China

Letter from Dr. Gieser:

Colleagues,

Marge and I are on our third trip to China. I don’t remember my first trip, as I left the country of my birth when I was four. Fifteen years ago we went on a teaching trip to the northwest corner of China. We were north of the Gobi desert and west of Mongolia at the Urumuchi College of Medicine.

This trip has been centered at the Provincial Hospital in Lanzhou, the capital of the Gansu province. Gansu province is in north central China. It is over 1,000 miles long and one of the poorest of the provinces, mainly rock. The Provincial Hospital has about 650 beds and is one of the main hospitals. I examined about 25 patients on the first day. There were three detachments and 12 patients with vitreous hemorrhages. Fortunately, I brought an old Keeler indirect scope. The one scope they had didn’t work. I agreed to do the three detachments and two of the patients with vitreous hemorrhages over the next two days.

I was gripped with feelings of sheer terror the next morning as I donned a muslin scrub suit. I had my loupes, a needle holder and forceps. I brought along silicon sponges and a few bands. The surgical gowns were lined with plastic. As I started the procedure with poor lighting, no speculum, no means to mark the sclera, the sweat started to flow. Fortunately, all the detachments were relatively simple. Both the patients and I survived the harrowing experiences and the retinas did well. It was the first detachment performed at the hospital using an indirect scope.

I asked myself the next morning, why did I agree to do the vitrectomies? The detachments were enough of a challenge, but the vitrectomies require much more technical help. The operating table didn’t go very low so I sat on a kitchen stool on a 4-inch wooden platform. The foot pedals for the vitrectomy machine and the microscope were on the floor, hard to reach. The optics of the microscope were quite good, but the on/off switch was on the microscope stand. There was an X-Y mechanism which made a noise when you moved the switch, but the scope didn’t move.

I knew I was in trouble when I asked what the suction was set at and they turned off the cutter. At times, when I asked for the microscope light to be turned on, there was no one in the room. The X-Y movement was accomplished by the nurse grabbing the microscope and pushing it in the direction desired. I was so anxious to get finished with the cases before a disaster occurred. A young lady I operated on with bilateral vitreous hemorrhages did look great the next day.

Ron Kruger, a corneal specialist from St. Louis, and I spent the next two days giving lectures to 80 ophthalmologists. The high point of the lectures was when Ron put away the academic slides and diagramed simple aspects of cataract surgery.

Although we were thoroughly feted at banquets and given lovely gifts, the greatest memories are of the colleagues we worked with. The bond that comes from examining patients and struggling through surgery together is lasting.

The contrasts from our last visit are striking. The sense of oppression is faint and the women now wear attractive western-style clothes. Cellular phones are all over. There is still no great support for medical care.

God bless America.

Cordially,

Richard G. Gieser, MD