TRAFFIC ADVISORY:

President Trump is scheduled to be in Philadelphia on Tuesday, September 15, 2020 at The National Constitution Center (NCC) in the Independence Mall area. Increased police presence is anticipated in Center City throughout Tuesday afternoon and evening. Please allow extra time if you are going to Wills Eye. Please be advised of area street closures to vehicles beginning at 1:00PM on Tuesday 9/15. Pedestrian access will also be limited in the area. This is subject to change and area restrictions, which could widen, will be lifted once the President departs the NCC. There are also demonstrations planned for Tuesday 9/15 around Independence Mall as well as City Avenue.

An Ophthalmic Force in the Forest

     The next day, I donned my white coat, and presented myself
for work. Geta Eye Hospital is a stand-alone eye hospital in the Terrai region
of far west Nepal. Surrounded by dense forest and farmland, it is the only
tertiary center for Ophthalmology outside of Kathmandu (which is a sixteen hour
drive eastward through mountainous terrain). Patients often travel for days
from both Nepal and India to receive consultation from one of the six
ophthalmologists on staff. The hospital, established just about twenty years
ago, is impressive in its success and productivity. The entire campus is a
secured, self-sustaining  compound  with clean drinking water, a canteen serving
all meals, a guest house for visiting staff and an apartment complex serving as
doctors’ quarters for long term staff.
Geta is able to offer the specialty services of pediatrics, glaucoma,
retina, and cornea, having trained a single doctor in each of the
subspecialties. Outpatient clinical services are provided to hundreds of
thousands of patients per year.
Surgically, Geta performs between 30,000-40,000 small-incision cataract
surgeries per year. Additionally, Geta also performs a considerable number of
phacoemulsifications, glaucoma surgeries, oculoplastic procedures and retinal
surgeries. The hospital is equipped with basic diagnostic services, like a
single small B scan, and the ability to perform basic bloodwork. For more
advanced services like OCT, chest X rays, and any other imaging modalities,
patients must travel sixteen hours to Kathmandu, or across the border to India.

I quickly fell in step with the three junior
ophthalmologists who worked the one-room general clinic. They sit stoically
behind one of the three mobile slit lamps as hundreds of patients present
themselves for examination.  After
traveling for days, carrying everything they might need on their backs and
sleeping the night under the stars on the grounds of the hospital, these
patients have been registered and funneled through the basic assessment by
ophthalmic techs. All patients in need of further evaluation have now been
directed to this tiny room at the rear of the hospital. I poke my head through
the doorway and note that the line of waiting patients extends hundreds of
feet, snaking its way around the atrium and folding in on itself. I do my best
to incorporate myself into the flow, taking a seat and keeping the line moving
when one doctor has to take a patient to the B scan or down the hall to a
subspecialty clinic. I use the few words of Nepali I’ve heard to conduct an
exam. It’s in these moments that I am always charmed by the phenomenon that is
language. This year I’ve been immersed in many cultures, surrounded by foreign
words and sounds. Each time, I meagerly attempt to pronounce a word that feels
strange in my mouth.  Each time, I am
delighted when it has its intended effect. I marvel at the idea that this word—this
sound I’ve never heard—is significant to them; it holds meaning, infers action.
And just like that, I have conveyed my request. It’s like a key unlocking a
door; my request is granted and they look left, they look right, they blink.
What a miraculous thing it is for humanity: the ability to communicate through
spoken language.  It never ceases to
incite awe for me.

Just a few days in, I am invited into the OR. I watch the
production and realize what a feat is accomplished here, every day. Six days
per week, hundreds of SICS are performed in under three minutes each, restoring
vision to thousands of people. The patients seen in the morning are in pre-op
by noon. They are given retro-bulbar blocks by locals who have been trained as
OR techs. They are guided four at a time into the OR’s. The OR is a large room
with two beds side-by-side at a microscope. There are four beds to a room and
two surgeons sit at the head, alternating every few minutes between the tables.
As they finish a case, the nurse escorts the patient off the table and a new
patient jumps up from their chair at the foot of the bed. And so it goes, for eight
hours. The efficiency is nothing short of amazing.  At first I am shown… and then I am observed…and
then I am a part of the surgical team.

A flash look at the
clock reveals how many hours have passed. The day is done. There is a surging
return of thirst and hunger, ( not to mention the urgent need to use the
bathroom…) that has been quieted by the requirement of the absolute and total
focus demanded by surgery. No matter how overextended and plagued my mind may
feel, once a patient is draped, the world is hushed. I’m ever grateful for the
singleness of purpose it brings me. My thoughts almost echo in my otherwise
quiet mind.

At the close of the
day we are tired, but satisfied with the work accomplished. The patients will
stay in the ward for the night, often sharing the twin bed with the person who
escorted them to the hospital. The next morning they are evaluated at bedside
by penlight. Anyone with obvious corneal edema or a shallow chamber is sent on
to the clinic.  After rounds, the vision
is checked for every patient by techs. Anyone with a vision below 20/40 is also
sent for evaluation in the clinic. After the suspicious post ops are cleared,
the new day begins again with lines as long as the day prior.

Usually a few hours of sunlight remain after the doors of
the OR and clinic close. I have fallen into casual friendships with the other
ophthalmologists easily. We often spend those twilight hours together,
meandering through the villages beside the hospital or making dinner after
going to the market to buy fresh meat and vegetables. After dinner we walk the
hospital grounds. Tomorrow’s patients are already arriving and staking out
their land. The village dogs gather, hoping to nab a scrap of food. Monkeys are
watchful from the shade of low hanging branches, waiting for their own
opportunity. We review the day and laugh and talk. It feels within a week or
two like I’ve been here for ages, insulated from the rest of the world. I do
revel in inhabiting these spaces this year: living and working in spaces so
different from what I call home, but no less full of joy, humor and satisfaction.