Articles

A Volunteer with a Vision (continued)

By Sandi Smith

Jay said enthusiastically, “What a heavenly existence, don’t you think? We’re so lucky to have so much: the BBC, the lovely ginger tea, our sleeping bags. Isn’t it great?”

I looked around and agreed with him, at least for the moment. “It’s all we could ever need,” I said. Then I thought, “Well, I wouldn’t mind having my watch fixed.” The strap had broken a few days ago. “Didn’t you tell me that if you had a watch and a radio, that you were among the richest of the Nepalese households?”

“Yes. Only about one in five households have those items,” Jay remembered.

“Wow. We do have so much here.” I sheepishly thought about how excessive my house full of furniture and appliances would seem to a Nepalese family.

Early the first morning, the Lions Club inducted Jay as an honorary Lion. Jay gave a great speech about how he loved to come over and do the surgeries. The Lions described how grateful they were to have Jay and the Bhairahawa team here doing the camp’s work. I couldn’t get over how nice everyone treated Jay and me.

After the festivities were over, it was time to start surgery. The three surgery team employees spent all morning sanitizing and preparing the OT. Pressure cookers, the same equipment used to steam rice at night, were ingeniously turned into autoclaves that could sterilize surgical instruments. A generator would power the microscope light since there was no electricity.

Four hundred Nepalis crowded in front of a tiny window where assistants wrote their names down on pink cards. Then the patients crowded in front of the clinic door to hear their names called so they could be examined. For the thirteenth year in a row, Parajuli, an ophthalmic assistant, ran the clinic. The Nepalis could spend all day waiting to see the doctor, or even longer if surgery was required. Americans probably would not tolerate such a system. Without magazines to help us wait that fifteen minutes or more in a doctor’s waiting room, at least a few Americans, including me, would become impatient. In contrast, the Nepalis sat on the grass in front of the clinic, basked in the sunlight, met new friends, ate oranges offered by a fruit vendor, and enjoyed the cool clean air and incredible mountain view.

At noon, thirteen Nepalis were already waiting for surgery and lined up at the OT door. Jay reviewed each case, then changed into a light blue, sterilized scrub suit, scrubbed with an assistant’s help, and started on the first case.

Dil Ram stood in the line of people waiting for surgery. He solemnly recounted some of his Gurkha stories at my request. Dil Ram listed the countries he had fought in: Burma (now Myanmar), Macau, and Timor, part of Indonesia. He pointed to his arm, leg, and nose one at a time and told me through an interpreter about his three bullet wounds.

Other patients and relatives leaned in to hear Dil Ram’s colorful tales. Once, he’d had to eat leaves when there was no food. Later, he recalled how the dead bodies, many of his friends, piled up while he was in the middle of the action. He, too, was wounded and taken to an army hospital nearby. As Dil Ram spoke, I noticed a few English words creeping into his answers. I asked him, “Do you speak English?”

“I am speaking a little English,” he said quickly, with an Indian lilt. The crowd of patients laughed happily at his attempts. All Nepalis learned English in school, but many had no chance to practice it and were very shy about speaking it.

“What did you do before last year’s operation, when you were blind?” I asked him gently.

He said he was idle most of the time – unable to work in his fields. His granddaughter and son had to help him get around. After the operation, he happily worked on the wheat crop and gained his independence back. Now he lived alone.

“Are you anxious about this operation?” I asked him before he went into surgery.

He instantly shook his head no. He had been here last year and knew what to expect, he explained. Then, he lifted his head, puffed out his chest, smiled, and declared in perfect English, “I am British Army!” The crowd laughed heartily as he disappeared into the OT. I just sat there and thought about what a fascinating person I had just met, here in the middle of nowhere.

After dark, the surgery team was still at it. Jay and the three members of the surgery team stood on their feet all day and had to constantly work quickly and accurately. The task required intense concentration and was extraordinarily stressful. There could be no mistakes. The result had to be perfect; a person’s sight depended on it. For ten hours straight, Jay had to sit on a stool that was not the right height for him, hold his hands and arms up in the exact same position, peek into the microscope, and perform the precise maneuvers of surgery.

The surgeries didn’t always run like clockwork. During patient seventeen on the fourth day, the generator unexpectedly ran out of gas, and the microscope light went dark. In the middle of the operation, Jay, about to extract the cataract, suddenly could not see anything under the microscope. The patient’s eye could suffer if it took too long to restore the light. The anesthetist, Narayan, ran out to get the generator started again. Jay and the patient waited quietly in the operating room. What else could he do? Jay knew that Narayan was trying his best, so he remained quiet and tried not to become anxious. After a long few minutes, the motor of the generator began to hum, the light shined again, and Jay quickly got back to work.

Jay had come to expect such challenges in a setting where resources were precious and infrastructure was lacking. One year, a power surge blew out a microscope bulb, and a replacement had to be found. It always happened right in the middle of a surgical case while he had the patient’s eye cut wide open. Later in the week, another surge blew out the replacement bulb, and there were no spares. Uncomfortably, Jay performed the last few surgeries of the camp with a spotlight instead of the coaxial illumination provided by the microscope. Jay slept poorly that night, worried about the results of those last few surgeries. During post-op rounds the next morning, he nervously examined the patients and found their results to be successful. Needless to say, he was extremely relieved.

