August 2, 2011
My good friend Geoff Tabin has climbed Everest and the other Seven Summits. He's also Professor of Ophthalmology and Visual Sciences and Director of the Division of International Ophthalmology at the John A. Moran Eye Center, University of Utah, Salt Lake City. Over the past 15 years, Geoff has organized cataract removal projects around the globe, starting in the Himalaya and expanding to other regions.
This past winter, Geoff and his team were working in Nigeria. He sent the following letter to friends and I asked if I could share it with you. Some of the language is technical but I think you'll get the drift.
We had a full on trip to Nigeria. We arrived in the evening after the long flight and stayed one night with Prakesh and discussed eye development in the country until quite late. It was good I met with him as he really bailed us out with equipment and consumables as the kits from Aurolab are still stuck in Lagos.
We drove early the next morning to Zaria with a quick stop to walk around Zuma Rock. We found the first bolt from where the Lithuanian/Latvian team climbed and got an idea of the climb, then drove to Zaria. Patients had been referred from all over Nigeria for possible corneal transplant. I brought 15 fresh and 5 glycerin corneas. We had 67 pre-screened patients waiting in hopes of a transplant. Some had journeyed four days. I gave priority to bilateral blind children and then young adults then bilateral older people and finally a few VIPs I was forced to do. We then started surgery around 4 PM and worked (myself and my fellow Matt Bujak working at 2 tables) until 1:30 AM. We stayed in the University Guest House, which did not have air conditioning, and it was quite hot, but at least there were lots of bugs. It was also near the mosque and we were blasted with the call to prayer every morning at 5 AM, but at least they did not have running water or a toilet that flushed. [Editorial comment: I love it when my friends use positive pessimisms!]
The next day we returned and after quick post-ops we started surgery. KK (who we sent for SICS training) and another Nigerian doc doing cataracts and I continued transplants with Matt. With one short break at 4 PM we again worked through to midnight. Timmy O’Neill was invaluable as a circulating "nurse" and controlling the flow of patients. Although he lost his usual confidence when I offered to let him do part of a surgery (a corneal tattoo on a blind and white eye).
One notable case was a 16-year-old orphan girl from the blind school who Linda Lawrence had examined. She was very bright and funny. She lost her right eye when she had blunt trauma from a rock and a total retinal detachment at age 7. Then at age 9 she had an injury to her left eye. She told us she was taken to the native healer who used a broom on it and then put in liquid (urine mixed with other things) and she developed a total corneal opacity. Her vision had been LP for 7 years. I did a transplant where I harvested her right cornea (and filled with a glycerin-preserved tissue and then used her own right cornea to transplant into her left eye so that it will never reject. She did great and could see to count fingers at 10 feet and could read print post-op day one. Post-op day two she said she loved Andee (who runs the Hope For The Blind program), but that she is NEVER going back to the blind school. At post-op day 4 she is doing fantastic and her personality is feisty and bubbly.
In all we did 18 corneal grafts (14 PKP; 2 DALK, one autograft and one rotational autograft as well as 3 corneal tattoos. All went well. We then turned to the cataracts. Except for KK the standard is low and they are still doing mainly sutured large incision ECCE with mediocre post-op vision and no biometry. This is the national training program and they do not have much by way of sub-specialty and no fully trained subspecialists. It is a busy program but has had low surgical volume.
We had a couple of problems; the first was that our shipment from Aurolab did not come. It was only shipped to Lagos and had no one to get it through customs (bribe!) and they needed a shipping agent to clear customs (bribe). In addition, there needed to be a new agency to ship from Lagos across the country and the quotes we were getting were around $2000 and Dr. Samaila was negotiating to get it lower and hope it would end up near $750. In any event, we then scrambled getting other NGOs to send us blades, viscoelastic, lenses etc.
Working from early to late every day we were able to complete over 250 cataracts. They were very impressed by the better results of SICS and the patients were joyous. Almost every eye was HM or LP. The surgery was free to the patients and the hospital staff and Dr. Samaila and her department did an amazing job of housing and feeding so many patients. It was, by far, the biggest cataract program they had ever had. The other small problem was that they had one Zeiss microscope with a teaching head, but it broke and they could not get it fixed, so it was more difficult to teach as much as I would have liked. In addition there were so many surgeries that I needed to operate all-day and evening every day instead of being able to help the Nigerian doctors with their cases. A final problem was that our ophthalmic nurse from Nepal was denied a visa for Nigeria and there is a great need for nurse training in equipment management and high volume sterile technique and patient flow.
We finished surgery early on Wednesday (10:30 PM) and decided to climb Zuma Rock on Thursday before our flight at 5 PM. It had only one previous ascent, but seeing the bolts we though we might be able to climb it quickly. There is a myth that the spirit of a dead chief lives in the rock and it has a distinctive face that is easy to see. It is sheer on all sides. The only one to climb it died shortly after (as did the previous people who tried) there was also plans for a tourist hotel near the rock but so many accidents happened that construction was shut down. In an effort to open the area, there was a helicopter flown to the top with the tourist minister two years ago and the Latvian climbed and was written about in the Nigerian press.
Our plan was to leave at 4:30 AM and drive to the rock to arrive about 7 and quickly do it. Andee from the Hope For the Blind Foundation had arranged for a permit from the tourist office for Erik to climb the rock (but none specific for us without Erik). Our driver was not there at 4:30 or at 5. We called Dr. Samaila and finally heard he was on his way, but then he had to stop to pray.
We did not leave Zaria until after 6. Then when we got to the place where we start to walk in (about a mile hike) to the climb we were stopped by "police" with homemade whittled rifle buts with metal tubes and triggers that looked like they might work and twisted wire hand cuffs that looked like they would hurt. One was very loud with comically large lips, a ripped tee shirt and smelled strongly of alcohol (at 9 AM). After a lot of argument and a $40 bribe and 45 minutes later we went to climb.
It turned out to be harder than we expected widely spaced bolts on slab climbing leading to a steep/blank section where they had a bolt ladder. Above that were tiny, drilled holds for hooking (a type of aid climbing) and no more bolts. They must have run out of bolts. We did not have any hooks. Timmy (our hero) led two very hard insecure sections with no protection on dirty thin steep slab and found no top bolts or anchor. He braced himself and also fixed our haul line to help me and Matt (who climbed with us) get up. We made the summit and found a plaque of the first helicopter landing on the summit in 2008. We had a huge crowd of kids gather at the base who were screaming as we rappelled down.
We also found uniformed police with real machine guns, along with local chief, the Muslim Emir, District Commissioner and several others waiting for us (BRIBES!!!). Because of the delays we were now desperately late for our flight. Fortunately Dr. Samaila and two other docs from the department had come to see us off and I gave Dr. Samaila money for bribes and she went to negotiate while we headed for the airport. We also bribed the local chief and he agreed to remove the curse from us—but he insisted on passing it on to our first born child—sorry Sara, be careful! Then we hit a traffic jam. Timmy got out of our hospital van and we hired a motorcycle to rush him to the airport to check in. I passed the bottleneck, two cars had bumped and the drivers were fighting leaving their vehicles blocking the road. We barely caught our flight, avoided overweight charges (another bribe) and flew to Ghana to work with James for a day.
There is much we can do to improve eye care in Nigeria. As a start, we need to give subspecialty (moran/tilganga) fellowships and also send a couple of nurses for training. But it all takes time, money, and devotion...all of which are in short supply.
I hope you found this as interesting as I did. Please share your thoughts with a comment. You can learn more about Geoff and his work at http://www.cureblindness.org.