Ophthalmology

Ok. I am going to try and be better about blogging so that you all know what I am up to but for those of you that know me writing is probably one of the worst things you can make me do so I tend to put off writing this thing but I promise to be better.

This week I have been working in Ophthalmology. I have been very surprised by what I have found here, not at all what I was expecting. First of all, they have an entire eye hospital. Crazy. Most Ophtho programs in the US don't even have their own building. This place has a glass shop, about 15 outpatient exam rooms, 3 different wards, and 4 operating rooms all dedicated to just eyes. I was expecting to go to the main hospital and find 1 or 2 exam rooms and a handful of ophthalmologists.

They have so many different areas you can work so I have been basically meandering around to see all sorts of different things. The first day I went on their outreach van, known as Eye Camp. They go out to a village and see all the people we eye complaints. This is basically their outreach. If a patient come to the Schell Eye Hospital through this Camp they receive services for free. For the most part everyone who came to be seen had cataracts. Not just small ones, but very very advanced ones. The doctor was explaining to me that most of these people are farmers so they do not need much vision for their daily lives, therefore, by the time they notice that their vision has decreased it is actually very very poor and the cataracts are very advanced. I was surprised because we were seeing these patients in the morning (120pts in 3.5hrs with only a flashlight and a vision chart) and they were going to go to the eye hospital that afternoon for a pre-op workup and have surgery the next day. Now, in the US you often have to wait months to schedule your surgery and here they have it the very next day! I was amazed by this.

There is an ophthalmology resident from Sweden working with me at the hospital. She has been there for a few weeks so most people know her and everyone assumes that I am also from Sweden since we pretty much look identical. ha.Anyways, she came down here to study for a month because they do not get many infectious keratitis in Sweden (severe eye infections with funky bugs). She and everyone else in the hospital have been a bit surprised that I actually know a decent amount about these infections. I tried explaining to them that San Antonio is very close to Mexico so we basically get the same strange infections that they do in India (for some reason people keep thinking Texas is up by New Jersey, I kid you not 3 people have asked me that). A kind of funny tidbit, most of these severe eye infections are the result of a cow or ox tail to the eye. There are animals everywhere so I am kind of not surprised that there are so many injuries (and car accidents) due to them.

How Ophtho here is different from the US: First of all is surgery. This is not going to make sense to any of the nonmedical people reading this and probably wont even make sense to most of the medical people reading this. In the US just about all the cataracts are done using what is called a phaco machine. Basically it is a little needle that chews up and digests the lens while it is still in the eye (kind of like a little vacuum cleaner) so that you only have to make a very small incision and you cause very little damage to the other structures of the eye. We also use foldable lenses which fit in the tiny incision. Here they use what is now referred to in the US as the "old way" of doing it. They make a much bigger incision and take the whole lens out all in one big chunk. I know this is nothing to you all but I was very interested because I have never seen that before. I was surprised by how sterile the OR is. When I was in Nicaragua the OR was open air and the surgeons would pick up their cell during surgery (not exactly sterile technique) and I kind of thought it would be similar here but its not! They basically follow all the same rules as we do, their ORs are closed and very well air conditioned (unlike the rest of the hospital). However, these sterile practices do not carry over to other areas of the eye hospital. The swedish resident and I both agree that this is what has shocked us the most. They do not wash their hands between patients or wipe off the instruments. This is quite dangerous considering some of the patients have infectious diseases. Similarly, when applying drops to the eye they will actually touch the eye with the bottle and then use the same bottle to apply drops to the next patient's eye. Very disturbing, I got yelled at big time for getting to close to a patient's eye with the drop bottle in the US and I wasn't even close to touching the eye! Really other than that their general practice is the same. They don't run quite as many tests as we do but that is to be expected. The clinic is basically a free for all with patients just walking in and asking to be seen first. One patient today actually walked in, looked through the stack of charts and moved his to the front. Hilarious. I get a good laugh everyday watching the patients come in and bless the doctors, and compliment how wonderful they are, and then ask to skip to the front of the line.

I have really enjoyed my week thus far on Ophtho but I have also found it very frustrating because I can only catch about 1/4 of what is going on. Ophtho is very visual, you need to get at the microscope to see what is going on and only one person gets to be there. The residents are also so busy and there are so many patients that there simply isn't time to let me examen every patient as well. So not only to I not get to see very much but I also can't understand a thing about what is going on. Every patient speaks a different language and none of them are even remotely similar to english or spanish. I have resorted to reading the chart after the resident is done and then periodically taking the patient into the next room to examen quickly at the microscope.

Tomorrow I am scheduled to go to the testing room and watch them take pictures and do angiograms and OCTs. All pretty boring. I may try to roam and find something more interesting going on, if I do I will let you all know, otherwise I will post about my weekend (we are planning on going to Mahabalipuram where they have cave temples and artist villages).

Jacq