Annapurna outreach: eyecare, altitude and adversity

As part of the refraction team, it was impressive to see that many of the Annapurna people were emmetropic and required only a referral to the ocular health station to address their presenting concerns. My most frequent diagnosis was presbyopia and it was rewarding to see the reactions from patients who could now read easily with lenses. Yang Wang, the other optometrist on the refraction team, was able to refract a patient with high astigmatism to 6/6. The patient’s smile made her day.

One of my takeaways from the eye camp was to keep the patient’s lifestyle and visual demands in mind. I saw a 13-year-old with low myopia who reported no issues seeing the board in class and who leads an outdoor lifestyle, walking in the mountains. Back home, the typical management for myopia would have been full-time glasses with six-monthly reviews. In this case, we agreed that the benefit of glasses was not sufficient to warrant prescribing, given the lack of environmental risk factors and the patient’s disinterest in wearing them.

Many patients had moderate cataracts and dry eyes. The ocular health team organised referrals to the Himalaya Eye Hospital and provided ocular lubricants. I learned later that the Eyes4Everest team visited the hospital and the hospital director and chief optometrist agreed to provide free cataract surgeries to those who could not afford them.

At the completion of the clinic, we were thanked with beautiful flower garlands and a tika (a sacred red mark applied to the forehead) from the elders, who wished us good luck.

After we returned to the lodge, Shaun gave a binocular vision talk as a CPD event and presented a case of divergence excess exotropia he’d seen. Since vision therapy is not an option in the mountains, Shaun explored options such as spectacles with overminus lenses, yoked prisms to move the patient’s gaze away from the affected field of view and a temporal marker on the lens of the turned eye. The latter would serve as both an anti-suppression tool and a feedback device to help the patient maintain an ortho posture.

Helicopter and hospital

On our most anticipated day of climbing to ABC, I became jaundiced following what was later diagnosed as an acute liver injury. We had arrived at a rest stop in Deurali (3,200m), surrounded by beautiful mountains. Shaun coordinated with the chief guide, porters, travel insurance and the helicopter company to get me to hospital. I spent the rest of the day trekking down to the nearest helicopter pad, in Upper Sinuwa (2,340m). The slow going, with heavy rain and me becoming increasingly unwell, gave me firsthand experience of the barriers to healthcare that Annapurna locals face.

From the air, I was treated to spectacular views of the mountains and the colourful buildings of Pokhara, where I stayed in hospital for the next week. A helicopter ride had always been on my bucket list, but I never imagined this was how I’d be experiencing it!

Reflections

My time in Nepal, from Annapurna to the hospital in Pokhara, showed me there is something to be gained in every experience. The trip was fun and rewarding, but also tested me physically and mentally. During challenging times, I discovered how adaptable, resilient and independent I can be. This experience has given me the confidence to pursue future adventures and I would definitely return to the Himalayas.

Even though I didn't reach ABC this time, the fun I had on the mountain with the team reminded me that it’s about the journey, not the destination.

For anyone sitting on the fence about taking part in a similar outreach, I’d encourage you to go for it. There are likely to be detours and surprises, but I found that if you make the most of the experience, it will still be an extraordinary adventure.