TWECS Eye Care Mission to Africa, 2009: Ethiopia

The following are dispatches by Dr. McDougall sent from Addis Ababa, Ethiopia, on a November 2009 mission with TWECS (Third World Eye Care Society). 

Greetings from Africa!

November 7, 2009

I can’t believe we made it. It literally was 30 hours door to door, but amazingly I don’t feel too bad. We made it through customs quite easily, and without too much grumbling (as we expected). Our hotel is nice, and we just celebrated arriving with some local beer, and I just had my first bit of gurdga (which is when one of the locals asked me to sample his dinner, then fed it to me by hand!). I had read about that, but didn’t expect it within the first couple hours here!

It already feels like I have been away for weeks. Tomorrow we start to set up our clinic, and tour the city and the barrios before we start. I am with a great group of people, and so far the Ethiopians have been lovely.

So far I am safe, have been hand-fed, and am a bit buzzed on local beer and happy!

First Day At Clinic

November 10, 2009

We are just on our way to the clinic to set up for the first day. There are more bureaucratic hurdles to jump than you would imagine here. But there are certainly lots of people to help. Yesterday we toured the area, and it is hard to believe the houses people live in! Living under a pile of garbage is not really an exaggeration in some cases. However, the kids are a bright spot in all of that. Not only are the children truly physically beautiful, but they are so happy, smiley and excited to meet you it is so heartwarming to see.

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Yesterday Dr. Cindy Wagner and I met two boys (around 7 and 10) who live down the street (they were literally doing handstands in front of our hotel to try and get our attentions… doesn’t hurt that Cindy is pretty and blond) and they took us to their house, which was literally 6 feet by 10 feet, IMG_3771made out of old sheet metal, no furniture, no beds and they lived with their grandmother (who was not only happy to have us in her house as well, but wanted to make us coffee!) because both of their parents have died. Even though they literally have nothing, they told us that they love their house, and they very proud to have us there.

 

 

Late Night In Africa

November 11, 2009

It is the middle of the night here, which likely means you are all having lunch right now, but I am having a sleepless night after a crazy day of clinic. There really are no words to describe this experience but chaos would be a good place to start. We saw over 400 people today, ranging from blind babies, to old priests in flowing robes, to farmers, to teens with vicious scarring all over their eyes. It is overwhelming for all to complete tasks like holding back a few hundred people banging on the door trying to get in the clinic. Quite a sight!

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There really is no lack of emotional stories happening, almost at all times. Seeing a 25-year-old get his first glasses (a minus 10 myopic (that is even worse than I ever was!), which essentially means that up to this point he has been treated as blind: no school, no job. The look on his face when he puts the glasses on is half disbelief, half shock. I think it will take awhile for the joy part to sink in for him. He simply asked the guy who gave him the glasses, “How do I start to learn now?” That has some impact. And to think those glasses were old and discarded by someone at home.

We also saw a baby this morning with bilateral cataracts, who is hopefully young enough that when we can arrange to have them removed her brain will be plastic enough to still develop normally and save her from a life of total blindness and social dependence. The look of worry on her mother’s face is no different than a mom in Vancouver, it’s just that this mom has so few options to try and help. We all really are so lucky to live where we live.

There are of course some crazy and funny moments, and people are people in so many ways. We have enlisted the help of several children we have become friends with to act as translators in the clinic. They have been working their brains out, and feel so important, that it really has been one of my favorite parts of the mission. One of my favorite kids, Mekel, was working so hard running around, it looked like he might drop. So, one of the guys gave him some money to go and get a snack, which at first he didn’t want to take, but eventually he ran off and came back with a receipt and the change, all for 5 Birr, which is like 50 cents to us. Each one of us wants to take him home.

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I hope I will not be up in the middle of the night too much… but I am thinking of you all, and feeling the good energy you are sending me.

A “Miracle” of Sorts

November 13, 2009

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just the start of the line up outside of the entrance of the eye hospital where we are stationed

The clinic at the Melenik hospital has gone crazy: today there was a lineup of over 2,000 people! And really we can only see 500-600 (and that is working an 11-hour day at maximum speed), so you can imagine the scene at around the perimeter of the clinic. I am very glad that I get to be inside examining people instead of outside doing “crowd control.” It really is quite desperate, and emotionally draining.

