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"I Can Do That" – Dr Phetsamone, Lao PDR

Dr Phetsamone Indara says everything with a beaming smile. “I can do that!” is his typical enthusiastic response to most questions, his accent placing particular emphasis on the ‘do’. It is fitting because it is this underlying belief that he can—or in fact should—do something, that makes Dr Phetsamone—an ophthalmic surgeon in Lao PDR—so special.

Today Dr Phetsamone is in Muang Houn, a district of Oudomxay Province in north western Lao PDR. Dr Phetsamone lives and works three hours away Oudomxay, the provincial capital, but has come to Houn for one important reason: a 58-year-old patient named Juan. Juan has cataract in both her eyes.

web-dr-phetsamone.jpgDr Phetsamone Indara

“The left eye can be saved but I can’t fix the right eye,” Dr Phetsamone said. “The left eye has what we call a hyper-mature cataract, but the right eye has had cataract for so long that the lens has dislocated. I can’t fix that here in the village. But I want to save the left eye. If I don’t, in a few years it will be like the right eye.”

To reach Juan, Dr Phetsamone loads his ute with essential eye surgery equipment and drives to her village. It is the second phase of a mobile health care model that actively finds patients.

“My team came to this village to do house-to-house screening and met Juan,” Dr Phetsamone said. “They recommended she go to the provincial hospital but she is from a poor family so cannot go.”

So instead, Dr Phetsamone goes to Juan. The alternative is to do nothing which, as Professor Fred Hollows once said, is not an alternative.

Mobile care is also a concept that Fred Hollows espoused: taking eye care to the people and not expecting that people living in poverty in developing countries will have the ways or means to travel—sometimes hundreds of kilometres—to reach health care facilities and then pay for a health service.

“Mobile outreach and surgery is very important in Laos. Poor families can’t afford to travel to district or provincial hospitals. If we have no mobile service, many, many more people will be blind,” Dr Phetsomone said.

web-juan-village.jpg
Juan is led to the community meeting house by her daughter Sek

The need for outreach is so great that The Fred Hollows Foundation supported more than 4,300 mobile cataract surgeries, and supported an additional 639 cataract surgeries in provincial eye units, across the 10 provinces in Lao PDR in 2018 alone. But with a cataract backlog estimated at nearly 50,000, it is a fraction of what is required.

“We could do mobile eye surgeries for the next 10 years,” he said reflecting on the significant need. But it is why so much effort is made to reach patients like Juan.

Juan’s village is a long way from anywhere. Once off the sealed road near Houn, Dr Phetsamone drives for nearly an hour along a narrow dirt road, through corn and banana plantations, crossing streams and passing through a number of smaller settlements. It would be impossible for a blind woman like Juan to travel this road. The importance of mobile health care becomes readily apparent.

Juan first noticed a problem with her eyes four years ago.

“I went to the paddy field and it felt like something was in my eye that I couldn’t get out. It became like a wall,” she said describing the decreasing vision she has experienced over the past four years.

The once active Juan is now confined to her house, rarely venturing outside. She cannot work, she cannot cook, she cannot contribute to her family or to her village. She has become dependent.

web-juan-in-hospital.jpgJuan waits while Dr Phetsamone and his team set up the mobile operating equipment

“I just stay home,” Juan said. “I used to plant corn. I used to fish with the net and I would cook. I cannot find food. I have to wait for someone from my family to bring me food. I cannot go anywhere. I cannot do anything.”

Juan now also sleeps on the kitchen floor. The house is in the typical style or rural Lao PDR: made of wooden planking, thatched roof and elevated above the steep ground. The kitchen is separated from the main dwelling by stairs which are too dangerous for her to negotiate. Juan’s life is very lonely.

Dr Phetsamone and his assistant Khamthan Amath unload his ute and set up a makeshift operating room in the community meeting house in Juan’s village. It is dark, there is no electricity. For power, Dr Phetsamone removes the battery from his ute and connects it to his equipment with alligator clips.

Juan is led in to the room she knows so well from village meetings and lies down on Dr Phetsamone’s portable operating table, surrounded by the boxes and cases that moments before had housed the equipment. Watching eye surgery take place in such a way and in the remoteness of Juan’s village is surreal. Yet it wouldn’t happen any other way. Dr Phetsamone’s “I can do that” refrain is suddenly loaded with meaning.

web-dr-phetsamone-operation.jpgDr Phetsamone performs cataract surgery on Juan. Mother and Child Health (MCH) nurse Khammane Yabee looks on. To increase integrated health care capacity, Khammane was supported by The Fred Hollows Foundation to receive Primary Eye Health Care training. When she visits villages in an MCH capacity, Khammane is also able to conduct eye screening. It was Khammane who identified Juan.

Thirty minutes later, the operation is complete. Dr Phetsamone packs up his equipment, replaces the car battery, and lets Juan rest. He moves to a nearby waterhole and eats his packed lunch, has a quick swim and waits.

Two hours later he returns to the meeting house and removes the bandage from Juan’s left eye. Juan lets out a joyful and surprised cry.

“This is the first time I have seen clearly in four years!” she says. A crowd of children has gathered around her, eager to see the transformation in this lady they knew only as being blind, frail and dependent. Juan immediately sets about trying to identify them, straining to recognise now older faces and to see for the first time the younger ones she knows only by voice.

“I can see now,” she says. “I will make Lao wine. I can cook my own food!”

Dr Phetsamone is obviously happy with the outcome. “I know that if we didn’t come here, she would be blind for the rest of her life,” he said.

web-dr-phetsamone-battery.jpgJuan's village is so remote Dr Phetsamone needs to use his car battery to power his surgical equipment

But he is still concerned about Juan’s right eye and will now seek ways to bring her to the provincial hospital where he can operate with a full team and equipment – and without needing to remove the battery from his car.

But as Juan gets reacquainted with her family and villagers, Dr Phetsamone stands off to one side. Despite his ever-smiling demeanour and ‘I can do that’ attitude, a hint of frustration seeps through.

“I cannot do it by myself,” he admits quietly. “I am proud to be a partner in her life. But I am only one partner, we need many partners to really help.”

web-juan-post-operation.jpgJuan laughs as she tries to identify the children of her village. Many she has never seen before and knows only by their voice.

Dr Phetsamone is soon on his way. There are four more patients waiting for him at Oudomxay Provincial Hospital that he needs to operate on tomorrow, including a single father and his two children – all with cataract. “I can do that!” he says.