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Voluntary activity: Eyesurgery Training

Saving eyesight together in Kampala

With great joy, I returned to the Mengo hospital in Kampala, Uganda for another week of voluntary training in eye surgery. It was here during my first stay in October 2016 where I could support the great local team performing some complicated procedures. At the same time, I could help Dr. Ludo, the eye specialist at the hospital in Kampala with macular surgery.

Augenabteilung Klnik

Still in Austria, I could solicit from my colleagues several surgical instruments as donations, which I brought to the Mengo hospital. Also, I was able to arrange for a retinal laser on loan to be used during my stay. Fortunately, I had found out in time that the Mengo hospital still does not have such a device yet.  Using this laser, the detachment of the retina and resulting blindness of the patients can be prevented. As a result, it facilitates the necessary surgical care significantly.

Eingang Augen Klinik

When I arrived at the clinic, Dr. Ludo, the other doctors, and the nursing staff welcomed me warmly. Some of them were already working here during my last stay, and I was delighted to meet them again.

Assistent Augenärztin

Dr. Ludo wants gradually to retire from the hospital, so one of my most important tasks in the next few days would be to train the young specialist, Dr. Dan as her successor in retinal surgery.

Monday morning, we started and selected ten patients for an operation. Since this time, my visit had been announced much longer in advance, the planning of the local team worked perfectly, and we could start our work without any major loss of time.

As always, I thoroughly examined the patients before surgery. Unfortunately, we found one patient with high blood pressure, which could not be controlled even with medication. Because an operation under such a circumstance is far too risky, I had to cancel his surgery.

Most cases are very delicate because many are already totally blind in one eye and can see only very poorly with the remaining eye. This is why it is particularly important to preserve the eyesight of the remaining eye. Therefore, I performed the majority of the operations myself, but with the alternating assistance by Dr. Ludo and Dr. Dan, who thereby could advance their knowledge.

Augen Gerät check

From Tuesday to Friday we conducted the operations all day long which was very strenuous for all of us, but also a very enriching experience. During this time, we also deepened our personal contact and had a lot of fun together.

In the operating room of the Mengo hospital, conditions are rather unusual for us. During my first stay, I had experienced these already, but in the meantime almost forgotten about them.

The equipment had been considerably improved since my first stay, and my back was very grateful for the better chairs for the surgeon. They offer much better comfort during lengthy operations and cause less fatigue.

Augen Hygiene

 

For patients, the new ergonomic operating chair is a great improvement, because, during the operation, patients are less uncomfortable than before.  Unfortunately, I could see this new chair only from a distance because for reasons unknown to me they were used just for cataract surgeries which don’t last very long. But who knows, maybe there will be a surprise next time.

Although the two doctors mainly assisted me during the procedures, the feedback was very positive. We discussed in detail individual cases and the surgical options during and after the surgery. I noticed with joy that the “Teaching Effect” was substantial.

Together we were able to successfully treat some very severe cases and save people from total blindness:

Four patients came with retinal detachments respectively recurring retinal detachments. We were able to successfully treat these patients with vitrectomy, laser and subsequent tamponade.

One patient had a severe diabetic tractional retinal detachment of the center, two patients had macular holes, and one patient had a persistent vitreous hemorrhage and possible retinal defect following a trauma.

The case of one patient was particularly dramatic. While working with a hammer and chisel, he got injured with a perforation of his bulbous and a fairly large intraocular foreign body. Fortunately, we were able to remove it successfully and could save his eye.

 

fremdkoerper-auge

Still during my stay, I was able to get initial feedback from our patients during the follow-up, and I am very proud that the results were very nice. I will follow their postoperative development from a distance because I then can address any further upcoming questions and can continue to observe the recovery process.

After completing this exhausting but rewarding stay, I was especially pleased when I was asked to continue to act as a “Mentor on a Regularly Basis”. The medical achievements, as well as the personal contact with colleagues and patients, make me proud and I am pleased that I could help with my feedback and my assistance with some severe cases to save precious eyesight.

Augen Arzt Team

Voluntary Surgical Training for Retinal Problems

Tagada, small incisions and new friends

Surgical training in the Mengo Clinic, Kampala/Uganda

friends

The Mengo Hospital in the capital city of Kampala has a history of 120 years and is not only the oldest clinic in Uganda, but in all East Africa.

The clinic has been founded in 1897 by Sir Dr. Albert Ruskin Cook, a British physician and missionary. After a trip to Uganda he was fascinated by the country and its people and decided to dedicate his whole life to their medical education.

Together with his wife Katherine he also founded the first midwife training center in Uganda and in 1907 his nephew Ernest brought the first x-ray machine in East Africa to the Mengo Clinic – sensational in those days.

mengo-alt

The tradition to aim for the most advanced medical equipment in Uganda, a country with a population of almost 40 million, is still alive today. The ophthalmic division has several specialized outpatient departments and orthoptist’s practice.

In addition, they have four experienced surgeons for cataract, eyelid and glaucoma surgery. Another surgeon was trained in retinal and vitreous body surgery by an international fellowship. The equipment available for retinal surgery includes only the most necessary items, but they have a good microscope and surgical instruments.

