Visit to Kano – September 2009

Courtesy of the Vision 2020 links programme and thanks to Emirates, we enjoyed a very comfortable and hassle-free journey to Lagos. On arrival, we immediately experienced the heat and bustle of Nigeria and were very grateful for the help of Samuel, a local ophthalmic nurse who arranged transport to the domestic airport and our fourth flight of the journey. The seating allocation system for the plane to Kano appeared to be run by the Nigerian National Lottery and as a result, I was labelled a “bad boy” by other passengers for the duration of the flight!  Once we arrived at the ECWA Eye Hospital, the warmth of our welcome matched the heat of the climate and we enjoyed wonderful hospitality from our hosts for our entire stay. Yvonne was so keen to stay for longer that she mislaid her (and Kathleen’s) passports, which, following a brief panic, were located!

One cataract removed, one to go!

I spent some time with Thomas who is an ophthalmic nurse with a special interest in paediatrics. We had some great discussions around his desire to help develop the children’s eye service in Kano. The clinic is an incredibly busy place and I got the chance to see a number of patients there with Thomas and demonstrate some basic orthoptic techniques to him. It was at these times that I realised what an impact lack of equipment can have as I struggled to assess children’s vision without the tests which I take for granted in the Western Trust. I talked Thomas through the use of what equipment he had and suggested how he could make adaptations to these tests. Currently there is no orthoptist anywhere in Nigeria and I believe that training someone to have these skills would be of great benefit to the eye care provided in Kano. Over the next three years, I hope to develop and carry out a training programme to enable staff to deliver a basic but competent orthoptic service to the patients at ECWA Eye Hospital. This will involve developing skills in vision testing (particularly in children); detecting and measuring squint/strabismus; ocular movement testing; and binocular vision assessment. I look forward to this challenge and I’m confident that it can be achieved – with some hard work and co-operation in both countries!

David Wright.   Orthoptist

Journey
An uneventful journey made effortless by Marcia’s contacts and ‘fixers’. Luckily the in-flight food was satisfactory as Yvonne was not overly keen on purchasing the goat’s head soup or peppered snails at Lagos Airport. Rosie’s attempts at sleeping included a variety of yoga like seating positions which caused much amusement.

Accommodation
Basic but pleasant guest house accommodation. We were woken one morning by the half hour severe flogging of the next door neighbours dog who apparently had consumed its owner’s rather plump turkey – an important economic commodity. When we commented on the brutality of this beating to one of our hosts they replied ‘this country has to sort out its human rights before sorting out its animal rights’. I did wonder which was worse however – the yelping of the dog or David’s snoring.

Work
The whole basis of our role is to provide education and a support network for clinicians who are otherwise working in isolation. Our hosts were well educated but lacked some modern techniques and skills which it is hoped this link will provide.

Pathology
I was given my first introduction to the complications of ‘couching’. This is a very primitive and crude technique to treat mature cataracts. Although obsolete in the Western World since 1750, it is still common in Northern Nigeria where it is carried out by local traditional eye healers using a large thorn or unsterile ‘couching’ needle and a very ‘secret herbal solution’ known only to the couchers. The procedure is often not effective and can cause a painful blind eye. Patients present at this stage to ECWA eye hospital. If you’d like to find out more, here’s an interesting article on ‘couching’ by the way.

Having listened to the medical staff in the clinic, it was apparent that patient education will be as important as clinic throughput if blindness is to be significantly reduced in Nigeria.

Outpatient waiting area

My enduring memory will be of seeing a very sick child lying on a dilapidated hospital bed dying from the effects of retinoblastoma, an ocular cancer. The child had been abandoned by his mother who could not afford his upkeep and his father who considered him an embarrassment.

The ward had 20 beds and due to frequent electrical cuts had no fans for ventilation in the searing heat – truly horrendous. Relatives of patients admitted to the wards also cooked in the wards as the hospital is unable to provide food. Patients arrived at the hospital having travelled for almost a day and slept in the corridors until clinic resumed at 7am the next morning. One patient I spoke to had travelled 10 hours by car to get to the clinic. This was both a reflection of the lack of eye services in this country and a measure of the high regard Nigerians have for Dr Abuh and his team.

