Here They Aren't, So Quickly

Today’s outreach was disastrous. Even ignoring the appalling patient turnout, which may be considered the sole bright spot on our short-lived clinical visit to Gbalahi village, it is hard for me to imagine the couching of more folly through such a limited frame of time. First it was the car engine, which whinnied and sputtered, but refused to turn in the morning. Then it was the reading glasses, generally brought in grand variety, every power from +1.00 to +3.75—we grabbed the wrong bag, leaving us with 4 different powers instead of 11. Then it was the nurse’s defunct ophthalmoscope, which confused us for the longest time until we finally cracked open the battery chamber and found a vacant, spring-loaded hole staring us in the face. The owner of the scope, Sister Beatrice, our ophthalmic nurse for the afternoon, asked if we had spare batteries, to which I responded in the negative. It was then that I thought about Ali’s absence from the outreach, for he had jumped a 13 hour bus from Accra the night before and would doubtlessly arrive casually, if not unacceptably, late to the event. So I called Ali, asked him if he could pick up the batteries on the way to the outreach, and he gladly obliged, albeit with the caveat that his tardiness would be more extensive than before. Truthfully, it was irrelevant—the patients dropped in one by one by one, leisurely and ungrouped. The recording computer was dead. It was hot and sticky and Razak, our trusty transporter, was passed out on a shaded bench, body spanning a length of six patients that, for whatever reason, weren’t showing up today. It was laughable and, I hope, an aberration from the massive outreaches that typify the Unite For Sight program in Tamale. This was our first outreach as a trio— Safari Sam, Snake, and I— and I’m left thinking longingly about the missing parts of our former octet. So, as I did with the last group, I’d like to memorialize them here.

To Dolpho, my roomate, confidante, and storied consultant on feminism and its manifestations in the developing world, I am sincerely grateful for what I’ve learned from you. To be concise, you are impregnably Rudolph Wong—fast-talking, smile-ridden, last-word-having, sometimes-wrong-but-never-in-doubt. You relish your strengths, refuse to fear your weaknesses, and appreciate most the people who won’t accept anything other than the real, bona fide, bullshit-less Rudy. I like that— admire it even— and after finding my own identity and emotional self on shaky ground following this tumultuous year, it was refreshing and instructive to watch you be. I am more confident, comfortable, and ultimately happier in my own skin as a result. The gravy: your infamous one liners dropped like pancakes on our lovely female griddles (“So Nicole, how are the sunsets in Iowa?”), the sincere apology delivered to Mr. Feminist, the Camfed Slogan Affair that almost got you verbally castrated, the sunglassed, Harpoon hatted, Banana shirted, Aldo shoed, slick haired figure that sat behind the drop desk and 5 standard deviations away from the average group dress code (probably 7 SDs from mine), your extensive and well expressed medical acumen that you promise we “will all acquire after a year of medical school.” I’ll hold you to that, Dolpho, especially when I see you in Boston somewhere down the line...

To Lily Flower, the ever-interesting Ellen Degeneris of the Unite For Sight realm (and I mean that in the most flattering of ways), with lightning fast quips, views loud and pressing onward like Prussian armies, and hilarious stories to the hills about life, liberty, and how EMTs can shy away from hangovers without limiting their intake. To express my favorite Lily scenario among the swelling file of choices would be far too difficult in my current state. Instead, let’s just leave it at this: no one comes to Baobab to buy glasses from us anymore... On a final note, I thought you were an incredibly responsible, conscientious, and progressive part of our team. Volunteering to undertake the custodial duties required to manage our data and accounting record showed me immediately that you had a professional attitude toward UFS and I, for one, appreciated that immensely. Best, best, BEST regards as you enter medical school and I’ll catch you if I’m ever in Blacksburg (I think that’s where V-Tech is...)

To Nicky C, the sweet and spicy, hectic electric Iowan who had the cajones to do a public impression of me (Disclaimer: I do impressions of everybody I’ve known for any length of time, assuming they’re idiosyncratic enough, but rarely receive an accurate rebuttal), I will miss your partnership in Type-A crime. Timeliness, efficiency, precision, progression—these were the desired grapes of our obsessive wrath and I appreciated how devoted you were to those criteria. With studying for the MCAT on your plate alongside volunteering, I was concerned that you would fall out of the group dynamic as a few others had previously. Of course, you would probably respond, laugh rising and palm vertical, “You. Don’t. Know. Me. Jordan,” then appropriately slapping the table, “I will be at every group dinner, at every movie night, every night at Mike’s Pub, I can make everything, the MCAT stuff will. Get. Done. Period.“ and, of course, you would be right. At the very least, I’m happy you made every dinner, since it “Alot-ed” me a guiltless extra helping of spaghetti or fried rice each time. But seriously, it was great working and talking with someone who operates under paradigms similar to my own (putting aside political persuasion). More than anything, you’re just a downright fun person to be around, so much so that even my solemnest moods were softened in your presence. You are going to perform swimmingly on your MCAT, gain admission to a very fine college of medicine, and become an unquestionably devoted physician and mother (though probably the first before the second). But in the meantime, get me that stint we talked about on a farm up there—I’m making a photography book entitled “Iowa Skies for Rudy’s Eyes”.