In an effort to minimize some of the unknown factors, Jay brought his own surgical tools each year. The first year he visited Nepal, he had no idea if he was going to be able to cope in the foreign environment. In his Irving hospital, he was used to a closely controlled, immaculate operating room with nurses, anesthesiologists, and other trained personnel in an air-conditioned or heated setting. In the stifling hot Bhairahawa OT, Jay emerged dehydrated and drained of energy after a long day, and in the shivering cold Sandikharka OT, his fingers were constantly stiff and cold. The generator could go out at any time, and supplies such as surgery knives were reused until they wouldn’t cut anymore.

On the third day of camp, Jay woke up early to run ten kilometers on the mountain road. Dressed in shorts, a T-shirt, a sweatband, a heart monitor, and running shoes, he sprinted down the hill and headed off in the dim early morning light.

Although he returned perspiring and breathing hard, he looked energized, his muscles freshly toned and an accomplished look on his face. “You should have seen the sunrise this morning,” he gushed in between breaths. “It was so clear that I saw the Annapurnas. The snowy tips of the mountains were a lucid pink. It was beautiful,” he puffed. He was walking fast, in a long oval, trying to cool down. Clearly invigorated by the scenery as much as the running, he talked rapidly. “It was probably the most beautiful sight I have ever seen. The blue sky, the green fields, the pink-orange mountains, the colors are just so vivid here. Think of how many other Dallas ophthalmologists start their day this way,” he chuckled.

Later, in one of the post-operative rooms, I talked with another patient. Sita and her husband had walked for three hours on the muddy road to reach the eye camp. At 38, Sita was totally blind with mature cataracts in both eyes. For six months, she hadn’t been able to see her food plate, her children, her husband, or anything else. She was beside herself with desperation and unhappiness. She hated being dependent on others, especially at so young of an age. She felt like her life was over, she told me through an interpreter.

But that was before her surgery. Sita, with a bandage over her right eye, now sat quietly waiting for the doctor to make his morning rounds. The post-operative rooms were sprawled all over the campus in the old buildings. Straw mats and a blue tarp covered the concrete floor. Twenty patients, each on a six-by-three-foot mat, were crammed into a small room. Relatives crowded into the room as well. The patients had no running water, no electricity, no heat, and no toilets.

On his first trip to Nepal, Jay was shocked at these conditions. They were a far cry from the semi-private rooms, automated beds, state-of-the-art equipment and testing facilities, and round-the-clock nursing care to which he was accustomed. Somehow, the eye camp patients did not seem to mind the hardship and seemed thankful for the medical care that was offered. The patients seemed to end up with good health care and excellent surgical results, despite the conditions.

Jay walked in to the post-operative room as an assistant removed Sita’s bandage for the first time since surgery. Her blank, desperate face suddenly showed an instant, overwhelming relief. She looked straight at me with a new hope and energy and said, “I can see your brown hair, your black camera, your shoes.” Then she looked around. “I can see the doctor standing in the doorway.” Sita’s energy filled the post-op room. She excitedly yet cautiously realized her new capabilities with each moment.

“What would you like to see the most, Sita?” I asked.

She thought about it, then wheeled around to see her husband behind her. “My husband…and my children.” She smiled shyly at her husband. He smiled back. She could see his smile for the first time in a long while. I looked away to give them privacy, but also because tears welled up in my eyes.

When Jay examined her, he said, “Ramro cha!” That means “Great!” in Nepali. I could tell he was quietly elated, too, but he kept his serious doctor personality in check.

“What do you think about me doing your other eye in a few days?” he added. “I hate for you to have to wait another full year before you will have two good eyes.”

Parajuli translated, and Sita anxiously nodded her head. It was arranged.

Jay examined the remaining patients, then lifted up a large stack of blankets, pretending to look for another patient to examine. The patients laughed at his good-natured antics. He felt at home with the Nepalis, after so many years here.

This year a record number of patients sought treatment, in part because of a successful advertising effort. The region’s residents heard about the camp from radio announcements, from health workers who came to their homes asking if they needed eye care, from the local village development committee -- a kind of news dissemination group, or from friends who had been to one of the previous sixteen years’ camps.

Many more patients needed surgery than could be done in the five days of camp. The surgery team couldn’t work any longer each day; the group was already performing at maximum capacity. After some discussion, the team decided to stay two extra days so that every patient with a treatable cataract could get the operation. Parajuli called the Bhairahawa hospital administrator to notify him of that decision and to ask him to tell the workers’ families that they would be late coming home.

Relatives escorted their blind to the camp, and some, such as Gangi, came by human ambulance. Her daughter, Jaya, carried her in a basket on her back for a full day. Signs of hard physical work showed in the women’s faces. Gangi, 73, and Jaya, in her fifties, wore colorful saris on their tiny frames. Jaya was lucky her husband allowed her to make this trip since she lived in a different family from her mother.

Gangi had been able to see only shadows for a whole year. Gangi had never even seen her one-year-old grandson except as a shadow. Most of the time, all she could do was sit around the house and watch the chickens as shadows moving around the yard.

Now, in the bright sunlight on the hill in front of the clinic, Gangi sat in front of the eye chart. Amrit, an assistant, removed the patch over her left eye, and asked her to point in the direction of the tails on the Es. She pointed accurately all the way to the bottom row, which was 20/20 vision. Amrit proclaimed excitedly, “You can now qualify for a driving license, or even join the army!”

Jaya and Gangi were thrilled at Gangi’s result. Bishnu, acting as translator, pointed to something on the ground and teased her, “What is this little piece?”

“A stone,” Gangi replied and looked up at Bishnu for approval.

“You will be able to see a small insect now,” Bishnu laughed happily at the thought. Overnight, the woman had gone from seeing shadows to seeing insects.

“Insects are nice, but it will be a very happy day when I can see my grandson,” Gangi laughed in reply.

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