Postcards from the Field - Papua New Guinea

Postmark July 22, 2015

PostmarkJuly222015 Edited

I had been up at 5am every day ready to go, but in PNG the hospital wakes up slowly. It takes time for the patients to walk up to the hospital from the resource center and for us to see our postops. It was exciting to see the patients from yesterday and another round of red carpet treatment awaited the patients going for surgery today. At this point there was less of a need to see new patients (we finished seeing 90), and so I focused on doing preoperative evaluations while Ben and Alison focused on teaching in the OT. Our students: Drs. Maggie, Agnes and Jambi turned out to be very quick learners and started doing cases on their own with us standing by and watching. They became quite adept with the instruments and were having great results in lifting the patients'dropped eyelids. With water now readily available, we discovered that we had ice packs in the OT which greatly decreased swelling for our patients. We had a small baby girl with blepharophimosis syndrome, but unfortunately she was sick and could not have general anesthesia, so the next patient was a 14 year old boy who needed squint surgery. We didn't have any prisms to measure how much crossing he had in his eyes, but it was so much that would exceed the prisms. I desperately wanted to straighten his eyes, because those who look “weird” or “different” in this culture are very much excluded, thinking that they are “possessed” or “cursed”. I looked up my old notes from doing strabismus surgery in Honduras with Dr. Nesper and proceeded to the OT to do the case. Little did I know that he ALSO wasn't able to have general anesthesia, so after a family conference, I consented him and his dad to do the case with retrobulbar block only! I've never done that before, and so I asked that he be at least on a monitor to make sure he does well with tugging on the muscles (this sometimes causes a dangerous severe bradycardia). I did the block and Maggie and I took our time resetting his very tight muscles to a more normal position. I chickened out doing a bilateral retrobulbar block in this child, which would mean that he is completely blind for at least 4-6 hours, and left the second eye for the next day. The case went well, no bradycardia, but can't speak of my heart rate!

Later in the day, Michael came back from the workshop with a stack of ptosis crutches. He and Joseph made a whole new prototype. This felt like Christmas because it helped us take care of patients who due to high risk could not have surgery to lift their eyelids. The PNG ptosis crutch was a big hit and patients were grateful for a new way to hold up their eyelids!



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