Full reports of trips to give eye care to refugees on the Thailand/Myanmar border
Full Report November 2023
Consumables: A spreadsheet was devised by Simon to allow for the planning and ordering of consumables. However, this did not clearly provide a stock take of the IOLs, so we ran short of some of the popular sizes. Tom created a stocklist of current in date IOLs in our bank and we will need to plan which lenses we will need to replace using data from the cases performed in previous years. This will need to be completed in a timely manner to allow for SICS operations to proceed prior to our next trip (if Dr Tin will be operating) or in time for our next visit in April. The team was able to set up the clinic and biometry room straightaway and Simon and I could get operating as soon as possible. We therefore advised that the theatre teams prepare the theatres prior to our arrival so that we could start operating as soon as possible. Prescreening was essential and performed very well (especially in SJD by Goong). This meant that the patients with cataracts could be identified and listed straightaway. The patients had also been prioritised according to functional disability/need, and once this was communicated to the ‘reception’ area, it worked effectively. Some instruments were required (Kelly punch for trabeculectomy and suture tiers) but were not available. We have suggested a stock take of the current working instruments and the cataloging of them so we can replace them and ensure they are brought to every trip.
At SJD Pre-screening was excellent. Patients with bilateral severe cataracts should be prioritised to be seen on the first day so they have a chance of having bilateral surgery during the week. If wifi could be guaranteed it would be save time if combined shared google spreadsheets could be used for pre-assessment, biometry, surgery and maybe first day outcomes. For the moment wifi is only available at SJD but this could be discussed for future trips. It was disappointing the new YAG laser could not be set up at MTC. It is expected that it will be set up at SJD and the old laser be transported to MTC, ideally before the next camp. During this camp Goong was trained on applanation tonometry (intraocular pressure measuring) and it is planned to train him on gonioscopy at the next camp so he can follow the glaucoma protocol proposed by Frank Green, and perform laser iridotomies earlier in the glaucoma pathway for patients with angle closure disease.
Full Report April 2023
San Jae Dee (SJD) clinic
Following the feedback from the previous trips, prescreening was recognised as playing an important part in the service, and this was performed very effectively by Goong and his team. Sixty four patients had been prescreened and this meant that 29/32 (92%) of the patients screened on the first day were listed for cataracts. The set up was the same as previous years, with the clinic processes much the same, such that the inclusion of the new staff members meant we could start the surgery sooner than previous. This was also helped by Goong remaining at SJD to prepare for the week’s work while we travelled by minibus from Bangkok.
Despite the very different working environment and the limitations this can pose, Kate got to work immediately and worked tirelessly along with the new translators and helpers (Hazel). Philip set up the biometry, which had issues, possibly due to the heat, and required troubleshooting and his immense patience to get working. Ailsa was initially observing and setting up her project and then became scribe, as well as learning clinical skills to help Kate. We were able to open up two operating tables on day 1, and Simon and I both had the same scrub nurses (S’Lai for Simon, Star for me) all week, which helped efficient working. It did mean that Goong was stretched as he was largely having to run the steriliser and act as a runner. During the latter part of the week, Tok’s clinic reduced their activity as Tok was on leave, so the staff there could help Goong with these tasks. As we had learned from the previous set ups, the theatre team were instructed on how to set up a ‘sterile consumables table’ so that the scrub team did not need to have to rely on a runner to get extras e.g. spare cannulas, phenylephrine, vision blue, dexamethasone and antibiotic. This made for very efficient working and hence we could carry out a record number of operations in SJD. Total: 83 cataract operations+76 SICS, 2 eviscerations, 2 Yag Caps, 3 Yag PIs
Mae Tao clinic (MTC)
Goong had largely unpacked everything on Sunday, so by Monday, we pitched in to organise the theatre and clinic. The clinic staff knew how we and Dr Frank ran previous clinics, so had set up chairs, the equipment and patients so that the clinic to screen patients were all set up. The theatres were again run as in SJD with prefilled sterile syringes of antibiotics, steroid, phenylephrine etc made up by the scrub team every morning. Fortunately the sterilisation was run by Mr Tamlawah, so that Goong could lead the theatre and manage the team.
