Acumen Blog

2009-08-03-pictures-transferred-074-2

Summer Spotlight: A day delivering mobile eye care

Bekezela Ncube is a Summer Portfolio Associate in the East Africa office of  Acumen Fund. She is pursuing a joint MBA from the Wharton School at the University of Pennsylvania and Masters in Public Policy from the Harvard Kennedy School. Prior to graduate school, Beke was a Senior Regional Analyst at the Clinton Foundation on the Laboratory Services Team where she provided technical assistance on developing HIV lab systems to governments in Africa, Asia, and Latin America. Before that, Beke worked in Finance Consulting at CRA International and in Equity Research at Sanford Bernstein, where she covered large-cap banks and consumer finance companies.  She holds a BA with honors in Economics from Harvard University.

The abject and glacial dismay brought on by a 6am alarm clock going off is possibly the Worst Feeling in the World. Waking to that feeling, I reach for that mysterious store of resilience known as “the will to get out of bed,” I shower through a fog of denial, anger and sleepy disbelief. It’s only when I brush my teeth and the shock of raw Listerine hits my mouth cavity that I am sledge-hammered awake by the force of Tartar Control.

Today is the day of my first outreach observation, and I curse my self-crafted Workplan, where I eagerly detailed to my supervisor how I would try to understand the market for mobile eye care services partly by observing eye camps. This morning, I am joining the PCEA Kikuyu Hospital outreach team as they travel about 30 kilometers off-site to examine patients without the money or ability to travel to the hospital. They will deliver eye care, orthopedic, and diabetic diagnoses to a community that has been prepared in advance for their visit. While the Kikuyu mobile eye care team’s mission is mainly to find and remove cataracts, I am there to research the potential for camps targeting Diabetic Retinopathy, a disease that can result in severe vision loss or even blindness.

Diabetic Retinopathy (DR) occurs when abnormal new blood vessels grow on the surface of the retina and, because their walls are thin and fragile, burst and leak blood. It is the leaking of the blood vessels that causes blindness. Vision loss, however, is preventable by a simple procedure that uses a laser to burn off the proliferated blood vessels. Unfortunately, many patients seek care only when retinopathy is advanced and it is too late to operate.

The extent of DR in Kenya is not well-known, but the eye doctors at Kikuyu are alarmed at the number of patients with DR who come to their facilities. Dr Kibata, one of the specialists working with PCEA, is particularly keen to raise public awareness of the disease and find patients before the disease advances beyond his ability to help. On the day of my early start, I have to make a 35 kilometer trip to Kikuyu so that I can join their outreach team.

After a remarkably traffic-free drive of 45 minutes, I arrive at 7:55am at Kikuyu for my strict 8am appointment time. I make a phone call. The 6am despair again slides down my throat and settles in my small intestine when my contact, Macharia, drops it to me that he’ll be with me “in 20 minutes.”

20 minutes?!

As every living human knows, the insane alchemy of time-before-10am means that Mr. Macharia has deprived me of the equivalent of 2 hours prep / dream / shower time. I swallow. I forgive him. Magnanimously. When Macharia shows up 35 minutes later, he tells me he was up all night taking a sick colleague to the hospital. Ok.

Like scavenger hunters, we assemble the team piece-by-piece, picking up some from the Eye Care Unit (Margaret and Faith), others from Rehab (Jackie and Edward), and a lone ranger from Diabetes (Jane). Macharia is clearly their leader and cheer-leader, energizing us all like a vocal Red Bull. More motivational than Caesar, he rallies us to throw off grumpy sleepiness and get excited about finding cataracts.

Our destination is Renguti Women’s Guild Dispensary, a church organization affiliated with the Presbyterian hospital we are driving from. When we pull into the (wrong) gate, we are met with the sight of clusters of mostly women sitting on the grass, indifferent to the tender morning sun as only people who live near the Equator can be. Faces expressionless, they have mastered the infinite patience that the Hollywood Martial Arts Disciple climbs arduous mountains to achieve. Even after we keep them waiting while our hosts welcome us with compulsory morning tea, there are no clucks of indignation or a sense of “hurry-up.”

Eventually, after a prayer-service-cum-educational-talk during which I admire Jane’s exhortative charisma, camp stations are set up. I lurk as others work and try to be helpful (I am not). Ridiculous surfer sunglasses already give me up as an outsider, but nothing makes me more self-conscious than not being able to understand the rapid Kikuyu tumbling over rolling tongues around me. Stripped of the ability to understand human speech, I have become truly stupid. An ancient lady with a mature cataract sits down next to me as I perch on a bench next to Jane’s Diabetes station. Her only recompense for her relentless attempt to talk to me is an ever-more-desperate blank grin. I am a deaf-mute maniac. I start taking notes at a feverish pace, and find any excuse I can to snap photographs of the professionals at work.

At lunch time there is no break to eat, but I do need to use the toilet. It’s a long drop. I’m grateful that after the deed there is a tap of running water for washing hands. The little girl that shows me (village idiot) how to turn it on and off is rewarded with a toffee. The other kid that shows up as I fish around in my bag is rewarded for her opportunism and great sense of timing.

The orthopedic exam room is a genteel place, detached from the congregation of the diabetic and eye exam hall. Nestled here in case any patient needs privacy as their bones are poked and prodded, the sanctuary of Jackie and Edwards’s orthopedic exam room is appropriately housed in the church vestry. My fairy grandmother shows up again assertively stomping her foot at James to demonstrate her pains. He gently folds back her skirt hem to reveal her strong legs, unmarred by unsightly veins or spots. When she goes to Jackie for her prescribed creams, she looks at me repeatedly. Jackie is too kind to tell me what she is saying. I scribble at my note pad.

At about 3pm, all patients have been seen and camp supplies are packed away. As we munch on a well-deserved bag of banana chips, a solitary late-comer sidles up to Macharia, complaining of pain in his leg. Edward gamely unpacks his box of creams and makes gentle ministrations of the offending limb while the rest of us pile into the van, jokingly threatening to leave him behind. When he’s done, we tally the day’s work. In 4 hours, the mobile camp has seen over 100 different patients, and dispensed dozens of medications. Itchy eyes have been soothed, painful muscles relieved, and even cataract surgeries booked. Although I had nothing to do with any of it, it was a privilege to watch Macharia and his team in action. At the end of it all, I’m glad I got out of bed today.

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