Sunday, 8 November 2015

Congo Eye Surgical Safari - Trip II

by John Cropsey

In January 2014, the Department of Ophthalmology at Hope Africa University’s Kibuye Hospital opened its doors with the stated mission of ERADICATING PREVENTABLE BLINDNESS IN THE GREAT LAKES REGION OF CENTRAL AFRICA.  What can I say, I like to dream big.  We started with one crazy ophthalmologist, five untrained staff, an old paper eye chart and a big vision.  Today, we have a capable staff running a pretty well-oiled clinic and specialized surgical theatre. 
The Kibuye Eye team posing for a fun photo with an old box of glasses
First Retina Surgery in Burundi          First Corneal Transplant at Kibuye
Most importantly, we are training the future of African healthcare professionals with over 100 medical and optometry students having completed rotations with us already.  We have also just joined forces with a brand new ophthalmology residency program in Rwanda and together we plan to train the future eye surgeons and physicians of the Great Lakes.  It’s a great start to what we hope to build into the major referral eye hospital for the region.

But our vision extends beyond that.  Burundi (10 million plus) sits on top of Lake Tanganyika with Tanzania and Democratic Republic of Congo stretching along either side and Zambia 500 km away sitting to the south.  Twelve million people live on the edges of the lake with virtually no access to eye care.  There is good reason for this.  This basin is geographically isolated, sitting in the heart of Africa with the impenetrable Congolese rainforest to the west and steep mountains rising out of the lake to the east leading to the vast East African plains of Tanzania.  The region has been plagued by decades of war and instability making it one of the poorest, least developed places on earth, yet it remains one of the most densely populated areas of Africa.  In other words, a virtual gold mine for any eager ophthalmologist willing to work around a few “road blocks”.

Our vision is to divide this population of roughly 20 million (Burundi + Tanganyika basin) into groups of 1 million and begin building primary eye care infrastructure (blue dots around the lake) with a floating referral eye hospital that can service the primary eye clinics around the entire lake.  Today, I want to share with you how we are embarking on this voyage with our pilot program at Nundu in Fizi, South Kivu, DRC.
The "Master Plan" for the Tanganyika Basin

We first visited Nundu Free Methodist Hospital in Fizi in February 2015 at the invitation of missionaries working there.  Fizi is home to 400,000+ people.  During that visit, we asked the hospital to identify a healthcare professional to come train with us at Kibuye in order for them to have the knowledge base to begin providing very basic eye care and compiling surgical cases at Nundu.  Dr. Songolo was selected and joined us for one month at Kibuye.  He happened to arrive just as Burundi descended into political chaos in late spring, but he stuck it out and finished his month of training.

Between June and September he compiled a list of nearly 100 patients requiring sight-restoring surgery at Nundu.  So this October we decided to pay him a visit.  What does that entail?  

Step 1, getting visas for the eye team.  Since rules change constantly and there are many layers of bureaucracy this required trips to get passport photos, vehicle documents and immigration papers in the capitol 2.5 hours away.  We received our visas just days before departure.  

Step 2, packing everything you will need to to do eye surgery in a setting with no electricity and minimal running water.  And note, this has to fit into or on top of the eye clinic’s 1986 Landcruiser, affectionately named “Umutama Kazi”, i.e. the “Old Lady”.  This includes generators, surgical microscopes, surgical supplies, exam equipment, meds etc…

Step 3, decide if security is good enough to carry out the mission.  This requires gathering intel from folks on the ground and from news sources.  BBC was reporting an ambush of a military envoy delivering civil servants’ pay near a town we would be passing through.  Eleven soldiers were killed and 20K stolen.  Concerning.  My Congolese contacts on the ground assured me this was to the north of the town.  Security was “good” passing to the south where we needed to go.  Hmm.  Tough call.

Step 4 getting to and successfully crossing the border.  This is VERY stressful.  The Congolese border guards were particularly “thirsty” this day and worked us over trying to leverage extortions of one kind or another.  Thankfully, the medical director from Nundu arrived as the “Old Lady” was about to be opened-up for full inspection.  He had a word with the boss man who happened to have presbyopia.  After an impromptu eye consult and a pair of reading glasses dispensed, we were on our way relatively unscathed.  

Step 5, traversing the main “highway” of Eastern Congo linking north to south.  This is a dirt road requiring one to ford at least three rivers where bridges have been washed out and to drive over several other bridges that look like they could be the next to go.  The road weasels its way sandwiched between the water and the mountains sitting on the lake’s edge.  From the border to Nundu it is about a three hour bone-rattling journey.  There are road blocks along the way where one must negotiate and pay not inexpensive “tolls” for the use of their fine road.
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