Nigeria
In some respects Nigeria’s image problem is not dissimilar to Northern Ireland’s of the past. Its dangerous reputation does not portray to the outsider the true reality of the warmth and generosity of its people. Everyone we met, from hosts to patients through to people we met on the streets, were extremely courteous and welcoming and our initial paranoia and nervousness quickly diminished.

However, there was no disguising the extreme poverty of this country. We were shown photos of the villages where the hospital staff travel to provide outreach clinics. The photos evidenced the lack of basic amenities which westerners take for granted. Poor sanitation also aids the spread of the blinding condition trachoma.

Compiled by Richard Gilmour, Optometrist

Our 32 hour journey to Kano involved a dogs leg to Dubai. Apart from a forgotten yellow fever certificate brought at speed to the airport by a dedicated spouse, the journey was uneventful.

Western trust team with 3 of the 4 ECWA doctors

ECWA eye hospital in Kano has a total of 126 staff including 4 doctors, 20 nurses, 7 administrative staff and 25 cleaners. Kano has a population of 7 million. Nigeria, a population of 149 million. In the Western Trust patients can travel up to 100km for treatment. In ECWA some patients had come 1,500km! Dr Abuh, the paediatric ophthalmologist draws these patients from far and wide for treatment of such conditions as childhood cataracts, retinoblastoma and glaucoma. There’s a screening programme by CBM for paediatric cataracts reaching the poorest of the poor. I saw many patients they’d referred with bilateraly blinding cataracts allowing only light perception vision. The absence of nystagmus (wobbly eyes) suggested these cataracts were likely to be developmental rather than congenital. After surgery these children were moving around independantly. I watched a 6 year old girl who had been blind for 4 years exploring the room with wonderment.

Dr Abu is keen to offer a service “that would be good enough for his own child”. He has been requesting a VISION 2020 link for 5 years. He has a clear idea of the areas that he wants to improve upon. Our visit allowed us to see their case mix and watch how the clinics and theatre sessions were conducted. In late November a team from ECWA eye hospital will visit us in the Western trust. At the end of their week with us, we’ll draw up a 3 year activity plan detailing the training programme we’ll conduct. I think the collaboration will be fruitful for both departments.

Compiled by Rosie Brennan, Paediatric Ophthalmologist

A number of supporters join in for the final leg

How many of the cyclists can you identify? We met up at the North Pole Bar in Dumfries (North of Buncrana). Hilda had made some sandwiches to provide some much needed energy for the final leg of the trip.

Some had cycled from Strabane, some from Derry/Bridgend and some started in Dumfries. Rosie, Chris and Patrick were also supported by the motorcycle ‘marshals’ who kindly helped keep the cyclists safe.

At the end of the cycle we had tea and goodies – thanks to all who helped. Thanks also are due to the staff at Halfords (Crescent link) for providing Martina with some free goodies which we gave to the cyclists at the end of the trip as a little reward for their efforts.

Martina (who drove the team down to Cork and supported them on days 1-4 of the cycle) has put together a little fun video about the trip from Mizen to Malin. See what you think of it!

The triumphant trio celebrate at Malin Head!

Mission completed. Victoria Bridge just outside Sion Mills was the starting point of our last day on a memorable and never to be forgotten adventure from Mizen to Malin. 3 became 4 with Barry joining us along with 5 out invaluable out riders, Trevor Alan Colin John and Glenn. with gusto we pace through the stubborn,early morning fog as we add to our 5 day tally of 435 miles. Rosie takes a heavy fall at Prehen but with typical determination and never say die attitude she is straight on the saddle and we arrive at Harry’s Restaurant Bridgend an hour and a half ahead of schedule.
More wonderful hospitality from Harry’s staff, (Colin had a special surprise!) as we relaxed before our numbers increased even further with riders from Omagh Belfast Letterkenny and locally, to support us to the end. The North Pole Bar was the next stop and again ahead of schedule as the sun burnt away the fog to release a most glorious day. Fitting for the end of a wonderful week of cycling.

Hilda, manager of the North Pole Bar, met us with even more hospitality and refreshments as our numbers swelled including to over 20 young and old. Photos, now a compulsory part of each day completed, we left behind the flat roads from Harry’s to face the hills of Donegal. I feel a song coming on!