R: 129 G: 255 B: 181 X:49972 Y:10944 S: 392 Z: 53 F: 120

Yewoinshet Masresha of Hope for Ethiopia.

However, today was one of the best, and literally one of the hardest days of my entire life. Luckily, our team leader, Marina, selected me, another optometrist John, and another volunteer to go off-site to three schools in the area to examine children. We spent the day with an amazing woman, named Yewoinshet Masresha, who is considered the mother Teresa of Ethiopia. With good reason: she runs several orphanages around Ethiopia and takes care of literally thousands of children, whose parents have died mostly from AIDS (www.hopeforchildrenethiopia.org/index.htm). She is one of those amazing people within aura around her. You can just feel how good she is. She told us of twin boys that just came to her that are only 40 days old; hard to believe the magnitude of it.

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one of my favourite pictures ever; school children waiting to have their acuity measured

We loaded up a cargo van with equipment and set out for three different schools to examine more than 150 school kids that the teachers had identified with vision and eye problems (just the four of us for all of those kids!). These were all schools for the poorest of the poor. She told us that these were kids that are really well below even what is considered poor by Ethiopian standards. But they were amazing! So polite and quiet and co-operative. It will make it hard for me to see the squirming and complaining some of the kids do at home! I honestly don’t think I have ever worked that hard. It will be hard to really describe it, and for sure the pictures will not do it justice, but I know for a fact we were able to change many kids’ lives today, and I really feel honored to have that chance.

R: 130 G: 255 B: 176 X:16644 Y:10944 S: 73 Z: 52 F: 108I am of course feeling quite moved by the experience, and one of my favorite moments was with a boy where I really feel I had the chance to see the miracle of eye-care right in front of me. There was an 11-year-old boy who had a severely turned-in eye and was naturally very shy and uncomfortable. Here, like anywhere, the appearance of a turned eye can be pretty disturbing (and of course kids are cruel worldwide), but here in particular there seems to be some association with the “devil turning the eye in” (don’t even get me started on that…). He was severely farsighted (10 diopters for those optometrists out there, and had never had glasses) with accommodative esotropia (meaning that his eyes were so out of focus that the muscles turned the eye inwards). After literally five minutes with an old pair of glasses I happened to grab from our stock that morning (only with the intention of just using them to help with the refractions) his eye completely straightened. It must have been karma that I grabbed them because they fit him like they had always belonged to him. I think I was more shocked and amazed than anyone including him. I am never, ever, going to forget that moment. I can’t imagine what his parents are going to think when he went home today after school. Again, I really feel honored.

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I am so tired but at the same time wired, thus the long email. I need to go to bed now, because tomorrow will be another mosh-pit at the clinic and there is no stopping the momentum. I wish you were all here with me (especially my husband, Walley, and my dog, Jackson, who I miss very much…).

 

It Finally Hit Me

November 16, 2009

Today it finally happened. The magnitude of everything kind of hit me, and today after clinic I had a bit of a breakdown. As a colleague on this mission said, if your cry-er doesn’t work here it is broken.

R: 124 G: 255 B: 179 X:49972 Y:10944 S: 18 Z: 53 F: 188We spent the day yesterday visiting another charitable organization that is focused on helping women, mostly former sex-workers actually, become self-sufficient through weaving silk scarves. It was really amazing, not only because we had the chance to see and learn about the indigenous caterpillars who form cocoons that are then harvested for the silk (which are then hand spun and then woven into beautiful scarves) but also because of the ability for local women with no advantages to change their lives and be able to earn a proud living for themselves through an honest day of hard work. The metaphor of the whole situation (of a caterpillar cocooning and changing into a butterfly, just as these women are transforming their lives) was not lost on us. And the fact that the amazing woman who has started and run this whole organization is from Northern Alberta, again made us proud to be Canadian.

