  Another thing different from the US is that we see a lot less hypertension and diabetes, though we do see some, particularly in better off patients from the big cities.  We also see a lot of very elderly individuals, if someone survives the risks of their youth even the very poor can live quite a long time out here.

We do see some very rare things, like advanced cancerous and a number of fairly exotic conditions that greatly interest the doctors and that I can't name or spell without help.  One particularly interesting thing we see is a woman with an eye implant (sorry, can't be more specific).  This woman had gone blind due to a drug reaction, one of the doctors from a previous team had paid to fly this woman back to the US for treatment.  She stayed in the US, along with a woman who works at the eye clinic, for several months for the surgery and follow up.  None of the doctors had actually scene one of these in a patient before so it was of great interest even to our experienced doctors.  The implant had provided her with enough vision to see and get around, though it isn't able to give anything close to 20/20 vision.

We're kept at work till a bit after six for the first few days due to the high number of patients.  After work it's back to the house for dinner and not long after for bed since we're all still so jetlagged.