Kate really benefited from having help from Ailsa, Bryher and Hazel, and we hope to attract other trainees to future visits.
The MTC team were asked to limit the numbers to 150, the prescreening was very good, though there were no IOPs measured and the visual acuity testing was a bit variable, but this could be due to the density of the cataracts or communication issues.The new proforma was used which helped continuity. At MTC they were still using the old forms so we had to transpose info to new ones, duplicating work. Proposal was that MTC should use same forms as SJD – Goong worried the new forms did not have consent form – not sure old ones had this anyway.Again, Simon and I set up the theatres, with Ailsa, Kate and Bryher in the clinic and Philip helping with biometry a managing the team.
Total:88 cataract operations+ 83 SICS, 1 trauma repair, 2 pterygia, 1 trabeculectomy, 1 ACIOL4 1pterygia operations
Full Report November 2022
The team arrived safely in Bangkok on Saturday 19th November, and after loading the truck we started the 8 hr journey to Sanghklaburi. Monday morning, we met the staff that had be recruited to help us with this campaign. Approximately 60 patients with cataract/ pterygium and uncontrolled glaucoma had been screened. The new microscope had been set up and also a new steriliser. We saw approximately 122 patients as others who had not previously attended for screening also arrived as word spread. It became clear that there remains a high demand for eye surgery; many had difficult and dangerous journeys across Burma to reach us. A total of 61 patients had surgery for cataract, pterygium, glaucoma or evisceration. 13 patients who had one good eye were deferred for cataract surgery in April. We had some issues with the steriliser which delayed the start of operating on Day 2 (the wrong type of distilled water was used inadvertently), and the lack of space in theatre gave some issue, so the second table was moved to the laser room which helped. I was able to run 2 tables and try to maximise operating, whilst also performing lasers and giving a second opinion in between cases. The staff kindly agreed to stay until 1900 so we could operate on the last patient who had travelled a long way in Burma through danger zones in order to get to her operation. Due to the demand for surgery, on our last day in SJD we had to perform 4 urgent cataracts operations and 2 washouts (from retained soft lens matter/cortex from prior cases) and 2 lasers. We packed up the truck and said farewell, starting our 9 hour journey to Mae Sot clinic.
In total, we saw 203 patients with 103 patients listed for surgery, of which, 95 were completed (10 of these were for pterygium, 1 surgical iridectomy and 1 chalazian). 3 of the patients could not have their surgery this time due to the lack of required equipment (no lens power available, need for specialist equipment), with the others deferred as they were low priority (second eyes with good vision in one eye). Given the demands, we were able to effectively prioritise patients this time, with clinic staff informed so that we performed surgery on those in greatest need, as operations would have to be completed by Friday. Several patients were found to have primary angle closure and or chronic angle closure glaucoma, but as there was no YAG laser in MTC, we had to perform riskier early lens extraction in these patients, and one patient had a surgical iridectomy, as he had near normal vision. The very last patient seen and operated on was found to have albinism and bilateral dense cataracts. We were very glad to prioritise this patient and ensured that they received their surgery. We were informed that they were very happy with the results the next day!
Full Report April 2022
Day 1 Mae Tao Clinic. 86 seen 54 listed .
Tuesday, 19th April 2022 106 patients were seen. An additional 58 procedures were listed(mostly cataracts). A few pterygia and emergency trabeculectomy for end stage open angledglaucoma causing pain despite maximal treatment was listed to be done.
Wednesday, 20th April 2022Total of 30 operations completed.
Friday, 22nd April 2022 Total of 76 operations completed (17 SICs, 2 Pterygia), with the current numbers listedas123, including 2 urgents for blind, painful eyes due to secondary angle closure glaucoma. We were asked to operate until Sunday lunchtime to complete all the cases listed. 2 PCR +VL had to be managed today.
