Ophthalmology outreach at MEDREACH in Malawi
May 27, 2011
LILONGWE, Malawi - "Few memories from a medical exercise that wraps up here today stand out so vividly for a team of Army ophthalmologists than the moment when an elderly cataract-surgery patient danced with joy when the bandages were removed from her face.
It was a high point among almost two weeks of high points, said Army Lt. Col. (Dr.) Darrell "Casey" Carlton, assistant officer-in-charge for the eye clinic at the Lions Sight First Eye Hospital here.
"There is nothing quite so gratifying as that moment when the bandages come off and the patients realize they can see," Carlton said. "It's a life-changing change for them."
Life-changing events like this became the norm during a medical readiness education and training exercise conducted here in tandem with U.S. Army Africa's MEDREACH 11 mission. That mission, featuring medical training exchanges between U.S. and Malawi Defense Force members, included three medical and dental outreach clinics that delivered care to the Malawian people.
The eye clinic was a smaller effort, conducted by the only active-duty military members among about 100 U.S. MEDREACH participants. But for the 308 patients who received cataract surgery as of yesterday, and as many as 50 expected to have surgeries today, the impact was beyond words.
Cataract surgery candidates in Malawi aren't like those in the United States, where patients tend to see an eye doctor at the onset of a problem, Carlton explained. In Lilongwe, he said, many Malawian patients have advanced cataracts, with the lenses of their eyes clouded over almost to the point of blindness.
Larry Grandorff, a civilian Defense Department nurse here from Madigan Army Medical Center at Fort Lewis, Wash., made a rundown of the patients the eye team had treated. One-third had only light perception. One-third could discern nothing more than a hand waving in front of their faces. And only one-third could count the number of fingers held up before them.
Treating these patients with advanced cataracts is a relatively simple procedure that averages about 30 minutes, start to finish, said Army Col. (Dr.) Bill Wilson, a Walter Reed Army Medical Center ophthalmologist serving as officer-in-charge of the eye clinic here.
Using a "tunneled" procedure that reduces the need for post-operative care, doctors achieve extraordinary successes without the need for a lot of high-tech equipment, he said.
Carlton, who noted he might conduct seven or eight cataract surgeries on a particularly busy day at Womack Army Medical Center at Fort Bragg, N.C., marveled at the team's efficiency and output.
"We're averaging 50 patients a day," he said. "You can compare that to a busy civilian practice that might have a little more than 20 a day."
Among yesterday's patients was 78-year-old Valentino Kachindamoto. He climbed up onto the table as Army Maj. (Dr.) Charles Redger, an anesthesiologist from Madigan Army Medical Center at Fort Lewis, Wash., numbed the area for surgery. With advanced cataracts in both eyes that enabled him to see little more than hand motion, Kachindamoto was scheduled for two surgeries: one yesterday and one today.
"I can't tell you how unbelievably fulfilling it is to be part of a team like this, with everyone doing whatever needs to be done to help these people," Redger said. "Some of these patients have never seen their own grandchildren, and what we are doing is going to allow them to enjoy their grandchildren in a whole new way."
"I get goose bumps just talking about it," said Army Maj. (Dr.) Travis Frazier, another Madigan doctor screening candidates for cataract surgery. "Seeing them smile and dance, it feels great knowing what a huge difference this is going to make. The impact that this is going to have on their lives is really hard to measure."