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Saturday, March 1, 2014

Transition time

Life is difficult for the majority of Angolans. If you live in the capital, Luanda, and have money or at least a job, you have a chance of having a “normal” life. But, if you live out in the distant provinces and are born blind, life will be difficult. It is with this knowledge that the case of 3 siblings who showed up at Boa Vista caught my attention.
Josemara (12), Fernando (9) and Juliana (6) live in Lunda Norte, a 20 hour bus ride to get to the Boa Vista Eye Clinic. Their mother brought them all the way to Benguela with the hope that something could be done for her children. She had already taken them to several doctors in the north, all of whom said that the kids needed a surgery but had no way to provide it. When somebody at her church suggested that they be taken to Boa Vista in Benguela, she began saving and borrowing money to pay for the bus ride. This is no small task for a mother of 3 blind children. Once she finally buys the bus tickets, she must pray and hope that when she gets there the doctor will see her children, and be able to do something about their condition and won’t charge a huge bribe to accomplish it. A major leap of faith. The reality of most health centers is they only work for those who have money. The poor are unable to pay enough bribes to receive the “free” government healthcare.
Our team at Boa Vista was able to see the three kids, schedule and perform their surgeries all on the same day. Yesterday, I performed cataract surgeries on one eye for each child. We started with the oldest child, hoping that if he didn’t have any trouble with the local anesthesia he could tell his brother and sister that it was okay. Then the second boy also managed to cooperate and laid still during his intraocular surgery using only local anesthesia. Imagine that! But the youngest, a 6-year-old, was quite difficult, but with the bribery of chocolate she was able to manage. Is there no end to what chocolate can do for a woman?



Today we saw them after the patches were taken off. The family is very happy, but you have to be sneaky to get photos of people smiling here. All three of the kids are now walking without any assistance! No longer totally blind and with good expectations of visual recovery over the next few weeks. I am very grateful that we have been able to be a part of helping so many people here in Angola over the last 2 and a half years, the Boa Vista Project has done over 6,000 individual cataract surgeries since my arrival in late 2011. It is stories like these that I will remember with fondness from our new home in Portland, Oregon.
For those who have not heard, our family will be leaving Angola in May of this year. I accepted a position at the Casey Eye Institute of Oregon Health and Sciences University (OHSU) in Portland, Oregon. I will be an Assistant Professor of Ophthalmology and work in the cornea division (cornea transplants).
We feel like OHSU is the next chapter for the Clements family.  At times I was not sure what was happening in my life or for our future, but we prayed about our families future at every step of the way and felt confident of the steps we were taking. When mentors told me that moving to Angola was a bad idea and I was throwing away my career, I confidently told them that I didn’t see it that way and God had a plan for our lives. Before that when I did not match into a cornea fellowship (my dream since college), and wondered what was happening with my life, God opened the door for me to go to Harvard. Imagine that, Harvard inexplicably had an open spot when I thought the doors to cornea fellowships were closed. Who does that? God does.

I plan on using this new post not to escape the fight against preventable blindness around the world, but to amplify the resources available for the fight. The Casey Eye Institute has a history of international service and has leaders with a global vision. Somebody once told me prior to our move to Angola “John, in the fight against preventable blindness you don’t want to be a foot soldier, you want to be a general”, meaning don’t go to Angola, and dirty your hands living in another country. I replied that I think the best generals were once foot soldiers. Now I have first hand experience treating blindness in Africa. I have insight into the factors that keep places like Angola poor: the craziness and injustices, the cultural practices and beliefs, financial strains, politics and corruption--I have that experience. These will help me in the future develop more effective strategies for blindness prevention in the developing world.
 I could not be happier about the move, but it will be difficult. We will be leaving part of our heart here with the Angolan people. We appreciate your support over these last 2 and a half years. Lori and I both always have received wonderful responses from you, our readers, through prayer, financial support, and projects sending supplies over. Thank you so much for being apart of our journey.


Saturday, February 22, 2014

Out with one Project in with the New

Remember Rita's house project? Well, this week Rita and her family finally moved into there new huge house! We are so happy and thankful to all of you that contributed.