The rise out of Dunree was challenging but the freewheel into Carndonagh was a joy. Outriders marking our route although Lisa did feel the need to checkout the road for Moville for some reason. Malin Town and 13 km to go pointed the sign. But the road planners did not account for Rosie’s dog leg and scenic route. Left after the Five Finger Strand and up a spectacular climb, piece of cake it definitely was not! Standing on first gear, zig-zagging the climbs were conquered. Closing in on almost 500 miles we met 3km from Malin Head. Rosie, Patrick, Martina and Chris moved to the front and escorted by the motorbikes set off for the final 3km: emotions were high. As we rounded the final corner 1km from the finish we could see the glint off the cars and feel the anticipation from those waiting. Rosie led the charge Patrick and Chris decided to do it in slow motion! Families friends and colleagues covered the embankments and with cheers whistles and horns resounding across the Inishowen hills we completed the challenge we set ourselves 6 days ago. An amazing finish to amazing week.

Celebrations were the order of the day, A proud moment for all involved.

Rosie, Patrick and Chris extended their thanks to everyone who supported them along the route, families and friends who provided refreshments on the day, those that have contributed to date, and to our 5 outriders who kept us safe to the end. A final thanks to out Editor for the great work on developing this site.

No one took Chris up on his offer to sell / give away his bicycle so we were so taken by this experience that we have decided to cycle across America next year…. sorry that was obviously the effect of too much sun. until the next event ……..

Rosie heads to Nigeria next weekend so look out for further fund-raising event and encourage further donations.

Day 5 and we waken to see the early morning fog caress the gardens of John and Olivia’s home. Greeted with a hearty full breakfast and the now compulsory photo shoot (including grandchild Jack). Their hospitality really sets us in good heart as we face yet another 80+ milies through lakeland and rolling hill. John not only escorts us out to the outskirts of Boyle but takes pity on our need to carry our bags and takes us right to Enniskillen. Truly wonderful man.

Patrick’s middle set is beginning to give him bother (gears that is) but we make great speed through some amazing lakes and waterways and the customary odd hill – another piece of cake!!

Lunch is purchased from a local deli where we bump into Brendan a friend of Rosie’s who is off to France to cycle next week. And a welcome surprise in the deli is our C.E. Elaine and Director John -more fotos and banter.

We have lunch by the lakeland forum. Patrick gets his middle set sorted but not before making an impromptu visit to ward 8 at the Erne to show off the new uniform for staff!!

Of to face the climb from Ederney with 67 miles behind us for the day. 4.50 comes the call from Radio Foyle and we get a short time to give an update on the Mark Patterson Show.

Castlederg beckons and there is a wonderful “Derg Welcomes Rosie Patrick and Chris Mizen to Malin Vision 2020″ just wonderful feeling to see that. Lets us know who placed this massive banner A BIG THANKS for lifting our hearts

Just the boost to speed to Victoria Bridge and meet our families and off to our homes before the Final Frontier in the morning.

Thanks again for all the support Rosie Patrick and Chris

I want to ride my buy-c-cal. I want to ride my bike. I want to ride my BICYCLE. I want to ride it where I like…..

Misty start along the road to Portumna. Rode down to look at Lough Derg. There was a quiet sense of endless summer by the still waters edge. Then up we went past the little fields with dry stone walls to Ballinasloe and then Roscommon town. Had our morning tea break at Clontuskert Abbey. Site of St Baetan’s original monastry. Later stopped at Tulsk for hot chocolate. Our waiter gave us a lecture in local and national archeology. Cruachan we were convinced was of greater significance than Tara. The N5 was built on eskers left by the glaciers.
Patrick and I were competing for the reddest nose on this day 2 of unrelenting sunshine. I had only packed factor 15 reckoning factor 50 would not be required.

Chris, a most considerate cyclist, had had plenty of opportunity to do a sinuous dance one arm dropping down alternatively to point out potholes as we spun down regional and third class roads. Dreaming of shiny, smooth tarmac we opted for a National road for the last 25 miles.
This was our last day of being looked after by Martina. It was a real luxury to have unlimited drinks, hot and cold plus any amount of necessary and unnecessary luggage. On her way home, she generously dropped our bags at our destination – the Kellys house in Boyle. As strangers we were received there as friends, and wined and dined before sinking gratefully into our beds to relive in our dreams the 91 miles we’d just covered.
Rosie