Day 3 - September 15, 2014

Kokoda

-Morning

Twas our second day of clinics today. In the morning we ran sessions at Kokoda hospital – yes, Kokoda, as in the famous walking trail and WWII history – consultations in one room, eye clinics in another. We could see the famous “Kokoda walking track” arch as we drove into the hospital, framing a backdrop of cloud-covered hills.

Kokoda hospital is a bumpy but beautiful 10 minute drive from Mamba, where we are staying. The panoramic views as we were driving this morning were nothing less than breathtaking – clouds drifting so low you feel as if you can reach out and touch them, crests of lush green mountains, growing palms in the foreground and little winding rivers. Even now writing from our room as we rest from the midday heat, I struggle to capture in words just how incredible the landscapes are – so vivid, so intense, so stunningly beautiful. Hopefully photos can do a better job at what these words can’t.

Morning clinics were busy as usual, although to be honest nothing compares to the lines of hundreds we had at Itokama. Eye clinics were run in a spacious room. People were told in advance that medics would be coming to the hospital and would have glasses sessions available. Again, I was reminded at how huge a need there is for eyecare. Even in one of the best-cared for areas of the province, in a major district hospital, there is an overwhelming sense of just how difficult it is to receive services.

A woman had eye injuries from wood splinters which had caused scarring and irritation, problems that had been going on for 4 years. 4 years!!! Let that sink in.

 Here’s another example – a man with cataracts so bad it stopped him from doing anything – from working, gardening, reading, doing things around the house. Cataracts are not uncommon here, but the necessary surgery to fix it, is. (For cataracts we took down patients details with Liz to create a priority referral list; with over 100 people Fred Hollows may be able to come and offer services.)

Breaktime over, we’re going off now to return to the hospital.

-evening

The day went by with eye clinics, vaccinations, presentations to health care workers + patients, and bumpy car trips. Going on all the time in the background are chatting and jokes, and discussions focused on development, identifying priority areas and brainstorming possible strategies (a network of exchange between mum, Sue, Liz, Dorothy, Robert the government representative and the staff of Kokoda Hospital).

Oh yes, and I forgot to take my camera to the clinic. *facepalm*

I can’t speak much for what was happening in other parts of the clinic, but being involved in the eye sessions with Sue has been very enlightening and interesting. To give you a bit of a picture of how they’re run – it’s a mixture between a short eye history and a brief examination (DISCLAIMER: I’m a student, Sue is a nurse – clearly we’re not eye specialists. Our focus is to match optometrist-measured glasses to refractive error.)

So without going on any more tangents, this is my thought process/what I would do in a typical sesh:

General feedback from these clinics – I find these exhausting but incredibly rewarding. It’s a thousand times easier here with Sue’s help and also with some kind of orderly system (its not perfect but it sure is better than nothing). When its busy we do need to try and work as quickly as possible as people end up waiting for 30 minutes to an hour or more, but that being said – the procedure is still undergoing development, and the whole thing takes time. The history is most important and also the most insightful – both into the patient’s condition and their general life – but it takes up a lot of time. It’s necessary to ask more questions when the situation is more complex, but for the simple needs for reading glasses it can be cut short more.

Some highlights – identifying a woman who had an abnormal history which didn’t seem to add up to be checked by mum. I thought she may have cataracts in both eyes but she had said that her left eye had vision while the right was almost completely gone – seated opposite from me less than 1 metres away, she could only make out my left shoulder. It didn’t make sense to me. From a quick check with mum, moving her fingers around to see in what position it was visible in, she suspected “quadrantinopia” (I could be making this word up) – a visual field defect where the patient could only see in her 4^th quadrant (explaining why she could only see my left shoulder – her 4^th quadrant). Long story short we put her on Liz’s list of people to be referred for eye specialist services.

This is what I love the most about eye clinics – talking to the patients, finding out exactly what it is that their eye problem is affecting in their lives, and seeing the possibility that correcting their refractive error can solve this. The last patient today was a teacher, she had problems reading when she was working at night, mainly marking schoolwork. Every hour or so, her eyes would be strained, she wouldn’t be able to see clearly and she would have to take a break. She also found that strong sunlight caused her pain/discomfort. The sunlight issue was not uncommon – there were a lot of people who appeared to have difficulty seeing in the harsh sunlight. I was kicking myself for deciding against bringing sunglasses in the throes of our 2am packing hurricane the night before departure, for lack of space and prioritising more glasses over sunglasses. We’ve made sunglasses a priority for next trip.

So I just deleted about 1000 words when my computer crashed (sigh) but will try my best to recapture what I was ranting and raving about before, which is basically that we’re trying our best to refine and “finesse” this eye care program to the best of our abilities. We’re asking questions all the time and discussing the possibilities, with the key goal to make this as sustainable and effective as possible. The whole process starts off easy - collections are an absolute no-brainer, followed by measurements (and I am so, so grateful for the help of our amazing UNSW Optom partners who kindly measure the glasses in their own spare time!). When we hit the ground up here is when things really start to get more complicated.

eg. Is there a need? Yes – we established that yesterday and today, and the need is immense. There are a lot of people with eye difficulties, many of them affected in their work, and not so many services to go around. 

Where is the need greatest? Reading glasses around +1.00 - +3.00 is in greatest demand. We are still determining whether its most effective to collect donated glasses of all ranges or to bulk-make glasses within high-yield range.

Whats the best/most appropriate way to test refractive error?

            How can we assess the usefulness/impact of these glasses in correcting refractive error and ultimately, improving quality of life?

Photos from around the hospital earlier in the day:

Mum and Rahda analyse an xray outside in the light

Okay, so something else we were doing in these clinics was presentation sessions. Today, mum gave a talk on Hepatitis B to the hospital staff, and here's her perspective on how it went:

***

                There is a feeling that has been growing gradually over the last day or two since being here. It’s taken a while to develop, especially since the route we have taken from Sydney to Moresby and now here in Popondetta/Kokoda gradually conditions you to the changes in opportunity and standards of living, rather than the full-blown contrast of Cairns/Australia to Itokama in a day.

My mind wanders back to my friends in Sydney and all the experiences I’ve been fortunate enough to have over the last 9 months since we were last here in January. And wow – what an incredible 9 months it has been. Just now, looking at the desktop of my computer and seeing the smiling (okay more like grinning/derping) faces of my friends scrubbed up for medball, it’s a stark reminder of where I’ve come from and the strangeness of the world we live in. I see from the photos of us smiling the difference between life “here” and life “there”, and I can feel a strong sense of how very privileged we are.

And I say this with absolute sincerity – not that we are rolling in bundles of cash or strutting around conceited, but just the fact that we are incredibly fortunate. We have everything and need nothing – or simple we have enough. We are privileged enough to not be fighting for survival and basic needs, they are taken care of one way or another, and we are privileged enough so that we have the luxury to worry about complex, abstract, non-essential, trivial (call it what you will) things. To put it in Gary’s words, our problems seem to be like “staplers” in a sea of real-world problems of survival and basic needs – education, health, employment, security, social infrastructure. “Perspective yo” takes on a whole new meaning and suddenly you don’t really feel entitled to complain much anymore.

Okay, so that was a long rant from me. It’s been nice to just verbally vomit onto this word document and chug out some thoughts before they’re reabsorbed and lost forever in the dark abyss of my brain. Tomorrow brings new learning curves, challenges and experiences (having a camera should also help).

Carrie