Cataracts Out of the Bag

"Oh the iris is coming out, dat's really not good..."

Four health workers took their vacation from the US (originally Hungary x2, Jamaica, and NJ) to Senegal to perform miracles. A 5 minute simple cataract surgery in the US has never occurred in Kedougou. Thus, many blind or nearly-blind citizens of the surrounding area who never would have gotten the chance otherwise, can now see. Being a part of it is probably the coolest thing I've ever done.

And what exactly did I do? Did it involve a crescent blade and lots of "oops" peppering my speech?

A Day in the Life of Me/ Restoring Sight to Blind Lepers

(OK OK, that may sound slightly pretentious... In actuality there was only one obvious leper.)

-I start by donning scrubs of a beautiful blue that splatter with iodine and eye fluids hourly. I also get a hairnet and face mask and can't wear outdoor shoes on the operating room floor.
-Wipe down everything with alcohol. It's weird trying to reconnect with my American germaphobia after losing all standards of cleanliness in this country.
-Next I fill syringes with nerve-blocking drugs. I tap them in the air and feel cool.
-Run around and open packets of things like wexel sponges, miostat, various blades, needles, syringes, gloves, drapes, provisc, satures... during the surgery as well. The first couple of days this stressed me out (WHAT are you saying to me and where is it ahhh?!) but I got the hang of it.
-Find patients' correct lens (for which they'd been previously measured). Most go posterior cortex, but if something goes wrong and the posterior is injured, I run and get an anterior one.
-Dress patients in scrubs and a hairnet that may or may not already be wet with eye liquids, saline, blood... (we don't have a lot to work with!) If the patient's last name is Camara, my joking cousin, I will at this point tell them not to steal the scrubs. Hilarity ensues.
-Lead them to the OR and assure them 200 times no one will steal their broken flip flops and dirty head rags while they're gone. Help them climb up on table. Tell them not to fall because we only feel like doing one operation for them.
-If Dr. Donald McDonald II is operating (he and Judith switch off), he's probably singing by this point. I will make fun of his voice with the patient and we'll have a lovely little private giggle.
-Clean the eye area with iodine swipes and explain why they should not move during the surgery and that we can give them more medicine if it hurts.
-Standby to counterpush microscope as surgeon places a sterile cap on it. If anyone touches this or the drape or nurse's table or gloves, they will freak out and have to change everything.
-Give patient a drop of viximox, turn on the microscope light, and hold up face drape so patient doesn't suffocate. I use an old cut out box to make sure they maintain breathing capacity. I'm not sure how any OR has ever functioned without me.
-Watch as surgeon clamps open the eye and threads through back of eyeball and clamps it down so that it's looking down, enabling him/her to make a cut above. Sometimes this already hurts the patient and I have to hold them down and tell them we'll give them more painkillers. Then make said painkillers.
-Next, the surgeon snips the main cut above the iris through which (s)he'll do most of the prodding/ extracting/ inserting. The line of this cut is then cauterized (burned) so that it stops bleeding. Sometimes it smokes and smells, but is otherwise quite cool. This is extremely painful if the patient's nerves have not been properly blocked.
-Stand around gawking (I was glad to have a face mask the 1st day while I couldn't shut my mouth) as surgeon enters eye, spins milky full moon of cataract to surface, and drags/ sucks it out of the entry wound. That is the most exciting part and the lens's always surprise me with how big they are. They look like odd gummy candies until they dry out. I collected them one morning to show the others, so they rattled around in a little box.
(By the way, the "others" are doing lamer jobs like handing out glasses, testing eyesight (harder than it sounds for people unused to characters inked on paper. Even the villager-geared version with pictures of snakes confuse them to the point at which they feel like that have to explain to the idiot toubab that that is actually NOT a snake, it is a squiggle on paper...) The worst job, though, is telling people who travelled who-knows-how-far that they actually have glaucoma, not cataracts, we can't do anything for them, they'll never see, and they should not continue to seek help.)
-Surgeon removes clouds from eyes and replaces the old yellow (once- black!) lens with a new one. I open it with a flourish over the nurse's table, careful not to touch anything.
-Opening things, moving chins, table, microscope magnification, pleading with patients to stop moving, watching everyone working there roll their eyes over their masks for various reasons....
-When the lens is in, the edges of the iris hydrated to seal, the suture sewn, and the pupil pressure appropriately low, tbe silken stitch is removed, the eye rolls back, and we're done.
-Put in 4 eye drops, remind surgeon to inject steroids (they're allowed to forget this one thing when I'm there to remind them-- they don't do any of this stuff in America which a machine does it all!)
-Patch up eye with gauze and tell patient not to take it off, come back tomorrow morning EALRY, Dr. will remove it and give medicine... If Allah wills it, they will see a little tomorrow, more the next day, and so on for a moon.
-Patient thanks profusely, blesses us, and asks where the shoes are. I lead him/her off the bed (one lady jumped and I had to catch her...) and away. They get their stuff with advil and instructions. We're all happy.
-Repeat 9-15 times a day, sometimes for 12 hours. Mentally apologize to feet.

(Of all the surgeons and fellow nurses, I'm the only one who attended every single one of the 107 surgeries! Am I an expert now? Anyone wanna let me take a stab at their eye?)

