Blog bombing

Since Internet is so impossible here, I've been writing my blog every day and just updating this online when I get access, which is why I'm bombing you with information - it's going to be like this I'm afraid, no news for ages and then suddenly 10 posts in a row.

Sad to say, connecting to the internet was the thing that got me most excited so far. Funny how isolated you feel when you are used to being connected all the time, even for an absence of 2 days. That really is a sad dependency. Anyhow, logged on to find that I already had several new friend requests on facebook (which is huge in Ghana – everyone is on it all the time, even in between patients in clinic), which made me smile.

Tuesday was another eye opener (har har) in theatre, where I observed small incision (extracapsular) cataract extraction, and Dr Prince was teaching one of the Ghanian doctors, Dr Gyasi, phaecoemulsification. The day started off well with a car breakdown on the way in at the busiest junction imaginable – we had to be pushed offroad by an extremely sturdy young man who pushed the car with all of us sitting in it – and then taxi’d to our final destination. Theatre, though air conditioned, was extremely warm – I was soon sweating attractively and profusely under my mask. Fascinating differences: they use tryptan blue to dye the anterior capsule for capsulorhexis (probably fascinating to no one who reads this blog). What I mean is, they use a blue dye which they inject into the anterior chamber of the eye. This dyes the front of the lens capsule, which is the envelope that holds the lens in place, and which needs to be opened (capsulorrhexis) to extract the lens in a cataract operation. The dye is to make the capsule easier to see. Why is this interesting? Because  usually in cataract surgery no dye is needed to see the anterior capsule; you use the light reflected from the back of the eye to visualise it. But the cataracts here are so dense that there is no light reflected from the back of the eye and so you have to dye the capsule to peel it.

Another interesting thing – big incisions, superior approach. Why is this interesting? In phaecoemulsification you normally use a temporal approach with a small incision, which minimises the amount of distortion the eyeball suffers, which minimises astigmatism. Here, it doesn’t matter how much astigmatism you end up with – because the patients do not do any close work. A vision of 6/24 is great vision, because the comparison is to counting fingers or light perception. For the same reason, they do not do biometry – i.e. measuring how long or short the eye is, to decide what strength lens to put in – they just put in any old lens! This blew my cone, and I’m not really sure how I feel about it.

Cleanliness was also a massive issue. Scrub technique was haphazard. There were mosquitoes in theatre. Instruments were ‘sterilised’ with a quick dip in a soap solution. And yet, apparently, their infection rates are low (I would love to see this data). Consent was a thumbprint on a little slip of paper saying, “I agree to the following operation (usually not filled in) to be performed under local or general anaesthetic, and understand there may be complications or further surgery may be needed.”  Cone. Blown.

We operated till 4:30 then had some food. The consultant was really struggling – it was hot, the operating microscope was at an odd angle and difficult to adjust, there weren’t enough chairs, the phaeco machine only had one setting, none of the instruments were quite right – and it was so fascinating for me to watch because it’s hard to appreciate how difficult surgery is when things aren’t quite right, until you’ve seen it. Surgery is such a controlled business usually – after all, you are cutting into someone’s body, you are performing something that can go terribly, terribly wrong – and everything is set out to try and minimise risk, so that everything is smooth, smooth, smooth; the right instrument at the right time, familiarity with everything, and everything that breaks it makes surgery impossible. I appreciated for the first time, fully, exactly how important the environment is, the supporting staff are, all the infrastructure that we have.   

Dinner was at a Chinese restaurant staffed entirely by Ghanians (though I caught sight of a couple of Chinese chefs vanishing into the kitchen) and I was asked to order for everyone, which was very fun, though being naturally Asian  I ordered far too much (“Connie, are you sure you aren’t Jewish?”) The menu was in Chinese and English and the food was great.

Wednesday, we went to a village in the eastern region, where everyone speaks Ewe (eh-way). I introduced myself, again to rapturous applause. This, it turns out, is because ‘Connie’ is short for ‘Comfort’ in Ghana, so everyone is familiar with my name.  I did some pretty mind-numbing data entry, and about a million visual acuities. Plantain chips for lunch, and I also got a lovely surprise in the evening – a phonecall from Tim! So nice to hear from him. 

Wednesday night was reggae night on the beach. Words cannot describe. A good time was had by all. 

And today - surgery again. Apparently this surgeon often goes on till 10pm at night, so wish me luck.

Much love to all of you, and missing you all here in Ghana

xxxx