Constructing a home-made carriage for a portable slit lamp

Mobile clinics are necessary to reach remote communities, but this can often mean leaving behind bulky, but desirable equipment, such as the major slit-lamp microscope – universally used to examine eyes to diagnose diseases such as trachoma, pterygium (common in tropical Africa) and glaucoma.

For your information, here is a brief account of a portable set-up I produced for the 2009 trip, where we knew we would be working in a number of very remote sites.

There are excellent portable slit-lamps on the market which generally have most the capabilties of their 'fixed' consulting room cousins but when hand-held they inevitably wobble a bit and the optics magnify the wobbles quite nicely making the equipment less satisfactory. The portables also generally weigh about a kilogramme which can be rather wearing during a day's work so I set about designing a carriage for the Kowa slit-lamp to be light (needs to go in our hold baggage), simple (I'm not an engineer), usable on a standard height-adjustable hospital table and as cheap as possible. It has two horizontal pieces of hardboard separated by vertical telescopic columns made of PVC pipe bought from a hardware store. The Kowa was attached to the centre of the top board with a bolt, and the weight of the instrument countered with a springloaded toilet paper roll holder. Happily, the friction between the pipes was enough to allow the slit-lamp to move
vertically over a range of about 25 mm which was sufficient for most (if not all) patients. The traditional screw-jack height adjuster was unnecessary. For horizontal postioning the bottom board simply slides along the table. For stability the bottom board needed to be larger than the top one. It was convenient to place the battery pack (from a model shop) on the lower board.



The other half of the story was the patient's chin rest. Two G clamps were attached to the edge of the hospital table separated horizontally by about 120mm. Each clamp was attached to a vertical strut about 40 cm high made of L section extruded alluminium. The struts were attached to the G clamps with automotive hosegrips- crude but effective. Each strut had a short length of PVC pipe sliding on it, the opposite sides linked by the chin rest which was made of bent mild steel. Each strut was gripped by a powerful Bulldog clip upon which the sliding tubes rested; the clips could be moved vertically for height adjustment. There was no brow rest.

The components were attached to each other with small bolts, pieces of bent mild steel and tape, assembled on site with a multipurpose tool.

Planned improvements:-
Swivelling struts on the lower board to increase it's effective area. Quick releases on the telescopic columns so the carriage can be dismantled swiftly. Tapped studding to screw into the G clamps- more stable and eliminate hosegrips.

See a few pictures of construction and in use.

Jim Seymour BSc optometrist

We're back but the work goes on...

We're safely back! Thanks to all who have been supporting and praying. Above is the new eye-clinic at Livingstonia which was completed and opened while we were there. Below is a pic of trainee Angella doing an eye examination.

Heading back home

On Thursday last week, the team departed from Livingstonia and headed south to Ekwendeni for a brief stop to catch up with people there. Caroline, Jim and Sue fly back today, via Johannesburg.

The coming week

The team's having a restful weekend at Livingstonia. On Monday, they'll open the new clinic, and say good-bye to Chris and Zoë, who head north for Tanzania. On Tuesday the plan is to do a day clinic at Phoka, a remote village on the western edge of the hospital's 'catchment area'. Wednesday, it's back to the new clinic.

Lakeshore clinics go well

The team's visit to the remote village of Tcharo was successful with many patients seen. Jim had to clear out three wasp nests from the house they were staying in. On the way back today, the boat stopped at another remote village, which has no landing stage, so they and their equipment were carried ashore! There they did an ad hoc clinic and saw another 40 or so people. Sue reports that the pier at Tcharo looks as good as new.

A new ambulance boat, Good Hope, which arrived from Scotland this week was not, in the event, available for the trip, so they had the leaky old Robert Laws for the traditional Lake Malawi experience.

The team arrived back at Livingstonia tired and hungry, but Robert (the local restaurateur) had prepared them a tasty meal with chicken.

Settlements along the shore of Lake Malawi, some only accessible on foot or by boat.

View from above...

A map showing places mentioned in recent posts. Original pic from Google Maps.

Earthquake!

Sue reports that, at around 1am this morning, the team was woken by some seismic shaking in their house at Livingstonia. Nothing was damaged (in their new house) but, in the old place where John Challis is staying, lumps of plaster were falling off. Take a look at the US Geological Survey site for details of the earthquake. It appears that its centre was east-south-east of Livingstonia, in the middle of the lake. Apart from a minor landslip on the Gorodi Road, I have no other reports of damage.

This week: lakeside clinics, with boat trip

The team is heading down the Gorodi Road to do clinics at various locations along the lake this week (while the Scouts make the finishing touches to the eye-clinic before they depart on Thursday). They're at Mlowe Monday, then they do two day-clinics at Luwuchi. The exciting trip is the one to Tcharo, which is only accessible by boat.

Mlowe from the water, departure point for the coast trip south to Tcahro.

Eye-clinic nears completion, Scouts make it happen

Sue's just emailed to say that "The eye-clinic is very nearly finished: it's going to be perfect to use. We'll be moving in there probably on Monday, and we'll be using the primary health care building, as last year, until then."

As mentioned in a previous post, the eye-clinic building was paid for through fund-raising by a Scout group from York, UK. That group, 30 Explorer Scouts and leaders, is now camping in Livingstonia, busy doing many jobs, including finishing off the eye-clinic, as well as new accommodation for visitors (the eye-team are the first guests!). For more info on the Scouts' visit, see their blog and website.

David Gordon Memorial Hospital, Livingstonia, courtesy Google Earth.

2009 team arrives in Malawi

Caroline, Jim, Chris, Zoë and Sue have arrived safely in Malawi. Caroline visited the hospital in Nkhoma today, and we've had news that one of the trainees will be able to start their course later this year (but final confirmation from the college is still required).