05/07/2008
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Charity Case Study Writing & Photography SkillsCase study for blindness charity ORBISBurma, December 2004 Words and Photography by Tine Frank “Mummy has a new face. She looks so beautiful now.” This touching statement is made by ten-year old Summi at the Mandalay Eye, Ear, Nose and Throat Hospital in February this year. Just six weeks earlier it was a different story. Back then ‘Mummy’ – a lovely 43-year old lady called Daw Myint Myint San – was ashamed of going out and scared of facing people, tired of the curious stares she got from strangers. When we first meet her, in December 2004, it is indeed difficult not to stare at her. A tumour has been growing behind her left eye for more than fifteen years, pushing the eye so far out, that it is now grotesquely bulging. Fifteen years ago, Daw Myint felt an increasingly painful pressure in her eye and with time the eye became increasingly protruding and her vision decreased gradually. Her doctor told her that no operation could be done to restore her sight and tried, unsuccessfully, to treat it medically.  Had Daw Myint lived in the developed part of the world, her doctor would have done a scan, discovered the growth and removed it immediately, leaving her with no lasting damage to her sight or her appearance. But fifteen years ago, Myanmar did not have such treatments available, and by the time more specialised care was established in the country, the tumour had grown so big that the doctors were afraid to remove it. However, with the arrival of the ORBIS Flying Eye Hospital in Mandalay in December 2004, there is new hope for Daw Myint. ORBIS is in Mandalay for an intensive two-week training programme in which local ophthalmologists work closely with ORBIS volunteers from around the world, updating their skills and knowledge in selected sub-specialties. On board the Flying Eye Hospital is veteran volunteer, Dr Francesco Bernardini, an oculoplastics specialist from Italy. Together with Dr Aye Ko, he examines some 25 patients, among them Daw Myint, with a variety of pathologies that the local doctors are unable treat. Closely following the examinations are ophthalmologists and residents from throughout the country, all eagerly crowding around Dr Bernardini to hear his diagnosis. Due to time constraints Dr Bernardini has to select no more than ten patients for surgery, a selection based first and foremost on the suitability as a teaching case. Because of the severity of her condition, Daw Myint is immediately put on the surgery list. “I have never seen this sort of tumour before,” says Dr Bernardini. “I really can’t say for sure what it is until it has been taken out, but there is no doubt that we will have to remove it. If it keeps growing and keeps pushing the eye out, eventually the lid will close behind it and then, the only thing you can do is take out the eye.” Although seemingly happy to be selected for surgery, you can tell that Daw Myint is sceptical, having been told for fifteen years that nothing can be done for her. Three days later, she arrives at the Flying Eye Hospital, where Dr Bernardini and Dr Aye Ko perform the surgery watched live by around forty doctors in the on-board classroom. “It took me a while, but finally the tumour came out with all the capsule and no damage,” explains Dr Bernardini after the surgery. “The eye that was pushed so far forward is now back in position. In fact, it’s a bit further back than the other eye because the tumour has been there for such a long time, but that’s an aesthetic problem. At least now, she won’t have anything pushing against her optic nerve or retina, so she should have a good chance of visual recovery of some sort. She had very poor vision before with a very severe sign of optic nerve damage, but we will know in a couple of weeks when the eye has had a chance to recover from the pressure. Worst case, she will keep what she has now and she will definitely preserve the eye, which is great news. Also, it seems to be a benign tumour because of its behaviour. We don’t know for sure yet, but it would surprise me very much if it were malignant.”  Dr Bernardini teaching Burmese eye care professionals in a deserted Mandalay International Airport
For Dr Aye Ko, assisting on a surgery of this calibre was a first. “I have done some oculoplastics before, but mainly eye lid-surgery, he explains. “Dr Bernardini did an excellent job. It was a large tumour and it was very difficult to get out, so we had to be very careful. He is a great surgeon and teacher, very good at explaining how to do the surgery and very patient. I am extremely interested in oculoplastics and it’s a service our country desperately needs. In all of Myanmar, not a single ophthalmologist is specialised in this field so there is a huge backlog of patients. So I will have to try my best in the future to learn more. It would be great to be able to go abroad for more education, as there is no way I can study it here, but that will be very difficult. So the fact that Dr Bernardini was able to come here and teach me in my hospital is a great start and has given me a really good basis.” ORBIS has been working in Myanmar since 1991 and has over the years conducted ten Flying Eye Hospital and hospital-based training programmes in Yangon and Mandalay. The partnership is an excellent example of how ORBIS through continuous support builds capacity in the long term. Explains Dr Ye Lwin, an ophthalmologist at the Mandalay Eye, Ear, Nose and Throat (EENT) Hospital who has participated in every ORBIS programme; “ORBIS sparks ignition. Fifteen years ago we were fifty years behind in terms of medical knowledge and today, in some areas like cataract, we are more or less up to date. There are still other areas where we are ten to twenty years behind, but at least it’s no longer fifty! And with every programme we jump at least five years ahead.” The following day, the last day of the programme, Dr Bernardini checks up on his patients one last time, happy with the results. “It has been a excellent week with a great variety of interesting cases. The doctors here have a good theoretical knowledge, but their surgical experience is quite limited, so hopefully this week has been useful to them in that respect. This has been my sixth ORBIS programme and I really think it is a great organisation – otherwise I wouldn’t keep coming back. It’s a lot of hard work and a lot of responsibility, but it’s great sharing your knowledge and working with people from all over the world.” 
Six weeks later, returning to Mandalay for a surgical follow-up we meet
Daw Myint again, and the difference in her appearance and personality
is simply astonishing. You have to look very closely for any trace of
the tumour that was threatening to push out her eye and the smiley and
chatty lady in front of us now is a far cry from the introvert patient
we met six weeks ago. Having fully recovered, Daw Myint is now happy to relate what is was like to live with her blinding and abnormal condition. “Before the operation, I couldn’t face people – I felt uneasy and ashamed about the way that I looked. Even my family, although they never told me before the operation, found it difficult to look at my face. But they didn’t have to tell me, I could feel it, it was like that everywhere.” Daw Myint is interrupted when a man comes over and excitedly points at her face. A father of a fellow patient from the ORBIS programme, he remembers seeing her before the operation and is amazed by the results. “I get that a lot,” laughs Daw Myint. “It’s great, everywhere I go people are so surprised. We all thought is was an incurable disease and I had resigned myself to the fact that I would lose the eye sooner or later. So I was so surprised when the ORBIS doctors said they could help me. But still I didn’t really believe the result would be very good. It wasn’t until I woke up after surgery and put my hand where my eye used to be and it was gone – it was no longer there, but back in its right place. I have been so happy ever since and I am so grateful to the doctor, he was so kind to me. He saved me.” As Dr Bernardini had feared, the prolonged pressure on the optic nerve seems to have damaged it permanently, as her vision hasn’t improved much after the operation. But to Daw Myint, that is a small price to pay. All that matters to her is that she will not lose her eye, that the pain is gone and that she can feel like a normal person for the first time in fifteen years. |
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