The Land of the Blind

The spell-checker on WordPress complains about the word opthalmologist. The eyecareamerica website defines one as: ‘a medical or osteopathic doctor who specializes in eye and vision care.

As so often happens when I write, I was immediately sidetracked, curious to find what an osteopath can do for your eyes. Images of laterocranial compression and other forms of pressure, squeezing, and cracking of the optical persuasion come to mind.

Science is rigorous about definitions, so I began by investigating what an osteopath does. Wikipedia dixit (this is the third word so far that bemuses the spell-checker).

Osteopathic manipulative treatment (OMT in the U.S. or simply “osteopathic treatment” elsewhere) is the therapeutic application of manually guided forces by a practitioner, intended to improve physiologic function and/or support homeostasis that has been altered by somatic dysfunction. Somatic dysfunction is defined as impaired or altered function of related components of the somatic (body framework) system.

I love the word bemused—my theory is it contracts bewildered + amused. Very much my feeling when I read the definition of OMT. Manually guided forces? OMG. So far, my eye-cracking theory remains valid.

I get the feeling this is about to get weird, as I delve into the realm of ocular OMT—let’s call it OOMT. I don’t find much, but cataract operations may partly fall into OOMT in the U.S. I don’t really get that, since surgery that involves cutting, replaces lenses, and uses techniques such as ultrasounds and stitches seems a little far from the old ‘manually guided forces’.

Whatever forces you fancy, if you live in the small African country of São Tomé, you’ll be shit out of luck trying to find an EyeMD. Why is that? Because there isn’t a single one on both islands, São Tomé (Saint Thomas) and Príncipe (Prince).

The islands lie on the equator, and were uninhabited until 1470. That year they were discovered by the Portuguese navigators João de Santarém, Pero Escobar, and João de Paiva—Escobar is one of the pilots who sits with Abraham the Astronomer in The India Road, and the second island was surely named after the Perfect Prince, who in 1481 became King John II of Portugal, El Hombre.

There were about four thousand Portuguese on the island when the 1974 revolution toppled the regime in Portugal—they returned home to Europe as the local marxists du jour took over government—the current population of STP is around 190,000.

That’s roughly equivalent to the population of my area, where thirty-one EyeMD are available.

How would European austerity look to this native of São Tomé?

How would European austerity look to this native of São Tomé?

The whole health system in São Tomé appears to be in crisis, because there is no mechanism for charging for its use, and no tax base to fund it.

Portuguese doctors, including eye doctors, have been using telemedicine, one of the most promising forms of supporting desperately poor countries such as STP, whose per capita GDP is $2200 (2013), placing it 191 in the world—for comparison, despite the disaster of recent years, the Greek equivalents are $23,600 and 63.

Medical services are guaranteed by the usual suspects, such as Doctors Without Borders and the International Red Cross, together with a Portuguese foundation, Instituto Marquês de Valle Flôr (IMVF).

The first remote eye consultation took place this week, promoted through IMVF. It tested a device called TELEYE. On the remote site, it required a laptop, projector, and an EyeMD. Locally, it needed a nurse, and the typical hardware you find in an eye doctor’s office, such as retinography equipment. Oh, and a patient.

The Portuguese papers touted the software as being the first of its kind. It clearly isn’t, but it does represent locally sourced technology, and works miracles for a desperately poor population on a couple of islands in the Gulf of Guinea.

The first patient was diagnosed with a cataract, which means scheduling an operation. The second was a young girl whose vision was fuzzy. The doc in Lisbon determined what corrective lenses were needed, and a Portuguese charity will send her glasses by post, free of charge.

One of these days, this young lady will see for miles, perhaps far enough to take her country to a better place.

Atmos Fear and The India Road. Quick links for smartphones.

Atmos Fear and The India Road. Quick links for tablets and smartphones.





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