Postcards from the Field

Living in the Shadows - Tigray Region, Ethiopia

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The rugged Tigray Region of Ethiopia has one of the highest rates of blindness in the world. The vast majority is due to cataract blindness. On March 14-21, HCP partnered with Dr. Tilahun Kiros and the Quiha Zonal Hospital to provide 1,110 sight-restoring cataract surgeries to patients from this beautiful part of the world. Taking part in this outreach was Moran Eye Center-HCP International Fellow Dr. John Welling. Below Dr. Welling shares his experience of the high-volume cataract campaign.

For the last 5 years or so I have been aware of Quiha Zonal Hospital and their track record of performing very high volume cataract campaigns in parternship with the Himalayan Cataract Project. I have seen the videos of post-op patients singing, dancing, and ululating after their patches had been removed. Expectations for this outreach initially are very high – Quiha has reportedly screened about 2000 patients. I can’t wait to experience this for myself.

Postmark: Sunday, March 13

I flew in to Mekelle tonight – was supposed to get in around 10, but flight got delayed and didn’t get in until after 11. Thankfully, Mulu, the driver from Quiha, was still waiting for me. We threw my bags in the back of the Land Cruiser and were off for Axum Hotel. A few minutes down the road Mulu suddenly swerved off to the side of the road. Frankly I was a little startled. He pointed out into the darkness saying, “look! Hyenas!!” Sure enough, about 30 yards away on the side of the road about 6 or 7 sets of green eyes reflected back at us. I have no idea how he spotted them while driving, but was glad for the chance to see them - first time I’d seen hyenas in the wild. It wasn’t going to be the last “first” of the trip.

Postmark: Monday, March 14

This morning at breakfast I met up with Caroline Cromelin and Praneetha Thulasi, both senior residents at Emory University. They arrived yesterday afternoon. I worked with them last year when I was a cornea fellow at Emory and am very glad to have them join us as part of their senior global ophthalmology elective. Emory has a partnership with Menelik Hospital in Addis Ababa and has been sending ophthalmology residents there for the past 3 years. Emory Eye Center will also be starting an International Ophthalmolgy Fellowship next year in partnership with the Rollins School of Public Health.

On arrival at Quiha this morning we met with Tesfay Teklemariam, Quiha CEO who reviewed the plan for week and also explained a little about Quiha’s impressive patient screening network and mobilization process. They do as well as any eye hospital of which I am aware in terms of consistently mobilizing very large numbers of patients for these high volume outreaches. They work through a network of government eye care facilities staffed by ophthalmic nurses who regularly hold screening events in their local communities. Patients found to have operable cataract are then bussed to Quiha for further examination. If cleared for surgery, they then undergo pre-operative measurements for intraocular lens calculation (in order to give the best possible post-operative vision) and are booked for cataract surgery. Tesfay told us that 500 patients had already registered and many more were expected throughout the course of the week. He explained that many of the patients would be coming later in the week, but that we would go ahead and get started with a few cases today. Dr Tilahun Kiros, the only ophthalmologist for the entire Tigray region (population > 6 million), met us in the pre-operative area, welcomed us, and brought us back to the OR. There we met up with Dr Mekdes Merid, Chief Resident from Menelik Hospital in Addis Ababa, completing her 1 month rotation at Quiha. We had a short afternoon in the OR – collectively doing 40 cases.

Postmark: Tuesday, March 15

Post-ops were amazing this morning. The patients are so happy, animated and interactive. Many break into celebratory ululation and dancing. Today we were joined by Dr Adam Jorgenson, Chief Resident from the University of Utah Moran Eye Center. It was a bigger day today – we did 100 cases. Tesfay tells us that 700 patients have arrived and up to 500 more are expected. Wow – this is getting real. Time to get to work. Tomorrow is expected to be one of our busiest days.

Postmark: Wednesday, March 16

Walking down the long stone walkway toward the clinic, we are surrounded on all sides by the hundreds of patients who have already registered for surgery. Many have come by bus from hundreds of kilometers away. Many had a day’s walk before getting to the bus pickup point. You can’t help but feel the weight of expectation.

