Pineapple pineapple

The end is in sight! On Thursday I went in to surgery, which again finished around 9pm. All cataracts this time, apart from 2 eviscerations for florid endophthalmitis (a devastating infection of the whole eye) – one was really quite painful to watch as the eye was so inflamed that the local couldn’t penetrate very well (local anaesthetics are usually slightly basic, and so in inflammatory conditions, which produces acidic environments, they tend to precipitate and do bugger all). Dr Clarke, the incredible surgeon, injected another huge bolus of anaesthetic into the eye but the poor patient kept up a persistent low-grade whimpering underneath the cloth and you could see his hands clenched for a long time under the gown – not pleasant. That eye must have been paining him for a long long time because it was absolutely awful – completely blind, proptosed, angry red, ulcerated, and the anterior chamber, the iris, lens and the aqueous humour, was completely black with degeneration. Anyhow, after all the gunk has been scooped out things settled down a lot and he endured the rest of the cleaning and sewing up with no discomfort.

We also did a lot of kids with terrible bilateral cataracts and probably very poor prognosis as a lot of them had horizontal oscillatory nystagmus and astoundingly bad vision – probably due to intrauterine infection with something like rubella. If you could see these children then I think anyone against vaccination for rubella who can maintain their views should be absolutely ashamed of themselves. Even after cataract removal most of them will probably be almost blind, with no hope of a cure, but you have to do something and it may be that some of them will benefit from the surgery. Their cataracts were very interesting to see – liquid, unlike a senile cataract, which usually just pops out like a little button.

Another interesting thing was the way the anaesthetic was administered. I say interesting – I really mean a bit horrifying since there was no IV access, the kids all had LMAs of various sizes – and I am not an anaesthetist but frankly the sizing of those LMAs was way off, the anaesthetist just seemed to be shoving whatever she felt like into those tiny little throats – one I thought would probably do for a 100kg man and she was just shoving it into this tiny 9 year old, who looked the size of a 6 year old, with gleeful abandon. He obviously wasn’t having any of it and was coughing and choking up a lot of increasingly bloody sputum. It really made my toes curl to think of all the trauma his poor airway was undergoing – and the anaesthetist just kept on trying and trying, and the tube kept on rising up (well of course it would, it’s not the right size you idiot, is what I thought). I didn’t really know what to do – no one else seemed concerned, and I am clearly not an anaesthetist, and I didn’t want to offend, but at the same time I felt this was really wrong. In the end, I said, pathetically, “that seems like a big tube for such a small boy.”

Anaesthetist: “the little tubes are not good for him.”

Me: “I don’t think this one is very good for him.”

Anaesthetist: (quite surprised that I was talking to her) *ignores me with expression that clearly says “as if you know anything”*

Anyway, after 20 minutes of messing about with his airway (she tried every tube on her trolley 3 times. 3 times!) she eventually got the LMA in and then halfway through the op he started waking up. This seemed to happen with every child on the list – she always seemed to be talking on her phone or not paying attention and then the little body would start coughing and the surgeon would have to call her attention back. Then agonisingly slowly she would check the valves and the tube and all the plumbing – and usually something would have fallen off somewhere and be leaking gas into somewhere and she would put it back on, and then something else would fall off...

It was absolutely a shambles and quite depressing to watch, but I suppose none of the children came to much harm in the sense that they were all alive at the end and had their ops done, and they clearly don’t have the resources for anything more. This was happening to the private patients just as much to the Unite for Sight patients. I did feel though that this whole place was one long adverse incident waiting to happen.

Anyway, depressing rant over. Friday was my last outreach and was also slightly depressing. We had a new volunteer (a local Ghanian) who was a highly efficient woman and who enjoyed summoning me and patients by clicking her fingers and looking very disapproving, something which I really did not enjoy. I’d never really understood before why waiters always complained about people summoning them by snapping their fingers. I’d never done it to anyone and I’d also never seen anyone do it so I couldn’t imagine how offensive it was. Well after having it done to me repeatedly I can quite see how a few days of it would drive me into a murderous rage.

An amusing thing happened though during the day. I needed to use the loo and this is always a big deal in outreach because you have to get a translator and then someone has to speak to the local people and then they have to find a loo for you and often it's locked up and it's no end of palava. Anyway, when I returned, before I could sit down, the local woman seized my wrist in a vice-like grip and asked me a series of questions in Twi. Our volunteer translated for her –

Volunteer: “She says, are you quite empty?”

Me: “Er – yes! Thanks! I’m feeling much better.”

Volunteer: (raising eyes to heaven piously) Thank God for that.  Bless him.

Local woman: (also raising eyes and hands to heaven expressively)

Tickled. 

So I'm just killing time now before I go home and today I had a bit of a walk around and explore and also ate another huge pineapple. Pineapple is one of my favouritest fruits ever and I can never get enough of it, much like strawberries and raspberries and blueberries in season. I remember reading an article (in the Guardian, naturally) about how the author got sick of berries in season (they were naturally doing the Guardian thing of trying to eat only local and British and therefore in summer ate essentially nothing but berries because of the glut), and plums, and all the rest, and I couldn't sympathise because I could eat my favourite fruits every day and not get sick of them. Lucky me, because pineapple here is so super cheap - you can buy a really huge one for £1 - and I mean huge, bigger than you've ever seen - and the nice lady with a machete waves it around and asks shyly, "shall I peel?" and of course you say "yes please" and then she does this amazing thing with the machete - peels it all and chops it with minimum of mess and then puts it all into a bag for you and you're happy for ever, until you run out and have to buy another pineapple.

So I've been stuffing my face with pineapple (no surprise for any of you that know me, I'm sure, since I'm perpetually stuffing my face - when the US folk were here, they were all too hot and bothered to eat at any time but I was always very keen to eat because I never knew when I was going to eat next - as on the outreaches, a whole day could go by without food of any sort, apart from a lukewarm can of Fanta Orange - , and whenever I looked up from having a meal they'd all be sitting watching me with this disbelief on their faces, sweating profusely, and eating hardly anything. One of them eventually said, in a very considered voice, "you're an amazing eater, Connie" and then after a thoughtful pause, "I like that about you."To which I couldn't respond with any dignity because my mouth was full of rice.) which has been absolutely lovely, and wandering about reading James Herriott. I love that man. And then eating more pineapple. I estimate in the last week I've eaten approximately 6 pineapples, to say nothing about how much pineapple juice I've drunk. It's all a bit blissful, really. And also vanilla ice cream. I think I am now built up entirely of vanilla ice cream and pineapple juice.  

So my last greetings from Ghana, and I'll see you guys on the other side when I return

love

Connie