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Volunteer Insight - Gift of Sight Team in Guatemala

3/17/2011

 

Dr. Iftikhar Ali

This past week has been a very good experience for our family.  I went primarily as Zoya’s babysitter (or ninero, as it’s called here) but also as the general medical physician in case any emergencies came up.  Tayyeba (my wife, a resident ophthalmologist) and I were nervous about bringing Zoya (our 13 1/2 month baby girl) to a foreign country on a surgical mission trip.  We feared the unknown more than anything, but thus far this trip has been a deeply fulfilling mission.  This is the first time that we’ve done something like this together with Zoya and hopefully it won’t be the last.  Though I’ve been fortunate to go on several disaster relief trips abroad, going on an eye mission to Peru in 2006 with Tayyeba for our honeymoon is when I gained a deep appreciation for the gift of sight.  It’s been said many times that you don’t know how important something is until you lose it.  Of all our senses this is most so for our vision.

In Hispanic culture, when a family member is blind or disabled one of the family members (usually the youngest) becomes the caregiver for him or her.  Often times in Peru, and also here in Guatemala, you’ll see young family members literally leading their blind or near blind family member lovingly by the hand.  It’s a tremendous burden for that person - because often times cannot work, go to school, or lead a “normal life.”  When sight is restored to that one person it frees not only that patient but also the caregiver.  Now the patient is free to care for himself and even provide for his or her family and the other family members can be their own persons.  It’s a subtlety that’s easy to miss when you focus simply on the surgeries.  I think about 30 patients’ cataracts were extracted this past week.  Although that’s the simple “bottom line” that many will focus on, I prefer to think of it at as a minimum that 30 patients are now more independent - and that 30 families will be more productive in society.  That’s huge!

Fortunately there were no emergencies to deal with (at least not yet - don’t want to jinx anything)!  Three or four of our team members came down with gastroenteritis but are convalescing nicely.  I think Zoya had a great time and I’m sure that she gained a lot in this experience.  We really want Zoya to travel the world and serve those in need.  It’s a blessing to be able to do this together as a family.  We hope to be back next year - “same bat time … same bat channel.”  I think the local nurses who bonded with Zoya will get a kick out of seeing her grow over time.  The nurses and staff at the Santa Barbara Clinic were so hospitable that it felt like we were with our extended family here.  They were vying with each other for Zoya’s smile and attention. 

We’ve made some great friends during this trip.  I hope we’ll have a family reunion of sorts with the same team in a year or sooner.  There’s definitely a need for our services and I think that many in our team will have a void that can now only be filled by helping strangers in need.  It’s a difficult feeling to describe what it’s like leaving your work and the comforts of home to travel far and help complete strangers.  What I like best about these trips is the inspiring people I always meet.  I consider the volunteers who sacrifice their time and money to do this work to be the cream of humanity.  It’s good ‘news’ that hardly ever makes the news.  It’s reassuring to know that there’s good in this world - something for me to aspire to be a part of.

Iftikhar “Ifti” Ali  MD
ER/Internal Medicine
Little Rock, AR

 

Shafat Sirajee

I watched the woman slowly shuffle her feet
Across the grounds she navigated
With the arms of her son around her
Never knowing the beautiful country that surrounded them
She wandered through our doctor’s hands
And out came another woman
Her eyes and her hands found mine
And she proved to me that she could see
Never have my eyes nor my heart felt so blind
In the presence of another beating heart like mine

 

Dr. Richard Harper

The opportunity to see a new world through my own eyes was something I expected on this, my first trip to Guatemala. I was completely unprepared, however, for the impact of experiencing this new world as part of a team of people completely dedicated to, and focused on, helping the people who live here.

I had not personally met most of the team prior to the day we arrived, but I knew from conference calls that the group was extremely well organized and had excellent leadership. During the planning process, all of the attention was on the details necessary to carrying out a surgical mission: supplies, schedules, travel and living arrangements, etc. It wasn’t until we began seeing patients, though, that the true nature of the team became evident.

Despite all of the meticulous planning, multiple situations presented themselves for which we were unprepared. In each case, however, the ingenuity and skills of one or more team members lead to a solution. Most importantly, the attitude of everyone was positive, upbeat and energetic. No matter if a task was outside someone’s experience, or even out of their comfort zone, one or more of the team was eager and ready to jump in. In my mind, there is no better evidence of selfless commitment to the well-being of others than in these spontaneous acts of service.

Finally, I realized that Guatemala is not so much a place as it is a people. The patients that we treated, and the native Guatemalans that worked in the clinic, were uniformly warm, gentle people; quiet and reserved, undemanding and stoic. They were quick to smile, unpretentious, and seemed genuinely content despite their lack of material possessions.

