I've just returned from two weeks working with the Andean Medical Mission in San Borja in El Beni, Bolivia. AMM send medical teams to Bolivia every year to carry out sight-saving eye surgery and set up eye care services in remote parts of the Bolivian Amazon, and the Andes. There are only three ophthalmologists in El Beni, an area almost the size of England and with a population of over 400,000 people. In our town of San Borja, there is only one. He's a busy man. However, without equipment, facilities, supplies or help, our ophthalmologist had patients who were living with treatable blindness. This is where AMM come in, providing equipment such as a microscope for surgery, and working every waking hour to treat as many people as we could, to restore their sight.
If I had a 'comfort zone' in my job it would be theatre nursing in eye surgery. It's what I have done for most of my nursing career, so it's familiar - but it's fair to say that in Bolivia my comfort zone was uncomfortable. Surgery in austere environments is always very challenging, but eye surgery, reliant on its modern techniques and technology, can be particularly difficult to do in a poor setting. In the UK we have very smart machines to help us remove cataracts using sound waves and laser incisions. In Bolivia, all the surgeons have are standard instruments and a lot of skill. In the UK, surgical instruments are increasingly disposable. In the developing world we reuse whatever we can. We can't rely on the sterilising process in the Bolivian hospital, so between cases I frantically scrub the instruments in iodine and alcohol before they're steam sterilised. I am telling myself the entire time that an eye infection in this environment could be catastrophic for the patients, so I am bordering on obsessive about sterility. Meanwhile, the surgeons are going back to basics and using techniques rarely practised in the UK, and whatever supplies we have, to perform impressive surgery. The electrics in the operating theatre are dangerous, so we are running the microscope from a car battery. The theatre becomes stiflingly hot. Next door, women (sometimes, sadly, girls) are giving birth. One of the nurses tells me they have no pain relief, only a drug to intensify contractions and speed up delivery. Whilst our surgeon is concentrating on precision microsurgery, the women's screams fill the theatre. When we encounter problems, we have to improvise. Patients have come from miles away and travelled difficult journeys for treatment, so providing we're safe, we do whatever we can to treat them. This is not easy surgery, but it is essential.
Blindness is a disease of poverty. Whilst malnutrition continues to be a huge problem in the developing world, blindness can occur as a result. If a child in Latin America is born blind, they have a mortality rate of 60% in their first year. The overwhelming proportion of patients we treated in Bolivia were blind or vision-impaired due to simple neglect or environment. Cataracts as thick as M&M's develop over the years and pterigiums (benign conjunctival growths, common in the tropics) spread over the cornea. With no treatment, these conditions slowly put people in a severely visually distorted world, or a world of darkness. Of course, blindness doesn't just affect the blind, but their families, friends and carers. It can mean the difference between earning a living and not. In an already poor country, this can contribute to a cycle of poverty and leave entire families destitute. 80% of visual impairment is avoidable or preventable. AMM's goal is simple, and that is to restore vision to blind people who either have no access to treatment, or just can't afford it. We got great results on our trip. We treated a lovely, cheerful lady in her 80's who hadn't been able to make out more than light perception for years. When we spoke to her before surgery, she giggled the entire time and her laugh was infectious. Maybe nerves, but I remember thinking that it's true that when you have nothing, you have nothing to lose. That wonderful lady came back the next day with vision that is not much worse than my own. It's difficult when there is a language barrier to understand what this difference makes in patient's individual lives, but we hear snippets of stories of mothers seeing their children for the first time in years, and men able to earn a living for their families again. The patients are often overwhelmed with gratitude. This year, AMM treated a man who had been blind for 20 years, and enabled him to see his 16-year-old granddaughter for the first time. All in, AMM have screened 2000, and operated on 220 patients this year. They know that there is no reason people should accept their fate of blindness if it is avoidable. They will continue to send teams out to Bolivia as long as there is a huge demand, and there is.
Despite the hard work and challenging conditions, I have no regrets about going to Bolivia. I came home to a divided country with notions of separatism when I didn't feel separate at all. The world is smaller than we think. If nothing else, being part of something that improves the lives of others reminded me that humanity cures despondency.
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