New Vision: Working in the Eye Clinic in Tamale, Ghana

By Vanessa Hux
Yale University Student
Summer 2007 (July 1-August 18) Global Impact Fellow

It was a hot day in Tamale with the sun radiating overhead in uncomfortably static air. The rust-colored dust so characteristic of this bustling transport hub blew about as we pulled into the eye clinic of Tamale Teaching Hospital. The clinic consisted of just a few rooms: a doctor's office, a small optometrist room, an examination room, and a treatment room with a tiny closet-sized space for procedures. However, that which stood out most was the hall. People sat on aged, wooden benches lined up against it. Perhaps twenty or thirty patients sat in this inside hall: men, women, and children---the women sometimes with infants tied onto their backs with a colorful sash. However, it was their eyes that stood out. Some had only white in their pupils, mature cataracts; others' eyes looked as if they had been glazed over, with what would be a dark brown iris looking grayish under a layer of fog. These patients were the result of almost 15 years without an ophthalmologist in the Northern Region of Ghana. Only recently had one, Dr. Seth Wanye, come: one ophthalmologist for more than two million people.

In July of 2007, I began work as a volunteer with Unite For Sight, an international organization dedicated to ending preventable blindness. As a volunteer in Tamale, Ghana, I worked with Dr. Seth Wanye at the Tamale Teaching Hospital. Unlike other Unite For Sight centers in Ghana, the Tamale site has a much different history. Tamale is the capital of the Northern Region and home to 400,000 people. Described as a "dusty transport town" by many visitors and characterized by its orange-brown dust, busy bicycle lane, and Dagomba population, Tamale stands in stark contrast to the wealth, tropical vegetation, and cosmopolitan-feel of its southern counterparts. The Northern Region is one of the poorest regions in Ghana, and despite its drier climate, the majority of inhabitants are farmers.

For almost fifteen years, the entire Northern Region lacked a single ophthalmologist. The region had subsisted on a few dedicated nurses with more serious cases being referred to an ophthalmologist in the Northern region's neighbor, Upper East. In 2003, an ophthalmologist finally arrived; however, in order to serve the people of the region, two major issues needed to be addressed: the backlog of cataract patients accumulated over more than a decade and the provision of services to and how to provide care to two million people, most of whom lived in rural villages accessible only by dirt road.

As a Unite For Sight volunteer, my role was to assist Dr. Wanye on these issues. A typical day consisted of meeting at the eye clinic and then going on outreach to a village, where our convoy consisted of Unite For Sight volunteers, an ophthalmic nurse, and a Ghana Red Cross volunteer to serve as a liaison between the village and outreach volunteers. The objective of many of these village outreaches was to identify and refer cataract patients. These patients could then reach the clinic, where they would receive a free cataract surgery paid for by Unite For Sight. These screenings for cataracts and other eye conditions consumed the majority of our time.

Dasiba. Naa. Tumasim. Naa. Ibiera. Gwen biene. To.
A yuli? A yuma a la.
A nyara?

These words in the Dagomba language of Dagbani were essential to our typical day. The most important of the group being "anyara," meaning "Can you see it?" In outreach screenings, we would first meet with local, native volunteers and sometimes with the chief of the village. After meeting, we split up into teams, registering people and seeking out good spots to set up visual acuity (VA) stations. An example of a "good" VA would be a tree or side of the building in a well-lit but not overly sunny spot where a bench could be set up six meters away. We usually set up at least two of these stations. Registration was its own challenge. Registration consisted of gathering the name, age, and gender of each person before their VA examination; however, it often became a game. After conquering the spelling of each name, it was on to age, and especially with the women, the game never got old:

"Ma, a yuma a la?" [Madam, how are you]
"Piaanu." [fifteen, when she is clearly over 70]

I'd respond with a head shake and then guess an age, which was usually met with a smile, but sometimes bargaining was necessary.

At the visual acuity stations, my first step was to check vision after a cursory look at the eyes. Unlike in the United States, Ghana uses the metric system, so a visual acuity that would be 20/20 in the U.S. is called 6/6 in Ghana. Due to the language and literacy barrier, we used E-charts for examinations. The E-chart is characterized by use of an "E" in different orientations. In this way, the E-chart can be used despite language barriers and illiteracy since patients simply point in the direction that the "E" faces. After a visual assessment, patients are asked if they have had any problems with their eyes such as pain, itching, recent trauma, or difficulty reading. In addition, patients were screened by the ophthalmic nurse for certain conditions that can be treated, most notably cataract, pterygium, and trachoma.

Through these screenings, we were able to screen over a thousand individuals in villages. However, the most memorable experience in Ghana was working during eye camp. During that time, a team of 4 ophthalmologists visited the eye clinic under a training project called the Himalayan Cataract Project. Unite For Sight had connected Dr. Wanye with Himalayan Cataract Project. The project, directed by Dr. Geoffrey Tabin, aims to train ophthalmologists in developing countries about techniques that allow them to handle a high volume of surgery in a shorter time period. His new technique would allow cataract surgery to be completed in as little as six minutes. During that 5-day period, our team screened over 1000 patients, providing free cataract surgeries to 306 patients.

The results of some of these surgeries were truly incredible. Some patients that had only the ability to sense motion in one eye saw improvement in that they would only need refraction to see normally. One younger man had had a congenital cataract in one eye that had blinded him. He left the clinic, and at a one-week post-operative examination, he was able to see with perfect vision, 6/6. These results in the clinic were phenomenal; however, it was the reaction of the people in town that allowed me to truly gauge the impact of my work in the clinic. Walking through town, people would stop me by saying, "Do you remember my father? He can see so well now. Thank you so much" or "My sister, she is so happy now. Thank you." These responses are those that allow us sense that we have touched and helped so many others.

I left Ghana feeling that my time there had been too short, that if I had spent another month, another week, another day, that I may just help one more person. Though leaving was sad, it was in some ways satisfying. I felt that I had accomplished something and, in a sense, made my mark on a place in the world if only for a short minute. However, though the giving remains the focal point of my stay, I cannot neglect those things which I have received: the opportunity to truly serve others, the cultural immersion, the memories of foreign friends, the visions of true poverty and despair, and the desire to change them. These all make an experience and start the growth needed to address and solve the problems of the world. Through these small actions, we all contribute to the lives of one another, making each small action one step toward long-lasting change.