Vision For The Masses

In addition to his reputation as an excellent ophthalmic surgeon, Dr. Strauss is known for being a kind and humble person. Friend and colleague Alison Brieseman, Operating Room Supervisor onboard the Africa Mercy, has worked with Dr. Strauss for several years. She describes him as a "team player," who even helps mop the floors after a long day of surgeries in the OR.


Hundreds of people wait outside of a Mercy Ships eye clinic in Benin, West Africa, hoping to be scheduled for cataract surgery. According to the World Health Organization, cataracts are responsible for 48% of world blindness, affecting 18 million people.

This is a story I wrote about Dr. Glenn Strauss and the amazing things he has doen this year in Benin. And at the end of the day, he and his wife, Kim, are two of the kindest, humble people you will ever meet.

Vision for the Masses
By Megan Petock
Photos by Bebra Bell and PJ Accetturo

According to the World Health Organization, cataracts are responsible for 48% of world blindness - affecting 18 million people. Although surgically curable, cataracts are the leading cause of blindness and visual impairment in the developing world, where nine out of ten of the world's blind live. Barriers to surgical care include high cost, inaccessibility due to lack of trained surgeons, and poor visual outcomes. If no action is taken, it's estimated that the number of people blind from cataracts will swell to 40 million by the year 2020.

Having a diameter of only 2.5 cm (1 inch), the human eye is slightly smaller than a ping pong ball. Most of the eye remains hidden and protected within the bony orbits of the skull. Only the cornea - the eye's clear, outer wall - is exposed to the environment.

The optics of the eye are comparable to a camera. The cornea allows light into the eye, which continues through the pupil until reaching the transparent, flexible lens. The lens focuses a precise amount of light onto the retina - a light-sensitive tissue on the eye's inner surface, filled with visual receptor cells. These cells, called rods and cones, generate an electronic impulse which transmits images to the brain. The images are transcribed by the brain, and the result is sight.

A cataract is the clouding or loss of transparency of the lens. The lens cannot focus light onto the retina, which means that a clear image cannot be transmitted to the brain. The affected individual's vision becomes blurred and unfocused. If the cataract is not removed, the clarity of vision continues to deteriorate, eventually causing blindness.

In the Western world, cataracts are removed long before vision is threatened. They are most commonly removed using a technique called phacoemulsification. A small ultra-sound probe breaks the cloudy lens into pieces and suctions them out through a tiny incision. Then a new lens is inserted. However, in the developing world, where resources and personnel are scarce, this technique is not feasible.

Traditionally, the alternative method used in developing countries has been the extra-capsular technique, in which the surgeon makes an incision in the eye and removes the entire cataract in one piece. The procedure takes 20 to 30 minutes and requires stitching the eye, which results in a prolonged recovery.

Dr. Glenn Strauss, an American ophthalmic surgeon, has spent more than a decade performing free eye surgery in developing countries. Serving with the global charity Mercy Ships, he and his wife, Kim, live onboard the world's largest non-governmental hospital ship, the Africa Mercy.

Dr. Strauss received his medical training at the University of Texas Medical Branch in Galveston,Texas. It wasn't until his last year of medical school that he became interested in ophthalmology. "It was the fourth year of medical school when we had a very short rotation through the eye department - only two days," said Dr. Strauss. "It caught my attention, and I really hoped it was something I could do. However, obtaining an ophthalmic residency was very competitive. There were 500 people that applied for four positions. I was given one of the positions. I thank the Lord for opening the door and allowing me to do it."

His first experience performing ophthalmic surgery in the Third World was with Mercy Ships in 1997, when Dr. Charles de Haven, a local ophthalmologist, invited him to work onboard the Caribbean Mercy. "After that experience, I continued coming back, and it became an annual routine," said Dr. Strauss. In January 2005, he left his successful ophthalmic practice in Tyler,Texas, to serve with Mercy Ships full-time.

It was during this time that Dr. Strauss recognized the need for an alternative cataract removal technique.

"The ultrasonic device needed for the phacoemulsification technique is expensive, the cost per use is very high, and maintenance of the machine is very difficult," explained Dr. Strauss. "In underdeveloped countries, the environment can be very harsh. I've seen machines that have been donated just sit there after being used just once or twice. And that's it. We needed to find a solution for people that did not require a lot of technology but produced the same quality. That was the objective," he said.

Over four years, Dr. Strauss developed a high-quality, sutureless cataract-removal technique, that can be performed in only five minutes and requires basic surgical instruments.

