Craig Blackwell, MD

Santa Cruz, CA
Diplomate: American Board of Ophthalmology
Fellow: American Academy of Ophthalmology

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An Ophthalmology Practice in Santa Cruz, CA

Guatemala Eye Clinic Part 1

Town of Santo Tomas

There are many medical groups in the US who provide medical services to underserved populations elsewhere in the world. This is the story of one of those groups that works in a small rural town in Guatemala, started by ophthalmologists Keith McKenzie of Santa Cruz, and Bob Singer of Fremont.

In the 1980’s Dr. McKenzie was part of a larger medical group, La Familia, working at another rural Guatemalan town, Nuevo Progresso. In that town there is a small hospital (built with private donations from the US) that hosts large multispecialty groups, including ophthalmology. They draw patients from significant distances within the country and as far away as southern Mexico. A half day’s drive away in the town of Santo Tomas there is no eye care available. Sister Mary Waddell, administrator of the Santo Tomas clinic, would collect people who needed eye care and drive them to Nuevo Progresso. After several years of making this trip she approached Dr. McKenzie with the idea of hosting an eye clinic in her town. He said he would give it a try for one week. That was in 1996. This year, 2008, marks the eleventh year of twice yearly trips to the Santo Tomas clinic.

Examining a post-op patient. Standing on the left is Dr. Singer. Dr. McKenzie is sitting at the microscope. In the background Milt Camp, one of our fix-it guys, is helping out with vision testing.

“Jornada” is the local term describing our one week eye clinic and surgery. A typical team consists of three or four eye doctors, two operating room nurses, an operating room helper, a native speaking Spanish translator and a general fix-it person. Ideally two doctors work in the clinic while the other one or two operate. I can not emphasize enough that this is a team effort. Without good nursing help the doctors can’t operate, let alone do so efficiently. The clinic can’t build good rapport with patients and the community without translators who can put medical decisions in appropriate cultural terms. And nothing would work without the savvy administration of Sister Mary and now Sheila McShane.

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.

The supply boxes are stacked in the back of this covered truck under supervision of Dr. McKenzie and Sr. Mary. The passengers Pile into a minivan and leave for a three hour drive to Santo Tomas. It doesn’t show in the picture, but in the background is a volcano cone spewing smoke that is mixed with the cloud cover.

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.

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 Scandinavian 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.

This is my side of an exam room shared by two of us. With a slit lamp microscope and chairs this is about as basic as it gets.

After years of doing this trip the routine is fairly well set. We 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.

After Sunday market day comes Monday morning in clinic. See part 2.