Tambacounda Eye Clinic
From January 24, 2011 – February 4, 2011 a team of two American ophthalmologists, two nurses, and one optometrist, working with the NGO #!Right to Sight and Health#, traveled to #Tambacounda to perform #cataract extraction surgery and to train a local ophthalmological technician in a new, and more effective extraction technique. The mission was conducted at the Tambacounda Regional Hospital in coordination with the local eye nurses and staff. The mission was organized differently than any mission the NGO has done in the past wherein the consultations were done mainly by the local eye nurses thus allowing the American ophthalmologists to work mainly on surgery and training of the local technician. The week prior to the doctors’ arrival, three local eye nurses screened patients and signed up those with cataracts for surgery during the two weeks with the visiting eye surgeons. #Optometrist, and father to volunteer Anna Alsobrook, worked in the consultation room for the first week seeing up to 35 patients a day and signing up patients who qualified for surgery. In addition, local eye technician Gallo Diop learned a new and more effective extraction technique in a few short days and was performing surgeries alongside the American ophthalmologists for the duration of the mission. Throughout the two weeks over 2,000 consultations were performed by the Senegalese eye nurses and Dr. Alsobrook, over 500 eye glasses prescribed, and a total of 186 cataract surgeries were performed.
The American team was composed of five members: ophthalmologist #!Dr. Judith Simon# (founder of Right to Sight and Health), ophthalmologist #!Dr. Donald McDonald#, RN #!Christine Hedges#, RN #!Dominga Villagomez#, and optometrist #!Dr. Rick Alsobrook#. In addition, a total of 23 Peace Corps volunteers participated throughout the two week mission playing a vital role in the mission’s success. The hospital put all of the ophthalmology staff at the mission’s disposal for the two weeks; this team was composed of Bassouriba Cisse (head of the dept), Landing Sane, Moussa Keita, Assane Diatta, Gallo Diop (operating technician), and Hawa Sy (surgical nurse). The director of the hospital, as well as the head of the Department of Health for the Tamba region were both equally supportive and instrumental in the success of the mission. Patients from across the country of Senegal as well as from neighboring countries such as Mauritania, Guinea, Guinea Bissau, and Mali came to take part in the mission. The overarching goal of the mission was to perform cataract extraction surgeries but moreover to train a local technician in a new, safer, and more effective extraction technique.
Planning for the mission began after the second mission in Kedougou ended in March 2010. The mission itself lasted for a total of three weeks: week one, the week before the mission began was used for consultations and screening so that the hospital could begin signing up patients for the first week of surgery with the American team, and weeks two and three took place with the American team and were devoted to surgery and training.. During the consultation week, the local team signed up approximately 60 people to be considered for surgery with the American team. The remaining patients that were operated on were scheduled upon the arrival of the Right to Sight and Health team. The first week of surgeries was Monday – Saturday from approximately 8am – anywhere from 5pm to 7pm with post-op on Sunday morning. The second week held surgeries from Mon – Thurs and post-op on Friday followed by the doctors’ departure.
When surgeries began, there were two operations being performed simultaneously in one operating room with two nurses and three Peace Corps volunteers present to assist. During the first few days, either Dr. Simon or Dr. McDonald was operating while the other was training local surgical technician Gallo Diop. Once Diop was comfortable with the new technique he would perform surgeries without the supervision of the other doctors. This allowed the surgical team to start much earlier in the morning since post-op could be conducted by one doctor, pre-op by another, and the last doctor could start surgeries as patients were prepped and ready. Post-op was conducted the day after surgery (1 day post-op) and 4 days after to make sure that there were no issues, and if there were any problems this allowed the doctors to address them immediately. The doctors distributed antibiotic, steroid and anti-inflammatory eye drops for postoperative care and for some other ocular conditions.
In two weeks, 186 cataract extraction surgeries were performed and over 500 #!eye glasses# were prescribed to those in the local community who needed them. In addition, the American team was able to work alongside the local eye nurses helping them better understand eye care, clinic procedure, and diagnoses. The motivation and hard-work exhibited by the local nurses working in the consultation room allowed for a successful working relationship to develop between the two teams; the American team, through education, was able to augment the work of the local nurses and consequently the healthcare being provided to the population at large. In addition, a local surgical technician can now perform cataract extraction with a new, safer, and more effective technique.
From the beginning of preparations, it became clear that the hospital was 100% willing to cooperate with both Peace Corps and Right to Sight and Health. However, given the nature of the event and the difficulty of attempting to mesh the American approach to preparing for an event and the Senegalese approach, various problems arose throughout the three-week mission.
One of the largest problems was ensuring that both groups of doctors were able to work in the manner they were accustomed to with as little disruption as possible. The hospital wanted to ensure that all hospital records were being kept and procedures for consultations were being adhered to. In past missions, hospitals were less worried about maintaining hospital records and the NGO was able to work as they pleased. However, the Tambacounda Ophthalmology Department is more organized than most rural hospitals and they wanted to keep their records intact, which is commendable. This required much work on behalf of the PC volunteers who were charged with tracking down hospital index cards (records) every morning as they seemed to go missing on occasion. It would be advisable beforehand to come up with a clear solution for dealing with this issue. However, this mission forced us to deal with problems as they arose since no one was ever quite sure what was going to happen; past missions were run much differently and only so many problems could be predicted ahead of time. In the end everything worked out but only because the helping PC volunteers and the ophthalmology secretary were extremely flexible and attentive.
Secondly, crowd control was huge problem. There were three – four groups of people coming to the hospital every day: those seeking a consultation, those having surgery, one day post-op patients, and four day post-op patients. So on any one morning volunteers were attempting to usher about 60 people for surgery and post-ops alone into two small rooms. In hindsight it would have been better to have separate entrances for each group but that was not possible. Volunteers did a great job of sorting each group and making sure they were taken to the correct area. Next time, it would be advisable to warn volunteers ahead of time (especially in the first week) and work together to figure out how to deal with this issue. Again, this mission was a test run, being organized and executed in a completely new manner and required patients and on the spot thinking by volunteers, which they were fully capable of doing.
Every patient was told to return within one month after his/her surgery for a follow-up exam to ensure that there are no problems and that the eye is healing properly. The Right to Sight and Health team hopes to return to Senegal next year and will hopefully be able to see some of the patients whom they operated on and track their progress.