Mix of people waiting outside the clinic door.

Some days are full, working to dinner time. Sometimes we finish early and get to do other things. Further up in the hills is a school that Father Hazy, the mission priest, has been instrumental in building. Part of the aim is to train local people as teachers who will extend the reach of education. We try to visit the school site almost every year, and there is always building going on. Last time they had just acquired several computers, but their internet connection was sketchy at best.

Group visit to the school in 2004. Another building underway. With Dr. Hsei and my daughter Kate.

Sister Anna runs several programs to benefit the poor. In the town there are people who are older and can’t work any longer, and if they have no family or source of income they have very basic needs like food. These people and their situation are known within the town and those who able to donate funds to Sister Anna who purchases basic food supplies like rice and cooking oil. After packaging them up she delivers these supplies to intermediates who have agreed to distribute them. One afternoon Dr. Hsei and I got to go on a food delivery run. Sr. Anna drove us through the back roads of town, one of which runs through a school yard with students playing soccer around farm animals grazing there. Not only did we see another side of life here, but it was a moving experience to be part of food delivery to people that would otherwise have little to eat.

Late afternoon foray into town for the 2008 crew. Left to right. In the colorful shirt is our Mr. Fix-it this trip, Ron Young. Dr. Hsei in tan (UCLA) cap. Reynalda Flatte, our excellent translator, and veteran of many other medical group trips. Nurse Shelly Young with hands in the air. Connie Rose, veteran nurse and visitor to Guatamala.

That this endeavor has been so successful is due to the combined efforts of the nurses, translators, clinic staff and other eye doctors all sustained by the leadership of Dr.’s McKenzie and Singer.

Dr. Martin Fishman of Los Gatos has taken over leading the summer trip. Sr. Mary has been a great administrator, advocating for these people. She is now retired, but still living there, while a new administrator, Shiela McShane has taken over running the show. Sr. Anna, as of early 2008, is recovering from her own health issues. Fr. Hazy continues his work with rural villages and school building.

We do a fairly thorough eye exam including pressure check and dilation. There is a supply of glasses, mostly readers, to give out. It doesn’t matter where you live the need for reading glasses occurs at the same age and progresses at the same rate.

Quartet of women waiting in the hallway. Their matching dresses suggest they are from the same village. Sr. Mary says you can judge a person’s financial status by their footwear or absence thereof.

Examining a patient in the clinic.

We see a lot of people with eye irritation from the smoke from the cooking fires in their open air homes. Exposure to sun and wind means frequent pterygia, the membranous growth over the cornea. If it is near the central cornea, likely to block vision we surgically remove that.

Trachoma is an eye infection we don’t have in the US. It’s spread is facilitated by close quarters and poor hygiene. It starts as conjunctivitis, but with time it scars the inside of the eyelid causing it to rotate inward so the lashes rub on the cornea. That leads to pain, corneal scarring and vision loss. If caught in the early stage the treatment is antibiotics (oral, drops or ointment). Once the lid is scarred inward then a surgery can be done to rotate it outward, to the great relief of the patient. Having only read about trachoma before coming here, I got an education on how to recognize the early signs from Chepe, one of the clinic’s medical technicians who travels to outlying villages to screen and treat.

Cataract is a problem that so far has only one solution, surgical removal of the clouded lens and replacement with an artificial lens. In the beginning of the week when the surgical schedule is open we will operate on patients who have a dense cataract in one eye. By midweek as the schedule fills we only operate on people who have dense cataracts in both eyes. Specifically, we do one eye so they can be functional. Consider that people who are bilaterally blind require the nearly full attention of a family member, who is freed of that responsibility if vision is restored.

Patient with cataracts getting ready for surgery. Note the pupils are white.

A large percentage of patients have pseudoexfoliation, an eye condition with extra deposits inside the eye associated with an increased chance of glaucoma and a weakened lens capsule.

Dr. Hsei performing cataract surgery, with nurses Pat McVeigh scrubbed in and Denise Weybright circulating. Shelf on the left holds sutures, lens implants and other supplies.

The main operation is for cataract. We have a simple operating microscope. There is no complicated phaco surgery here, only the older, but much simpler extracapsular technique. It requires a large incision and sutures to close, but the equipment is simple, and manually operated.
Eight to ten cataracts can be performed per day with an occasional pterygium removal, lid repair or glaucoma surgery. One of Dr. McKenzie’s goals is to include a local ophthalmology resident in training for surgical experience to which they have limited exposure.

