- Email: [email protected]
Vietnam Through the Ophthalmoscope
VIETNAM THROUGH THE WILLIAM
OPHTHALMOSCOPE
JOHN HOLMES,
Honolulu,
M.D.
Hawaii
The United States has been concerned with problems of South Vietnam, formerly a part of Indo-China, for over a decade. After the costly war between the French Union Forces and nationalists and commu nist Viet-Minh forces from 1946 to 1954, Vietnam was split at the 17th parallel with a communist regime in the north and an anticommunist regime in the south. This divided the country's economy into an industrial north and an agricultural south. The coun try is essentially trilingual. The three lan guages most commonly used there are Viet namese, French and English, in that order. Over 60 percent of the people are literate.
The aid described in the following para graphs was a completely fresh approach to the problems of this war torn country. It was a joint effort of the Canadian Nurs ing Brothers of St. John of God, who supplied the hospital and nursing facilities, of the German Bishops' Overseas Relief, which supplied drugs, sutures, dressings and equipment, of volunteer American ophthal mologists, who examined over 2,000 patients and operated on 800 of them and of Ameri can, Canadian and Vietnamese women, who sewed operating room linens and gowns from discarded surplus flour sacks.
In 10 years, South Vietnam has had all the problems of a new nation. It has had to hasten economic improvement to stave off internal discontent and spend a large part of its budget for defense against invasion from the communist North Vietnam and infiltra tion in the south by her own people. The guerrilla-type warfare has increased marked ly in recent months. United States aid to South Vietnam between 1955 and 1960 has been 500 million dollars in military aid and $1.3 billion dollars in economic aid.
nouncement in THE AMERICAN JOURNAL OF
For a population of 14 million, there are said to be 4,000 recognized "traditional practitioners" and 700 western style physi cians in Vietnam. It must be kept in mind that practitioners of traditional medicine in the East are often the only practitioners available to the community, and that it is impractical to suppress their activities. Of the western style physicians, there are, at the most, 10 ophthalmologists. The majority practice in the metropolitan area of Saigon with a population of 2,000,000. The Medical School in Saigon, even with help from the Agency for International Development, will not be able to train sufficient numbers of competent ophthalmologists for some years to come.
The Vietnam eye project followed an an OPHTHALMOLOGY: OPHTHALMOLOGISTS WANTED: American Board qualified or certified ophthalmologists are wanted for unlimited ophthalmologic surgery for four- to six-week periods in Vietnam. Room and board in Vietnam will be provided. Round-trip transporta tion must be borne by the ophthalmologist him self; however, these expenses along with other incidental travel expenses may be deducted from U.S. Federal income tax . . . for further informa tion, write 280 Alexander Young Building, Hono lulu, Hawaii.
Dr. Eliott B. Hague of Buffalo, New York, Dr. Jou S. Tchao of Lewiston, Maine, Dr. Herman A. Iverson of Eureka, Cali fornia, and Dr. Alexander Krill of Chicago, Illinois, volunteered their services. Each provided his own ophthalmoscope, retinoscope, tonometer and surgical instruments. The following is a resumé of their reports: The eye clinics were held at the hospital operated by the Brothers of St. John of God at Honai, 39 kilometers north of Saigon. Although there were no announcements in the local newspapers, news of the clinics quickly spread. Word-of-mouth publicity was responsible for bringing patients from as far as Hue, a distance of 690 miles from Honai. The physical plant at the hospital was in
36
W I L L I A M .ΓΟ Η Ν HOLMES
good condition and satisfactory. The operat ing room was air conditioned. The equip ment, together with the instruments brought by the visiting ophthalmologists, was suffi cient to carry out practically all clinic and operating-room procedures. For the most part, there were adequate surgical and medi cal facilities and supplies. Unfortunately, there was no slitlamp. The staff, composed of two nurses, one student nurse, one interpreter and one or derly, was enthusiastic and cooperative. Nursing care was provided by the patient's own relatives. In I960, during the month of March, 679 patients were examined and 102 were operated; in April, 154 patients were ex amined and 106 operations were performed ; during July, 554 patients were exam ined and 389 operations performed. In August, 1961, 508 patients were examined and 158 operations were done. One of the surgeons listed his operations during a onemonth stay as follows: 42 cataracts, 14 glaucoma operations, three optical iridec tomies, 19 pterygium resections, three mus cle operations, 62 entropion repairs, two corneal transplants, two capsulotomies, three enucleations, two eviscerations and six miscellaneous procedures. Three ophthalmol ogists reported no postoperative infections. One had two cases of postoperative panoph thalmitis that occurred within two days after surgery. He attributed these to a bottle of contaminated saline solution. Individual records were kept of the princi pal eye complaints, the visual acuity, tonometric measurements, the diagnosis and treatment for each patient. Refractions, for the most part, were not done except in patients with strabismus and with high errors of refraction. One ophthalmologist com mented on the high frequency of myopia. The patients seemed to offer a higher degree of resistance to pain and discomfort than is usually encountered in the United States. Even such procedures as enuclea
