Days at Lusaka Eye Hospital, Part 2

Dr. Celestin:  "Are you Seventh-day Adventist?"

Me:  "No I'm Christian but not SDA."

Dr. Celestin:  "But you look like you are SDA."

Me:  "How's that?"

Dr. Celestin:  "You look like a small preacher."

[I'm not sure what that meant either]

Dr. Yoo and her patient, the former Zambian ambassador to the US (and graduate of Cal Poly SLO)

One day Dr. Yoo let me put in a suture in a patient's eye who had had corneal trauma.  It was incredible getting to do something "hands-on" with a patient's eye rather than watching as I usually do.  I realized that I've watched so many good ophthalmologists who make things look so easy that I didn't realize how difficult the procedures actually are.  I hadn't taken into account that I would have to adjust my depth perception to the microscope and that the tear film covering the eye would adhere to the suture, causing it to stick to itself and tangle before I could get a good grasp on it.  Overall, it was much more difficult than I thought it'd be but I was really glad to be able to get to use some tools under the operating microscope.

Dr. Celestin (to little girl needing her eyes examined):  "What kind of food do you like?"
Little girl (smiling):  "Nothing."
Dr. Celestin: "Nothing?"
Me: "Do you like candy?"
Little girl:  "No."
Me: "Do you like nshima?"
Little girl:  "No."
Dr. Celestin:  "Do you like pizza?"
Little girl:  "YEAH!!"

I also had a chance to see Dr. Yoo use a glycerol graft to treat a patient's Mooren's ulcers, a type of corneal ulcer with unclear cause with a higher incidence in Africa and India than in other parts of the world.  Glycerol grafts are a really cool option for corneal surgeons in the developing world.  The grafts are human corneal tissue preserved in glycerol, which allows the tissue to last up to 5 years.  To my understanding, fresh cornea grafts can be very difficult to access in the developing world due to a number of factors.  For one, most developing countries lack any sort of eye bank system where corneas can be harvested from cadavers and provided to patients needing transplants (although there is one in Ethiopia!).  Additionally, transporting fresh corneas from a country with a robust eye bank system, such as the US, can be difficult as the fresh tissue must be kept at a certain temperature and used within a short amount of time before it becomes nonviable.

A glycerol-preserved cornea that Dr. Yoo has transplanted

Enter the glycerol graft.  Dr. Yoo gets her glycerol grafts from an eye bank in Alabama, which sells them for a low cost.  As mentioned above, these grafts can last for up to 5 years, much longer than the life span of a non-preserved cornea.  The downside is that these grafts are rather opaque and do not allow the recipients much visual acuity, though Dr. Yoo said she has had glycerol graft recipients who can count fingers at 3 meters after surgery which is pretty remarkable!  The benefit of these grafts is that they can work as a "patch" for corneas damaged by conditions such as ulcers or erosions that would otherwise be severely threatening to the corneas and eyes.  And to me one of the most remarkable things was that these grafts can be used as a "placeholder" of sorts, as they can be removed and replaced with fresh corneas, should those corneas become available.

The work being done at Lusaka Eye Hospital was exciting and inspiring, and I'm glad to have had the chance to observe and learn from the ophthalmologists there.

Interview with Argent Moonga

Argent Moonga on right (Dr. Celestin on left, me in middle)

What is your official title?

I am a cataract surgeon.  It may not be common to other countries, probably something more common to African countries.  It is where a non-medical doctor- so in my case I've done clinical medicine which is a diploma- can still go further in a specialty, ophthalmology.  First we do what is called clinical ophthalmology, which is a two year program.  Then we do another two years of cataract surgery.  But in my case, after doing the two years in clinical ophthalmology, I did one year of cataract surgery because I already had the background.  So I had just to go straight into the second year of cataract surgery.  

I did it in Moshe, a very well known institution in Tanzania.  Actually that's where Dr. Celestine [the Rwandan ophthalmologist at Lusaka Eye Hospital] trained and most of the ophthalmologists we have in Zambia.  They have the patients, they have the facilities, they have more advanced technology than we have, they have a school.

But I did my attachments at a different hospital, a non-governmental hospital where they have a lot of patients.  But in a day in the outpatient department [there] you can see up to 100 patients!  They can do up to 100 surgeries in one day, of course with different surgeons, so maybe there will be six [operating] tables.

Where was this?  You said it was your attachment?

In Dar-es-Salaam, in Tanzania.  It's a hospital called CCBRT.  It is sponsored by CBM, Christian Blind Mission.

And the attachment- is that like your residency training?

Yes, where you do the hands-on training.

How did you decide to do ophthalmology?

Well I developed a passion when I was a student doing general clinical medicine.  We had a program where we rotated through the hospital.  We had just an orientation to the eyes, ears, the different specialties.  So when I came here [to Lusaka Eye Hospital], there was an eye surgeon who actually initiated the whole program.  Even the hospital, actually, is like his brain child.  So he was the medical director then at this hospital.  So when we went into [the operating] theater, he gave us some homework to do.  "I want you to look at this and this and this," he said.  So I started reading and started getting interested.  When I came back, he said, "I think you have a passion for this.  Why don't you start thinking about doing ophthalmology when you finish your training?"  So from then I started developing that interest.  I applied at this hospital and was picked!  Before I even did any ophthalmology training.  And this hospital sponsored me to do clinical ophthalmology here for two years before I went to Tanzania for cataract surgery training.

What do you like most about practicing in ophthalmology?

Ophthalmology is a very interesting field because- especially in my capacity as a cataract surgeon- here come these patients who cannot see for years, maybe two or three years.  Then I do an operation on this eye and the next day they are able to see and are jumping up and down.  That gives me so much joy.  I feel so happy when I see somebody who was not seeing then after a fifteen minute surgery, the following day they are able to see.

What do you think are the biggest challenges in your job?

I think the biggest challenges have to do with equipment.  We are just a developing country.  With the limited resources, we are able to do our best.  But IF we had the up to date equipment, I think we could do a tremendous job.

What are your career goals?

There are some barriers in terms of career progression.  If I want to do something higher it means I have to divert a little bit because there's no straight path to go and do a master's or anything.  So it means if I want to go and do something higher in ophthalmology I need to do public health, primary care...

Oh, administration.
...administration, that sort of thing.  So I'm planning to still remain in my practice but I may do something that will do with administration.  I still have the passion to have the hands-on with the patient- that's what I enjoy most.

Did you grow up in Zambia?
I was born in Zambia, grew up in Zambia.  Of course I've gone to a few African countries, like Zimbabwe, Tanzania, Congo, Angola, but Zambia's home.

A few random questions- how many people are in your family?
I have a daughter and a wife.  My daughter is six years old.

What's your favorite food?
My favorite food is rice.  Rice and other things you can mix it with.  Of course nshima is our staple food but I think rice is my favorite- rice with beans, rice with chicken, there's a lot of things you can add to it.

What's your favorite thing to do in your free time?
I like nature walks.  I just go walking around, enjoying nature.  I like watching these National Geographic channels where they just show animals.

Thanks, those are all the questions I have.
Thank you so much.