Day 5: Surgeries at Kampot Eye Center
Mon, January 19th
It’s Monday morning, and like usual it is time to get back to work. Today our commute is a quick one, a few blocks inland from the river lies the Kampot Eye Center, the location of SWAP Socks’ first eye camp in Cambodia. With a long day ahead of us, we eat a full breakfast and get moving around 9am. Our bus driver has shown up and is dutifully waiting out front to ferry the Seva crew around. It seems rude to turn down the ride so we all pile on for what is a two minute spin around the block. Stepping off the bus we are greeted by the local Seva staff, a few doctors, and a giant SWAP Socks & Seva banner hanging from the front of the center.
People come from all over the countryside to visit the eye camp, some hours away, packed three or four to a moped or motorcycle. Many have already arrived when we show up, but people with longer journeys continue to trickle in throughout the day.
The eye center, although quite sparse and simple, has an efficient system of moving patients from intake, through paperwork, pre-op screenings, and finally into surgery.
Dr. Bal Kumar K.C., who prefers just “K.C.” is a Nepalese Ophthalmologist, Eye Surgeon, and Executive Director of two private eye hospitals in Nepal: the Kakarvitta Eye Hospital and the Birat Eye Hospital. Dr. K.C. has been performing eye surgeries in Cambodia since 1996, taking a few trips a year to perform surgeries for Seva as well as help train local doctors and streamline processes.
On an average day in Nepal, with his full team, he often performs upwards of one hundred surgeries a day; quick, efficient, and absurdly talented. Today K.C. will be operating by himself for much of the day, with novice assistants and limited tools; we hope to perform closer to thirty.
Patients are still arriving, but for those who were here early and have made it through pre-op procedures, it is time for for the scalpel. Although we expected to observe, one by one from afar, we are thrilled when the four of us are ushered into a “clean room” and handed scrubs and masks. The operating room hardly resembles those back home but it's sterile, orderly, uncluttered, and efficiently set-up.
The first two patients are led in from the opposite side of the room; a older Cambodian woman is helped up onto the operating table while a younger man sits in the lone waiting chair. This two patient process may work to demonstrate the simplicity of the process, washing away the terror of the unknown; although throughout the morning, all patients, old and young, appear more apprehensive then scared.
Aside from very young children, only local anesthesia is used, and each patient is conscious while Dr. K.C. lowers his blade to the cornea. Almost all of the surgeries performed are to correct cataracts, a clouding of the eye’s lens that can occur at birth or develop over time. Small incision cataract surgery, or phacoemulsification, is primarily used. This involves the Dr. K.C. making a small incision in the cornea, breaking up the lens into manageable pieces, and suctioning them out through the incision. The lens is finally replaced with a permanent silicon or plastic intraocular lens and patched up overnight to heal. This whole process takes between ten and thirty minutes, pace that starts slow while the team of three gets accustomed to each other and picks up as the day goes on.
The first few corneal incisions make my stomach do somersaults but quickly it becomes routine and I begin to appreciate the steady hands and level head of Dr. K.C. Twice tubes come loose from old equipment and banana bags spray medical fluid and water across the patient. Everyone flinches but his hands remain steady. In an operating room outside of his normal hospitals Dr. K.C. often finds himself without the properly angled scalpel or syringe and must, in a moment, use a small clamp to bend and reform the tools to suit his needs.
The rotation of patients continues all day. Thankfully Dr. K.C. is joined in the afternoon by a second surgeon and they are able to perform forty surgeries by the time the sun sets. After surgery, the patients are bandaged and sent to rest overnight. Those who live in Kampot or have family nearby go home and will return in the morning, while those with longer journeys line up on cots in a spare room to heal. The process is fast, overnight, and the air is thick with anticipation; Tomorrow bandages come off.