To ‘We Jamen’, the baby-loving, Cali-repping, sweetness itself wrapped up in a long dress and bound with a floral headband, it always brought a smile to my face to see how much this trip meant to you. From the group’s first bonding in Mole to our most recent revelry at Mike’s Pub, it was clear that you were genuinely happy and comfortable and relishing the moment so much. On the outreaches, you were perpetually engaged with the patients, particularly our pediatric cases, and having a blast at any and all stations—no one dropped conjunctivitis patients with your panache. We talked ad nauseum about the ins and outs of being pre-med and med and I thought it was so, so commendable that you candidly revealed your doubts and struggles with pre-med life. Regardless of grades, scores, and the overly competitive and self-righteous attitude typical of a high-octane pre-med, you have an empathetic edge in patient relations that is instrumental to the proper delivery of quality healthcare. It doesn’t take an academic genius to diagnose cancer, but it takes an emotional genius to shepherd the patient through his/her treatment. You’ve got that emotional IQ, especially with children, and I know that, if you want it, you’ll be a splendid doctor. Just don’t forget to join the Skype discussion between Snake, Ni-NAHHHH, and I when you crawl into the lambent caverns of organic chemistry.

To Ni-NAH, Nina Pinta Santa Maria, Niña, the person whose wavelength, hewn from the right blend of life-loving chill and New York assertion and liberal collegiate passion, we’re all trying to get on, it was a privilege getting to know you over the last month. There is much to recount in that month, beginning with the three days you, Safari Sam, and I were waiting eagerly for the new bloods (memorialized above, plus Snake, who is currently aloft in a mosquito net of dreams) to arrive. We had two of those long, personal, everything-under-the-sun conversations common to people our age and I came out of it with immense respect for you and with a stronger, more comfortable grip on life than I had before. The points of intersection were innumerable— the enigmatic process of figuring out what kind of doctor one should become, the common pathologies and smile-worthy moments of long distance relationships, cultures driven by alcohol and how different we are from our siblings and the local market value of various energy bars, since I was long Cliff and you had reasonable positions in Zone Gold and Market Pantry Fudge Graham. We went on literal mango runs with Alot, searched far and wide for the ‘sickest rays’ in Tamale (...well, TICCS at least), gutted enough Spanish omelets at Swad to declare our own Inquisition (must note Dolpho as a contributor), and led surprisingly triumphant 4^th of July plans. I eagerly look forward to ordering “The Jordan” at the practically existent Mimi’s Panini’s, I will not soon forget “I am LARGE and IN CHARGE,” and I’ll be sure to put a Bianco Farm visit into my New York itinerary this fall. Though, you should know, I am expecting to drink fresh goat milk out of the calabash, so guard it well.

To all of you, thank you for making the last three weeks meaningful, productive, and genuinely, humanly fun in the few ways that college is not. Salud. 

The Settling

I haven’t shaved in six weeks. My cheeks are pink, my nose a medium rare, my arms a pair of boles freckled brown. To exercise, I employ the boughs of two flowerless trees staked beside a white house and a curl-able metal bench parked beneath a thorny canopy just next to the trees. As of late, I frequent a “local gym” two blocks down, my friend Albert takes me there on a motorbike. They lift factory gears, stump teethed and rusted orange, hooped on axel rods and yank on a single overhead pulley, fashioned from long, splintery beams erected in the ideal of Robespierre and anvilled with bulky plates leashed by chain. It’s outside, the gym, and yarded by sixty feet of undulated roofing turned on its side. Enormous are its patrons, arms locked laterally and repelled from the waist, irrigated surgical-looking lines separating the packs of fascia along their backs and stomachs, a deliberate lumber woven into their strut. Everyone is a personal trainer, everyone is a client. I eat well, hardly the petrifying slumgullion portended by my parents; I’ve developed a predilection, in fact, for Ghanaian cuisine. Cold showers are no longer cold—the breathlessness accompanying the initial spray is now terrifically sensational, awash with pleasure and shock enough to warrant daily use. Many times over I recycle pants, and most of my socks are baked red in the toe with hot dust. Some days I wear underwear, and I seldom smooth sun block into my skin. Missing my girlfriend has become an institution more than a romantic bane and I hardly visit the internet café, hence the long stretches of postlessness on this blog.