At first I felt useless and insultingly unqualified to be there. What could I possibly offer? But I began to realize: a lot.
Doctors tend to be people who care, of course. But to reach the point at which you cut peoples’ bodies like a machine, you have to detach yourself. It’s hard to operate on your mother because you can’t just think of her as a body that will have to handle the pain of your cuts. But when you can’t speak the same language or communicate anything, it’s easier, sometimes automatic. You have to emotionally cut them off and stop trying to empathize or you’ll drive yourself crazy. Here’s where I could contribute.
I couldn’t translate everything the doctors would normally explain in the US. There are no Pulaar words for “cataract,” “lens,” “cortex,” “anesthesia,” “implant…” But I can get the point across in villager-terms. (She is removing your malady and replacing it with new thing for your eye. It will help you see.) I could ask how much it hurt; tell them it was going well; that they are brave.
It’s a terrifying experience to have an operation anywhere. But these poor souls have been blind for who-knows-how-long, missing fingers and toes due to related accidents, have never been to a hospital, are hearing fast foreign chatter and laughter and shouts all around them, don’t understand these physical medical explanations, most likely remember their last operations were genital cutting, are at the mercy of strangers they can’t see… TERRIFYING. I was glad to be there and make bad jokes and dance as I led them out once it was over.
During these surgeries, too, I held shaking fingers. The first times I did, the surgeons and nurse each individually noticed and said things like, “Oh! Good idea!” (Back to the empathy block.) I loved that I could do this, knowing it’s probably never done in Senegal. Here, doctors are powerful men who explain nothing and comfort less. Furthermore, I liked defying the anti-physical affection rule. I was especially crossing the standard line when I held men’s hands. But they squeezed back after a minute, hopefully slightly less terrified. I may not be qualified to operate, but I can still help!
The best part, of course, is telling people (Inchallah!) they will see again. They’re ecstatic. I well up. I asked a few people what they wanted to see and got these answers: the road, my wife and kids, Hadi Souare’s beautiful face! (“You’re blind; you don’t know that I’m beautiful!” “Yes, but I still know it.” Aww!)
It’s awesome awesome awesome. These surgeons are miracle machines and I was honored to be part of the magic. (Also honored to have the opportunity to work in an OR without all the years of study and sleepless nights that usually precede… sorry med students! You should’ve joined the Peace Corps!) People can see who thought it was impossible.

NOTABLE PATIENTS
(now that I’m done with the heart-warming part)
-A really old senile guy kept laughing and moving every part of his body. I had to clamp down his head so hard it made my arms ache. His son and Michele held his arms and feet. Sometimes performing miracles is hard work.
-A guy kept saying I was his wife and then praying extensively. When we finished, I couldn’t get him off the table for 5 minutes while he prayed enthusiastically and blessed us (amina…)
-One adorable tiny old lady kept saying, “Thank you thank you!” (always 2x) loudly and joltingly especially when the surgeon gave her a shot or made a cut. I had to keep saying, “You’re welcome, but please stop talking…”
-As I was explaining to one lady that she should tell me if anything hurts a lot, she said, “Just don’t hurt me!” I laughed, but she continued to say that everyone said it hurt a lot. I asked for names and she answered, “EVERYONE!” Judith was crushed when I translated and I told the woman she made the doctor sad. “Good,” she retorted. “She hurts people.” But, alas, at the end she had to admit it didn’t hurt so much, and she was thankful, and fine, she’d pass on the word that it wasn’t so bad.
-When we were about to start on one woman, we were talking (in English!) and we laughed about something. So did the woman. We looked at her in surprise and laughed harder. So did the woman, blind, under a drape, without a word of English in her head. On and on, and we all laughed harder for a good long minute, unable to stop and operate. I, of course, was the last one to stop.
-One old man smelled worse than the normal bad smells and we found out why. He started shouting something I couldn’t understand so I got his son to come in, thinking he was just scared. Then he took out his penis. Somehow, my first reaction was embarrassment for him as he’s probably a Muslim who wouldn’t want four women witnessing this. He had to pee. Judith was literally in the middle of his eyeball. Michele and I frantically thrust a kidney tray at him. He filled it and when Michele reached for it, he just dropped it on us instead. Rather than help the peed-on toubab girls, the Senegalese doctor who’d been watching rushed the son out of the room. He later explained that it was traumatizing for a son to see his father’s penis. This pee-throwing happened two more times. This guy had a lot of pee and apparently was unable to interpret our screams of agonized disgust as “Don’t do that!” Thank Allah for scrubs.
-The next day, more pee. But not thrown at me, just on the floor. I couldn’t get mad at that. These people are old, blind, and used to popping squats anywhere. Instead I got mad that no hospital worker would clean it up.
-One lady got turned around of the operating table and refused to be led out the door. She didn’t believe it was the right way and got semi-violent. She said she’d just sleep there since the door was apparently so far.
-Everyone’s favorite lady was an adorable slightly chubby tiny woman who couldn’t go 5 minutes without giggling. Her giggle made our hearts melt like snicker bars in Senegal. Unfortunately, we had to cancel her operation. Once on the table, she had a panic attack and her giggles turned to sobs. We brought in her daughter, duct-taped her head down, and tried everything, but she wouldn’t stop thrashing. So, she’s still blind. However, I felt better when she started her giggles up again as she walked out the door, holding our hands. I apologized and she said, “Don’t be sorry, I’m happy to be off the table!” Seeing isn’t everything, I guess.

(But it’s pretty fantastic.)