tions and the removal of orbital tumors were carried out with relatively small doses of local anesthetic and prayer. All of the ophthalmologists commented on the high incidence of trachoma. In some villages, it was estimated that 75 percent of the population was infected. According to one report, the disease occurred most fre quently among refugees from North Viet nam. Acute cases responded promptly to in stillations of antibiotic ointments such as aureomycin and Chloromycetin. Chronic cases, for the most part, exhibited cicatricial entropion, requiring surgical repair. Pterygium was commonly encountered. It was described as thick and highly vascular ized, often to a point where it interfered with ocular mobility. According to one of the ophthalmologists, eye diseases of particular local interest were large, unsightly tumors. These growths pro truded from the socket, the size of half an orange, and involved the globe and all of the orbital structures. They were "similar to those often seen in occidental ophthalmic texts in the early part of the 19th century, and included retinoblastoma and rhabdo myoma." Upon completion of their tours, all the participating ophthalmologists agreed that their experience in Vietnam was pleasant and highly rewarding. They felt that if the local political situation permits, the program should be continued. The eye project in Vietnam was a volun tary, nongovernmental project designed to meet some of the immediate and most press ing ophthalmologic needs of that country. In terms of dollars, the costs involved were negligible. In terms of helping the needv, the ill and the blind of Vietnam and pro viding great persona! satisfaction, as well as an experience of a lifetime to the partici pating ophthalmologists from the United States, the project was a success. 1013 Bishop
Street
(13).
OPHTHALMOSCOPE
JOHN HOLMES,
Honolulu,
M.D.
Hawaii
The United States has been concerned with problems of South Vietnam, formerly a part of Indo-China, for over a decade. After the costly war between the French Union Forces and nationalists and commu nist Viet-Minh forces from 1946 to 1954, Vietnam was split at the 17th parallel with a communist regime in the north and an anticommunist regime in the south. This divided the country's economy into an industrial north and an agricultural south. The coun try is essentially trilingual. The three lan guages most commonly used there are Viet namese, French and English, in that order. Over 60 percent of the people are literate.
The aid described in the following para graphs was a completely fresh approach to the problems of this war torn country. It was a joint effort of the Canadian Nurs ing Brothers of St. John of God, who supplied the hospital and nursing facilities, of the German Bishops' Overseas Relief, which supplied drugs, sutures, dressings and equipment, of volunteer American ophthal mologists, who examined over 2,000 patients and operated on 800 of them and of Ameri can, Canadian and Vietnamese women, who sewed operating room linens and gowns from discarded surplus flour sacks.
In 10 years, South Vietnam has had all the problems of a new nation. It has had to hasten economic improvement to stave off internal discontent and spend a large part of its budget for defense against invasion from the communist North Vietnam and infiltra tion in the south by her own people. The guerrilla-type warfare has increased marked ly in recent months. United States aid to South Vietnam between 1955 and 1960 has been 500 million dollars in military aid and $1.3 billion dollars in economic aid.
nouncement in THE AMERICAN JOURNAL OF
For a population of 14 million, there are said to be 4,000 recognized "traditional practitioners" and 700 western style physi cians in Vietnam. It must be kept in mind that practitioners of traditional medicine in the East are often the only practitioners available to the community, and that it is impractical to suppress their activities. Of the western style physicians, there are, at the most, 10 ophthalmologists. The majority practice in the metropolitan area of Saigon with a population of 2,000,000. The Medical School in Saigon, even with help from the Agency for International Development, will not be able to train sufficient numbers of competent ophthalmologists for some years to come.