This is Rita and all of her kids, plus her niece and her daughter that live with Rita. Her niece stays home with her kids while Rita is working. despite their demeanor they are all super happy. Something weird happens in this culture when a camera surfaces. All faces go stoic. Anyway, we are firm believers in empowering and not just giving things away. So we built Rita's house until it was in a position where she could finish it herself and feel the accomplishment. So our part was done a few months before, and she had it wired for electricity in the event that the community receives electricity from the city. And she also built her own bathroom on the side of the house. I guess that would be called an outhouse, but that gives Americans a negative idea, but here any bathroom is a luxury. So not only is she the owner of a beautiful new house, but she is also the one who saw the project through. Rita is so relieved to have something to pass on to her children that I can see a weight has been lifted from her heart.
Thanks again for all of you who helped.
This is Silva Mocili.
He is a husband and father of two girls, pictured is the oldest girl. The baby went with the mother (Mocili's wife) to the market to sell vegetables to support her newly blind husband. Mocili was a brick layer until three years ago when he went blind. (Non doctor writing today, I don't know why he is blind, but John did confirm that there was no hope as of yet.)

Mocili built his own house a few years ago and then started on a family store which would have been attached to the house, pictured below.
When he went blind the store project went on hold. Last week I was just out visiting blind association members when I came across his story. My heart leapt with joy to know that the lord put him across my path, and I've been given the means to finish this project! So far, the initial estimate to finish the store and make it nice! will only be $1,000. So we are already running with this one. In two weeks, I hope to be filling his little store with things to sell. And now his wife and new born baby do not have to spend the days trying carry vegetables around in the hot sun to sell. She will be able to stay at home with her husband and still make a living.
I still don't believe how this next story works out, but it is working. Pictured below is Jose Pedro.
He and his wife are both blind from a childhood case of the Measles. They run this store together. (His wife was out making store purchases during my visit.) Pedro and his wife received a government loan to build his store, and is paying it back. Normally his 9-year-old nephew helps with counting money, but when he is at school, Pedro's 5-year-old son (peaking over the counter) is his parents only seeing help.
I have no words to write, I'm inspired by this couple. May you also be inspired.
Thanks for reading, From Angola with Love,

Friday, October 11, 2013

Pediatric surgery: the best and worst surgeries to do

One of the absolute most fun things I get to do is take pictures with kids after surgery. Usually this means that their surgery went well, so family and child are happy to oblige. The actual performing of the surgery on a child, I don't like so much, and every time in the middle of surgery I ask myself why I endure the mental anguish.  For anybody who has done pediatric cataract surgery you understand. The following photos and stories are the reason. We have done close to 100 pediatric cataract surgeries this year alone and I wanted to take a moment to share a few great stories from surgeries I did this week.
First, I'll share about this family of three boys. I was touched deeply since the kids were nearly identical in age to my 3 boys. The oldest Dionisio, middle Evaristo, and youngest Nelson were all born with congenital lens opacities. Their family lives about 16 hours away by car, and a 2-3 day bus journey. Unfortunately they had never had surgery before, so they all had nystagmus  (the eyes moved all the time signifying poor vision potential, amblyopia). BUT.... I just can't leave them that way when I think there might be a chance, so we did surgery on them all the same day and this photo is after the second eyes were done. Fortunately they all cooperated for local anesthesia.
Despite the nystagmus, the vision was definitely improved and all lenses were in the posterior chamber nicely secure. We will continue to observe them and I'm optimistic that vision will improve with time.  I'm so grateful we got to help these awesome family.
Below is Zeferina. She got hit in the right eye by a rock and was left with a large, white cataract. I am always cautious with traumatic cataracts as they can present challenges unique from standard cases. Upon completion of the rhexis, I noticed a forward pressure coming from the soft lens nucleus, a little hydrodissection confirmed the presence of vitreous as there was an almost perfectly oval defect in the posterior capsule with fibrosed margins. A complete anterior vitrectomy to remove cortical remains and a lens was placed in the capsular bag. Vision today was 20/80 uncorrected. Doesn't she look adorable? Ok, Ok I get it Angolans as a rule don't like to smile for pictures (if this is your first time reading the blog, it's a recurring theme).

Ernesto is 9 years old. He was born with congenital cataracts that grew over the last several years. He did not have nystagmus, and I was very optimistic about his vision chances. He however, did not agree with the local anesthesia as whenever he felt something ( drop of water on this eyelid, movement around his face from my hands, etc...) He flinched his head from side to side. Very difficult to work like that when you have sharp instruments inside the eye. Unfortunately, I only learned about his reaction after the eye was already opened, in fact during the capsulorhexis, which was not completed successfully; not a coincidence.  Gratefully, I had enough intact capsule to place a lens optic in the bag with haptics in the sulcus. His vision was 20/60 today and I only had to joke around with him a little bit to get this half smile. I love the tuxedo shirt.
Please keep Angola and the rest of the developing world in your prayers as there are thousands of needlessly blind children just like these waiting for their miracle. What can you do to be apart of the cure?