"It's been developed out of a concept that was already being used in all areas of ophthalmology for cataract surgery," he explained. "I applied the same principles in making a tunnel in the eye-wall through which you can do all your work. The cataract can be slipped out, and the new lens can be slipped in. When that tunnel is properly constructed, it is self-sealing and doesn't require any sutures."

Dr. Strauss has seen positive results while using the sutureless technique in West Africa. The absence of sutures results in decreased trauma to the eye and an overall increase in recovery rate. "Patients are healing faster. The post-operative reports on our patients show that the day after surgery, the vision is extremely good. Some are even 20/20 or 6/6, which is considered perfect vision," he said. "They are seeing that well the first day, which says a lot about the quality of the procedure."

Because the procedure is inexpensive, faster, and more accessible, Dr. Strauss believes it has the potential to revolutionize ophthalmic care in developing nations and possibly decrease the escalating numbers of cataract blindness.

"Currently, the number [of those blind from cataracts] is not going down. It's my hope that because this technique can be done using local resources, it will start to turn the trend and chip away at that number," he explained. "We've needed the right tool to have that impact. At this point, this procedure looks like a very good option to do just that."

Although he has developed his own methodology, Dr. Strauss is quick to point out that he is not the only surgeon utilizing these principles.

"It was certainly something I developed as an application of these principles to this specific condition that we have here, but developing this technique is not really the same as inventing something. There are several other ways that the same thing is done, and there has been interest in doing this since about 2003. There have been similar techniques developed in Indiaand Nepal, and they have had a parallel development."

This year, Dr. Strauss has taught the technique to five ophthalmic surgeons from Benin. Currently, they are using the technique at their local hospitals and teaching it to other surgeons. "This new method is very quick and less expensive, which has been very helpful," said Dr. Doutetien, a Beninese ophthalmic surgeon who is now performing the technique at her hospital.

In addition to his reputation as an excellent ophthalmic surgeon, Dr. Strauss is known for being a kind and humble person. Friend and colleague Alison Brieseman, Operating Room Supervisor onboard the Africa Mercy, has worked with Dr. Strauss for several years. She describes him as a "team player," who even helps mop the floors after a long day of surgeries in the OR.

Brieseman believes that the work Dr. Strauss is doing and the knowledge he is sharing is revolutionizing ophthalmic care in developing nations around the world. Indeed, the technique Dr. Strauss has developed has the potential to impact millions of lives. "It doesn't replace what is being done in the developed world, but the quality of it is quite comparable," Dr. Strauss said. "Just because someone lives in a poor country doesn't mean they ought to be getting second-best. It's not offering a second-best, and that's what I really like about it. I think it's a terrific step forward," he concluded.

Exodus Orphanage

This morning I visisted the Exodus Orphange. Here are a few of the beauitful kids who live there.

Dental Team Prison Outreach

Dag, the long-term Dentist works on a patient. Apart from his dentistry skills he is a very good ultimate Frisbee player.
The dental team saw 240 patients in one day. The have seen almost 10,000 patients this outreach. They have worked really hard.
There was an entire community within the prison. This was the music room. These guys were the band, who played over a set of speakers the duration I was there.
One of the guards watches over the prison entrance.
A group of men at the prison. I was surprised at how friendly everyone was. Inside the prison are men, women, and children. During the day, everyone mingles within the community. At night, however, the men and women are separated and locked up. The kids who are there to be with their incarcerated mothers. I'm not sure what happens to them at night, but I imagine they stay with their moms.
A group of prisoners wait to be seen outside of the church where the dental clinic was set up.
A man waits to be seen.
One of the men gazes into the clinic via the wall openings.
The dental team also did oral hygiene teaching and handed out toothbrushes.

The shrine inside a small room which was designated the Catholic church.

Esperance: A lasting transformation

Story and photos by Megan Petock (me)

Laura Rawson was standing amidst the hundreds of people in line outside the Hall des Artes stadium in Cotonou,Benin. Mercy Ships was hosting a large-scale screening day to schedule patients for surgery during the 2009 Field Service. Laura was busy triaging potential patients when she heard an excited voice yelling, "Laura! Laura! Laura!"

"I looked over and saw this woman standing at the front of the line, waving her hands and calling out my name," said Rawson. "At first, I didn't recognize her. But then she said, 'It's Esperance.' I have only ever known one Esperance. As soon as she said her name, I went over and gave her a huge hug. I couldn't believe it was her."


Rawson first met Esperance in June 2006, while serving as a ward nurse on the Anastasis during a field service in Ghana. "Esperance had come to our screening day," she said. "I remember she was wearing a small hat and using a lappa to hide herself."