The Vietnam eye project followed an an OPHTHALMOLOGY: OPHTHALMOLOGISTS WANTED: American Board qualified or certified ophthalmologists are wanted for unlimited ophthalmologic surgery for four- to six-week periods in Vietnam. Room and board in Vietnam will be provided. Round-trip transporta tion must be borne by the ophthalmologist him self; however, these expenses along with other incidental travel expenses may be deducted from U.S. Federal income tax . . . for further informa tion, write 280 Alexander Young Building, Hono lulu, Hawaii.
Dr. Eliott B. Hague of Buffalo, New York, Dr. Jou S. Tchao of Lewiston, Maine, Dr. Herman A. Iverson of Eureka, Cali fornia, and Dr. Alexander Krill of Chicago, Illinois, volunteered their services. Each provided his own ophthalmoscope, retinoscope, tonometer and surgical instruments. The following is a resumé of their reports: The eye clinics were held at the hospital operated by the Brothers of St. John of God at Honai, 39 kilometers north of Saigon. Although there were no announcements in the local newspapers, news of the clinics quickly spread. Word-of-mouth publicity was responsible for bringing patients from as far as Hue, a distance of 690 miles from Honai. The physical plant at the hospital was in
36
W I L L I A M .ΓΟ Η Ν HOLMES
good condition and satisfactory. The operat ing room was air conditioned. The equip ment, together with the instruments brought by the visiting ophthalmologists, was suffi cient to carry out practically all clinic and operating-room procedures. For the most part, there were adequate surgical and medi cal facilities and supplies. Unfortunately, there was no slitlamp. The staff, composed of two nurses, one student nurse, one interpreter and one or derly, was enthusiastic and cooperative. Nursing care was provided by the patient's own relatives. In I960, during the month of March, 679 patients were examined and 102 were operated; in April, 154 patients were ex amined and 106 operations were performed ; during July, 554 patients were exam ined and 389 operations performed. In August, 1961, 508 patients were examined and 158 operations were done. One of the surgeons listed his operations during a onemonth stay as follows: 42 cataracts, 14 glaucoma operations, three optical iridec tomies, 19 pterygium resections, three mus cle operations, 62 entropion repairs, two corneal transplants, two capsulotomies, three enucleations, two eviscerations and six miscellaneous procedures. Three ophthalmol ogists reported no postoperative infections. One had two cases of postoperative panoph thalmitis that occurred within two days after surgery. He attributed these to a bottle of contaminated saline solution. Individual records were kept of the princi pal eye complaints, the visual acuity, tonometric measurements, the diagnosis and treatment for each patient. Refractions, for the most part, were not done except in patients with strabismus and with high errors of refraction. One ophthalmologist com mented on the high frequency of myopia. The patients seemed to offer a higher degree of resistance to pain and discomfort than is usually encountered in the United States. Even such procedures as enuclea
tions and the removal of orbital tumors were carried out with relatively small doses of local anesthetic and prayer. All of the ophthalmologists commented on the high incidence of trachoma. In some villages, it was estimated that 75 percent of the population was infected. According to one report, the disease occurred most fre quently among refugees from North Viet nam. Acute cases responded promptly to in stillations of antibiotic ointments such as aureomycin and Chloromycetin. Chronic cases, for the most part, exhibited cicatricial entropion, requiring surgical repair. Pterygium was commonly encountered. It was described as thick and highly vascular ized, often to a point where it interfered with ocular mobility. According to one of the ophthalmologists, eye diseases of particular local interest were large, unsightly tumors. These growths pro truded from the socket, the size of half an orange, and involved the globe and all of the orbital structures. They were "similar to those often seen in occidental ophthalmic texts in the early part of the 19th century, and included retinoblastoma and rhabdo myoma." Upon completion of their tours, all the participating ophthalmologists agreed that their experience in Vietnam was pleasant and highly rewarding. They felt that if the local political situation permits, the program should be continued. The eye project in Vietnam was a volun tary, nongovernmental project designed to meet some of the immediate and most press ing ophthalmologic needs of that country. In terms of dollars, the costs involved were negligible. In terms of helping the needv, the ill and the blind of Vietnam and pro viding great persona! satisfaction, as well as an experience of a lifetime to the partici pating ophthalmologists from the United States, the project was a success. 1013 Bishop
Street
(13).