            It’s a strange feeling to be settling in such an unsettled place. Simultaneously, I feel both an urge to pick up and jump a flight to the States and the Siren lure of worriless life reeling me in, tangling me in the unending topiary of disposable Ghanaian time. The way people are here, enveloped willingly in an omnipresent womb of laughter and language and human touch, one would think they harbored lucrative treasure maps in the brilliant upchuck of multihued headscarves, dresses and shawls. What richness they possess is palpable, flaunted well through the universally relatable phenomena of laughter, language, and touch as they exist here. They are, collectively, the pitch fork prodding my thoughts of staying and going, of remaining and changing, of malingering and straining.

They laugh when I speak their language. They laugh when I can’t speak their language. They laugh when we greet, they laugh when we depart, and they coolly sluice the soft flow of in-between dealings and reminiscence in laughter, as though we are all unabashedly naked and bubbling up in the equatorial convection. It’s nice, to put it tritely, being blithe all the time. So ensconcing is the lightness that I even tell jokes in Dagbani—one joke, to be precise. When taking patient information from the elders of a village, donning their finest Rip Van Winkle smocks and flowing dresses that accuse O’Keefe’s oeuvre of being fallow, I ask them how old they are, “ayumallah” in Dagbani, and following the “66” or “72” or “76” they serve up, I retort, “un pischy?”— 20 in Dagbani. They laugh every time. A bodily laugh that hobbles them and turns my wrist into a banister gripped impulsively so that they may climb back to an upright and smiling position. Interactions here are processional, the pedestrian kin of royal greetings flooded with camera flash and white teeth, except there are usually no cameras here and the dental situation remains thoroughly unimpressive. Greetings go on for minutes among a group, each member offering a genial “desibah” (Good Morning) to be emphatically recompensed with “Nah,” a placeholder of a response whose meaning is tacitly understood, but hardly explicit. How are you?,  how did you sleep?, what cool weather we’re having, how is work?—the salutatory drumroll patters on until all parties are thoroughly satisfied or, to be more exact, Nah-ed out. It’s like small talk at a summer gala, except no one has a loft in the Hampton’s or heaps of low-fidelity gossip about so-and-so’s divorce. Rehearsed, clean, uncorrupted—a locutional sterilizer priming the conversational palate for dialogue.

And another thing: touch is not strained, stigmatized, or taken for granted in Tamale. Handshakes draw out slow like long blades and end with an emphatic snap that requires the cooperation of both parties. I am particularly fond of the Ghanaian perception of hand holding. Amidst a thick, lascivious cloud of anti-homosexual sentiment billowing over the African continent, men can be found quite regularly holding hands with other men, and women the same. “Holding hands,” our coordinator Ali tells me as he hooks a few of my fingers with his, “it’s like I am saying we are friends, brothers, it’s like that, not like...homosexuals or we are in love.” Same goes for hugging, but for reasons I do not yet understand (probably British influence) Ghanaian’s refrain from kissing in public. Candidly, I’ve never felt so physically comfortable in my life in the presence of complete strangers, shaking and holding hands between sentences and laughing and volleying greetings like green tennis balls. It’s what I’ll miss most when I fulfill my obligations here and journey back to Chicago for the rest of August.

So, I have two weeks left in the russet loamed lands of north Ghana. That means I should be able to put out a few more blog posts about my experience. The next one will likely be an homage to my current comrades (Safari Sam, Ni-Nahhh, We Jamen’, Snake, Lily Flower, Nicky C, and my roommate Dolpho). Until then, live lively everyone.

The Sightly and the Bittersweet

For the optically challenged patients of North Ghana, post-op day harbors a spirit akin to Christmas in the summertime. Everyone gathers early morning in a sun soaked corridor flush with emerald clothed nurses and a coarse drywall awash with russet wear, giving the appearance of superbly toasted bread. At the end of the corridor is a consultation room outfitted with blue beds and kidney bean pans ballasted with saline gauze, stacks of surgical gloves perched beside two metal examination chairs. The patients, sheepish in their plasters and morning gowns, are a varied bunch (at least as far as attitude is concerned). There are those who understand completely and without question that they have just undergone sight-restoring surgery, their perception unblemished by the fearful baggage attached to the term “operation”. Then we have the willing, but uninformed, surgical patients who are aware that their vision will be restored, though the method of restoration remains unseen. Last are the “eyewash” patients, who deeply reject the premises of surgical remediation and will only subject their eyes to a traditional washing. So we invite those patients for an eye washing, one complimented by syringes, scalpels, and local anesthetic.

