May 23, 1996
Vol. 15, No. 18

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    Aboard DC-10 in Bangladesh, physician helps patients see again

    "One could see from across the room that the patients had cataracts. Markedly dense cataracts," recalled Kenneth Goins, Assistant Professor in Ophthalmology & Visual Science. "And Bangladesh has a backlog of 50,000 to 100,000 people, all waiting for surgery, operations that most of them will never receive."

    Goins spent the first week of March in Dhaka, Bangladesh, reducing that number only slightly but training the local physicians in the latest procedures in corneal and refractive disease. He went as part of a mission led by Orbis, a philanthropic organization devoted to eliminating blindness all over the world.

    Each mission brings three ophthalmologists -- in Dhaka, the specialists were trained in glaucoma, retina and cornea -- to economically disadvantaged areas across the globe that lack modern eye care. As one specialist teaches, another operates in a live setting or in a surgical wet lab with cadaver eyes. Local physicians attend the lectures and watch the surgery on live video. They can even quiz the surgeon over an audiovisual system that connects the lecture hall to the operating room.

    "The day that I arrived, there were 500 patients waiting," said Goins. "I examined 70 patients with specific corneal and refractive diseases and picked 10 of them, usually children or adults with vision loss in both eyes. We were able to help all 10 patients, but that meant there were many that we didn't have time for, and many more that we never had a chance to examine."

    Typical of those chosen was a 5-year-old girl who had been riding in a rickshaw when a bomb went off. She lost both hands and sight in both eyes due to corneal scarring and cataracts.

    "She could distinguish light and dark," said Goins, "but that's all, no shapes, only a blur." He performed a cornea transplant and cataract surgery with intraocular lens implantation to restore sight in one eye.

    "She was so frightened," recalled Goins. "When the Orbis staff first examined her, and in the morning prior to surgery, she was constantly crying. I had no idea what she was saying, it was all in Bengali, but you didn't have to understand the words to guess how she must have felt. Then, 24 hours later, the day after surgery, when I took the patch off and she could see me and count my fingers, she finally settled down. She even smiled. It was an experience that reminded me why I wanted to be a doctor."

    In one week, Goins gave eight lectures concerning cornea transplantation and refractive surgery, cataract surgery, phacoemulsification and management of astigmatism. He trained local physicians in the surgical techniques of corneal transplantation and cataract surgery, and he performed 10 operations: four cornea transplants, four small-incision cataract surgeries and two secondary intraocular lens implants.

    "These are all common procedures in the United States," Goins said, "but the average ophthalmic surgeon in Bangladesh is about 10 to 20 years behind in ophthalmic technology. They're fine doctors, and they're absolutely devoted, but they just don't have access to the newer techniques and equipment."

    For one week, however, they had great equipment. Goins' operations were all performed on the Orbis plane, a DC-10 that has been converted into a flying eye hospital.

    "The plane is awesome," said Goins. It has a lecture hall that seats 50, multiple video screens, an audiovisual center and a state-of-the-art operating room. The physician audience watches a live broadcast of each surgery and occasionally interrupts with questions.

    "It takes some getting used to," Goins said. "I usually have one or two residents with me in the operating room. But on the plane, while I was adjusting to all new surgical equipment and nurses that I had never even met before, there were also 50 doctors barraging me with questions -- 'How did you do that?' or 'Why do you do it that way?' It felt a little awkward, even intimidating at first. But we were all too busy to worry about that for long."

    They had other things to worry about. Goins reached Dhaka after 48 hours of commercial flights, thanks to donated tickets from United Airlines and British Airways. After flights from Chicago to London to Delhi to Dhaka, he arrived late Saturday night. The Orbis plane, on its way from another mission in Bangalore, India, had reached Bangladesh earlier. The physicians met on Sunday morning, screened patients all day and prepared to begin lecturing and operating the following morning.

    Monday morning a general strike shut down the entire city. None of the patients could get to the plane. Tuesday was business as usual, but Wednesday a threatened strike, which never took place, nevertheless paralyzed the city all morning. No patients arrived until noon, "so we stayed up operating until about midnight," Goins said.

    The next day, the medical team learned that despite cancellation of Wednesday's strike, 15 people had died from injuries during a confrontation in another part of Dhaka. Thursday was smooth, but another strike was planned for Friday. "At this point," said Goins, "the physicians began to get a little concerned about how they were going to get out of there to their own homes."

    In fact, Orbis decided to cut this visit short and flew its plane out two weeks earlier than planned. Undaunted, Goins is already making plans to return for an Orbis mission next year.

    "The mission has allowed me to examine my life from a different perspective," he said. "Whenever I get frustrated in doing paperwork, filling out grant applications, or trying to keep up with a busy clinic, I think about what the doctors who live in Dhaka year-round have to face and the limited resources that they have to face it with. Compared to them, I'm living like a god."

    -- John Easton