Dr. Adams and local ophthalmology resident are examining a postop patient. Dr. Adams is retired from his practice in Santa Cruz, now living in San Diego.

Rosie Camp, one of our translators, explaining postop drops to patients and their families. If they live in the vicinity they will have one followup visit a week later with the ophthalmology resident.

Line outside clinic on a sunny morning.

Clinic starts Monday morning at eight. There is a long waiting line on the benches both inside and outside the building. People who were seen at the end of the last trip, six months previously, and deemed to need surgery are seen first and sent directly to surgery.

Vision testing outside the clinic building.

In the clinic we rely on the regular clinic staff to make everything run. Most of the patients are of Mayan descent and speak one of the Mayan languages, K’Iche, and maybe some Spanish. Besides translating my limited Spanish into Mayan and back, my clinic helpers make the patients feel more comfortable by explaining medical issues in K’Iche and in culturally appropriate terms. I could not get much done without my longtime helpers Manuel and Miguel. And there is no getting along without our Spanish translators, Rosie Camp or Reynalda Flatte, for those times when patients launch into long narrative stories.

Reynalda Flatte and Sister Mary. Translators and facilitators.

Nice new road entering Santo Tomas.

Santo Tomas, La Reunion, altitude 2700 feet, is located on the other side of the volcanic slopes from picturesque Lake Atitlan. You can’t get to the lake from here because of the mountains. Just before crossing the bridge into town is Clinica Maxena. It was established here in 1966 as a mission site because electricity stopped here; there was initially no paved road. Supported by the diocese of Helena, Montana, a priest was stationed here and a small house was built, followed later by more building including a small general clinic. A Guatemalan doctor is paid to staff it part time the rest of the year. Extra financial support came from private donations and later Scandanavian governments and the European Union. One thing that was sorely needed, but not available, was eye care. Guatemalan doctors mostly stay in the cities where they will be paid for their services and government programs, for whatever reason, don’t reach rural areas.

At Sr. Mary’s invitation Dr.’s McKenzie and Singer, and another ophthalmologist from Montana, Joe Kupko, decided to establish an eye facility here. The building was available, but they needed equipment for a clinic and a surgery. In the clinic, specialized eye microscopes and other diagnostic equipment are needed to examine people’s eyes, screening for problems that can be treated medically, like trachoma, problems that require surgery, like cataract, and problems that are unfortunately beyond help. Then a surgery suite requires an operating microscope and instruments. Clinic and operating equipment has been accumulated by donation or purchase in bits and pieces over time. For instance, Santa Cruz Rotary generously donated the operating microscope.

All the disposable supplies must be brought along each trip. We try and plan ahead of time about what medications we will likely need, but something unexpected always shows up that challenges us to improvise.

Operating packs, lens implants, sutures and anesthetic agents must all be packed and brought along. There are no spare parts, so simplicity and improvisation are the orders of the day.

Pharmaceutical maker, Alcon, has been generous in donating medications.

After years of doing this trip the routine is fairly well set. Arrive at Santo Tomas on Saturday afternoon, get assigned to our rooms, unpack boxes and set up the clinic and operating room.

Sunday is market day in the town, which because of the newly paved road, is becoming busier and busier. Our group heads into the market for the adventure and to procure food supplies for the week. To say that we stand out is an understatement, a line of seven or eight oddly dressed strangers, a head taller than everyone else. Stalls are crowded into narrow streets leaving barely room to pass.

Entering Sunday market. Can you spot the visitors? Note the couple in front in typical dress; the seated woman in an embroidered blouse and wool skirt, and the standing man with the colorful shirt and wool skirt.

Baggage claim at the Guatemala City airport, with boxes of supplies loaded on a luggage cart.

We arrive at the Guatemala City airport with our luggage space allotted to medical and surgical supplies carried in ten to twelve large cartons or duffel bags. Time to clear customs with equipment and medications depends on whether they want to inspect some, none, or all of the boxes. Mostly they seem to be looking for outdated medications, which they will confiscate.
Piling into a minivan we leave for a three hour drive to Santo Tomas. From the capitol city at elevation 5,000 feet, we first head west and descend to the coastal plane, toward Escuintla. The scenery is striking, with smoke spewing from perfectly cone-shaped volcanoes. At low altitude sugar cane grows in abundance with occasional plantations of rubber trees with attached little buckets gathering sap. In February you share the two lane highway with double trailers hauling massive loads of cut sugar cane to processing plants. After heading north for a couple of hours we turn east and ascend into the hills at the base of the volcanic range. At middle altitudes coffee plants are everywhere, growing under a canopy of taller shade trees.