Once again, post-ops were amazing this morning. So many happy, animated patients. Big smiles, lots of ululating and dancing. Huge day in the OR today - we did 187 cases. Dr Tilahun did 101 of these - absolutely incredible. The OR staff here is awesome – dedicated, hardworking. They arrive early in the morning and staying until 10pm to prepare for the following day. All business, no complaining – everyone working toward same objective. 

Postmark: Thursday, March 17

Post-ops this morning were the best yet. 187 patients ululating, clapping, singing, dancing. We gathered all the patients together and shot video of the collective celebration – it was amazing. After shooting a few photos myself, Tesfay asked me if I wanted to get in the middle of all the patients for a photo… absolutely! When I walked down into the crowd of patients they all started clapping and ululating – I couldn’t help myself, I had to join in with my best attempt at ululation. I think they got a kick out of that. Such warm, interactive, appreciative, patients – I feel so lucky to be here. My only regret was that Dr Tilahun and the other surgeons and staff weren’t there to join in the celebration - they had already gone inside scrub. Today we did 144 cases.

Postmark: Friday, March 18

This morning at breakfast the residents and I were commenting how it’s starting to feel like the movie groundhog day – theroutine is the exact same every single day… Wake up, eat hotel breakfast, drive out to Quiha, see post ops, go to OR, operate until 2pm, eat a quick lunch (they have been stuffing us with incredibly good vegetarian enjera every day – this is the fasting season for the Ethiopian Orthodox church, so all the local doctors and nurses fast until 2pm everyday and eat no meat), operate until 6 or 7, then drive back, eat dinner at the same Ethiopian restaurant (a very good traditional buffet), call family, return emails, go to bed, then wake up and do it all again. Yet, somehow, there is no sense of fatigue or burn-out – every morning when you see the patches come off the post-ops, see the smiles and the celebrations, you feel completely re-energized. I can’t imagine anything being more fun than this. We hear that there are about 450 patients left – so probably about 3 days of surgery remaining. Today we did 140 cases.

Postmark: Saturday, March 19

Another great day today. The post-ops were great – excited and animated as usual. One of my favorite post-op celebrations was a tall, lanky man who, as soon as his patch came off started ululating and clapping his hands, over and over. We had 3 young children from the same family who all had bilateral posterior polar cataracts. All underwent successful bilateral cataract extraction by Dr Tilahun. All seemed to be seeing better on day 1. It will take some time before we know exactly how much vision they will get back – depending on the situation, congenital cataracts can impede the development of the neural pathways between the eye and the brain, but in this particular type of cataract the prognosis is relatively good. The parents of these kids were overjoyed with the successful surgeries. Today we did 148 cases.

Postmark: Sunday, March 20

Another great day. This morning as we were walking around taking patches off we came to agroup of women who looked like they were friends – probably came from the same village. All had great results and as their patches came off they started ululating and making exclamations in Tigrinya, their local language. Tesfay, who was standing next to me, said, “they are saying thank you, God bless you, you have given them their lives back.” Again, I can’t think of anything more fun than this. I’m not sure how many cases we did today – around 150. It was a blur! Tomorrow is expected to be our last day of surgery.

Postmark: Monday, March 21

Every day I tell myself that I am not going to take as many post-op photos – I already have hundreds of photos of smiling, ululating, dancing patients, but every morning I can’t help but keep shooting. This morning I had one of my post-op patients - an elderly man – bent down and wrapped his arms around my legs, hugging and squeezing. I put my arm around him and we ululated together. This week has been an unforgettable experiences on so many levels - I’d say “once in a lifetime”, but I hope this is the first of many trips here – I can’t imagine not coming back for more. Today we did around 130-140 cases. Total cases performed: 1110. A huge thanks to Dr Tilahun, Tesfay, and the entire Quiha staff for making this possible. A big thanks to Dr Liknaw Adamu, our HCP country coordinator, and all the other HCP team members for helping to organize and facilitate this huge undertaking.

Postmark: Tuesday, March 22

Saw post-ops this morning (amazing as usual), then took off with Adam to explore Gheralta Rock and climb up to some of the ancient, rock-hewn churches for which the Tigray region is famous.