And I'm back!

Where to begin?  How about where we left off?  One Sight.  Oh One Sight...  What is there to say?  Let's start with what it was and then I will explain how it was.

One Sight is an international NGO that is based in the United States that provides eye screening and glasses on site.  It is a pretty cool service and definitely much needed.  They provide these services around the world through makeshift clinics made up of an international team that come in for about two weeks.  Their team they brought with them was made up of 40 people, including probably six optometrists.  This is the second year we have partnered with them, doing all the ground work, utilizing our established relationship with the community and constant presence in country.  We also provided our services of health education, health screening, and VCT (voluntary counselling and testing) with nurses on site to provide basic care.  Last year when they came, we spent the entire two weeks servicing our local community in Mtubatuba.  This year we opted to service the other four municipalities in the area, spending two days in each over two weeks, particularly targeting rural, underserved areas.  This meant that the first week we got to stay at a swanky hotel to more easily reach the sites, which was very exciting for our staff, many of whom have never stayed in a hotel before, much less a swanky one.  They thoroughly enjoyed their swankster selves.

The nitty gritty of how it went down:
Refer to the awesome flowchart that I featured in one of my earlier posts.
The line,












patients attend health education,
register,

                                                                                                  Snellen chart,

eyes dilated (by me!),

auto refraction,













opthalmoscope exam, and then receive glasses, medication and/or referral if needed, got donated sunglasses to protect their poor dilated eyes (and also to look really freaking cool- hence how we drew the kids in).

The OneSight team brought some basic meds, like antibiotics, steroids, etc.  And then they would refer out for follow up of bad infections, anything surgical- cataracts, glaucoma, scarring- or anything beyond their supplies/resources of our makeshift clinic- children with strabismus (cross-eyed). 
Finding the right pair of glasses was pretty cool.  They had thousands and thousands of glasses that had been donated, new and old, and they had organized in boxes.  They would then enter in the perscription from the auto refractor into a computer system that would search through all the glasses remaining and find the best match.  This was correlated with a code that they could then use to find that pair among the thousands they had brought, which were then fitted to the person's face, and ta da!  They could see!  Pretty freaking awesome if you ask me.  I heard some awesome stories of little old people doing jigs when they got their glasses so excited about seeing.
Sadly I didn't really get to witness this because I was stuck in the dungeon of pain and torture.  Bwahaha.  Aka I dilated eyes.  In Zulu world, dilating their eyes means causing them pain and blinding them, so needless to say I was not their favorite person.  But, damn, did I dilate the heck out of those eyes!  Lots of them.  Thousands of them.  And I did start to notice one thing after pulling down all those eyelids.  The young people, especially adolescent females, had incredibly pale conjunctiva, suggesting anemia.  I guess I shouldn't of been surprised considering my awareness about their nutrition, but a couple were so sever that I insisted they get a referral to the clinic to get supplements because our nurses had run out.  I told the OneSight team that they should start taking advantage of looking at so many conjunctiva being as they are usually working in populations at risk for nutritional deficiencies.  The optometrists were less than excited about it, being optometrists and all.  But, I think it could be a really cool public health partnership, so if anyone can think of a way to make it efficient and sustainable, like perhaps a partner program/organization to provide the supplements, and what happens when a patient runs out being as OneSight is not a permanently placed service?  Could be cool, just something to think about... (says my nerdy public health self)
Despite being involved in a less than riveting or moving part of the process, I worked with an awesome team made up of South African public health nurses and a Peace Corps volunteer, Gayle, a 60+ American public health nurse.  We were the dream team.  We were like a machine by the end.  Even the OneSight people were impressed.  And I have to say I was partly grateful for not having to work that closely with their team...

So now, how was it?  Well, it was a learning experience, that's for sure.  Some of their team were awesome.  And some of them...   not NOT awesome, but, very American.  Even some that had done a lot of these trips, traveling the world.  As much as it was a cultural learning experience for them to be working side by side with our Zulu staff, it was a cultural learning experience for our staff about Americans.  They have experienced Americans in small doses, but it was definitely new to experience them en masse.  I will spare you the details of how exactly they came off as American, but it definitely showed in their expectations and leadership style.  I do have to say this experience also helped me learn a lot about myself.  I thought I would be comfortable working with these people, having worked with many like them before, but I actually found it very challenging as I found myself coming to the defense of Africa and her people.  I also had the opportunity to watch from the outside, looking in.  Watching these people interact with my African counterparts, as well as hearing what my colleagues had to say afterwards, made me cringe.  It was quite embarrassing.  This self righteousness, that the Africans just smiled and nodded at, because they are used to complying with authority, all the while rolling their eyes, like these people must be crazy.  I understood how ugly we could come off, even when trying to provide aid.  You know, you hear tale that there are people like this, but seeing is believing.  And I realized how much work I had in front of me, not only all there was to be done, all the disparities, everything that needs "fixing", but in earning these people's trust and respect.

And easier said than done.  As much as I want to believe and say that I am nothing like "those people", I think the best I can do is say at least I am self aware that I harbor these qualities and they sometimes make an appearance.  For example, throughout the OneSight process I kept thinking to myself, what would PL say?  If you don't know who that is, no worries.  The point is, that in our culture, especially in the medical field, we are taught to always think ahead.  Ten steps ahead.  I always think back to rounds with the "big" man and him asking "So what do you want to do?... And then what?  And then what?  And then what?  And what if this happens?  And this?".  And "Why?  Why?  Why?".  Pushing us to think our decisions out past the basic algorithm, justifying our every move.  This is not how their education system teaches.  A lot more rote memorization, a lot less critical thinking.  And so they don't have the habit of always looking ten steps ahead.  This often leads to Tim and I seeing a train wreck coming from a mile away.  And this is where the challenge is.  My instinct is to say "Look out!".  But, often, this is less than appreciated, perhaps found threatening, because in a sense, I am telling them they are wrong, that their idea is not necessarily the best way or the right way.  Tim is much better than I at sitting back and watching the train wreck happen and picking up the pieces afterwards, with faith that people learn from their mistakes.  I find this more challenging.  It seems to go against every grain in my body.  I can't help but be frustrated as I watch things happen that I know could be done in a more effective and efficient manner, especially when you always have an underlying anxiety about how much there is to be done here.  Sometimes I sadistically wish PL would show up to regulate.  But, the point is, I try to be aware of this quality of mine so that I can keep it in check when it makes an appearance, and therefore hopefully not become an ugly American.

So, all in all, a challenge, but definitely a learning experience, about my own culture, this culture I am working within, and myself.  And at the end of the day we provided services to over 6,000 people in very underserved rural areas, and it doesn't get much better than that.

Eish!  And this is all before holiday!  Just wait.  That's when the good stuff starts... :)