Surgical Training for Retinal problems

In recent years, instruments and operation techniques have been further developed, particularly in the field of retinal surgery. In October 2016 I had the opportunity to introduce these new technologies and my experience to the Mengo Hospital for a week on a voluntary basis.

One of my major concerns was to introduce Dr. Ljubo, the local specialist, to macular surgery and to support her in treating several particularly difficult retinal cases. I also succeeded to bring six “small incision packages” and several Instruments at no cost.

Chirurgie Training

The preparations for my stay in Kampala were rather stressful. Particularly the obligatory vaccinations and the gathering of necessary documents and recommendation letters for obtaining the license to work as a surgeon in Uganda required a lot of time and patience. I believe the requirement of  such a license is very reasonable – despite all the hassles involved – because it  ensures proper treatment and care on a high level and prevents surgical tourism by unexperienced surgeons.

The journey went as planned and also the suitcase containing the surgical equipment passed customs without too much delay, thanks to the confirmation letter from the Mengo Clinic.

airport-uganda

What I learned right upon arrival:
Sometimes you have to make a detour to arrive faster at your destination.

Traffic in Kampala is much worse than at home. Especially in the morning and afternoon traffic jams regularly cripple entire roads in this city of 1.3 million inhabitants. The roads are filled with mainly Japanese made cars and many motorbikes with two or even three persons riding on them, mostly without helmets.

Uganda Motorrad

The drive to the hotel was a rather bumpy one because the driver chose less busy side streets to avoid the traffic and we got a good shake. After the drive I felt as if I had done a few tagada rides in an amusement park.

 

tagada fahrt

Monday morning I was picked up by an employee of the clinic. My first day in Mango Clinic started with a tour of the ophthalmic department and the introduction of employees and colleagues. I was welcomed most cordially and with great expectations as “the doctor we have been waiting for”. But before I could meet these expectations with my expertise, my blond hair was the attraction of the day.

Mengo Hospital

Dr. Ljubo, the retinal colleague with whom I performed examinations and eye surgery over the following days, is a cheerful and young-at-heart 50-year-old lady who supports her whole family. While she is working very hard, her family takes care of the household, so she can concentrate on her work.

Soon after the introduction Dr. Ljubo and I started examining patients with macular and retinal diseases and decided on necessary operations.

Augenuntersuchung

After that I visited the operating room and inspected the equipment. The microscope and surgical device were very familiar and met our standards. The patient table, however, resembled more a metal plank bed.

All procedures were performed under local anaesthesia, but the patients were extremely cooperative despite the less than comfortable bedding.

My operation chair was some kind of office chair with limited adjustability for height, but after a while I got used to it. I was very pleased that the hygienic procedures were on a high level. This is reflected by the low infection rate in that department. All members of the surgical staff were well trained.

I noticed the engagement and enthusiasm of the surgical nurses who welcomed the “small incision” instruments and other new items.

Over the following three days I performed a total of six retinal operations and vitrectomies (as in phakic or pseudo phakic patients with retinal detachment, vitreous hemorrhage or macular diseases). Dr. Ljubo assisted me with all patients. Furthermore, I assisted her with two patients with macular holes. For two patients, I performed a combined cataract and retinal operation. We worked with endolaser and silicone oil tamponade, did membrane peelings and performed mainly 23-gauge but also 20-gauge vitrectomies.

 

Augen OP

Two of our patients were so-called “one eyed patients” with severe retinal detachments in their good eye. They were urgently included to preserve their eyesight. These patients were already nearly blind and had to be escorted to the clinic. One patient came in a few days later for a follow-up examination and gratefully reported that he had come alone to the clinic without any help of an escort. These wonderful moments lend meaning to what I am doing and I am very grateful that I am allowed to help people to preserve their precious eyesight.

We managed to perform two to three retinal operations per day, encountering more or less severe difficulties, like old and frail equipment, missing of usually available items and other minor obstacles. The packages I had brought along functioned perfectly and we could work successfully with the seamless small incision systems (23-gauge instruments).

For lunch they always cooked, and we ate our meals sitting on the floor of a room next to the operating room. In the evening we were deservedly tired because the eye operations were strenuous and we did not take many breaks. On the third day, while sterilizing the instruments between two operations, we noticed a soft sound of snoring. A surgical assistant had dozed off in a corner of the room and was awakened only by our laughter.

I am optimistic that Dr. Ljubo will treat patients with macular diseases by herself. She is a very skilled surgeon which I realized during procedures in the anterior segment of the eye.

Operation Augen Chirurgie-Training

 

The post operative control examinations I did went as I had wished for. The patients had no discomfort, looked fine and were extremely grateful. I could also advise the patients on proper behavior and further therapies.

Communication was mostly unproblematic, because almost everyone speaks English, the second official language of Uganda besides Swahili.

I really enjoyed the very pleasant atmosphere in the ophthalmic department and felt cordially welcome from the first moment on and during my entire stay.

Friday afternoon, I finally said goodbye to the whole team and promised to come back with more equipment, if everything went according to plan.

While spending time and operating, I got several helpful ideas for improvements, which will benefit the ophthalmic department and its patients.

Danke Augentraining

In summary, the week in Kampala was very strenuous and challenging, but it brought also many gratifying moments I would not want to miss. This stay has enriched me not only professionally but also personally. And it has brought new friends into my life.

Chirurgie Training Augen