For those interested in my view of the eye disease on Guam (pun intended), and what I've been up to, here goes.
We've been here a month, and I've been in clinic seeing patients for 3 weeks. These first weeks have included a steep learning curve as I learn how to use the EMR (Electronic Medical Record) system. As Karen has learned through the years, I get frustrated when I feel slow and inefficient on the job. This is naturally the case any time I've started a new position (residency, fellowship, and now my first job), but I still have to remind myself to have patience with the process. Thankfully, the staff here have been helpful and gracious as I have integrated into their clinic. They've had some staff turnover with the ophthalmic technicians in the last 6 months, so I'm not the only one learning on the job. The two new technicians are learning quickly, and best of all - are excited about their job. You can't teach someone to enjoy something, or have a good attitude, so I'm very grateful that they - and the rest of the staff - are so positive and upbeat!
The one disease that apparently is quite a plague on this island is Diabetes. At least half of all the patients I see are Diabetic, and some of them have pretty serious ocular complications from this disease. I've already done some laser and intra-ocular injections for Diabetes, and expect I'll be doing a LOT more. Dr. Wresch (the other Ophthalmologist at the SDA Eye Clinic) says that the incidence of Diabetes is 5 times higher than it is in the U.S., where it is already becoming an epidemic! One of the more surprising aspects has been the patient's lack knowledge of their disease. It was fairly commonplace for the Diabetic patients I would see on the "mainland" to regularly check their blood sugars, and many would know what their last HgbA1c level was (a blood marker that gives an average of the blood sugars over the previous 3 months). But so far, only a minority seem to check their blood sugars, and almost none of them know what their HgbA1c level was at their last medical check-up. One great resource here is the Wellness Center, which I hope to partner with to educate patients about their disease. I hope they can take ownership of their health, so they will be more motivated to avoid the inevitable effects of uncontrolled Diabetes.
One highlight so far, and one of the primary reasons I chose Ophthalmology, is cataract surgery. Needless to say, I was excited to get back in the OR a few weeks ago. My first case was a gentleman with a dense cataract. His pre-operative vision was 20/400 (legal blindness). At his first post-op visit, he was seeing 20/40! He and I were both pleased with the result, to say the least. The next case was a lady with a 20/100 cataract, and she also improved to 20/40 at her first post-operative visit. I've screened about 10 patients for surgery now, and at least half or more have pretty dense cataracts - with poor vision as a result. There are definitely a higher proportion of dense cataracts here than in the states. But I'm excited, because these are the folks that REALLY notice a big difference after surgery!
The surgery center is about 1.5 miles away from our house, but the eye clinic is a bit closer. My commute (or lack thereof) to the SDA Eye Clinic involves a very short 150 yard walk. So rather than spending an hour going to and from work (as I did the last few years), I spend about 3.5 minutes walking across the grassy field to work. :) I'm able to get home every day for lunch with Karen and the kids, which is great! We are enjoying this increased family time.
In addition to seeing the typical eye diseases - cataracts, diabetic retinopathy, glaucoma - I've seen a few less common things as well. I put my fellowship training to work last week when I saw a young lady (my age, I'm still young, right?) with a degenerative/inflammatory corneal condition called Terrien's Marginal Degeneration. It can lead to extreme corneal thinning and require corneal transplant in severe cases, which hopefully will not be the case for her.
A second interesting case, involving the back of the eye, was a middle-age gentleman with an intense posterior uveitis (inflammation of the posterior portion of the eye), and associated retinal lesion. The lab work just came back showing that it is a parasitic infection (Toxoplasma gondii). It is usually acquired from cats (litter box), or under-cooked meat. Hopefully he'll respond well to the antibiotics and steroids.
A third case was a 7 year-old girl that had had a two week history of worsening redness, eye pain, and sensitivity to light (photophobia). She'd been to urgent care when it started, and been told she had a corneal abrasion. They treated her with antibiotic, but it didn't get better, but rather worse. The mother implied that she didn't bring her in sooner because of a lack of insurance/money. She had a classic, severe case, of Herpes Simplex Keratitis (viral corneal infection). I saw a lot of this in fellowship, so managing it isn't too difficult (anti-viral medications). It's sad that it progressed to the severe stage, in part because of a lack of insurance/money. She'll likely have permanently decreased vision in that eye, how much ... time will tell.
There is definitely a need for eye care here, and I'm excited to be a part of a clinic that is not only restoring vision, but also focusing the patient's attention towards Christ. Please continue to pray for God's wisdom and presence in our clinic.
-Loren
