borneo 2005

Though I Sit in the Darkness, The Lord is my Light.
By MB Seal

“I see about one bilaterally blind person a year at my practice in Minneapolis,” stated Steve Anderson, MD, my friend and co-worker in the mission field, We saw many bilaterally blind people per day on our month long outreach to West Kalimantan.

Blindness from cataracts is one of the only curable types of blindness and intervention is much needed in developing nations of the world such as Indonesia. A thirty minute procedure performed by an ophthalmologist can return sight to a person who is blind from cataracts barring any other pathology such as glaucoma, diabetic retinopathy, retinal detachment, and more. The procedure is surgically removing the opaque lens, called a cataract, and replacing it with a synthetic intraocular lens into the lens capsule. Often no sutures are required though occasionally a few are put in, depending on the surgeon’s technique and the patient’s need.

My experience as a nurse and an ophthalmic assistant has allowed me to see first hand in the United States, Honduras, and Indonesia, the stark differences in medical care and its availability; and I am a changed person for it. People are the same all over the world. We all experience pain, loss, fear, and need, in the same manner. We all desire wellness and hope for our loved ones. When there is no hope, there is great sadness and grief. Being a short term missionary and bringing the gift of sight to the hopeless has opened the eyes of my heart. My vision is to continue to bring hope to the poor blind.

Recently I learned that the population of Borneo is approximately twenty-four million, and there are five ophthalmologists on the same island. I was astounded and aghast. I personally know 5 ophthalmologists that have offices less than five miles from where I live, and the population of the surrounding towns is less than fifty-thousand. To think that so many people would possibly never have an opportunity for eye care was more than I could imagine or comprehend.

On my most recent trip to help establish a new eye clinic at a village hospital, I was again reminded of the great need for eye health care. On one of our patient screening days, we encountered a thirty-six year old man who had been bilaterally blind for two years. He was led into our exam room by his wife; he could not identify the chair or direction in which it was. His intraocular pressures were 45 in each eye,( normal being less than 20), gave us an indication that even though we could remove his cataracts; he may not receive normal vision back. The doctor was unable to view the back of the eye to see if there was any optic nerve damage due to the fact the patient also had extremely tiny, fixed pupils secondary to posterior synechiae;(that is where the iris was stuck onto the surface of the lens) as well as dense cataracts. As the doctor explained the possibility of a poor outcome, the man’s wife wept. My heart felt as though it were breaking with hers. She had come with so much hope for help; and the idea of her husband having no sight was overwhelming to her.

I asked them if I could pray for them before they left that day. She could only nod as the tears kept her from speaking. We held hands and called on the name of Jesus; remembering that all things are possible with God.

We saw several patients with huge, fixed pupils and were either light perception or no light perception vision, indicating glaucoma or some other pathology causing blindness that could probably not be helped with surgery whether they had cataracts or not.. Unfortunately for these patients, we were unable to help them at all.

As an ophthalmic assistant for many years, I have been trained to assess pupils, anterior chamber depths, and to take intraocular pressures. I screened many patients in Indonesia with narrow anterior chambers, high pressures and decreased visions because of the glaucoma disease process. In America, when people come in for routine eye exams these things are always assessed and if a patient is what we call a “glaucoma suspect” they are treated with eye drops or sometimes they would have treatment with a laser to put a hole in the iris to allow intraocular pressure to remain low; called an iridectomy. If a patient has untreated glaucoma; blindness is an irreversible certainty.

I saw a very common pattern with these particular patients when I took their history before they saw the eye doctor. “At first I had pain in my eye (or eyes), then the pain went away, and now I cannot see,” were their replies when asked about their vision. This indicates to me, that specifically with narrow angle glaucoma, the pain they experience at first is from high intraocular pressure, and because of no treatment, the pressure causes damage on the back of the eye at the optic nerve resulting in vision loss over a period of time. Depending on how high the pressure is and how long the problem has occurred will determine the amount of damage to the optic nerve. Their physical assessments when we examined them many months or years after they had “pain” showed large 8-9mm pupils that were fixed and their visual acuities indicated obvious vision loss. Any patient that has a complaint of eye pain should always be assessed for high intraocular pressure.

In America, the patients I have seen with acute narrow angle glaucoma attack are in obvious pain and many of them experience nausea and vomiting. It is considered a medical emergency like heart attack or stroke. Without intervention the patient loses the vision in the affected eye.

We saw a number of patients with macular scars besides having very dense cataracts. We performed cataract surgery on them only to find out after the surgery that macular scars were present. The pupils on these patients don’t usually give any sign of this type of eye problem. Again, the doctor cannot see into the back of the eye just like the patient cannot see out of the eye from the dense opacity prohibiting either. People do appreciate some better peripheral vision though they may have a macular problem and can get around better in their daily activities of life; though they may not see straight ahead to read or drive a vehicle.

We had the great privilege of seeing our surgical patients at day one and week one post operatively. Many of them had much improved visions without the need for spectacle correction. Those that did not improve were those that had some other pathology that was impeding theirs. Regarding the thirty-six year old man I wrote about previously, we performed cataract surgery on both of his eyes. He was able to walk into the exam room alone, not being led around by his wife. His countenance was bright, he held his head up and appeared confident and smiling unlike the first time he came to our clinic. His wife was also smiling. He had count fingers vision, which is not good vision; but enough to be able to ambulate independently and move about freely. He was able to find the exam chair and to seat himself. That morning in my personal devotions I read from Psalm 146:8 “The Lord gives sight to the blind.” Puji Tuhan! Actually, that’s exactly what this patient said to us, “Puji Tuhan.”

Bringing the gift of sight physically to the people of West Kalimantan was a great blessing to me. Bringing the good news of the Gospel of Jesus Christ was also a great blessing. At the end of our one day post op checks we would gather our patients and their family members and express our appreciation to them for letting us serve them. I would tell them how the god of this world, Satan, has blinded the minds and hearts of people lest they should see and believe on the one true God and his son Jesus Christ. Then I would pray that God would open the eyes of their hearts to believe for the forgiveness of their sins, and of God’s great love for them. My cup overflowed.

To those that were irreversibly blind, I reminded them of the passage from Isaiah 50:10, “Let him who walks in the dark, who has no light, trust in the name of the Lord and rely on his God.” And to this I say, “Puji Tuhan.”

As I mused about my being in West Kalimantan, the love I felt for our patients and new brothers and sisters in Christ I had met; I came across another scripture that read the thoughts of my heart. The apostle Paul says it all here in Ephesians chapter 1 verses 15-19; “For this reason, ever since I heard about your faith in the Lord Jesus and your love for all the saints, I have not stopped giving thanks for you, remembering you in my prayers. I keep asking the God of our Lord Jesus Christ, the glorious Father, may give you the Spirit of wisdom, and revelations, so that you may know him better. I pray also that eyes of your heart may be enlightened in order that you may know the hope to which he has called you, the riches of his inheritance in the saints, and his incomparably great power for us who believe.”

I look forward with much anticipation to returning again to our newborn eye clinic and being with dedicated believers, physicians, nurses and friends from Indonesia and other parts of the world, in bringing the gift of sight to the blind.

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