Clinic and surgery days with Angie

I am playing catch-up from blog posts from last week, so I am post-dating this entry.  Angie and I are currently in Cape Town, South Africa for a bit of sightseeing and also to meet with Dr. Colin Cook. He is a good friend and mentor to Dr. Pons.

At any rate, last week's clinics were very busy! On Tuesday we were in Manzini, Wednesday at Good Shepherd in Siteki, and Thursday was surgery day in Siteki!

Angie was also overwhelmed by the pathology here in Swaziland.



Conjunctival lesion in 20-something male. Looks slightly atypical, so we asked him to get tested for HIV and we will do an excisional biopsy next week.

Same patient as above, side view



Classic eye injury: Metallic foreign body in the cornea
Public service announcement: Please wear safety goggles/glasses!



Congenital nasolacrimal duct obstruction (bilateral). The child is about 6 years old and has had tearing and "whitish discharge" from the corners of her eyes for her entire life! This is a very common problem in babies, which usually will resolve spontaneously in the first year of life. If not, we do a probe and balloon or stent of the lacrimal system, which usually corrects the problem. Luckily, we have the tools to do this! Dr. Pons and a visiting pediatric ophthalmologist from the U.S. will do the procedure next Monday.

Eyelid cyst in a young girl



Corneal blood staining in a 6 year old child who recently sustained a traumatic blunt injury to the right eye. He had an eight-ball hyphema, which eventually led to the corneal blood staining. He has a large RAPD on the right, so visual prognosis is very poor for the right eye.
 

Vernal keratoconjunctivitis in a teen male.

 

Central corneal opacity (ulcer) in a man in his mid-thirties  (in this photo it is yellow because the photo was taken after instillation of fluorescein). Unfortunately, it is bilateral in this patient. We do not have the ability to do corneal cultures here in Swaziland, so the working diagnosis is bilateral fungal keratitis. He has been treated with antifungals, and has not had much improvement. Fungal keratitis is typically very difficult to treat and often these patients require eventual corneal transplant.

Clinic in Manzini



Learning from Dr. Pons (in background)



Angie and me tag-teaming in clinic

Doing cataract surgery at Good Shepherd, while Jono watches on

Cataract surgery (manual small incision cataract surgery or MSICS) is finished and without any complications!



Angie doing a pterygium excision with conjunctival autograft while I assist her



Angie assisting me while I remove the pterygium on the second eye

Removing the head of the pterygium from the cornea with a crescent blade.

We did a bilateral pterygium excision with bilateral conjunctival autografts....it was perfect: Angie did one side, I did the other!

Jono inspecting (and approving of!) our handiwork

Angie and Sister Senani preparing an intravitreal ganciclovir injection (to treat CMV retinitis)

The OR scene: Angie preparing the injection in the left corner and Jono operating on the right
 

Angie giving an intravitreal ganciclovir injection for CMV retinitis. The patient has already lost all vision in the right eye (no light perception) from previous CMV retinitis. I have blurred the face for privacy purposes.

Angie doing panretinal photocoagulation (PRP or "laser") for proliferative diabetic retinopathy.

 

We stopped for a snack of grilled corn on the cob on the way home.

One final story: on our way to Manzini on Tuesday as we were reaching the city limit, we noticed there was a police stop. No sooner had I told Angie that Jono had related to me that we were unlikely to be pulled over (obviously expatriates in Swaziland), when the cop motioned me to pull over. He approached the car and asked for my driver's license, which I gave to him. He looked at it and handed it back. He then walked around the car to the passenger side...Angie and I were CERTAIN that we were going to be in trouble (yet again) for the crack in the windshield. The cop said to us, "When you get back to Siteki, you need to do one thing."  We listened intently, waiting for the fine. He said, "You must wash your car! It is so dusty!" And then he gave a huge laugh. I told him I had been wanting to wash the car for the past five days (it got very dusty in Kruger Park), but hadn't been out of work before 5 or 6 p.m. any night, by which time the sun was setting. He was SO nice, but Angie, myself, and the medical student, Charlotte, got a huge laugh out of it too. I am sure he just wanted to find some reason to pull me over to check my license and to make sure I was legal. But it was pretty funny after our not-so-fun experience with the cop in South Africa (more on that in a future post).



Dirty Swazi car.