Volunteer Optometric Services to Humanity

VOSH Southeast Cameroon Mission 2010

May 26-June 3, 2010 VOSH Southeast had an extraordinary eye care campaign in Bamenda, Cameroon. In preparation for the trip volunteers learned that Cameroon is “Africa in miniature”, as a geographically diverse central African nation on the continent’s west coast. Indeed, our journey exposed us to industrial ports, flatlands, lush, tropical regions, mountains, and beaches. We also learned the myriad towns and villages of Cameroon each have their own dialect. French and English, however, are the official languages, as vestiges of colonial eras, and link the varied regions together. Other facts we learned: it is a developing nation rich in natural resources. The predominant religions are traditional indigenous beliefs, Christianity, and Islam. The same authoritarian president has been in power since 1982, though the country is a republic. We also learned that medical facilities do exist in larger cities, for those who can afford it. Thus the purpose of our trip was to help bring the gift of sight to people who do not have access to eye care, in a distant, more rural location. We prepared for the trip to better serve those we came to help. Reading about a foreign country is one thing; it is quite another to be there. Being in Cameroon, we learned and experienced so much more.

We flew (at least 24 hours of flying time) into the humid industrial port city of Doula, Cameroon. By bus we traveled mostly paved roads, stopping every so often as required by security . We made our way through increasingly more rural and forested areas, where people stepped up to the bus to sell nuts and fruit. As it rained, we passed palm, coconut, banana, and other fruit trees. The many hours long ride gave us a chance to get to know one another; the bonding had begun! Eventually the steep grades and tight turns upward brought us to our destination.

We arrived at the remote highland town of Bamenda, in the northwest province late at night. Our teeming bus pulled up to the convent where we were to reside for the duration of the mission. There, the Sisters of La Verna welcomed us in. The dormitory was on a hilltop, with high walls of security and privacy surrounding the perimeter, somewhat forbidding at first appearance. In the morning, however, a tropical panorama was unveiled as we looked out from the second floor. We gazed beyond the concrete at the palm tree covered hillside, with gray houses and large gardens dotting the expanse; emerald mountains loomed in the distance.

After breakfast, which included fresh papaya (and in some cases fresh ginger!), we loaded onto the bus and headed down the hillside through the busy streets of Bamenda. This little journey every day was our opportunity to observe life in action, outside the confines of clinic. Motor-scooters zigzagged amongst automobiles, cyclists, and pedestrians. Children in crisp uniforms walked by hand in hand on their way to school; adults strode by dressed in urban fashion for work. Young ones towed even younger children precariously on carts and made their way through the traffic. Minibuses drove by with live goats or chickens tied to the top. Women set up stands to sell produce, grilled meat, or bread. Men were digging trenches. There were shops of every sort open, and men were washing cars, working metal, or creating furniture. Upholstered furniture was showcased outside—what was done to protect them during the punctual afternoon rain? People were everywhere, moving or standing, and ubiquitous soldiers dressed in tan uniforms observed all. Buildings were variably constructed: the few multi-storied European style structures stood amidst the multitude of wooden shacks with tin roofs (and without window panes). Some were visibly wired for electricity. Many were not. There was a mosque in the distance, as well as government offices, a hotel, a small pharmacy, and other shops. Most of the buildings bore signs hand painted in English. Some roads were paved in brick, the frontage unpaved and lined with open canals. In contrast to the tropical hillside, in town the dust and vehicle exhaust were pervasive.

Finally our bus would reach the open gates of the St. Blaise Diocese Catholic Center grounds, high on another hill, which included classrooms, dormitories, and playgrounds. Children played soccer and other games, or stood in line looking wonderingly at us. A great mass of people of all ages waited outside the large assembly hall where we set up the clinic. The anticipation was palpable.

The people were friendly, brightly faced, and very beautifully dressed, most often in colorfully patterned, traditional clothes, some with their hair in matching wraps. Mothers had their infants snuggly tied to their backs with a shawl or blanket. Many identified their occupations as “farmer”, “trader”, or “student”; but there were notable exceptions, such as “film maker”, and “Fon”. They came to us from Bamenda and surrounding villages and mountains. Many had never had an eye exam, and I am sure we looked strange with our retinoscopes and ophthalmoscopes; yet patiently they endured our examination techniques. We enjoyed their smiles and their sincere “thank- you”.