Esperance had been hiding for over a year. In December 2005, while sleeping in her home, she was awakened by her husband in the middle of the night. He was standing over their bed with a cup of acid. He poured the acid all over her body and then drank the rest, killing himself.

The acid burned the skin around her neck, arms, and torso, leaving many of her nerve endings exposed. For weeks, Esperance was in constant, non-relievable pain. When the burns finally began to heal, things only got worse. Severe contractures formed on her arms and neck, leaving them completely immobilized. Esperance was unable to do simple things like cook and bath herself. "At that time I was feeling very bad. All the skin was stuck together, and I could not move my arm or neck. Everything was hurting," she said. Grotesque scars covered her face and made her feel ashamed. People would stare and laugh at her when she went out in public. Wanting to stay hidden, she draped a piece of fabric over her head whenever she left her home.

Deep emotional scarring accompanied her physical wounds. Esperance had been betrayed by the man who had promised to protect and love her. "When my husband poured the acid, he knew what he was doing. He hurt me very badly and has caused me very great pain," said Esperance. "Since that time, it's like men are not men anymore. I have a hard time trusting them."

At the Ghana screening day, Esperance was scheduled for plastic surgery. When she arrived on the Anastasis, she was withdrawn and depressed. "When she first came, she didn't want anyone to touch her and refused to talk to anyone. All day, she lay in bed with a sheet covering her, hiding her face the entire time. It was obvious that she was in a lot of pain - physically and emotionally. She was so hurt from what her husband had done," said Rawson.

A Mercy Ships surgeon performed an operation to release the contractures on her neck and arms. Esperance spent many weeks on the ward while her wounds slowly healed. At that time, a special friendship began growing between Rawson and Esperance. "She was with us for a long time. I wanted her to know she was loved. At some point, I started rubbing cream on her back three times a day. I used to sing, 'It Is Well With My Soul,' when I did this. Later, she told me that small act gave her a real peace," said Rawson.

Slowly, Esperance began to trust the nursing staff. She stopped hiding under her sheets and greeted the nurses by name when they began their shifts. When she finally left the Anastasis, she was a completely different woman.

"When she came, her level of trust for other people was pretty low. The person she should have trusted most did that to her and then killed himself. But she totally transformed on the ward. She went from not talking to anyone or interacting with others, to saying hello and knowing our names. When she left, she seemed to have a lot of confidence in herself and how she looked," said Rawson.

The transformation continued after her discharge. When Esperance came to the February 2009 Benin screening day, instead of hiding under a piece of fabric, she was visible and smiling. Although physical scars remained, the love she'd received on the Anastasis had given her the confidence in herself to be joyful.

In Benin, Esperance received a second surgery to further release her neck and arms. She immediately sought out Rawson. Three year's after their first meeting, Esperance still remembered her kindness. "In Ghana, when I was having my pain and everything was hurting, Laura took really good care of me. She made me feel very comfortable and happy. I was really lonely at home - but on the ship, people loved me and were taking care of me," said Esperance. Their friendship was rekindled, and it has deepened Rawson's appreciation of the impact Mercy Ships has on individual lives.

"Not having any contact for almost three years and still having this level of relationship made me see the impact we can have on people's lives. It has given me more confidence to know that there are many patients like Esperance that have totally changed. It's not just a physical change, but an emotional and spiritual transformation. Esperance still has very ugly burns on her face and body, but she has confidence and values herself as a person because she knows she is loved. God has healed the scars on the inside through our caring for her on the ward. It's an amazing privilege to be a part of that transformation."

Oceane

Oceane at screening day in February.



Oceane leaving the Africa Mercy last week.

joy

Anicette had her steri strips taken off today. And she started to fall asleep with her head under my neck while I held her. Did I ever mention I love this baby?

Shame

Shame:
the painful feeling arising from the consciousness of something dishonorable, improper, ridiculous, etc., done by oneself or another:

I took this photo last week. This woman recently had surgery to correct her cleft lip. I've seen many patients like her before. Too hurt to allow a glimmer of her soul to escape through her eyes, she doesn't look into the camera. When you speak, she half pays attention, not having the confidence human conversation requires. Insecurity is written on her face. Without words, she communicates a lifetime of rejection. Shame embodied.

It breaks my heart to see someone in that condition. I don't want to imagine the rejection, humiliation, and mockery they must have endured.

But I'm hopeful. I hope, when her stitches and bandages are removed, she can smile. Maybe for the first time in years.

And I'm glad. I'm glad for little Anicette who has received surgery as a baby. I'm glad she won't come to the ship bearing shame in 20 years. She won't even remember anything was ever wrong.

And I'm happy for her.