We arrived at Bugembe Health Centre near Jinja for our first clinic to find that a group of patients, including several albinos, were waiting for us. Albinism comes hand in glove with several eye conditions, such as nystagmus (an involuntary, constant eye movement), strabismus (or “squint”), high prescriptions, and of course extreme sensitivity to light and generally results in extremely poor vision. Additionally being an Albino in Africa can carry quite a stigma.
We set up our equipment along one side of the room so that the four of us were testing simultaneously in a row (somewhat different from the plush consulting rooms in the UK!), and our Dispensing Optician had a small side room in which to dispense spectacles. Whilst the furniture was sparse and somewhat basic, the room was cleaner than the disturbing sign may suggest! Eww, indeed! I chose not to take a look at the pit latrines!
If we had thought that starting with a half-day clinic would break us in gently, we were very wrong! I will never forget my first ever VAO patient. He was constantly looking off to the far side, but kept changing from one side to the other. You can probably imagine how easy it is to do an eye examination when your patient can’t/won’t keep their eyes still? Not even remotely, is the answer!
Every Optometrist has their own set routine for eye examinations – an order in which they carry out certain tests. I usually perform retinoscopy (an objective test which gives a reading of the patient’s prescription without needing their responses) before ophthalmoscopy (looking inside the eye to check the health). This young boy had quite an awkward prescription, but it didn’t come close to accounting for his low vision of hand movements at 1 metre. When I came to perform ophthalmoscopy I found that practically the entire retina was scarred with atrophy and pigment patches. Lesson learned – in Africa, ophthalmoscopy first, retinoscopy second. I spent quite some time with him trying out different low vision aids, and was able to improve his vision slightly.
The rest of the patients in that clinic were equally challenging, and nearly all of them were provided with one of the low vision aids that we’d been convinced we would hardly use! At the end of the clinic, our team leader requested a photo of the team sitting looking tired outside the venue, and it was not at *all* difficult to oblige!
Once we’d packed up we were informed that we were “going to Paradise” – which in actual fact turned out to be Paradise Hotel, but since they had lovely grounds and HOT SHOWERS!!! they get my vote! Our work was not yet done however – every VAO Project collects a lot of statistics regarding eye problems and prescriptions encountered to help with future projects and determining the needs of different countries and regions. Next we learned lesson number 2 – in Africa, order dinner early – it takes well over an hour for it to arrive, regardless of what you order! After the first night we established a routine of ordering dinner, freshening up (lesson 3 – baby wipes are an ESSENTIAL part of your VAO travel kit!) and then sitting doing the stats with a beverage whilst awaiting culinary delight.