And now, we take a short commercial break from the Unite For Sight Christmas Special to bring you an extra important topic for discussion: patient consent. Many of you, healthcare affiliated or otherwise, probably question the ethics of the “eyewash” strategy employed here. In the States, it would doubtlessly be considered poor form, and likely malpractice, to trick a patient into having an elective procedure once they’ve balked, save for choice instances in which the patient is unsound of mind or is unable to render edified communication on the matter (i.e., is unconscious). In rural Ghana it’s different, the game is rigged from the beginning. Finger wagging elders, power-endowed by the calcified austerity of their steel wool beards, warn villagers against the practice of modern surgical medicine. They brand the term “operation” with manifold images and anecdotes depicting surgery as a macabre, ungodly, and inferior form of bodily therapy.  Imagine routine cavity patients refusing a filling for fear of the spirits melded into the alloy and you’ll get the picture. Instead, they swear by the familiar cure alls of local herbalists and medicine men— not that we necessarily disagree with the work of herbalists and medicine men. In fact occasionally, spiritual and traditional healing methods are given haircuts and called Western medicine. What we quarrel with is the scarlet letter drawn on our method that is proven beyond a shadow of a doubt to restore vision to the blind. And no matter how scientific, how thorough, and how persuasive we are in our quest to exonerate the “operation’ in the eyes of some of our patients, we are brow beaten by the deep driven stakes of African tradition. Then, for the time being, we play Jacob to sightless Isaac, albeit we aren’t quite as selfish or black hearted, out of necessity more than intentioned dishonesty.

Back to Christmas at the majestic King’s Clinic, where the girdered wheel cots are bountiful and the pace sluggish as a blood-bloated mosquito. But we’re a world apart, our lithe tones shimmying through the hinge of the consultation room door as we instruct, two at a time, the patients to kick off their sandals and “jzinema” (sit down) in one of the chairs. Gray edged tape and rosy gauze fly off like wrapping paper (I know, how much more predictable can a simile get?) and moments after we wipe the eye with saline, the patient can see. I won’t even posture as to what it feels like to regain sight after months or years without it, I’ll just tell you what happens. Patients over the age of 75 who formerly ambled taut-cheeked and stiff-eyed into pre-op now jumped up and down at the refreshed visage of color and light. “Sulaminga!,” one bilateral cataract patient shouted over and over again, identifying correctly each of the foreigners pulling bandages and wiping gunk on the other side of the room. The entire post-op process takes 30 minutes at most, but the resulting reactions are well worth the hours of screening, administrative tasking, pre-op, op, and post-op we all contributed to the process. And beyond the instant gratification of witnessing the patients take in the world I am very curious to see the longer-lasting results of our work–returning to the farm, greeting friends eye-to-eye, and most importantly, seeing grandchildren for the first time (Alhassan Iddrisu, I’m pointing at you).

***(The next part of this blog is about the other volunteers on this trip and is not critical or relevant to anything said above...so feel free to skip it...or read it in full if you have some extra time and a substantial latte on hand)****

On a soggier note, four of the volunteers shipped off to America yesterday. Someone once told me it’s always tougher to be the one left behind, and for the moment I’m beginning to understand what she meant. So I’m going to talk about them for a little bit and hopefully exhale any of the sadness lunged up from their departure. To Poy and Lynn, you two were a chimeric paragon of efficiency. Never in my life have I seen a two-woman team move so quickly, extensively, and bilingually as you both. You documented, formalized, created, dropped, refracted, visual acuitized (?), and played Wanye’s Angels to admirable degrees and as a result, I know the program, its contributors and its patients have benefited incalculably. To Laiyin, who had the most languorous journey on the planet from the States to Tamale and arrived jet, bus, and car lagged at her first outreach less than a day after landing in Accra, I was so pleasantly surprised at how quickly that mildly cranky Boston med student turned into one of the most capable, medically curious, and visibly compassionate people I’ve come across. You were like a mother to our group—I remember numerous instances when, mid-task, you would ask me or the nurse or anyone else around if he/she wanted something to eat or to drink or to take a break if we looked too sun beaten to function. On a very different note, I appreciated and admired your willingness to join the “boys-boys” culture created by the “A Lot of Tings” crew. Whether enduring the small and reasonable tussle at GIDDYPASS (Crest is passé, I’m telling you) or macheteing through the grove of cowlicky locks nesting atop Pietro’s head, you created an atmosphere of openness, positivity, and spontaneity, which is exactly what this trip is all about. So thank you! And to Chops, my brother from an endocrinologist mother and business partner in the newly christened African Rainbow Summer Camp, thank you for tolerating the multiform beast of witticisms, unnecessarily deep conversations, and nightblind fumblings I gestated and birthed in our time here. There are truly too many memories to count, so I’ll just reference a few on this blog, you know, for safe keeping:            

-       “I was not in Tamale”

-       ‘pum pum pum pum pum’

-       ‘Ok, so, you get a motobike...”