Following are two vignettes shared by first-time VOSH volunteers:

There was one elderly woman who had an eyeglass prescription with a lot of astigmatism correction, quite unique. Her exact eyeglass prescription was not in stock; the doctor did not speak her native tongue, and she did not speak English. Glasses that were a spherical equivalent were tried on to determine if that would improve her vision better than nothing at all; as soon as the glasses were on, the woman was happy: the lines of her face lifted, and her eyes lit up. The doctor slipped them off for a moment so that she might compare, and her face fell. As the glasses slipped back into place, like a switch the joy immediately returned! Another doctor relayed the instance of a rather stoic man in his late twenties, tall, thin, and dressed for work in white oxford shirt and black pants. He had high myopia. Glasses matching his prescription were available. He tried them on, and as he looked across the assembly hall at the sign posted on the stage, his face changed into a wide smile… his eyes became wet, and he quietly but very sincerely said, “ this is good, this is good.” Those were his first glasses.

Over the course of six days we did our best to serve approximately 5500 people, working increasingly as a totally unified, seamless team. We were blessed to have the wise leadership of Mr. Charles Covington as mission leader and Dr. John Spencer as clinic director, as well as the guidance of Dr. Valentine Lah, the chief administrator of Noah’s Ark, our host organization in Cameroon. Dr. Val’s sister Lucienne gave her invaluable support and friendship. We appreciated the time and care of Mary T, Inc. and Angels of Mercy. Two volunteers of St. Blaise clinic named Bridgett and Slim were instrumental in helping with blood glucose and blood pressure measurements, as well as translating the local dialects and Pigeon English to us. Jean, an optician from Congo, helped with eyeglass dispensing and was eager to learn eye care skills. Another local volunteer, James, was available for help as needed. Every day of clinic a lunch was prepared for us, and we rotated in for a few minutes to enjoy a delicious, heartening break that enabled us to continue helping more patients.

The first day, some time was spent setting up the different stations of eye care screening, then modified slightly in the days thereafter until streamlined. In this manner, the number of patients accommodated rose from 302 on day one to well over 1200 on the last day. Queue formation, registration, and visual acuity measurement were performed by volunteers under a tarp outside. Then, as determined by visual acuity and triage, patients were directed through the following stations: autorefraction; refraction; direct ophthalmoscopy; intraocular pressure measurement and dilated eye exam; blood pressure and blood glucose measurement; eyeglass dispensing; and eyeglass adjustment. Volunteers guided patients as needed. The eyeglass dispensing stations were divided into hyperopic prescriptions and myopic prescriptions. Others filled out cards that registered them for custom eyeglasses due to unique prescription need. Alison Leung, one of our optometry students, translated French as the need arose. All was photographed by another volunteer, so that a portrait of people and events may be shared with family and friends, and hopefully to help entice future volunteers.

Over 14,000 sets of eyeglasses were organized and labeled according to their prescriptions prior to the trip, and packaged neatly so they were easily retrievable as needed during the mission. Hundreds of ophthalmic medications used in the diagnosis and treatment of infections, glaucoma, allergies, inflammation, and dry eye were acquired through solicitation and donation for the trip. Many volunteers brought ophthalmic equipment such as ophthalmoscopes, diagnostic lenses, trial lenses, batteries, and retinoscopes. We were grateful for the binocular indirect ophthalmoscope and the Perkins tonometer. A manual of ophthalmic diseases in tropical locations proved useful as well.

There was so much need. The lack of clean, disease free water in Cameroon was daunting, let alone the paucity of accessible health services. The most prevalent complaint was “itchy eyes” which initially was attributed to allergy and dry eyes, as it would be in America. We soon learned however, that such symptoms also warn of the parasitic disease onchocerciasis, also known as “river blindness”, which is endemic in Bamenda and surrounding areas. It is transmitted by the bite of the blackfly, which breeds in local water. Cataracts were even more common, and farsightedness (hyperopia, presbyopia) was by far the most common visual complaint. Systemic hypertension was not uncommon in adults, nor was diabetes, and associated retinopathy was often seen. Glaucoma was frequently detected, even in children. A plethora of diseases were diagnosed, including but not limited to: Marfan’s syndrome, choroidal tumors, retinitis pigmentosa, strabismus, albinism, and congenital optic neuropathy. We were able to treat many conditions, including glaucoma, infections, and inflammation.