Saturday, August 10, 2013

Ladies Retreat 2013

Ladies Retreat Again! Two nights, lot's of singing, dancing and eating.
I'm dreaming of the day that a group of American women come over for a womens retreat. How fun would that be!! You are all invited.
We went out to this little village to visit a new church plant. Besides making lot's of joyfull noises we also went out to each house to meet the community and invite them to come meet the new pastor.
Thanks for watching,
From Angola with Love,

Monday, July 29, 2013

This is No Sacrifice

When John and I got married, we played a song called "This is no sacrifice, here's my life." And I loved those words but never really understood them until now.
There are some who have praised us for our "selfless" acts of selling our things to serve the blind in Angola. If I could convey our understanding of God and His Kingdom, and the amazing encounters we have had because we left our comfortable world; you would realize that we have sacrificed nothing. Instead, we have traded up in life. I have the privelege of being reminded  daily of our many blessings. Daily, we get to feel the reward of helping others in need without looking for them. Our children see, everyday, other kids who don't have it so good (although, they don't always sit content with the same "old" toys). I'm not bombarded with commercials for the latest and greatest gadgets telling me what I should be wasting my hard earned money on.
I've seen my children's prayers get answered. I've seen my husband grow in the Fruits of the Spirit. I've seen the Lord actively working in my life. Even when I thought I didn't have the kind of Spiritual Gifts that God needed in a Missionary, but I get to see Him use me! I can't hide behind all the "truely qualified" ministry people. I get to be that person. My life is so full! So blessed, so unified with my family.
I have made no sacrifice of true meaning, but I have traded up in the Kingdom of God; and want to hear no more of how amazing we are. If we were so amazing, God would have been able to teach us and use us in these ways right there in the U.S. But instead he had to send us way over here to get our attention. .
When I hear someone thanking me for coming here, I feel so humbled. It's like someone thanking me for eating a piece of chocolate cake. I just love my life.

From Angola With Love,

Note: The wording I used today, "traded up" was taken from the book "Love Does" by Bob Goff.

Wednesday, July 3, 2013

Proud to be an American

Happy 4th of July from Angola. It's the coldest time of year here, which means low 80s, brrrrrr. I'm loving it! I wore long sleeves all day today and didn't get hot, this is the life!
Anyway, our blog today will be a reflection on why we are proud to be Americans. I can honestly say, that before moving here, I was quite indifferent. Like many youngsters, I just didn't know how good I had it. But after living away from our precious land of Liberty for almost two years, the American pride is welling up inside me.
Let's start with road rules. You may not agree, but we are so very organized on the road in the U.S. and the people actually obey the rules, and cops only stop you when you break a rule, and not just when he is hungry. Thank you also for reliable street lights.
Customer service, when I walk into a store and I have to greet the staff first, I don't feel wanted, then they will be bothered that I had the audacity to bring in my children. My friend actually was asked to send her son outside to wait for her! And forget about exact change, if they owe me anything under 50 cents its totally acceptable to make up for it in candy. (My sons love that)
Thank you also America for paved roads! As we are driving back home from visiting a friend or a church outside of downtown, we all take an automatic sigh of relief as soon as we hit the pavement and the car goes silent and our ab muscles relax! Aaahh.
Thanks America for having enough teachers that our kids can all go to school at the same time in the mornings. Here, The even grades go in the morning, the odd grades go after lunch and many high schoolers go in the evenings. They have to share the buildings and the teachers. This goes for public and private schools.
Thank you America for having four seasons.
Thank you America for selling ground beef.
Thank you America for cleaning our tap water, thank you for tap water.
Thank you for vaccine options for our children.
Thank you for wonderful education options.
Thank you for Wal-Mart and coffee shops, and movie theaters.
Thank you for votes that count.
Thank you for water heaters!
Thank you for not having Malaria mosquitoes.
Thank you that we all have the option of electricity.
Oliver says, "Thank you for cartoons in English"
Zekie says, "Thank you for toys that don't break"
Romie says, "America?? Eu não quero ir no avião." (I don't want to go on the airplane.")
John misses green grass, baseball games, and steady electricity.