-       Reviewing Joseph’s file

-       Thinking I was a comic genius after “the pot calling the kettle black” and being Dagbani hustled by Mr. Dresses Like Rick James

-       All of Salam’s comments indicating that things simply “did not happen”

-       All of Pietro’s comments awakening our senses to a cleaner, funnier version of the way things did happen

-       And finally a childhood milestone that I recently stuck to my mental refrigerator: Alot finished his first calabash and brought it to my room today to present it. At 7:30 in the fucking morning.

As I closed the door, he said, “So now, if I make it with the glaze, I can make it very nice, with the glaze, it is 5 Ghana Ce...”

I’ll stop now, but seriously, becoming friends with you over this short period of time was awesome and the diamond-flush coalmine of memories we’ve amassed in such short order is (hopefully) indicative of how many more we’ll create when we meet up for a reunion. Who knows, maybe you’ll even see me at Myrtle Beach again... (there are no winks large enough on this computer, but you can imagine how hard I’m winking right now).

Take care everyone and though you’re already re-exposed to the familiar patriotic oeuvre of American culture, please don’t forget the following:

It’s nice to be nice. Sharing is caring. Make fufu, not war.

Sunny Days That I Thought Would Never End

For all its green-scrubbed glory and ceaseless, smile-lit tides of recovery, eye care can have its depressing moments. Down here, it’s easy to soak in the sun of our successes. After all, cataracts and pterygium and allergic conjunctivitis and other mild ocular prey comprise a Texas sized portion of the cases we see. Ophthalmic nurses probably have “book her for cataract surgery” and “tetra and gutt. chlor” (ointment and drops)  tatooed to their tongues by now because they are the remedy to nearly every case seen on outreaches. For weeks now we’ve seen treatable cataract case after treatable cataract case, flecked with a few glaucoma, corneal scar, and pterygium (a net of broth-colored phlegmish tissue crawling from the corner of the conjunctiva toward the pupil) to keep the crew on its toes.

Blindness, we were told, was lurking in and around these rural chiefdoms; Ali often reminded us that we must fight blindness with “machine guns” and blast its insidious mercenaries out of their foxholes. Not to contradict General MacArthur, I used to think, but the stuff we’ve seen is hardly insidious. The sluggish cataracts, the pterygium slouching like snails toward a pupillary Bethlehem, the conjunctivitis that EVERYONE (and I do mean everyone on account of the unrelenting dust) had—it all seemed so insipid, feckless, senior citizens brandishing walkers at Green Berets. With a good surgeon on board, we could wipe it all out while brushing our teeth before bed.  

            Then there was a patient who I will call Niya. She wore a green school-issued skirt and flitted around the consultation room like the white furs on a dandelion. Her mother followed behind her with an infant no older than 10 months yoked to her back by an overbearingly technicolored shawl, the child’s trio of tight ponytails sprouting like black vines from the mothers nape. For all of her wildness and excitement, Niya turned out to be a wonderful patient. As Dr. Wanye collected patient history from the mother, a few of us took turns examining Niya’s eyes through an oscilloscope and listening as the mother described the “shiny thing” she saw in her daughter’s pupil. This is not nearly as innocuous or “oooooh, interesting!” as it sounds. A glint in the eye, particularly in the pediatric eye, is the first lead for retinal blastoma. Retinal blastoma is a highly vascular, cancerous growth on the retina that, if untreated, expands, explodes, and metastasizes to the brain through the optic nerve. And sure enough, as each of us closed in on a circular slice of the retina, we saw it, bulbous and opaque with raspberry arteries sprawling from its center, a set of pumping highways converging in a dull white cloud. Standard protocol for treatment is chemotherapy and, depending on the size and nature of the tumor, surgical measures to excise what is otherwise a highly lethal pathology. Dr. Wanye explains this to the mother as her daughter wanders near the black and white examination device, stretching her fingers toward its gadgetry only to have them slapped away by a nurse whose wound braids must carve canyons into her scalp.  Wanye tells the mother to go to Accra, explains the treatment options softly, VERY softly because the usual recourse for an American child with RB is quite different from that of a Ghanaian child with RB. The unfortunate truth is that chemotherapy is expensive, wildly expensive, and yet all that expense can be repackaged and forcibly shrunk given a proper insurance policy. This family, the mother and her wonderful daughters, had no such insurance policy, making monthly payments on chemotherapy a practical impossibility. And Unite For Sight can’t cover it either, since we don’t raise and allocate funds for retinal blastoma treatment. So we go to option number 2, which surely can’t be much worse than option number 1, but it is. The only way to keep an untreated blastoma from spreading to the brain with any level of comfort is to remove any tissue that could potentially play concierge to the cancer’s metastatic desires. This includes a large segment of the optic nerve, the retina, and, as one would naturally, but regrettably predict, the orbit (eyeball). Option three is do nothing, to observe the cancer’s slow spread through the optic nerve, across the chiasm into the other eye and the brain, until it kills her. Option two it is, then. By bloodless, lugubrious default.

