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Blog From West Africa

 In February I was with my ophthalmic friend Dr. Edgar Ogaldez  in San Benito / Flores, Peten, Guatemala. Dr. Ogaldez visited my wife and I last year as part of the Rotary / AAO Host An Ophthalmology program ( Chair, Ken Tuck MD ). After visiting us in S.C. and talking to two of the local Rotary Clubs that sponsored his visit, we attended the Academy meeting in Las Vegas. This Rotary / AAO program is over 10 years on and we have had over 100 young ophthalmologists from 56 developing - world countries attend the AAO annual meeting for the first time through this program. Contact Annamarie Hastings at AAO for more information concerning this program.
We are hoping to secure an ophthalmic laser through the Rotary Foundation (District 7770 ) for his active eye clinic ( Vincent Pescatore Clinica ) as they currently are without a diode / argon laser. Their ophthalmic numbers / stats are impressive.  This clinic is part of Visualiza ( Guatemala ) which has received international recognition / awards for their ophthalmic program emphasizing sustainability / outreach. Most of their cataract surgery is free and almost all the outreach care/ surgery to  the Guatemalan indigent is without charge. 
Anyway, I learned several tips I wanted to pass along. #1. Dr Edgar had two dental chairs for his cataract surgery.  He used both chairs  and one surgical microscope. The dental chairs were great ---  much better than a regular O.R. stretcher.  They took up less room and  at the end of the surgical case the chair will raise up / lift  the patient’s  upper body.  So think about using dental chairs in operating theatre rather  than bulky stretchers. #2. You don’t need fluorescein to check IOP with a  Goldman ( Perkins ) tonometer. Put in a topical anesthetic agent , use the white light ( slit lamp ) and find  the mires ( overlap ) as you normally would. It might be a little more difficult  to determine the end point as opposed to a  blue light and fluorescein but it works. I think it should be an accurate reading. Nice to know if you working at a rural clinic without fluorescein. #3. Use a used toothbrush ( not your spouse’s ) to clean rollers on a slit lamp. Whenever I go to any rural eye clinic, I take a small can of 3 in 1 oil to lubricate / clean the slit lamps,  lift tables, eye stool’s etc. The more the slit lamp, tables, chin rests, knobs don’t work ( go up and down ), the more exhausting it is to see the eye patients esp. with large numbers.  
One more suggestion that I often forget to do. Patients that have hypertension and glaucoma  / normal tension glaucoma /  glaucoma suspect / ocular hypertension should take their hypertensive medications in the morning rather than at night. Right?  We all know this but I certainly forget to tell that to my eye ( glaucoma ) patients. Teach that.
To reduce mosquito activity ( malaria )  in your bedroom at night, if possible, keep room cold ( A.C. ).  Mosquitos less active ( bites ) if room cold.
I am currently in Liberia seeing post-Ebola survivals with eye signs / symptoms. My next  blog will  talk about my experience in Liberia / Ebola.      
Peace, Baxter

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