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After spending a pleasant day, on the way home we drove past the Melenick hospital, at about 9 p.m., only to find that there we about 400 people that were camped in line in hope of getting into the clinic the next day. Because of the elevation here it really cools off at night, so the sight of so many older people lying on the ground, prepared to spend the night really shook us. It was hard to sleep, and really put us all on edge for the morning as we headed into the clinic. I think what has happened is that the people we have seen, many of whom have had remarkable improvements in their vision for the first time in their lives, have returned to their neighborhoods with their glasses, and then it has blossomed into so many people desperate to get in to see us. I think that, generally the people of Ethiopia are not used to getting anything given to them for free, so this seems like an amazing, and unbelievable chance.

We have literally created a micro-neighborhood in the line up around the clinic. It is like a revolving city of around 500-1000, and there are vendors selling food and water, kids milling around everywhere, and of course some young guys who are there to take advantage of whatever they can. Generally the people have been very polite, self-policing in terms of order, and respectful of each other and the elderly. But the scene really changes when we arrive in the morning. The rule is that we will stamp the hand of the first 500-600 people in line for that day, and everyone has to wait for the next day. There are no exceptions to this rule, which is really the only way to keep order, but it is literally heartbreaking to people that don’t make the cut. We each have to share the experience of telling an older person, with obvious eye problems to leave, or get back in line for the next day. The impact of having to do this is really shaking some of our team members to the core. No one will come away from this experience unchanged. At home I refuse to wait in line at a bar or restaurant for 10 minutes and there are people here that are waiting two or three days straight to get in for an eye exam and eyeglasses!

In the clinic I am routinely seeing eye problems that are so beyond what would ever be described in any textbook. Corneal scarring from infection and trauma are routine. We are usually trying to just get good vision out of one eye. The magnitude of what I am seeing doesn’t hit me at the moment, but it kind of accumulates once I get back at night.

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Today I easily saw 50 children with scarred eyes, and one man who was blind in one eye, and the other one had been so badly infected over the years that the top and bottom eyelids had scarred together except for a few millimeters that were open on the nasal edge that he had to turn his eye to look at through the pus that was seeping out… if that is hard to read, imagine how it is to look at it, and clean it up with the minimal tools I had on hand.

When I got home today, I was really touched, because Mom, I saw you today in the clinic. not actual you, of course, but there was a woman in line, who was a nun, and in her eyes I saw you. She had openness about the way she looked at me, and she was living with such dignity and grace amongst these horrible conditions. IMG_3721It breaks my heart to think about “If my mom had to live like this”…. it really brought it home for me. How on earth is it fair for people to live in these conditions while I have so much at home?

We have all heard that the eyes are the window to the soul, and again it is not lost on me the fact that so many people have scarring, and trauma, and infection and disease. This is a hard life here, at least looking at it from where I come from. It is amazing that people are still able to smile, laugh, and enjoy life. But they do. Even as they wait in line for us. There is obviously a lesson to learn.

We still have so much work to do here. I am trying not to think about it too much. I love you all, and can feel all the love you are sending me.

The Yellow African Hat
November 18, 2009
There are only two more days of clinic, and at this point it feels like a marathon and I am trying hard to not look for the finish line yet. Each day really is epic in nature. One colleague said that it feels “cinematic” to her, meaning each day feels like something you could only see in a movie.
There are so many dramatic cases that it almost becomes routine. People here somehow seem to make it through daily life with really extreme vision problems: prescriptions of -10, +12, -22,+16 are really happening all the time (again best appreciated by those optometrists out there, but believe me, it is shocking for everyone involved when you put a -10 diopter prescription on a 30-year-old with extreme nearsightedness for the first time in their life). IMG_0636

We have all been commenting to each other that people are not reacting as crazily as we would expect, but I think they must be experiencing disbelief and shock. I imagine that it will really sink in to them when they get home, and the glasses still work days later, and it was not some kind of weird “magic” that the Canadian doctors did and in fact they do get to keep their vision.

Here is something remarkable, and really quite heavy. Yesterday at the clinic there was a man with a young child of about four years old. They were both tired and dirty, and the man was HIV positive, limping, and missing an arm. The young boy was his child. He was in a lineup of hundreds, so when I first saw them it seemed basically routine, although as I type this it seems kind of extraordinary. About an hour later, he attracted my attention and asked for my name, and asked me to write it down for him on a scrap piece of paper he pulled out of his wallet. I wrote it down for him, mostly just to satisfy his request so I could move on to the other people in line.  Thinking he wanted to know how to pronounce it.  Later, as he was leaving the clinic he handed me a hand-written note on the back of another dirty piece of paper which said:

“I am HIV positive and this child is my son and if you are willing I want you raise my child (just if you are willing).”

