Project Medishare | Practicing medicine in a developing world
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Practicing medicine in a developing world

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O’Rese Knight uses a Tono Pen to test a patient for glaucoma  at the clinic in Marmont.  The Tono Pen was a proper substitute for other equipment because it is powered by batteries. Knight is a fourth year medical student doing research at the Bascom Palmer Eye Institute. Photos by Jennifer Browning.

By Jennifer Browning

Practicing medicine in a developing country has its challenges. By the end of Bascom Palmer’s final eye clinic the group took into account for all the adaptations they had to make in order for the clinic to be successful.

“There are a lot of improvisations with regard to not having the same resources that you have you are able to have at home,”fourth year medical student O’Rese Knight said. “You learn to adapt in situations where there is no electricity without reducing the quality of care.”

candle.jpgFor example, for a typical glaucoma exam the patient sits in front of a slit lamp but here the test was done by using a Tono Pen which test the pressure of the eye.

“The screening was also cut short because it  also includes using a Frequency Doubling Technology (FTD) machine,” Knight said,  “but because we didn’t have electricity we couldn’t use that machine.”

Knight said the FTD machine is used to test peripheral vision because this is what is effected first in glaucoma cases.

“Basically you have to convert everything to portable,” first year opthalmology resident Tom Shane said. “We have to run everything on batteries.”

Patients eye prescriptions were also determined a bit differently.

“We don’t have the correct  prescription,” Dr. Michelle Caputo said, “but we have the spherical equivilant that we use when we are prescribing them their glasses. ”

Another adaptation was when Dr. Caputo was fitting her patients glasses she bent the frames using a flame from a candle.

But it wasn’t just equipment issues that had the team reflecting on their developing world experience, but the conditions they saw in their patients each day.

“Here in general you see very exagerrated presentations of simple disease,” Knight said. “In the states, many of the conditions we saw this weekend we wouldn’t see back home because people at home have the resources to treat the condition.”

From testing for cataracts and glaucoma to providing  prescription  glasses or giving sunglasses for eye protection, the Bascom Palmer group feels their experience was successful.

“The first night we were here Marie Chery explained to us that there is a need for specialty services here and I think that is where we were able to fulfill that need,” Knight said. “We saw around 600 patients and we were able to hopefully prevent blindness. That means a lot to many of the families here because they are dependent on their sight to manage and maintain their lives here. ”

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