For all the machine guns we wield to fight blindness, the war at our door is at times miles out of our league. Typically this is not the situation, but as in Niya’s case, we are not exempt from feelings of futility. The more pervasive scenario that grinds our gears as healthcare providers is the one where the war doesn’t meet us soon enough. My first day in Karaga, a village outside of Tamale, we saw a young woman blinded by absolute glaucoma—had she visited four years earlier when the symptoms became apparent, we could have started treatment and saved both eyes. Yesterday I saw a kid no older than my brother carrying the grotesque result of an untreated corneal laceration. The wound was left untreated for months and in that time much had changed about the eye; the cornea had melted off, the iris had prolapsed like a misshapen bead, and the sclera had turned meat red with inflammation. There was nothing we could do to save the eye and without an evisceration of the bad eye (the scooping out of the iris, pupil, sclera, etc. to prevent infection), the other eye would become sympathetically infected as well. Had we seen him immediately, we would have repaired the corneal laceration and sent him on his way. Oftentimes we find victims of a procedure whose outrageous price is only outdone by its incredibly frustrating result: couching. Sparing the gory details, the practice of couching (falsely) claims to ameliorate a patient’s cataract by poking the lens out of place and into the back of the eye.  This can present a very real difficulty to cataract surgeons, especially if the lens is not pushed fully out of place and sits cockeyed like a phase of the moon peeking out from the pupil. How these ignorant charlatans, no more skilled than a pub regular twirling a toothpick, are not immediately wiped clean from village premises is beyond me. But they’re not and sometimes they get their first and botch any shot we have at resolving the most resolvable medical dilemma in the optic world (aside from farsidedness in adults). The list of clouds floating over our sun keeps growing the longer I stay here­—patients with blinding infections from local “eyewashes,” patients that disregard post-operative care and needlessly end up with infections, the number of patients that refuse surgery because some “taboo” was spread throughout their village wagging a finger at Dr. Wanye and his pragmatic, secular approach to fighting blindness. Easy to get pessimistic over, that’s for sure. And yet, I’ve learned here that medical situations aren’t perfect, that our patients are not perfect, and that we certainly are not perfect either. That is the reality of a profession that demands constant, predictable results in a storm of chaotic causes. Atul Gawande once said that it is not assumed nor expected that a doctor be perfect in his profession—“only that he strives to be.” And though I saw it first in Gawande’s book, the guiding phrase is taking on a much deeper meaning here with every sun-lit day that passes.  

The Unflinching Vivacity of Our Man Ali

He sits at the head of the table, his head laughing, careering on its glabrous swivel. “Ya, masa,” he calls to the waiter of the empty restaurant, “we do not want break-delay...we want breakFAST!” The laughing continues and he gets bigger-eyed than before, his pupils expanding like oi slicks pooling on twin drifts. Suddently, the power goes out and the pulse of the ceiling fan  flattens to nothing. We can hardly breathe, swallowed up in the convection rushing in like a stampede from the outside . Ghana can lay it on thick, hot, and heavy; thankfully, Ali buoys us, the languor-stricken and hard-to-mollify, with his jokes. “So, how much ah we go-een to chahge for dem to look at these ladies?” He fans both arms across the table to encompass the four girls—Lynn, Poy, Ebony, and Laiyin—and tap dances on us all with glistening eyes. “Because dees four gals ah very special, they belongs to me so I will not let dem look at da face free of chahge.” Glowering now, distributing smarting glances among our expatriate family, “I will take no less den 500 tousand for dem to look at deez gals, not even dee docta will look at da face witout paying me for dem!”

