From Boston to Burma, with vision

By Dr. Bil Ragan
MANDALAY, Burma - A congenital defect makes it difficult for May Thet Swe to see. The 4-year-old's eyelids don't open normally, so to look at something in front of her, she has to tilt her head up to the sky.

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But she already has ambition: The spunky preschooler, who loves playing football and riding her bike, wants to be a doctor so she can help other children.

And she understands why her grandfather recently paid a small fortune to bring her to a flying hospital staffed by an international team of doctors and nurses: "They are going to repair my eyes and make me pretty like other children."

Thet, the type of child who brings happiness to those around her, was one of 191 patients helped on a recent mission by the Flying Eye Hospital, a converted DC-10 aircraft operated by the nonprofit ORBIS International. The aircraft travels to developing countries to train local doctors, nurses, and biomedical engineers, as well as treat patients with vision problems.

I recently spent two weeks with the group, screening patients, helping with their treatment, and training local healthcare providers to do the same procedures we did, to the same standards. As an anesthesiologist with an expertise in eye surgery, I was one of three physicians from the Massachusetts Eye and Ear Infirmary on the mission.

Despite the violent suppression last fall of a pro-democracy rebellion in Burma, we saw little sign of trouble during our stay. We had no difficulties traveling in the area, though we did notice police barricades and sand-bagged gun emplacements in the capital city of Rangoon. Had I not heard of the events last fall I would not have thought anything had happened in Mandalay. We were, however, encouraged by our team leader and our assigned translators not to discuss political issues with our patients, nor seek their opinions.

Our operating room was parked on the tarmac of Mandalay International Airport, about an hour south of the city, on a broad, flat, arid plain that resembles western Texas or New Mexico. The beautiful terminal and grounds are well kept, but it was largely empty during our stay.

We rode by bus from our hotel every day, watching the scenery change from small villages to rice fields and mango plantations. We passed children on the way to school, businessmen headed to the office, and farmers headed to the market. Many women and young people had covered their faces and arms with a pastel yellow paste derived from the thanakha tree, as a decorative sun block.

Thet, my first patient, was one of the ones who made the trip worthwhile.

Her operation went very well - the surgeon was able to raise both of her upper eyelids and use sutures to secure them to muscles in her forehead. Thet and her parents, who had ridden the bus for 170 miles for the treatment, spent the night in the local hospital. Her father held her throughout the night while her mother slept at the bedside.

Upon awakening, she played with a green bunny one of our nurses had given her. She named him Yon Ka Ley - "rabbit" in Burmese. Almost as soon as she was able to get up from her bed, Thet went over and started playing with our next patient, a 12-year-old girl named Chan Lin Mon.

more stories like thisWhen she is at home, 700 miles away, Mon entertains herself by imagining she is the chef in her own restaurant. She dreams of becoming a writer someday, and has been keeping a diary for several years, a little red book that contains her most cherished memories, hopes, and dreams. Watching Thet enjoy her family, Mon seemed a bit detached and quiet - she had lost her own parents in the car accident that left her with damaged vision. But she brightened at the attention the younger child gave her.

Both girls had made it past one of the most difficult parts of an ORBIS program: screening day. That's when we examine the patients who have come for care, ensure that we can help them and prioritize them as surgical candidates. Needs are always far greater than what we can provide, and at times we must make difficult decisions about which patients to treat.

A 2-year-old suffering from a traumatic cataract will have priority over an 80-year-old with a mature cataract, because the toddler will benefit longer. Patients must also have conditions that can be treated locally with the proper training and direction. Teaching is absolutely essential: Our goal is not to do the most sophisticated procedure, but to demonstrate a technique that local doctors and nurses can learn, and repeat themselves.

When we arrived for our first screening day, more than 100 patients were already lined up in the hallway of the local host hospital. We would see patients with glaucoma, corneal diseases, and those needing plastic surgery around their eyes.

As I walked down the hallway, I was struck by one young mother holding an infant who appeared to be about a year old. He had a large marble-sized tumor suspended from his left upper eyelid. It was attached to his cornea preventing him from closing that eye.

Every time I walked by, the mother would turn and look at me as if to plead for something to be done for her son. It was difficult to look away.

The boy was finally selected for surgery the second week. There were 20 ophthalmology trainees in the operating room observing his three-hour procedure. At the end, the room filled with applause. Words cannot describe the mother's smile when she saw her son. He was as beautiful as she imagined.

Dr. Bil Ragan is an anesthesiologist at the Massachusetts Eye and Ear Infirmary

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