Ginir

With great excitement we travelled to Ethiopia to facilitate our 11th year of free sight restoring cataract surgery to the people living in rural Ginir. Supported by Muhammed Elemo and Seifudin from Kayo Self-help Group in Australia, corporate and private donations, we were able to keep our promise to go to Ginir village in the Bale Mountains.

Following consultation with Ministry of Health, (MOH) Hospital Managers, phone calls to Dr Girmar at Ginir Hospital and continual support from Kayo Self Help Association Oromo Community from Ethiopia here in Australia it was apparent when we arrived that no work had been done to notify patients in the villages that EFA was coming to Ginir to perform free cataract surgery to the disadvantaged.

Robert and I along with two past self-funding volunteers, Dr Margaret Watson our anesthetist and Julie Anstis, our theatre scout nurse travelled to Addis and were met at the Bole Airport by a representative from Ministry of Health Department who drove us to our Hotel. MOH were unable to provide us with transport to Ginir due to budget issues. Fortunately, Ginir Hospital provided us with a 4WD for our equipment and we organised a coaster bus to travel to GOBA, then the Ginir Hospital 4WD returned to GOBA the next day to take us along the very muddy and dangerous unmade roads to Ginir. The last 100kms is only suitable for 4WD. Kayo Australia contributed A $1200 to cover our road transport costs. EFA paid for the fuel.

The rainy season had come early, resulting in the unmade roads in Ginir to be covered in mud and dung from the goats, cows, donkeys and horse drawn transport.

Our accommodation was at a reduced price at a newly built Hotel in Ginir, ‘Sikkoo-Mando’ which is owned and built by Seifudin, who now lives in Australia. We were delighted there was a flushing western toilet and a hot shower when the electricity was working, a luxury in Ethiopia.

We often ate at the same restaurant most nights until we got very tired of Injerra and tagabino. Not forgetting to mention the extra loud music each night. The Rift valley white and red wine took the sting out of the day’s events.

Muhammed ELEMO from Kayo and Seifudin, were in daily contact to help us through the endless struggles to gain cooperation from the officials to mobilise our patients. Dr Bushra The medical Director from Robe also assisted and encouraged us to screen the refugees, however, he was informed there was no budget to transport refugees patients to the EFA clinic. We met The Local Health Department Head, Seid Idris, who also promised to announce our arrival at the remote Community Centers. Dr Nagash, The Assistant Director of Regional Health Bureau also contacted the hospital management to facilitate announcements of EFA at Ginir.

Julie met with hospital management to arrange our staff. We agree the optometrist to screen, ophthalmic nurse in OR with Julie A, translator for Dr Margaret, cleaners and guards. As expected not all staff were ‘on the job’ everyday. In fact we heard the absent guards were working ‘under cover’.

Screening records were kept by the hospital optometrist and ophthalmic nurse. Their records indicate 300 + patients were screened over 10 days. 63 females and 60 males were consented for surgeries. The conditions that were recorded in OPD were Allergies,glaucoma,trachoma,conjunctivitis, corneal scars, cataracts and presbyopia.

Despite the struggles we managed 107 cataract operation, 8 pterygiums, r/o x 2 lid lesions, 1 iris repositioning following pen injury by a goat patient age 2 years under GA, 1 sphincterotomy age 7 - GA, x 1 excision of molluscum contagiosum x 1 lower lid triciasis surgery.

The patients started arriving at the Hospital during the second week by word of mouth, for example.

• A 70 year old lady got the bus from Karo 30 kms away she heard about EFA.
• Twenty year old man hit in the eye by a goat 6 years ago. He had an irregular pupil, and corneal scarring. Was told by previous local Ethiopian cataract campaign to travel to Addis for surgery. Dr Abu released the iris from the wound, including lens extraction and Intraocular lense implant.
• Elderly farmer had been bilaterally blind from cataracts for 2 years and travelled 60-100kms by bus, was informed of EFA by mobile phone.
• Elderly lady walked 3 hours and had been blind for 6 months
• A 6 year old boy had iris proplapse from a penetrating eye injury 2 years ago. Dr Margaret gave a General Anaesthetic and Dr Abu released iris from the wound.

We arrived some mornings for work to find there was no electricity, no suction available for GA’s and Dr Abu performed some cataract surgeries using a torch.

All our patients received postoperative education including demonstration and observation of a relative on ‘how to instill’ eye drops.

This was in addition to receiving donated sunglasses, and Lorraine Clarks hand knitted beanies from Australia.

Dr Abu operated on two sisters age 5 and 8. They had bilateral congenital cataracts and had been blind most of their lives. Dr Margaret gave both girls a general anaesthetic and Dr Abu operated on both eyes together.

In the absence of a translator Dr Margaret was able to translate her English into Oromiafa, the local language thanks to the laminated posters she had written on and stuck to the wall in the anaesthetic room.

EDUCATION:

Dr Margaret discussed:
• General anaesthesia with the local anaesthetist and in charge nurse of OR,focusing on caesarean section and foetal distress.
• Eye block anatomy including peri bulbar anaesthesia including complications

Julie T
• double scrubbed with local ophthalmic nurse Abiyat to teach sterility techinques and handling of sterile instruments for cataract surgery.
• Demonstrated use of our I- care probe to measure intra ocular pressure

Julie A reinforced safe storage of supplies and techniques for handling ophthalmic instruments, including washing and preparing for sterilising.

Rahima our optometrist and Abiyat our ophthalmic nurse educated our patients on post op care including demonstrating instillation of eye drops and observing a relative to do the same.

OUTCOMES:

All patients were instructed to return to our clinic on a designated day one week from surgery. All patients were reviewed on the slit lamp and no infections were reported.

They were all given extra post op drops of G. Gentamycin and G. Dexamethasone x 4 times a day.

As usual compliance was hit and miss. All patients we were not able to review were advised to return for Abiyat. Any complications was agreed would be resolved by Ginir Hospital.

Despite much forward planning, phone calls and support from Kayo the campaign had many unnecessary and unforeseen struggles. It appears there is very little communication along the Government chain to the village we were encouraged by MOH to visit and no accountability for poor performance during our arrival. The unhelpful attitude at Ginir didn’t change for the two week campaign. We were not greeted warmly and continually harassed for money. The outcomes for the patients were 100% success, no infections. Our resources and manpower should have restored sight to over 200 not 123, had it not been for the obstructive manner of hospital and government leaders.

Despite feeling betrayed by some members of the Government chain and colleagues from Ethiopia EFA provided a free service to the ignored, disadvantaged people that have no access to eye care and has enabled them to see again.

EFA will continue into its 12th year in 2019 and keep hoping for a truthful, transparent partnership from Governments, Health facilities and locals.

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