It was very difficult to relay a serious diagnosis to a patient or family member that we could not ameliorate, due to end stage disease or the need for tertiary care. Although it was important to remain objective for the sake of clear clinical judgment, it became hard not to personalize those situations. Those elderly patients and those children started feeling like our own, and at times it was very, very hard.

However, the dispiritedness of times like that was lifted by simply looking around the auditorium at the rest of clinic, and witnessing the entirety of care and service taking place. Medicines were dispensed, glasses were adjusted personally, ophthalmic guidance was given, people were directed, eyes were examined, blood pressure and blood glucose were screened, people were reassured and relieved to find out that they were fine… and volunteers were being positive and receiving the true gift of feeling the goodness of giving of themselves. The solidarity and grace of everyone in the room was very real.

One evening the VOSH group was invited to the home of a policewoman and her family. We were treated to a wonderful evening of delicious food and conversation, and were introduced to the local police chief, (the hostess’s supervisor), which was an honor. The host, the husband of the policewoman, gave a gracious welcome to us, and finally told us that he had been a patient in the clinic the day prior, and had been deeply moved by the compassion of one of our volunteers, particularly when she asked him to put his hand over his heart and promise to go to his doctor to address his medical condition. The volunteer of course had no idea until that precise moment that she had made such an impression, and it was touching to see this strong lady turn many deep shades of pink.

Another enlightening evening after clinic was spent at the Fon of Chomba’s palace, high on another mountain. The Fon is a chief of a village. Thus it was an honor to have been invited to his home and given a personal tour, as well as to meet his warm family and to partake of their personally prepared generous dinner. He was very open and affable with us, and encouraged questions, so that it was quite a fun and lively evening.

Most evenings were spent at the convent, where we got to know each other better, and relaxed in the dining room with dinner or out on the second floor balcony. Those were the times when the data of the day were tallied, and afterward we just relaxed and learned a bit about where everyone was from, where they have been, and what they hope to maybe do some day. Many volunteers were experienced VOSHers, but some were new to the whole adventure. The twenty -four volunteers were from all walks of life, including seven optometrists, two nurses, and one nurse practitioner. We had the good fortune to have six hardworking and congenial students from the University of Waterloo School of Optometry. The volunteers were:

Charles Covington, Sr. , Mission Leader

John Spencer, Clinic Leader

Christopher Mastores

Salliane Whitman

Se Xiong

Gurdaman Sarvaria

Casthoory Viswamathan

Shaninaz Moosa

Mariam Nahal

Palki Arora

Alison Leung

Alice Rummer

Joseph Pruitt

Eva Page

Victoria Landon

Sue Ellen Brauer

Stephanie Mastores

Stanley Sagara

Laura DeMent

Jeanne Forrey

Jeffrey Forrey

Douglas Whitman

Cliff Morris, Jr

Caryl Mikrut

The last day of clinic was May 31. That evening we packed our belongings. On June 1 we traveled by bus to the coastal town of Limbe, about a day’s bus ride, and stayed in a seaside hotel that overlooked a black sand beach and the warmest ocean water ever. Several volunteers left for personal travel the following day. The eleven of us who stayed in Limbe until June 3 were able to go to a market in town to do a little shopping, as well as enjoy a tour at the Limbe Wildlife Sanctuary. We also had a delicious lunch at a grill on the bay, consisting of the most delectable fish with chili sauce… That final day everything seemed to be a shade of grey--the sky, the water… The silhouette of the fisherman balancing in their boats was picturesque, if a little paradoxical given the oilrig and the thankfully obsolete relic of the trading docks also in view.

“You can’t return without bringing something back or leaving part of yourself behind.” It was overwhelming and humbling to try to help so many people in such a short period of time. In the process we made friendships that I hope will stand the test of time. Certain memories haunt: the children with their doe eyes shyly observing… parents proudly holding their babies, no matter if they’re blind… being tapped on the shoulder and suddenly given a hug by a patient who loves her glasses… and the wonderful feeling of being in Africa…the laughter…the mist settling over the hills just as the sun set… the rain, the storms… the distant call to prayer echoing over the valleys… the quiet line of nuns on their way to Church before dawn… the dust… the wide, clear view of Bamenda from up high as we drove away…

Being in Cameroon, we saw first hand the need for eye care, clean water, and general health services. We learned that delivering care involves challenging complexities far beyond simple language translation. We experienced some of the rich culture of Africa, the warmth and dignity of a people. We were a part of something bigger than ourselves. Impacting the lives of others, we were the ones transformed.

Submitted by E.M. Page, O.D.