Saturday, 23rd April - Sunday, 24th April 2022 24 operations completed on Saturday (including one tarrsorhapy, and 2 Pterygia + AG) on Saturday, 11 SICs operations completed on Sunday morning. Total operations completed in MTC was 109 out of 126 listed. Some patients were asked to return next visit, and some patients did not show up (either due to transport or other personal issues). The road from the MTC into MaeSot was manned by Thai Police for 2-3 days which may have prevented entry/re entry for some of the patients. It was sad to leave, with the remaining post-ops happy to pose for pictures and bid us farewell.
Tuesday, 26th April 2022 - San Jae Dee (SJD) clinic . We saw 45 new patients.
Wednesday, 27th April 2022 Post ops were seen and all doing well. We were very pleased that they were cared for diligently by their younger relatives, who helped also to translate. Total of 70 new patients seen, 27patientsin total listed. 7 operations were completed. The plight of these patients was highlighted by one patient who had suffered a fractured wrist, but she had decided to travel the 5 days in order to see us, and despite this wanted to have her cataract surgery before heading back to Burma to have her wrist treated and plastered. She must have been in pain throughout. We carefully prioritised her case and treated her cataract upon diagnosis. She was then transferred back to Burma to fix her wrist.
Thursday, 28th April 2022 Total of 95 patients seen and treated, with 31 patients in total listed for surgery.
Friday, 29th April 2022 Final day, final patient was an urgent cataract operation performed on a 53 yo lady who had had complicated surgery in her left eye in Myanmar, and a white cataract in her right eye (with no fundal view), causing her to be blind for the past 12 months, and being reliant on her husband for her care. This was performed under a guarded prognosis, and intraoperatively a pale fundal lesion was noted with zonular dehiscence temporally. 12 SICS operations were completed as planned. A total of 124 patients were seen and treated, 33 cataract operations completed.
Saturday, 30th April 2022 Final post op reviews were reassuringly all positive and all doing well. One lady unfortunately found minimal improvement in vision (she had been warned that this was the case). It was sad to see her depart, with vision not much different from before her operation, but we felt we had to offer the cataract extraction as her last hope for any further vision. She was then offered dilating drops as she found these to be helpful. The other post ops were a delight to see, and we could tell of their happiness of sight being restored.
IFull Report April 2019
Thai/Myanmar border 2019
Dr Lai-Yeung Ngai, Dr Simon Hewick
Three Pagoda Pass, like Mae Sot is a border crossing between Thailand and Burma, and is therefore accessible to the Myanmar border communities. The Saan Jai Dee clinic has a general surgical service provided by Tok Nadek, and Goong who has equipment and rooms to refract and dispense spectacles. There is a ScanOptics operating microscope with and output to an LCD screen, a YAG laser and autoclaving facilities. When Frank Green was in Thailand, Goong helped manage the day-to-day running of the service. He was also trained in refraction by a visiting ophthalmologist. Having a local healthcare worker with these skills and also the facilities, we hope to continue Frank’s work in a sustainable and ultimately, self-sufficient way. The team at SJD had advertised our trip to the Border teams, and helped organise translators and transport of patients across the border. We were grateful for the help of Sarah and Colin who came out for the first week to assist. We saw 300 patients in the first week; 43 required surgery (33 of which were cataract/small incision cataract surgery (SICS) operations, the rest were pterygia with autografts and one tarsorrhaphy). Colin and Sarah were able to improve the vision of the vast majority who came, with either reading glasses or recommendations to come back to see Goong for refraction.
The second week was marred by fighting between the Mon army and the Burmese army which caused closure of the Border at Three Pagodas Pass. This resulted in difficulties for the patients to travel to and from the clinic, and thus fewer attendees. This had some benefits as it allowed more time for training Goong, who was able to complete 10 SICS operations. I completed 2 SICS, 3 ptergia and 1 peripheral iridectomy (PI). Two patients were brought in by a volunteer medic, who had come upon these patients whilst at her local temple. The elderly, frail gentleman was blind and had no relatives. He was living at the temple and would have had no means to access health care. Another elderly lady was dependent on her widowed daughter for all her care, and her blindness had rendered her housebound. They both had dense, white cataracts. We performed cataract surgery on both; and the benefits were immediate on removal of the dressings the next day; the gentleman was able to read, and we could prescribe reading glasses to help improve their quality of life and independence.