My Experience Volunteering in Tamale, Ghana

By Joyce Ho, Stanford University Student, Unite For Sight Volunteer in Tamale, Ghana

Imagine a place where there is only one ophthalmologist for a population of 2 million individuals. A place where 7.1% of the world's blind population resides, and 50% of this blindness is preventable, cured by a simple cataract surgery that takes at most 30 minutes to complete. It is hard to believe that such a place exists in the seemingly well-advanced world of today, but Ghana is one example of such an area. In the northern region of Ghana, one doctor and his team of ophthalmic nurses run the eye clinic at Tamale Teaching Hospital, and this group is responsible for overseeing the eyecare of millions of individuals in the this part of the country. When I heard about the opportunity to go volunteer at this clinic through Unite For Sight, a non-profit organization that partners with eye clinics in developing countries to combat preventable blindness, I jumped at the chance. I am pursuing a future career in medicine and am considering ophthalmology as a possible field, so I thought the internship would give me hands-on experience dealing with eye health and patient care, as well as open my eyes to see how the healthcare system works in a different country.

To prepare for my work in Ghana, I shadowed an ophthalmologist at Stanford Hospital for two weeks during July. In those two weeks I learned how to diagnose different types of cataracts and corneal infections, how to identify glaucoma, how to recognize trachoma and trachiasis, and how to use a slit lamp and ophthalmoscope. In addition to learning all about eye anatomy and diseases associated with the organ, I was able to observe the manner in which the physician interacted with his patients. The ophthalmologist was also kind enough to allow me to assist him in some of his minor eye surgeries; I was allowed to give local anesthesia to a patient before he underwent a tarsorrhaphy, a procedure that improves eye closure by decreasing the distance between the eyelids.

I worked as a Unite For Sight volunteer at the Tamale Teaching Hospital from August until the middle of September. My role as a Unite for Sight volunteer was to assist the doctor and ophthalmic nurses during daily outreach sessions. These sessions consisted of visits to different villages in the area around the hospital and screening the available villagers for eye problems. The other student volunteers and I learned how to communicate with the villagers using basic Dagbani terms (Dagbani being the native language of Northern Ghana) and utilized the E-chart to assess the vision of villagers ranging from ages 10 - 90 years. After completing the vision assessment test and obtaining a patient history with the help of translator student nurses from the clinic, we sent the villagers to the ophthalmic nurse's station.

Another job was helping the ophthalmic nurse fill out referral sheets for patients that needed cataract surgeries or should be seen by the doctor back at the clinic. This post was very educational, as the ophthalmic nurse often explained rare and interesting cases as he or she examined the patients. Because the villagers were more reluctant than most townspeople to make the trip to the hospital, there was an abundance of very developed eye diseases such as end-stage trachoma and extremely mature cataracts in the villages. These are cases that are rare in more developed countries, because in places like America, there is no way these problems would be left untreated to progress to such a catastrophic degree of blindness.

I also helped dispense reading glasses and sunglasses to villagers after they had been seen by the ophthalmic nurse. Most people did not need very high prescriptions, so I just started out by fitting individuals with +1.00 reading glasses and having them try to read a diagnostic card with 11-point font. The patients then tried on different glasses of increasing power until they are comfortable with their corrected eyesight. The reading glasses and sunglasses were being sold to the villagers at 10,000 Cedis apiece (the equivalent of a little less than 1 U.S. dollar), and I learned that this cost was not a way to make the clinic some more money but rather a way to ensure that these individuals will really appreciate the glasses. The ophthalmic nurses explained that in the past when the glasses were given free of charge, individuals would not treasure them and would carelessly break them. By making the villagers pay for these glasses, we are making certain that the glasses will be handled with care.

The student volunteers were also given the opportunity to observe Dr. Wanye, the head of the eye care clinic in Tamale Teaching Hospital and the only ophthalmologist in the area, doing outreach surgeries at another hospital. That day we got up at 4 A.M. in the morning and drove three hours away to a hospital in Salaga, the former slave trading capital of the North. Dr. Wanye completed eleven cataract surgeries in only seven hours, doing the surgeries one after the other without a single break in between. The operating room was scheduled to house other procedures soon after these eye surgeries, so the doctor was working under time pressure, too. In addition to observing the surgeries, the volunteers helped change the patients into hospital gowns, assisted them back to the waiting room following the procedure, and explained post operation instructions.

This internship not only taught me about eye care and working with patients brought up in a culture completely different from mine, it also opened my eyes to the glaring health disparities existing in the world between developed and developing nations. Probably a third to half of the children I saw at the villages all exhibited swollen bellies with inside out belly buttons, a sign of protein deficiency in their diets. This condition, called kwashiorkor, made the kids lethargic, and the only time I saw them get really excited was when I gave them all the clothing I had brought with me on my trip. I had heard about this malnutrition problem in my Human Biology class last year, but actually seeing these kids made me realize just how much work still needs to be done to improve health care in these developing countries.

The education of the villagers is an entirely different issue altogether. Most of them do not think going to the hospital is necessary; they say that if they go blind, "Inshallah" ("It is God's will"). Even if they seek help, most of the time, their injuries or eye diseases have already progressed to such a state that their vision cannot be fully recovered.

Another problem lies in the villagers' beliefs in folk medicine. A popular practice that is thought to cure cataracts is "couching", a procedure that involves sticking a needle or any other sharpened object straight into the eye to dislodge the lens and therefore allow people who were once blind to now sense light. As one can imagine, couching is extremely harmful to eyes and mostly results in permanent damage that surgeries cannot fix. Traditional healers advocate this practice because they do not know or do not believe that cataract surgeries can restore people's vision; there is still a sense of distrust concerning Western medicine. As a result, Dr. Wanye's office is often frequented by couching cases gone wrong, and most of the time, the damage is irreparable.

My Unite For Sight internship is an unforgettable experience that has only renewed my passion for medicine. I learned about not only eye care, but also about interacting with patients in a completely unfamiliar setting. The language barrier was frustrating at first, but it trained my patience and forced me to learn how to communicate through other means. I observed and learned to respect the great influence culture has on individual approaches to health care, and this lesson is one I think I could only have learned in a country completely different from America. I actually saw eye diseases in the villages at such advanced stages that I only heard about or saw pictures of online while shadowing my ophthalmologist. Global health care issues were no longer stories I heard in class or read about in books. Going to the villages and seeing the state of things made these problems real, and only after I saw everything did the impact of the work we have yet to do finally hit me. I hope that one day I can go back to Tamale as a doctor, and actually do surgeries and diagnose patients, helping to bridge the gap between the health disparities that still exist in the world today.