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Overcoming Distances to Gain a New Perspective: Cataract Surgery in the Low Amazon

15.000 surgeries make a difference

Many barriers prevent patients from accessing surgery. Dr. Ricardo Nosé from UNIFESP/EPM describes the situation in the Amazon region: "Amazon is quite populous and difficult to access. The project serves riverside towns and uses the local hospitals for logistics support. The people take shower in the river; however, they don´t see the river; they cannot fish anymore; they make craftwork for living, but they cannot work anymore because of blindness. We feel that we can help the people return to their normal lives and everyday activities." Overall, about 15,000 surgeries have been performed since the beginning of the project in the 1990s.

On the expedition in October 2015, a team of ten doctors performed 400 surgeries within eight days. The team visited six cities, starting in Urucará, a city of 17.200 inhabitants. One of the patients there was the five-year-old Sophia. She was born with an eye disease and was not able to open her eyes in the light. Playing and walking in daylight were difficult for her, since she used to hit things all the time. At the age of five, there was finally a diagnosis: congenital cataracts. Local physicians were able to correct one eye; Sophia's second eye was rectified thanks to the Amazon Project. 

Overcoming Challenges

The Amazon Project has come a long way and has continuously developed from its early days. Some hindrances are easier to overcome than others.

Getting there: In the beginning, the doctors used small airplanes and boats to reach the villages. In 2005, they got a proper boat, the D. Luna, to transport all the equipment. Since 2012, surgical projects have been carried out twice a year. Cooperation with companies such as ZEISS, who manufacture equipment and consumables for cataract surgery, make the amount of surgeries possible. Since the beginning of the latest phase of the project, the predominant techniques have changed. The physicians now carry out cataract surgeries by phacoemulsification with an intraocular lens implant in the capsular sack, with no dressing and points.

Waiting time and number of operations performed: "In the Amazon countryside, there are patients waiting in a queue for eight to ten years to make the cataract surgery," adds Dr. Lincoln Freitas from UNIFESP/EPM. The cost of each project varies according to the number of surgeries performed and the consumables used. The two projects in 2015 used state-of-art equipment and first-class consumables, and the sum of all donations reached half a million reals.










The Low Amazon faces a severe shortage in ophthalmological care. "There are several Amazons within the Amazon, such as the Manaus Amazon, which is provided with all possible medical assistance, and the Amazon countryside, which is deprived and needs resources", reflects Dr. Marcos Jacob Cohen.

Collaboration: The severe lack of ophthalmologists in the area may be the biggest issue for the locals. For that reason, the project surgeons help the young local physicians to improve their surgical techniques. "We have 24 hours a day to stay with the younger people exchanging ideas and experiences. This is important and disseminates the concept of collaborating with the communities, as well" says Prof. Dr. Walton Nosé.

Peculiar clinical characteristics: "We see much more hypermetric patients, which, from the surgical point of view, leads to higher technical difficulty", lists Dr. Lincoln Freitas. "The pathologies associated to this kind of patients are, for example, pseudoexfoliation, pterygium, which sometimes is not only temporal pterygium, it is bilateral, and very small slit, very hard core, pupils, which do not dilate and uveitis. So, all these diagnoses make the work difficult, in addition to the patients´ age and the time they wait to be operated." 

Get a visual impression of the work in the Lower Amazon region and watch this video:












The technical edge

Prof. Dr. Jacob Cohen states that today there are trained surgeons and technology which can help people to recover their sight after surgery in less than 10 minutes. The patients recover their sight fully within one week, with no risks of severe complications.