I can’t really explain how I felt when I read that, but it was mostly shocking, and a bit surreal, especially framed in the middle of crazy day where I was surrounded by hundreds of people needing my attention. How are you supposed to respond to that? How could you be prepared? The father just kept walking past me after he slipped me the note, so I didn’t really have to respond in the moment… but I suspect that moment is going to sit with me for the rest of my life. Reflecting on it, I am proud of the father for trying to take care of his son, and certainly heart broken at the reality of both of their situations.

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As an aside to our clinic experience, there have been lots of foreign couples in our hotel adopting children from Ethiopia. We have all been goo-ing at the babies while we eat breakfast, and mingle around the hotel. The children really are so beautiful, and the parents all look so happy, it is a nice thing to see, especially since we see so many children in need in the course of our day. Even though our hotel is full of these babies, we have noticed that it is very quiet. No crying. One of the women with our team has also spent time volunteering in Romanian orphanages (we are really with some amazing people), and she has explained to us that none of the children there cry at all: they lay in their cribs, and never get picked up or held, and so they learn that there is no point in crying. In fact the nurses working at those orphanages get mad at the volunteers for picking up the children because then they start to cry, and they would prefer the peace and quiet. Since hearing that I can’t look at a quiet baby in the same way.

We have some great local students helping us translate at the clinic. They are so happy to help, stay all day without a break, and get there before we do in the morning. And they don’t get paid (imagine someone doing that in Canada!) One of the main guys that has been helping me over the last two weeks is named Kia. He is a 19-year-old, who lives just down the street from our hotel with his grandmother and three siblings in a metal shanty shack that is no more than 100 square feet (and that includes the “cooking shed” which is basically an indoor coal fireplace, and all their beds).

Kia

Despite his poverty and living conditions, he is extremely bright, clean, compassionate, and thankfully very fluent in English. I couldn’t get through my day without him. Yesterday he brought me a gift. It was kind of a crazy yellow knitted skull cap that some of the local guys wear. I don’t know where he got the money for this, but he said he wanted to give me a gift because of how much I have been helping everyone in his country. It is one of the best things I have ever been given in my life. I will look crazy in it wearing it in Vancouver but I absolutely love it, and will proudly wear it in honor of him. To get a gift from someone who has absolutely nothing is staggering. I want to bring him home with me, not just the cap!

Only a couple of more days until this experience comes to a close. It has affected me in so many lasting ways. I imagine the impact of it all won’t settle until my mind has a chance to slow down and reflect on everything that has happened. I can’t take it all in at once.

I really miss Canada. We live in a great place, and I can’t wait to get back and see you all, but in the meantime I wouldn’t change where I am sitting right now for anything in the world.

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PS: I found out today that here in Ethiopia the date is 3/19/2002… though they still call it November. November is the 3rd month. I like the fact it is 2002… that really only makes me 33!

The hand-written note said: “I am HIV positive and this child is my son and if you are willing I want you raise my child (just if you are willing).”

Late Night Message From Canada

November 27, 2009
About two weeks ago, one of the first emails I sent from Africa was in the middle of the night because my mind was racing and I couldn’t sleep. So, I find it kind of funny and ironic that I am typing this last email to you, now from the comfort of my own home, in the middle of the night… again because my mind is racing and I can’t sleep! But, no need to worry… I have made it back to Vancouver safely, and have even put in my first day of work at my own practice. It may take me awhile to get used to the time change again, but I am very happy to be back in Canada, and am looking forward to settling back into a more normal routine.

On the last day in Africa, we all woke up to a very thick, smelly smoke covering the entire city of Addis. So smoky in fact, that one of our team members said when he woke up, his glasses were covered in debris from the air in his hotel room! We found out later that day, after the smoke had cleared by noon, that there is a custom every couple of years where people celebrate the end of the cholera outbreak by dragging all the trash from their homes and neighborhoods and setting it on fire all across the city. It was kind of a dramatic start to the dramatic last day of our project, and it retrospect seems kind of fitting.
Of course we expected that the last day would be emotional for everyone, and even anticipated the mini-riot of having to determine where the line of people waiting would be cut-off, and explaining to those waiting that we were having to pack up and return to Canada. But we didn’t expect to get basically barricaded into the hospital when trying to leave in the van with our equipment!

