Fighting Blindness with the IAM-NOOR Eye Program in Kabul, Afghanistan
This article was originally printed in the September 2004 AANA NewsBulletin.
Daniel Moos, CRNA, MS, is a nurse anesthetist with Kearney Anesthesia Associates, PC, Kearney, Neb. In this column he describes a trip he recently took to Afghanistan with International Assistance Mission (IAM). IAM is a Swiss-registered development agency that has been working in Afghanistan for over 35 years.
Afghanistan is a land-locked country covered by magnificent mountain ranges and desert. Of the many needs Afghanistan currently has due to the wars of the last 25 years, eye care is one of the most urgent. Fortunately, the International Assistance Mission (IAM) has been providing eye care since 1966 under its National Organization for Ophthalmic Rehabilitation Program (NOOR). Interestingly, NOOR means 'light' in Persian. IAM-NOOR provides the most extensive eye care available in Afghanistan. In 2003 they provided care to 234,570 outpatients and performed 14,618 operations.1
Despite the efforts of IAM-NOOR, more than 300,000 people in Afghanistan are blind and 21,000 more lose their sight each year.2 Blindness per capita in Afghanistan ranks among the highest in the world, often caused by cataracts, glaucoma, trauma, vitamin A deficiency, and trachoma. Retinoblastoma (a malignant tumor of the retina) kills most of the children it afflicts.
In April 2004, I had the opportunity to travel to Kabul for 10 days to assist and teach nurse anesthetists at two hospitals. The PolyClinic, under the Ministry of Health, has 75 beds and two operating rooms where two operations can be performed simultaneously. The University Eye Hospital, under the Ministry of Higher Education, has 45 beds and the capacity to perform five operations simultaneously in one large operating room.
I donated items collected from CRNA colleagues, including anesthesia textbooks, nerve stimulators, a Heine laryngoscope set, Sprague-Rappaport stethoscopes, precordial stethoscopes, pens, and clipboards.
As part of my teaching duties I gave a CPR lecture to approximately 20 nurses, nurse anesthetists, and ophthalmic technicians. I spent time with the nurse anesthetists reviewing basic anesthesia preparation, fluid management, basic resuscitation of pediatric and adult patients, airway complications such as laryngospasm, post-extubation croup, and right mainstem intubation, and use of the precordial stethoscope. I worked closely with Richard Lewis, MD, medical director, and Karen Mindling, RN, nursing administrator. We took solid steps toward creating policies, protocols, and procedures, tackling subjects such as preanesthesia preparation, induction and maintenance of anesthesia in adults and pediatrics, and nausea and vomiting.
Volunteering in this environment takes flexibility, understanding, and acceptance of the limitations imposed by the economic, cultural, educational, and technical differences between Afghanistan and the United States. The absence of EKG monitoring, CO2 monitoring, agent monitoring, mechanical ventilators, and resuscitative equipment such as a defibrillator can be disconcerting but not insurmountable.
I was fortunate to have a wonderful nurse, Mary Roach, who has a good working relationship with the nurse anesthetists and greatly aided me in advice and translation. Dr. Lewis and Mindling were supportive and eager to discuss ideas and explore ways of improving anesthesia care delivery and safety. These expatriates were crucial in making this trip successful.
The Afghan anesthetists are intelligent, warm, kind, and motivated to learn despite cultural and language barriers. The hospitality of the Afghan people is exceptional. The needs of these anesthetists are great; help in the form of anesthesia consultants is rare. Dr. Uffe Romer, an anesthesiologist from Denmark associated with the International Safety Assistance Force (ISAF), has donated time to help teach the nurse anesthetists. However, there is much more work to be done. Through education and donation of material and financial resources, lives can be saved and anesthesia delivery can be made safer.
Those who feel led to help these Afghan anesthetists or wish to know more about the experience can contact me at firstname.lastname@example.org. To donate financial resources for eye care please send to Interserve, attention financial officer, PO Box 418, Upper Darby, PA, 19082-0418. Make checks payable to Interserve and place the name Helping Hands Account in the memo portion of the check.
1. NOOR Annual Report for 2003. (2004). Unpublished raw data.
2. IAM NOOR Eye Care Program. Information sheet.
Moos (left) and Iqbal during surgery.