Then in an instant, his demeanor turns smoothly on its ever-spinning axis. Delivering a cheek-creasing smile, “I like dis, I am very hahppy.” We laugh. “Ebony, you ah eating so well for me today. You make me so, so happy” he continues, gesticulating his syllables with a conductor’s flare. He swiftly nabs an unbridled bone from my plate, eyes it hastily, and delivers it to his indiscriminate mouth. The girls say ew; the guys leak smiles; Ali says “what is hahppenin?” and follows up with an “offer” to Lynn, our resident ballerina. “Leeen,” he shouts from two feet away, “you ah going to dance wit me please” and offers her his two hands, fresh from clearing the remains of our meal. Lynn shakes her head, but Ali insists, “One dance, Leen, please, why you will do a very much dancing in the State, but when I say ‘you like to dance,’ you will not do it. AH-ah!” This last sound, AH-ah, lies somewhere between a turntable scratch and an animal yell.  

Ali is considered by many, foreign or otherwise, to be a typical Ghanaian. Beside both sides of his nose are vertical tribal scars— pocked, tobacco colored wells no longer or wider than a blade of grass—that he often attributes to a ravaging case of diptheria he endured as a child (never mind that scarring isn’t a symptom associated with diptheria). He lives in a spavined pink flat locked in a horseshoe with five others just like it. The red lawn is covered with black rubbers, thin tufts of saw-grass, and breathtaking children that clean dishes outdoors and assemble in a cluster along the street when cars arrive and depart, as though welcoming a heralded bus at its main terminal. They are all his children, as he says, since in Ghana your neighbors are literally considered an extension of your nuclear family. His clothing is recycled and pregnant with a fowl, but forgivable odor memorializing two or three weeks of unlaundered use. Money is tight, time stops and starts as he pleases, and everything, and I do mean everything, is a worthy subject of his GI tract. Typical Ghanaian, yes; typical human—hardly. Ali is unflinching in his dedication to our cause.  He picks up every volunteer from Accra and lugs them 13 hours to Tamale, where he has already made his or her living arrangements, he coordinates all medical outreaches and outreach living arrangements and culinary accommodations and transportation and sundry requests like laundry and fan repairs and bottled water, and then he has to take the outgoing volunteers all the way back to Accra every ten days, only to turn around on a dime to meet us back in Tamale—not to mention the hundreds of eye exams he conducts on a daily basis and the handfuls of surgeries he books and oversees year round. He is tireless, more so than anyone I have ever seen, and embraces his life with unabridged alacrity.

There are people that sluice our spirits like profligate floods, and there are those that visit and leave us just as naked as we came, and there are those so ostensibly packed with goodness or energy or whatever you would like to call it that they are tacitly obliged to share it with others.  And then there is Ali, a man who urgently, forcedly injects us with his zest and alchemizes from our womb-weary, trembling curiosity in this beautifully abstruse land a harvest of confidence and comfort.

“When we live dis way, it is not that we should be hahppy,” Ali says, “It is dat we MUST be hahppy if we ah to keep living dis way.” Word, Ali.

The Surgeon Man Cometh

Dr. Wanye arrives on Ghanaian time, two hours after we take breakfast near the clinic in Karaga. It is 10:30 Am when I see him first, strolling in black loafers and a tucked oxford toward the plastic chairs, his bowling ball head sprayed with morning light and thin arteries of sweat.

“Hello, hello, good to see you again,” he greets. The doctor extends a gentle, steadied hand hip-height and relieves our group from visual acuity tests, a full, symmetric smile preserved as he rotates and shakes, rotates and shakes. For a man of his responsibility—he is the only ophthalmologist for the 2 million people in the Northern Region of Ghana- he exudes a seasoned serenity, as though he has already rehearsed the surgical cases for the day and trusts his hands to cut and hold and tie mindlessly into the darker hours of the evening. There are 30 something surgeries to be performed today, 30 more the following day, and an overflow to be dammed up on Sunday when the stragglers and last-minute consenters rush to reintroduce their eyes to vision. Dr. Wanye performs cataract surgeries with a swift, itinerant motor, incising a dense organ of colorful gowns and sweet, leathery faces one after the other, cleaning the next patient’s eye before the previous one has left the theater.

Surgeons are often conjured up to be the doctor kings of the healthcare profession. Publicly perceived, they are the smartest, fiercest, most unshakeable healers we have, thoroughly adorned with rafts of instruments and machines and supporting staff to carry out our most sacred of medical rituals: the operation. But this is not Wanye, poised over a microscope with surgical scissors, clipping his eigteenth conjunctiva of the day, then slicing through to the sclerotic tissue and cracking the anterior chamber of a glazy cataract, only to slide in a limpid lens the size of a snowflake. He talks with the single nurse about the punctuality (or lackthere) of lunch and occasionally voices a staggered narration of the procedure. “Usually...the iris sags downward in the eye...and it opens up the incision...further...so that we can reach the anterior chamber with...relative ease.” Over and over, he cleans and clips and slices and injects and implants and sutures. No barking at frantic nurses for pharmaceutical x or instrument y, no spurting blood soiling his scrubs or disposable mask, and there is no monitor pealing out like a dial tone when the phone drops off the hook (and it never does in our operating room).