Unfortunately, our last taste of the hospital in Addis was of corruption, and seeing the worst side of people. A hospital contractor came to us at the last minute and accused us of damaging the clinic property, breaking windows, and breaking a toilet, and basically he wanted to be paid off.

In particular, when he told us we had broken the toilet the collective look of shock on all of our faces transcended the language barrier, as the whole two weeks there was no functional toilet in the entire building we were working in. We had all been carefully planning our food and water intake every day to avoid the drama of having to leave the clinic to walk the 400 meters to the nearest toilet, which was a nasty squat toilet at that! So our last moments were spent having a physical struggle with the contractors who were standing in front of our equipment van, and at the same time trying to lock the gate to the hospital. There was a lot of shouting and posturing, but after we choked down the principle of the issue, and paid him off we were allowed to leave, and were just glad to be out safely. There was a thread of corruption that wove its way through the whole project, starting the CEO of the hospital, who was more interested in getting control of our donated glasses and eye medications to sell and make a profit, than to help us arrange to distribute them to the poor and needy who otherwise wouldn’t have access. I really didn’t expect that it would be so difficult to donate time and resources (properly to the people who need it), but I think with such poverty comes desperation, and ultimately corruption, and an attitude of “What is in it for me?” One of the guys on the team said ironically… “Of course we should have to pay to help you.”

But I think that as time fades on, I won’t remember the bad things but rather all of the great and good things that happened. And the smiling faces of all the lovely, yet desperate people we were there to help. I will remember how gracious and thankful they were, and remember that each member of our team received enough thank you hugs, kisses and bowing to last our lifetime. Not to mention blessings! There are so many nuns and priests in Addis, it seems bizarrely disproportionate to the population but at any rate I received many formal seeming blessings from priests, who would stop and put the sign of the cross on my head on their way out.

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I will also very fondly remember some of the young teenage kids that helped us interpret over the weeks. We really got to know them more personally from working with them day in and day out. In fact one of my favorite interpreters, Kia, invited a group of us over to his house for his sister’s birthday party (she had been hanging around the clinic as well, and everyone came to love her as well). So a group of about ten of us went to her 11th birthday party, in their tiny tin shack down the street from our hotel. It was one of the most heartwarming birthday parties I have ever been to. There was singing and dancing, and a lot of love crammed into a very small space. That family does not have very much in terms of physical stuff but they certainly have the ability to happily open their hearts and home to a bunch of strange looking people they don’t know very well. It is hard not to get too attached to the kids and people that we spent time with but our very wise team leader, Marina, advised us at the start of the trip to be careful about the bonds we form with kids during this trip (she said it happens all the time), because to each of us, coming from Canada, it certainly feels great to lavish love and attention (and how can you not want to slip some of these kids money) on the kids. But she reminded us that after just two weeks we get to come back home and slip into our everyday lives, and all of the kids will have to stay there in their lives. It was a perspective I had not thought about, and we struggled to balance it with still giving love and affection to some kids who were badly in need of it. I guess life is always about balance.

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As you all know, my father passed away about a month before this trip. He was a great man, and many times throughout this trip I felt his presence. Many, many times I realized how blessed I am to have been born into such a great family (in such a great place), that always supported me, loved me, and encouraged me to make the most out of life. I wouldn’t have been able to be on this trip, and help so many people, had my dad (and of course my mom) not supported me through school. Before I left, my mom, my sister, and I decided that I should take dad’s old glasses with me, and find the right person to donate them to. Below is a picture of me with the man who is now wearing dad’s glasses. It wasn’t on purpose, but fittingly, I had given them to him on Remembrance Day, as you can see from my poppy. I know that the glasses will change his life, and a piece of my dad will live on with a goat farmer in Africa, just as my dad’s memory will live on with me forever.

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Thank you for all of the love you have sent to me over the last few weeks. I can’t wait to see you all soon, and show you pictures, and tell you more stories about the amazing people I met on this incredible adventure.