05/07/2008
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Charity Case Study Writing & Photography SkillsCase study for blindess charity ORBISParaguay, July 2004 Words and Photography by Tine Frank Rodrigo Chavez, a lively 8-year old boy, lives in Luque, a suburb of Asuncion, with his parents and three brothers. The family has been surviving on the money his father earns from construction work since his mother had a stroke two years ago. In spite of their hardships, Rodrigo is a healthy and happy child however, although he does not realise it himself, he is at risk of going blind. Since the age of about 3, his parents started noticing that his eyes were turning inwards, and took him to their local doctor. Being diagnosed with strabismus, his parents were told that Rodrigo would need surgery to straighten his eyes. But on the family’s meager income of $120 a month, this was simply not an option. 
Strabismus – or crossed eyes – in adults will cause double vision,
whereas in children, the brain will decide to use only one eye in order
to avoid this, thereby causing amblyiopia (lazy eye) in the other – a
condition that, if untreated, can lead to irreversible blindness. Though visually impaired by his strabismus, Rodrigo has not yet developed amblyiopia, and his vision is good enough for him to lead a relatively normal life. In school however, he does struggle to keep up, and as a result has had to repeat one year. His teacher, being concerned with the difficulties he was having, urged his parents to seek treatment and advised them to take him to the Fundacion Vision, a charitably supported ophthalmic clinic, on the off chance that he would be offered free care. A Fundacion Vision ophthalmologist, Dr Carlos Gonzales, examined Rodrigo, but as he did not feel confident enough to carry out the procedure himself, he included him on a list of patients to be seen during a forthcoming ORBIS Flying Eye Hospital programme. The ORBIS Flying Eye Hospital, with its team of international volunteer specialists, was in Paraguay for a three-week skills exchange programme in July 2004. Dr Joseph Giangiacomo, a US Paediatric Ophthalmologist and first-time ORBIS volunteer, was partnered up with three local ophthalmologists, one of whom was Dr Gonzales. At screening day, which is when all selected patients are presented to the ORBIS volunteer doctors, Dr Giangiacomo and his trainees together examined and diagnosed a number of patients of which they made a short list of around 10 children for surgery during the forthcoming week of surgical training. Explains Dr Giangiacomo; “Rodrigo’s condition is called esotropic strabismus, which means that his eyes are crossing in, causing a reduced peripheral vision. One of the things you can do to treat this is by patching the ‘good’ eye, thus improving vision in the ‘bad’ eye. However, it does not align or straighten the eyes but rather makes the vision come to a level which functions quite well. Rodrigo has had patch treatment for several months, and now we can actually surgically move his eyes to straighten them and enable them to move equally.” Rodrigo was accompanied to the screening day by his mother and teacher. With his cheeky grin and open personality, he quickly charms the ORBIS staff. Chatting to them, he relates how his favourite things are flying kites, playing football and marbles and going to school. When his mother and teacher laugh at this last statement, he grins mischievously and admits that his favourite part of going to school is in the fact the breaks. It is obvious that he is very close to his mother. “Rodrigo is such a lovely child, she says. “He always helps me out at home and hugs me a lot – he is quite different from his brothers.” Rodrigo’s surgery is scheduled for the last day of the programme and takes place at the local Instituto de Prevision Social Hospital. To maximise the teaching value, Dr Gonzales, having observed and assisted in surgeries throughout the week, was operating with Dr Giangiacomo assisting. Says Dr Gonzales of the experience; “I have done only about ten strabismus surgeries in my career – on children as well as on adults, so I really gained a lot from working with Dr Giangiacomo, as he showed me several new surgical techniques and how to work with different sutures. He was very patient and gave me great advice so I felt very confident working with him.”  The day following the surgery, Rodrigo and his aunt come to the Flying Eye Hospital for his post-op examination. Amazingly, Rodrigo’s eyes are completely straight, and he does not feel the slightest discomfort or pain. Whilst waiting to be seen by the doctors, one of the ORBIS staff takes him on a tour of the Flying Eye Hospital and later on gives him a mirror for him to have a look at his ‘new face’. Rodrigo’s jaws literally drops, followed by a long silence where he just stares amazed at the image reflected to him, upon which he agrees with the ORBIS staff that he does indeed look very handsome. 
Both the doctors are incredibly pleased with the results of the
operation. “Dr Gonzales had pictures of Rodrigo from before the
surgery”, says Dr Giangiacomo, “and comparing those to the way he looks
today, the difference is quite striking. I am very pleased with the
results, and Rodrigo was happy and smiley this morning so I think he is
happy too.”During a Flying Eye Hospital programme, life-changing experiences like that of Rodrigo’s take place every day, yet the true effect of an ORBIS programme is what goes on after the medical team leaves. As Dr Gonzales explains, this is an experience that will benefit himself and the people of Paraguay for years to come; “This week has been fantastic for me, I have seen so many different things, different ways of working, many of which I had only read about before, but never seen in practice. Strabismus and cataract are the main causes of childhood blindness in Paraguay, so the training I have had here this week has been invaluable. Personally, it was great to get the opportunity to help a kid like Rodrigo. An operation like this normally costs about $300, and the minimum wage in Paraguay is about $120, so there is no way a family like his would have been able to afford this treatment. There is a lot of unemployment and poverty in Paraguay, particularly in the rural areas.” Adding to this problem is the fact that over 90 percent of Paraguay’s ophthalmologists live and work in the capital city of Asuncion. What is more, is that only three or four institutes in all of Paraguay offer peadiatric ophthalmic services, and all of them are situated in Asuncion. So what Fundacion Vision is trying to do is to bring quality and affordable eye health care to these rural communities. Dr Gonzales hopes to be able to play a vital part in this; “My plan for the future is to do a fellowship in paediatric ophthalmology in the States, after which I want to return to Paraguay and work in the rural communities where my skills are needed the most. So even if this programme has been relatively brief I think it is the beginning of something better. I just want to say thank you to all the ORBIS staff who came here. We, the general population and medical staff alike, are in desperate need of this kind of help.” Dr Giangiacomo is equally enthusiastic about the programme; “All of my three trainees were really excellent, they were all extremely knowledgeable, and I think that considering the resources I have in America and what they have in Paraguay, they really manage to make the most of what little they have. I very much hope to go on more ORBIS programmes in the future, as I really like the philosophical aspect of ORBIS in as far as everyone gets involved. You have ophthalmologists, nurses and technicians – there’s a whole group of people involved so you are not just teaching one doctor, you are teaching an entire ophthalmic team. Actually, if all the participants from this programme got together, they could go and start themselves an ophthalmic clinic and do just fine.” |
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