Eye Mission Abetifi, Ghana July 7 – 23, 2006

1. Eye MissionAbetifi, GhanaJuly 7 – 23, 2006 Robert Wong MD

2. ACGME Requirements • To effectively deliver eye care to a remote population where care is lacking • To work with local government, churches, and hospital administrators in a professional fashion • To learn about eye pathology not commonly seen in the US • To educate the local population about routine eye care

4. Ghana • Population 21M • Gov’t: Constitutional Republic • GDP in 2001 $1980 • Agriculture • Cocoa, Timber, Gold • Unemployment 20% • 31% below poverty line Abetifi

5. Conversion to Socialized Medicine Doctor : Population = 1 : 22,193 Infant Mortality 66 / 1000 live births Child Malnutrition 27% Access to safe water 65% Life Expectancy 60 years HIV 3.8% seropositive Outpatient attendance Malaria 44% (most common complaint) General Health (2002) Ghana Health Services 2002

7. Need for Eye Care • 48 ophthalmologists serving 21 Million • Acute Eye Infection 2.61% (6th) • Cataract 0.16% (32nd) • International Organizations Help Fill the Void • Fight for Sight • Surgical Eye Expeditions International • Private Organizations

8. Our Group

11. Church is Important

15. Rev. Emmanuel Osafo Boateng

16. Through Church Contacts • Through the Presbytery Church of Ghana, we were able to obtain visas, import our medical equipment and supplies, and advertise our services easier • Advertisements 3 – 4 months prior to our arrival

17. Ongoing mission over past 7 years • Dr. Robert Brown, Foothills Presbytery in South Carolina • Kwahu Presbytery of the Presbyterian Church of Ghana

19. Creating Eye Exam Rooms

22. Dispensing Glasses

24. Pre-op Testing Area

25. Converting a Maternity Ward Into an OR

27. Interesting stuff I saw

28. 17 year old ♂ Trachoma

29. Micropththalmia OD Cataract OU

30. Hot Angry Eye OS Gumma Probable Syphilis

32. Statistics • Over 9 clinical days • Total # pts: 1492 • Males = 570 (38%) • Females = 922 (62%) • Average Age = 53.2 yrs old • Range 2 mths – 103 yrs • 41 surgeries 40 ECCE, 1 PC, 1Lateral Canthopexy

33. Patients Had Really Good Vision or Really Bad Vision(Distance)

35. 35 Corneal Scars 10 Uveitis 6 Amblyopia 5 Strabismus (3XT, 2ET) 3 Band Keratopathy 3 Microphthalmia 3 Retinal Detachments 3 CRAO 2 TORCH 2 Angle Recession 2 RP 2 Trachoma 2 Corneal Ulcers 2 CRVO HRVO Keratoconus PHPV Pediatric Cataracts Ocular Albinism Vascular Tumor NOS Orbital Fat Prolapse ?Acanthomoeba Other Diagnoses (8%)

36. 81 patients returned from previous years 70 PC/IOL 8 Aphakia 3 AC/IOL Findings Noted: 7 PCO 4 CR Scar 3 K Scar 3 RD 2 Iris Capture 2 Optic Neuropathy 2 Glaucoma 2 Vitreous in AC 1 PBK 1 CME 1 HRVO 1 ERM Post-ops

37. Final Thoughts • After 7 years, do the expectations of the patients change? • Standard of Care change? • Should we modify our goals for future missions? • Issues of long term follow? • Care for chronic diseases?

38. To the Beach! Gulf of Guinea

39. Accra

40. Buying Textiles at Central Market, Accra

46. The Group Judith Simon, MD Marta Leirer, RN Mark Leirer Pamela Spranger, RN Kathleen Osmanski Friends from Scotland Sinclair & Kim Dyer Kwahu Presbytery Church Rev. Emmanuel Osafo Boateng Alex, Charles, Kwasi, Timothy Mr. Kissi Abetifi / Donkorkrom Health Clinic Ignatius Ayonnayele Vic & Judy The Interpreters Obed Agyekum Agnes Datsomor Lydia Ofosu-Brako Doris Sarfoop Special Thanks