Our first venue was Budoma school where we were given a whole classroom with barred windows (read: window-sized gaps in the brickwork) and huge craters in the concrete floor that meant we had to be careful not to rick an ankle each time we walked over to the test charts. As with everywhere we went, the children were entranced by us and peered in through the barred windows which made them look like little prisoners! There was a constant surveillance team around, but several feet back from, the doorway. Every so often one child (a prefect maybe?) would charge at them all, hitting their legs with a stick so they would all scatter. Within a minute the group would have reformed and they’d gradually creep closer and closer to watch the weird white strangers. At one point I saw some fingertips clinging to the windowsill. I waited immediately opposite for the face to bob up and said “Boo!” The face recoiled with surprise before breaking into a sunny smile and laughing.
We had some interesting pathology cases today – our team leader saw an active case of trachoma, a bacterial infection that is a leading cause of blindness worldwide that is common to hot, dry, dusty climates, and always associated with poverty and unhygienic living conditions. One young girl had an odd melanoma (tumour) growing on the conjunctiva which actually had a few hairs growing from the surface. As the melanoma had shown no change for several years, we simply educated her on the importance of monitoring it and seeking help if any changes occurred.
En route to our second venue we passed many of the little wigwam-esque houses which were so common in the villages. 2 of the team were lucky enough to be invited to see a teacher’s house (a great honour in Uganda) and found a family of several adults were living in the tiny space inside, which was divided into a living area and a sleeping area by sheets hanging from a rope across the room. Anywhere we drove there were random cows tethered by the horns, goats tethered by one leg and chickens running free with their chicks. Once or twice we saw turkey and guinea fowl.
Our second venue was Ikumbya Health Centre, which was one of the newest and most well-constructed buildings we saw, although the brick walls dividing each room only came up to chest height. The clinic was very odd, with nearly all the children’s eyes looking perfectly healthy and having no notable spectacle prescription but exceptionally poor vision with no apparent cause for it, or particularly good distance vision, but incredibly poor near vision (in the absence of pathology, there is an established link whereby you can calculate what near vision a patient should achieve, based on their distance vision). Each test was lengthy, demanding and tiring, with copious amounts of time being spent first finding a low vision aid that was most effective for the child, and then explaining, via an interpreter whose grasp of English wasn’t always ideal, how to use it. We discussed the clinic at length over dinner and our theory behind the unexplained poor vision of these particular children is malnutrition whilst in the womb.
Any Optometrist will tell you (and I’d wager any GP or Dentist also) that clinics seem to run in patterns. Sometimes I’ll get a day with numerous referrals with suspected glaucoma (and then none for days), or a cataract clinic, or the nightmare-get-me-Giant-chocolate-buttons-NOW! Emergency Referral clinic. Our clinics covered quite an area of Uganda, often travelling several hours in each direction to reach our venue, and the patterns in the clinics was marked.