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Eye clinic, third day

Vosh 2014 Samaipata, Bolivia Wed, Feb 12, 2014 (this post is delayed due to lack of internet service)

Rachel, the fourth year optometry student from St. Louis, moved downstairs and we worked together. We made a good team..double checking things for each other etc.

The electrical situation is giving us fits. I don’t really understand the problem, but the electricians here tell me that our equipment charges on 110 and their system is 220. The problem is that none of the batteries that we use for our various scopes are charging. We spent the entire day sharing one retinoscope and using the ophthalmoscopes that vision equip gave us that run on aa batteries. By the afternoon, the retinoscope gave up which made us take longer to figure out prescriptions. The electricians hopefully came up with a solution to charge the batteries overnight or tomorrow is going to be tough.

We have an autorefractor which for a lot of patients gets us close to the prescription so we only have to refine in the exam room. It doesn’t work on everyone, but it certainly is a useful device. When someone has a strange prescription or a media opacity like a cataract, it cannot “read” the prescription.  When this happens we rely on the retinoscope so that we can “read” the prescription.
I saw a guy in the morning where the autorefractor readings were obviously wacky.  So I get out the trusty retinoscope.  I can’t see the reflex. I check the light. It’s fine. I check to see if the patient has a cataract. Nope. I get Rachel to see if she see the reflex. Nope. I sit there stumped for a minute. My lenses “only” go up to -15.00 D. I finally decide to pick up Rachel’s -15.00 lens and hold it together with mine.  Ureka, I see a reflex.  That means this 30 something year old guy’s prescription is about a -32.00 with some astigmatism on top of that.  In 20 years of practice, I have had one patient who was a -25.00.  A couple of times a year I get someone who is in the high teens, but it is rare.  Someone who is -32.00 really quite literally cannot see past the tip of their nose.  This guy has never had a pair of glasses, EVER.  The highest prescription he could accept was a -9.00.  I tried to give him higher, but it was too much for him to adapt to all at once.   He was thrilled.  He could still only see clearly up to about maybe arms length, but at least he could tell that there were people across the street.

And not 10 minutes later, Rachel had a woman, who did have glasses, who was a -22.00.

The sad part of the day was the 7 year old girl, Maria Jesus, who was born 3 months premature.  I knew immediately that it was not going to be good because she continuously JABBED her finger into the socket behind her right eye and pushed on the eye.  This happens when a child is blind.  They are trying anything to get the retina to send any signal whatsoever to the brain.  Mom brought her into the room and as soon as mom asked her to look at me so I could examine her, she started screaming.  We attempted to console her for about 5 minutes.  Finally we asked her to take her daughter outside to calm her down and then bring her back in.  Repeat this about 5 times.  When I could finally see into her eyes, although briefly, I could tell that the right eye was indeed blind from a retinal detachment and that the left eye was not fully developed.  She has retinopathy of prematurity where the retina does not have time to completely form.  I had to tell her mom that there was nothing that anyone could do to make her see better.  The only hope was to find a low vision specialist that could teach her to best use the little vision she had.  Mom just stared at me for awhile because she was so sure the American doctors could help her child. And I had to give her the bad news.

We ended up seeing 360 patients again today.

The team making glasses rocked the day making almost 100 pair of glasses.  This is a lot even with great equipment.  However, they were using a band sander to get the lenses to approximate shape and then using a hand edger to finish the lens.  Amazing.

After clinic, we went to an fantastic restaurant / hotel called El Pueblito.  It was high above the town.  The owner heard of our mission and invited us to dinner.  We only had to pay for our own drinks (he must have heard about us, LOL) but provided all of the food for the 25 of us.  After we ate he thanked us profusely for coming to his country and his town and providing a needed service.  It was the highlight of the week so far.  He and his wife were so very kind.  If you ever end up planning a trip to Samaipata, Bolivia, stay at El Pueblito.  It is beautiful and by far the nicest accomdations in the town.