Anatomy of an Eye Clinic

April 1, 2010

Bob, Lauren and I arrive at the church around 7:45, and we are heartily greeted by our nine translators. Circle up for prayer. Sometimes it is in English, sometimes in French, sometimes in Yaruba. As the others unload boxes of sunglasses, medicines, charts, and other odds and ends from the back of the truck, I take a casual walk outside to survey the crowd. The people organize themselves differently at each location, and even within one site it can change drastically from week to week. Every morning is a new puzzle.

West Africans have yet to understand the concept of a “line.” Instead, they assemble into clumps and lumps and amorphous masses. At our most organized cinic, I gaze at the expanse of people in front of me and can usually recognize the divisions: Children with their mothers to the far right, elderly adults to the far left, men and women in separate blobs squished in the middle. Each group bleeds into the next. The crowds number six hundred, eight hundred, a thousand–who knows for sure. Monday, Tuesday, Thursday, Friday. Each day they wait for us.

Pierre is from Benin. At around 62 years old (his guess, not mine), he is our oldest translator and carries the most authority, and so is my right hand man to address the crowds. We always approach the group together: My standing next to him instantly bestows him with legitimacy, whether I like that or not. Here is Pierre, measuring in at just under five feet, clutching a megaphone, and my less-than-mighy frame, facing such a swell of people! What a sight it must be! I speak softly to him, and he translates to the people in Ewe. We explain the order of the day: Children first, then the elderly, then the adults. The yovo will hand out numbers. Do not come to her, she will come to you. If you start crowding/shoving/pushing/smooshing, she will not hand out any more numbers.

Mothers tug little arms through the double doors. Most of these young eyes are infected or itchy. Bob bends down, shines the ophthalmoscope into an eye, talks to his translator, who then bursts into a string of incomparable speech to mom. Eye drops here, ointment there, re-papoose the child, and they are on their way. Sometimes the problems are more severe. At one Friday clinic–held in a poor part of town–nearly all one hundred children presented with trachoma, a bacterial infection that can lead to scarring or blindness. Transmitted through contact with infected people or objects, or by flies.

Outside, Pierre and I sort the elderly. Several hundreds are gathered, but I must choose between fifty and one hundred to bring in. As Pierre explains that I will hand out numbers, the group nods in unison and responds emphatically when he exhorts them to be respectful during the process. I will only give numbers to those sitting down, he says. (Survival tactic learned from the first few clinics: Distributing anything means an instant gigantic doughnut of people around me. I now insist on bums on the ground or in chairs, and–voila!–much less smooshing.) Arms reach out from every direction, tugging on my back, my arm, my sleeve, my leg. “Help me! My seesta! Help me!” “Yovo, yovo! Save me!” Fingers point to eyes that shine back at me, bright silver with cataracts.

Inside again, three translators test the visual acuity of every adult. Your optometrist probably employs a chart with different letters, starting big and bold at the top and waning to minute print at the bottom. Here, to factor out illiteracy, we use tumbling E charts, and patients twist three fingers to indicate the direction of each E. They then filter to the center of the sanctuary, where a queue forms to see the doctor. Many require eye drops and fervent instruction to wash the eyes and eat foods rich in vitamin A. Some will have surgery to remove a cataract or pterygium, and are scheduled at the next table with Lauren. A few cannot be helped by medical intervention. Blindness. Impending blindness. They are led to a corner where Isaac, a quiet translator, waits to pray with them.

This work often makes me wish I could be ten places at once, because the inside workings of the clinic are enough to keep me bouncing from door to door, translator to translator, Bob to Lauren. Indeed, Bob’s initial explanation of my job, way back in January, was, “Don’t sit down. When you sit down, things start to fall apart.”

But the crowds outside again demand attention, so off we go! The groups of adults have either managed to organize themselves by this point, or else are in complete disarray. Some days I stand before them in silence, simply thinking about how order can be created from disorder. How to distribute numbers to the seven lines that have formed when I asked for one. How to act in a way that motivates each person to stay where he or she currently is, when surely the most advantageous method for the invidual is to plow forward to be the next to clutch a number. Even the most civil person is taken captive by the desire to be first in line.

Eventually, all of today’s patients (and some wannabe patients) are inside, and the clinic rolls on, successes and laughter, hitches and glitches and all. We end in prayer. Thank God for His people. And thank God for His grace.

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One Response to “Anatomy of an Eye Clinic”

  1. Shanthi Jayakumar said

    Alana,
    “Dont sit down. When you sit down,things fall apart” …that really helps me visualize what you are doing down there. I hope that you are getting some rest in between?!!
    Take care.Hugs,
    -Shanthi.

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