To be able to serve on such a team, bringing care to people that would otherwise be unavailable to them, has been a remarkable privilege. It has also been an humbling glimpse into the magnitude of people’s needs; humbling because we could serve so few, and because these needs are multiplied many fold throughout the world. One could make these observations and conclude that the need is so overwhelming that there is no need to even try. This team, however saw the same need and was moved, not to cynicism, but to give of themselves. They chose to meet the needs before them with energy, enthusiasm, and a genuine desire to serve.

 

Dr. Ahsan Khan

Resilience. That is my first and lasting impression of the Guatemalan patients we have seen on our Gift of Sight mission. Many have lived years and years with blinding cataracts but cannot afford the surgery to restore their sight. They arrive to the clinic with cataracts in their eyes, but hope and patience on their faces.

We call Mr. Lucas Miguel Cuc into the screening room, an older gentleman, short in stature, dark wrinkles on his warn, tanned face. He smiles and says ‘Gracias’, although he cannot see me clearly.

We examine him and send him to the pre-op room to get prepared for cataract surgery. The medical student applies several drops in his eyes. He asks no questions and shows no fear, but softly offers a ‘Gracias.’

The resident explains to him what will happen next, and then promptly injects an anesthetic on a one-and-a-half inch needle through the eyelid. He flinches slightly, but doesn’t utter a sound. His legs are crossed, his arms slightly tensed, but no resistance. I look in awe, because I was expecting more of a reaction. I asked the resident why he is so calm and requires no anesthesia and she replies, ‘Because he really wants to see.’

We take him into the operating room, prepare his eye, place a drape over his face and begin the surgery. There is no anesthesiologist. There is no Versed to calm his nerves. Only topical anesthetic drops. The surgery is long and complicated and requires his cooperation, to look up and down and left and right, to which he complies. We ask if he is uncomfortable and he says no. Dr. Harper and I marvel at his cooperation, his pain threshold and his patience.

We remove the drapes and take him to recovery. There are beads of sweat on his brow, no doubt from anxiety and, yes, even some pain. He reads several lines better on the eye chart. We given him instructions. He smiles again and says ‘Gracias.’ As he walks away, I think to myself how special the people of Guatemala are. Their resilience is like nothing I have ever seen nor will ever forget. Performing cataract surgery on them is truly an honor, and the opportunity is a gift from them to us.

-Ahsan M. Khan

 

Dr. Tayyeba Ali

Maria Catalina, lacking the 36-week “glow” typical of expecting mothers, sat stoically in one of the white, plastic chairs that lined the cement wall of Barbara clinic. Above her head was a hand-written, taped sign designating our exam room. She had initially been seen by a Guatemalan student in the medicine clinic. However, complaining of an acute red eye, she was quickly transferred to be seen in the free eye clinic run by Humanity First. More obvious than her apathy was the leukoma, a dense white scar, that covered her left cornea. On further evaluation, she was found to have superficial vascularization, follicular conjunctivitis and corneal scarring in both eyes – the left eye so bad that her vision was only 20/400. Her belly was hardly suggestive of even a 20-week baby and she also complained of back pain, discharge and painful urination. At nineteen years-old, carrying her first child, Maria was diagnosed with Chlamydial keratitis.

Clinically, the case was fascinating, but my heart was heavy. Not only did I feel apprehensive about her health and the health of her baby, but I felt incapable of empathizing due to our language barrier. I asked Sonia, a Guatemalan ophthalmology resident, to explain the implications of her diagnosis, the importance of having her family members tested, and the need for follow-up. Though I again emphasized the importance of compliance, Iftikhar thought it best to ensure at least one dose of antibiotics. And so I rummaged through my bag, which was stuffed at the bottom of one of the operating room lockers, and found my Z-Pak. Grabbing a carton of juice from our “lounge,” I watched Maria swallow three 500mg pills of azithromycin. She was also given two eye drops to be taken four times a day and given a one-week follow-up appointment. I do not know how much was lost in translation, but I did understand that Maria was afraid of going blind.

-Tayyeba K. Ali

Under Pressure

Up until today, I never imagined an operating room without an accompanying dramatic score, one likely set to this scene: a manicured doctor digging into a body with a scalpel, asking for more tools, wiping the sweat off his threaded brow, exchanging worried glances with his team (all of whom are in relationships with each other) and then, cut scene, a killer is on the loose in the psych ward, and he’s headed this way.

That’s not how Day 1 of surgeries at The Barbara Clinic played out. I was allowed to sit in with the medical team to film and photograph the first surgery. I waltzed into the room like it was a cantina, forgetting to scrub in; the medical team advanced in a procession. The same faces I exchanged laughs with the evening before were now stone cold. Everything was okay but nothing was going to be funny for the next hour, because instead of a volunteer mocking as a patient on the table, Bibiano, a 78-year old Guatemalan woman with a cataract in her right eye, was lying on the table, quietly awaiting surgery.