But living in Africa does have some perks. . .

like two wheeled school buses.

and walking boutiques.

massive termite mounds

nursing mommy's photo op
hunting exotic game



and giraffe

and of course my precious boys.
Happy Independence Day America, we miss you!

From Angola with Love,

Saturday, June 22, 2013

He still cares for individuals

I find it easy to get caught up in the big picture of trying to fix all of Angola's eye problems, train future ophthalmologists, and lead the Boa Vista project, instead of appreciating the individuals that we treat. However, from time to time God sends patients with stories so memorable that I cannot help but thank God for allowing me to be a part of this good work.
Today I will share two stories from surgeries that were done yesterday at Boa Vista that touched my heart deeply. This work would not be possible without the generous support of readers like you. So read, reflect and give thanks to God because He is still in the business of performing miracles and transforming lives of individuals.

1. Joaquina is 45 years old and lives in Luanda. She is blind in both eyes from cataracts and she has severe leg deformities from the polio she suffered as a child.
 In the neighborhood she lives in there are no side walks or roads that a wheelchair could access. She crawls on her hand and knees using flip flop sandals as "shoes" for her hands. She entered the consultation room with some difficulty, feeling her way across the room using her hands to guide her blind eyes. Her eyes had a type of cataract called posterior subcapsular cataract. Previous to my arrival at Boa Vista this type of cataract surgery was not being done, because it is more difficult to perform than a "normal" white cataract. She would have been told to return in 6 months when the cataracts were "ripe".
However, thanks to a generous donation of a modern cataract surgery machine (thank you Chris and Steve) I said yes we can help!
I performed a perfect phacoemulsification surgery on her right eye yesterday and this is the sight I was greeted with today as I entered Boa Vista.
One very happy patient and one very grateful doctor who can't believe how good God has been. We were able to restore her sight and help her navigate through her world. I can only imagine the troubles she had navigating blindly on her hands and knees through the dirty streets of Luanda (which is a third world version of New York). Now, if only I had a friend who did orthopedic surgery....

We are now running a successful phacoemulsification program in addition to our manual cataract surgery. Effectively expanding our capacity to help the greatest numbers of people and blessing me with the ability to stay current in cataract surgery technology. When I left for Angola there was no modern cataract surgery being done here and I was worried that I would forget how to do the surgery and be unable to return to the United States because of my diminished surgical skills. Those worries proved (as most are) to be lies. Through the generous provision of donated equipment and materials my surgical skills have multiplied and I am a far better surgeon and capable of performing a wide variety of surgeries well.

2. Our next patient is Lorenzo,  a 31-year-old man, who was led into the clinic by his brother. For the last 16 years he has been blind. Imagine that. A young healthy man unable to work, study, play soccer because of blindness. They said his eyes always looked a little funny since birth; but only after the "white spots" came was he completely blind.

For the non-eye doctor I will briefly describe the pictures. First his iris (the brown part) has a congenital abnormality, the pupil is not in the center of the iris but rater displaced up and out. Actually this is as big as the pupil would get as it refused to dilate with eye drops. There is the white spot, or cataract as I like to call them. The pupils slightly reacted to light, but he could point to the direction from where my light was coming from so I thought he could see if only we could do a cataract surgery. I performed an ultrasound of the eye and discovered that it was a very small eye only 18 mm in diameter (normal is 22-24mm). He would also need a lens implant that was very high in power (33 diopters), which I discovered we actually had here!. I did surgery on friday. It was one of the most challenging surgeries I have done in a long time. The orbit/eye is very small and had difficult access surgically. The anterior chamber was extremely shallow. The pupil was indeed only this big after multiple rounds of eye drops. I was saved by another donation of flexible iris hooks (Thank you Chris) which allowed me to mechanically retract the iris and open a pupil to give me access to the cataract. When I opened the iris for the first time I saw a perfectly white nucleus surrounded by darkness, I was worried that the lens would be dislocated. However, after proceeding it was only the very clear cortex I was seeing and the lens was actually not dislocated. The case went well.

Pupil is round, still displaced after surgery, but minimally traumatized.
 His vision was 6/24 today 1 day after surgery. I expect that to improve in the next few days. But today we had a good time shaking hands and hugging as the man who was blind, now sees.

There are so many stories like these at Boa Vista. I admit with some shame that at times I forget about these precious individual lives and their stories as I strive to change an entire country's eye health care system (and become jaded in the process). Thank you God for sending me gentle reminders about your love and care for individuals and for using a selfish creature like me to bless others.