A Good Night with No eye Cat Glow any more

He was quiet and frail.
The three year, little boy, had an eye problem, and obviously not enough sleep the previous night. Living 50 kilometers from Nebbi hospital, father and son had to wake up at dawn to be the first in the queue. Still, little Jonathan Rwot was almost at the end of the long line that mostly had elderly people. He was sitting in his father’s lap. Never raising his head. Starring at the floor with his head slightly bent down all the while.
It was one of the hotter days. Rwot could have been playing hide and seek or kicking a locally made football with other kids but here he was waiting.

He had to have an examination; an operation and a referral. He was not only suffering physically but emotionally too. He was small, with a scary, protruding eye and undernourished. Such a pitiful sight. It was not his turn but got pulled out of the line. That was luck.
“He might not live beyond five years,” said Dr. Ben Watmon an ophthalmologist. He was using an ophthalmoscope to shine a bright light into Rwot’s eye as part of the examination. Only then, did Rwot, for three years look straight into another person’s eyes for a long time.
Gibert Onegi, the father was not fixated on the details of the diagnosis. Really, just some concerns loomed; If he could get his son out of pain, to play with other children and sleep with his eyes closed without crying at night. Maybe the emotional pain would go away too.

Dr. Watmon asked gingerly how and when the problem started. He probed. But Onegi had no exact answers.
It supposedly started when Rwot was four months, said Onegi. But his boy got no medical attention. He was living with his mother. She did not have much time or love for Rwot. She later found another man and abandoned her young son.
By the time Rwot was brought to his father two years after he was born, the tumor within the eye was fully grown. He was lonely. Kids didn’t play with him. They shunned Rwot. But he never cried in front of them – just watched them play.
At night, Rwot’s sick eye did not close. It glowed like a cat’s eye in their pitch black small, one-roomed house. Rwot did not sleep much and only at night did he cry, Onegi said.

Rwot was diagnosed with retinoblastoma, a cancer that starts in the retina. It is a common eye cancer in children and can be sporadic or hereditary. If not treated early the tumor grows outside of the eyeball. Exactly what happened to Rwot.

“The clinical appearance shows the cancer is in advanced stages,” said Dr. Watmon who was at Nebbi hospital for an eye camp. He explained that the camp is a bridging gap for the rural poor who may never afford or have a chance to see a specialist. But he is limited in his services.

“At the camp, I do not look at itching eyes. My main work is surgery. Rwot has had a chance,” he said. Based at Gulu hospital, about 70 kilometers away, Dr. Watmon is also the one ophthalmologist in charge of the whole mid-northern region with millions of people.

That is not strange. Uganda has only 48 ophthalmologists, according to their umbrella body, the Uganda Ophthalmology Society. Eight have since retired leaving only 40 to serve an entire population of 41 million people. 26 of these remain in the country’s capital, Kampala. 14 like Dr. Watmon serve the rural populations in hard to reach areas.

Many hospitals out of Kampala, Nebbi inclusive, lack specialized services. So conditions that could be treated early and reversed go untreated until the ‘arm of God’ presents breakthroughs like the eye camp.

The Uganda Government tries to solve the problem by partnering with non-governmental organizations to provide such services through camps. For this eye camp, its partner was Amref Health Africa, Uganda branch.

But the demand for specialist services for each hospital is different. For instance, in 2016, Nebbi hospital registered 49,809 outpatients. 2.3 percent or 1,180 were eye patients, said Dr. Charles Keneddy Kissa the medical superintendent, Nebbi hospital.

“We have one ophthalmologist officer who can only handle minor eye cases such as allergies although the hospital has a beautiful eye clinic, which has not been used for 10 years,” said Dr. Kissa.

They have tried to find an ophthalmologist doctor. “We have advertised many times but got no interested candidates,” said Dr. Kissa. Undeniably, this is a hard to reach area and with no incentives, doctors are not eager to work there.

As such, conditions like glaucoma, refractive errors and cataracts, which most of the people in the line waiting with Rwot have, cannot be reversed and cured because they cannot be intercepted early.

Another solution could be getting an eye donation but organ transplant in Uganda is illegal.

Dr. Watmon had two solutions for Rwot; first to put him on chemotherapy then remove the eye or remove the eye and do chemotherapy. He opted for the latter and referred him to Ruharo eye center, the only facility in Uganda that gives free eye chemotherapy services for children.

But it is in the western part of the country while Rwot lives in the northern part.

However, there is hope. If his case is forwarded to Ruharo, as a referral, transport money will be sent to Onegi to take his son for free chemotherapy.

But at Nebbi hospital at least the journey began. Rwot’s operation was among the 42 Doctor Watmon carried out during the five-day eye camp. 106 patients were examined but some were not as lucky as Rwot. They walked long distances back home to wait for the next eye camp.

“At least Rwot will be free of pain,” said Dr. Watmon. He will sleep with his eyes closed.

Lilian Mugisha