Dr. Richard Harper walked in, arms airing in a ninety-degree angle in front of him,  ready to scrub in. Dr. Ahsan Khan followed. Juan stood by with tools on hand, with Dr. Asima Bajwa and Dr. Swetangi Bhaleeya ready for the assist. A trio of Guatemalan medical students-Delea, Melissa, and Sonia—looked on. The group talked calmly among themselves about the details of the case. I fumbled around with my cap and mask and slipped into scrubs two sizes too small.

Dr. Harper and Dr. Khan took their seats around the patient table and scooted in close to a dual microscope, which allows both of them to navigate a magnified map of Bibiano’s eye. The tools that Juan had spread carefully across the cart all look the same, but under magnification, they are bent or contorted in extremely useful ways, awarding the doctors full flexibility when working within ocular boundaries. They were all set to perform cataract surgery, the bread and butter operation for eye surgeons.

Imagine if you will a young man’s bedroom floor. Littered with dishes, dirty socks, empty bottles, crusted pizza slices, and other cliche accouterments, the original Navajo white carpet is now barely noticeable. Then comes in a kind, loving mother who gently removes each obstruction until the carpet is revealed again; and while she’s there, she’ll check and make sure there’s nothing else out of order, thumb through your diary, shine your third place trophies, even replace the carpet, and leave with everything sparkling in its right place. A cataract is a dirty eye that needs tender love and care.

Dr. Harper calmly worked along, pausing only a few times to break down the method for the group. “You don’t want to dig it out like an ice cream scoop,” he says, explaining the gentle pull needed to remove the cataract. He holds the petrified lens high by the forceps for all to see before removing the tiny puffs of clouds still floating around along the cortex of Bibiano’s eye.

Delea gently put her hand over Bibiano’s, assuring her in Spanish not to move or worry. Meanwhile, I paced around in the shadows, trying to exchange a worried glance with the team or avoid tripping over a plug, all the while wondering what would happen if the whole case just burst into flames.

Dr. Harper finished removing the clouds using a device called irrigation/aspiration (IA). You flood the eye with air and suck up the clouds along the cortex, much like Mom putting the Hoover to the Cheetos on the floor.

Working with a clean slate, Dr. Harper moved right along to the last step: putting in a new intraocular lens (IOL). An IOL is a genius acrylic invention that replaces the natural lens with a manufactured one made to last for the rest of a patient’s life. Since it’s artificial, there is no cell growth or room for dark clouds. Once you kick the cataract out, it’s banned for life.

Everyone stopped. I put my camera down and glanced around, wondering what was next. The room was stuffy and I felt queasy, even though the whole battle was bloodless. I slipped out to use the restroom and reload film. I came back and bumped into an elderly woman being escorted out of the clinic. I glanced back again. It was Bibiano. She had dark shades wrapped around her face.

She put out both her arms and reached for my shoulders. “Muchas gracias, Senor,” she said with a big smile. Puzzled, I headed towards the operating room and bumped into Dr. Harper.

“How’d it go?” I asked.

“It went well,” he replied, already eying the next patient.

Dr. Khan walked by. I motioned him over.

“So what’s the next part?” I asked.

“That’s it. She can see again.”

-Ata ul Malik Khan

 

Gift of Sight: The Setup

It’s Sunday morning, the rain has cleared, and our work begins.

I am writing to you from El Centro de Salud Barbara, or “The Barbara Clinic,” a small health clinic hidden along a winding dirt road that leads to the village of San Juan Sacatapequez, about an hour outside Guatemala City. We are a team of physicians supported by students, professionals, volunteers, and me, the camera guy. Together we make 15 volunteers, and our goal over the next week, which I hope to illuminate over this space, is to efficiently and effectively run a free eye clinic for Guatemalan residents. Our program is called “The Gift of Sight,” and we have successfully run it in several other countries around the world.

In planning the effort, we were fortunate this time to be have the native expertise of David Gonzales, a full-time Humanity First volunteer and resident of Guatemala. He’s been a fine host, and has arranged for us to stay at Casa Damasco, a humble villa of sorts down the road from the clinic.

While I am holed up here in a visitor center at the clinic, the rest of the team is laboring away in various rooms, using today as time to setup equipment, designate space for our operations, and run a few practice sessions before nightfall. Surgeries begin tomorrow and last through Friday.

It’s only been 24 hours since I landed, but I can say our team is as beautiful and diverse as the countryside we navigate and the residents we’ve met. There’s a calmness to this country that makes you feel at home, a slower pace and smiling face that lets your senses settle in. I couldn’t possibly do justice to the kinds of interesting paths my fellow volunteers have taken to get here, but I hope to hand over the computer over the next week and let them tell their stories here. I’ll also be speaking with some of the patients and residents and letting you in on what’s going on over at the clinic. And of course, look for photos.

Until then, I need to find some Imodium.

-Ata ul Malik Khan

 

 

 

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