reaching out!

Now getting down to business. On our second day here, we started outreaches. Outreaches overcome geographic barriers to care in that we bring eye care to the communities that lack access. This first trip was to a monthly site west of Accra called Tishi. It was a gorgeous drive along the ocean with plenty of extravagant buildings surrounded by a lot of barbed wire. Oh! Before that on the highway we saw a naked man standing the road. Good way to start the day.

There were 11 of us packed into a van, bouncing around on the less than ideal roads. We passed a group of children running to school in their tan and brown uniforms. Some with backpacks (how Western!) and some with back packs balanced on their heads (how confused!). All of the school girls have very short hair the same length as the school boys and I think they have to do that until they get older and can grow it out.

We arrived on site at a church next to a grade school. The church was a large barn-esque building with brightly painted walls. Hundreds of people were already occupying it by the time we arrived (we had planned to leave at 7am Ghanaian time which meant we left at 9:30am after waiting around in the lobby fort the 2.5 hours). The routine introductory speech began in English by one of our ophthalmic nurses, a Ghanaian named Dennis, and was translated into Twi by a villager. He went through the process of the eye screenings and how they could expect medication and glasses for only a nominal fee--to make sure they attribute value them--or surgery completely free of charge.

That's when he addressed us who were also on stage saying that we had collected the money to make the free surgeries possible, and everyone clapped. They really really need it. Many of them will get it thanks to all of you guys.

Dennis also attempted to dispel rumors and traditional practices that are detrimental -- ie no urine, salt, or breast milk in the eyes, no couching to relieve pressure (pushing a pin to the back of the eye for glaucoma) and during surgery the eyes are not removed from the head, worked on, and then replaced. Also no anesthesia for the surgeries, so no temporary death involved. These are commonly held beliefs in this country and are also barriers to care and can be an unfortunate cause of blindness.

After we introduced ourselves, we set up registration, visual acuity, opthhalmic nurse screening, and medications/glasses dispensing stations. Unfortunately we had way too many people at this outreach and didn't have a whole lot to do at the dispensing station that day. I did get to fit a small girl for sunglasses who stood unmoving, patient, and trusting as I tried on different sizes for her. Nothing like the spoiled kids in the US squirming around and whining.

We spent the entire day there until well after sunset, and believe it or not people sat there patiently the entire day waiting to be seen. Without a single complaint. Imagine that in the US where people get mad after sitting around for 15 minutes!! They were so appreciative.

Meanwhile, the school was having a big graduation next door. 15 year old boys were commissioning as cadets for the military while drums played and girls wore bright colored cloth dresses. There was music and loud speeches with lots of qualifiers -- 'the best teacher, well you are all the best teachers but the best of the best teachers is...' It went on all day.

Before we were given a delicious lunch of spicy rice and fried chicken as a thank you from the village, my friend Naima and I went on a walk. Dennis said we could take breaks to go see the ocean. We left the school together and walked towards the beach. It was covered in trash and tires and goats eating the trash and tires and harsh looking people. We were called back by someone and told that it wasn't safe, that they are bad people and would steal our stuff. He offered to walk us through the village to the other side where the safe beach was. How long we asked? 7 minutes he said.

10 minutes later we had found out that he was not with UFS and had just brought his father to the clinic and followed us out (sketchy) and the village was super poor. With me being the only obruni of the three everyone in the village was calling me white girl in 5 different languages. 10 minutes and we could finally see the ocean and it was at least 15 minutes more away, so we asked him to head back and he accused us of being scared... well, duh!

After seeing several hundred patients, we started packing things up. I went and played soccer with the villagers--all males about my age with another girl. They were reluctant to let us play, but once they did everyone got into it. I wish I understood Twi. I love showing boys in other countries that girls can play sports too.

The next day, the outreach was a bit farther. A 3 hour drive each way on really rough roads. We made it there and there were about 130 people waiting patiently in a much nicer, tiled church (the church tends to be the nicest building in the village, even if the rest of the buildings are all broken down wooden shanties with rusted tin roofs).

We did the same intro, this time without English, and got started. We were better balanced this time, and I asked that day's ophthalmic nurse (the ophthalmologists are saved for the surgeries mostly) if I could sit with him at the screening station--still regret not bringing my ophthalmoscope. He agreed to it for me and an English optometry student. I offered to do a pre-screen for pupillary reflexes (afferent and direct) while looking for mature cataracts (severe clouding of the lens) and pterygium (a tissue growth on the sclera).

I saw some ridiculous eye pathology; really advanced eye problems that never ever would have gone that far untreated in the US. I saw a traumatic cataract which comes from injury that had gone untreated so long it was unfixable, much of the iris would also have to be removed and it would be unlikely that the eye would be able to recover--I'm not sure what the prognosis would be with the medical care we are used to. I saw a little girl with a corneal ulcer from a herpes infection. I saw really advanced pterygiums. I saw a school-aged girl making up her poor vision/need for glasses. When the nurse pretended he was refracting but used a clear lens with no prescription, she said she could read what she had claimed to be unable to see before.

On a lighter note, there were a few well-managed cases of glaucoma, a few cataract referrals, and the girl with the herpes was to be sent for immediate emergency care.

On an even lighter note, I ran down the street to buy a soccer ball, well kinda, a ball that looks like one and will be used as one even though it's made of plastic. Best part of the ball is the "JESUS SAVES" on it, who knew he was a good goalie on top of all that godly stuff.

I brought the ball back to the outreach and kicked it to a little boy in the grassy/dirty/flat area next to the church. Then there was a about 5 people I was passing to. Then about 20. Eventually there was about 70 kids and I was no longer the passer. They were running around shouting with happiness, and chasing the ball while a little boy next to me called me Jesus in Twi.

One of the kids playing was a boy with one shoe (naturally the shoe was a total 90) and for a 5 year old he was very good at soccer. When I took the ball to put it away to get back to work all the kids stood there staring at me with the saddest eyes.

We wrapped up the clinic as the rainy season downpour began. The car wouldn't start. We were 3 hours of bumpy road from the city and there wasn't much of a chance for jumper cables in this village. I was starting to set up camp for the night in the church. Some villagers helped push the cars (while we watched a safe distance from the rain) and eventually we got it going Little Miss Sunshine style.

I sat behind the back wheel of the van on the way back. The holes in the road had gotten deeper with the rain. Our driver wanted to get back to catch the end of the Ghana v Congo soccer game so he was bombing across the roads. I don't get car sick. Well, I never have, but the guy next to me had them stop the car because I went totally pale and felt really ill. Had to move up to the middle. Weak.