Wanye is a medical soldier, a factory physician even, not a cowboy. He has no interest in such dramatics. Atul Gawande once observed that the best surgeons are not the most naturally gifted or deeply ambitious, but rather the best versed in there respective operations. It’s not about genius, Gawande explains, it’s about who is boneheaded enough to practice the same thing over and over and over again until it becomes a fluid recitation, an indelible routine, a habit of the body as automatic and impregnable as breathing. Sometimes hospitals here lose power and running water; Wanye continues to operate with a flashlight illuminating the field and whatever bottled water he can scrounge for. His repertoire is that far engrained. As a lowly, aspiring physician, it is humbling and awe-inspiring to witness a master in his element, flexing the muscles of his craft with the grace and eminent prowess of an acclaimed musician or headlining athlete. Being inches away from the patient’s pupil, like a black umbrella against a fresh white cloud, I was entranced—with the surgery, with the anticipated result, with my own excitement crystallizing as the surgeries went on and on. “We are almost ready to call it a day,” Dr. Wanye says, 28 cataracts deep and kicks a pitch of blood-smudged cotton near his feet. We have 30 more surgeries tomorrow, 30 more practices to add beneath the doctor’s belt, and, most importantly, 30 more patients who will reunite with sight. 

A Lofty, Liberal, and Typical "Save The World" Post

Currently writing from a small village called Karaga, where the people are soft-spoken, the food is dense, and the flies are starving. We've just returned from an outreach inside the village, where we examined nearly 220 patients, dispensed hundreds of drops and antibiotic eye ointments, and booked 50 patients for free cataract, pterygium, and glaucoma surgeries to be done this Friday. Personally, I am finding the work extremely rewarding and vocationally corroborative-- that is to say, I am beginning to see myself as a doctor more and more as I examine patients. I've learned a bunch of phrases in the local language, Dagbani, and wield them flaccidly, but at the very least I can assess how the man is ("agbira"), ask him to cover his eye for a visual acuity test ("poma nimbla") and tell him that we will do our best to eliminate the problem (much too long to type and I still need a translator for some parts of this mini-spiel).

Seeing patients down here can be as thrilling as it is heartbreaking. At times, we find people no older than 50 with mature cataracts or full blown pterygium, and knowing that we can provide surgical treatment is very satisfying. At the same time, I saw a woman yesterday, 22 years old, with absolute glaucoma, meaning we have no effective surgical or medicinal treatment that will resolve her issue. Objectively, our solution is to hand her eye drops that will slightly reduce the vitreous pressure in the eye, but tacitly, among ourselves, we are certain that she will completely and irreversibly blind by years end. I read about this type of stuff in books and journals and visually observe all sorts of medical phenomena on TV. Somehow, seeing it in person unwraps it all for you, makes it crawl into your brain and say, "this is real, people actually go blind here for no reason." I met one woman today with immature cataracts and severe conjunctivitis, so severe that her left eye appeared as a membranous duct, running with a sickly yellow discharge, preventing her from telling me how many fingers I was holding up from five feet away. These pathologies-- glaucoma, cataracts, conjunctivitis-- are scoff-worthy here in the United States, controllable and swiftly corrected. So they should be here, these pathologies, so invariably squelched that no one should go blind from them as a result. We are plagued by the "lack"--of knowledge, of access, and of locally trained professionals-- in Ghanian eye care. Back in the states, many people told me of Ghana's beauty-- the lush plains gushing with verdant leaves and wild flowers, red dust roads slicing the heart of the north into bucolic chunks, and the warm, tactile-obsessed population, trying desperately to populate those around them with happiness. And it is beautiful, for those that can see it. For those that cannot see the thatched adobe lining the savannah like sunbaked ornaments or witness their children growing and walking and changing, Ghana is still a wonderful place--everyone takes care of everyone here. But if people are to have full agency here, to be employed and to parent and to take care of others when they are in need, then these pesky, resolvable pathologies must be eradicated. 

So. That is my blindness spiel. Now that it is out of my system, you can expect less lofty, less liberal, more interesting reflections in the future. My next post will center on our shepherd and infinite source of inspiration, Ali. Until then...