Dr Tani Brown : Oecussi, Timor-Leste

28th August 2016

We are continuing our outreach visit to Oecussi. The screening team have done an excellent job in coordinating patients to come for surgery from the local villages. The patients are driven down in the outreach 4WDs, given meals, have their surgery and then stay the night for their review the following day before being taken home. We manage approximately 20-30 cataract patients a day between two operating tables. These patients are truly suffering from reversible blindness from cataract and often literally stumbling into the operating theatre due to their poor vision. As a comparison of the impact of cataracts between the developing world and developed world, in countries such as Timor-Leste cataract extraction is normally indicated when visual acuity is worse than 6/60 where as is in countries like Australia, indication for surgery if often 6/12.

While there are few studies on the prevalence of adult cataract in Timor-Leste. Studies from Asia and South-East Asia estimate the rate of reversible blindness in adults from cataracts to be as high as 40%. Major efforts have been made over the last 25 years to reduce and eliminate avoid blindness globally and this reflects the efforts of the World Health Organisation (WHO) and International Agency for the Prevention of Blindness (IAPB). Blindness from cataract impacts significantly on individuals in terms of their daily activities such as cooking, toileting, employment and helping care for younger family members. It also of course directly and indirectly impacts on the social and economic development of families and communities as a whole and therefore restoring sight through cataract surgery can be a small part in assisting developing countries overcome the significant hurdles to development .

While the outreach teams aim to be self-sufficient in terms of resources needed to perform cataract surgery, sometimes we have to be improvise with makeshift operating tables and operating chairs. One of the operating tables is a desk with a mattress on it and the team is very creative in making do with limited resources. A head ring is fashioned from a tightly bound patient gown with tape wrapped around it. There is no anaesthetist but rather the peribulbar blocks are performed by the outreach team - either the Doctors or Nurses. Patients are brought into surgery, have their biometry (measurements to ensure we place the correct power lens for their eye), receive their peribulbar block and then proceed to surgery. The patients are remarkably stoic in what must seem a completely alien environment for them. The following day patients are brought down from their accommodation, their eye pad removed, visual acuity checked and then a review on the slit lamp by the Doctors. Patient are given their free drops and sunglasses and given an education session regarding drops installation and follow up by the outreach team. Some are booked for second eye surgery if we have time although the priority is always first eyes in patients with very poor vision. Most are told to represent the following year to get their second eye done if they wish.

Oecussi town or Pantemkaser is a completely gorgeous laid-back oasis. Large tree lined streets with little traffic, all surrounded by beautiful beaches. An enormous about of infrastructure work is being done in Oecussi at present and we will routinely walk up to the hospital in the morning, only to find the road ripped up, ready to be resurfaced in the afternoon. After work one afternoon we travelled up to the old fort sitting above town and were serenaded by a group of children. As always, the old forts always have a lovely high vantage and the road up, while only short, is quite precipitous. I have also managed to get a run in although I only ran west from town, which is pretty flat and boring albeit for the multitude of ‘Botardes’ I receive along the way. On the last night we had a dinner with all the staff from the outreach team and those local staff who were assisting us. They hotel we are staying at has done a remarkable job with a full spread of fish, beef, goat and vegetable dishes. On the final day we see post op patients and then pack the theatre up and outreach cars ready for the trip home. It will be nice to get home to my own bed after playing musical rooms at the hotel for the last 4 nights.

References:

Chua J and Cheng C. Visually significant cataract: a global challenge. Clinical and Experimental Ophthalmology 2016; 85-86

Pre-operative Peribulbar Block