This year’s mission report will have a slightly
different feel than those I wrote in previous years. I actually was the leader
of this mission, so you’ll get a little bit of insight from the “jefe” point of
view. The mission preparation began months before we actually left. Stu Zipper,
(who was supposed to direct the mission this year but was unable to do so for
health reasons,) and our board decided to base the mission in Jinotepe,
Nicaragua. Our hosts were to be the Rotary Club of Jinotepe. Before I was given
the reins, travel to Nicaragua was arranged, the clinic site was selected, the
hotel was reserved, and the mission consent forms were published.There were still many details to work out. Our post-mission plans for starters, which I had arranged in the past and did so again. We also had to arrange for transportation within Nicaragua, organize group meals, coordinate the arrival of patients to the clinic, and deal with government bureaucracy—which was obviously the most stressful part. As I had been told, proper advance planning can make a mission go much more smoothly.
Due to unavailability of our regular flight to Nicaragua, we could not travel en
masse. We took a total of six different flights to Managua, and our hosts had to
pick us up each of these times—including one flight that arrived five hours
late. The first person to arrive was Henry Mendoza. He is a physician originally
from Nicaragua who is currently living in New Jersey. Once he arrived, he
immediately began by arranging final details with our hotel, including deposits
and room assignments. He took care of quite a few other major details, for which
I am very grateful. The next day was Friday, January 17. About thirty members of our group arrived today, one day earlier than in previous years. Among this group was Joe England, who was the director for our mission last year. With the extra day, he was able to procure needed supplies for the clinic, and start arranging things with the Rotarians. This made my job much easier.
Most of our group of 80 people had already arrived by the time I landed at the Managua airport on Saturday the 18th. We actually flew down with members of another VOSH group--VOSH-NECO was going on a mission to Bluefields, Nicaragua that week. Upon arrival, a member of the national ministry of health (MINSA) met my group at the airport. After we retrieved our bags, we went to the Hotel Casa Grande in Jinotepe. Upon arrival at the hotel, I felt like a conquering hero returning from battle. There were welcomes all around, and no major problems dropped into my lap. At this point, I also met Silvio Bayardo Rueda,
who is a
pediatrician and president of the Rotary Club of Jinotepe. He was the contact
person between the rest of the Nicas and us. He later became nicknamed Dr.
Payáso (which means clown in Spanish.) Several other Rotarians were there as
well.The next morning, we had breakfast at 8AM. After breakfast, I gave my first speech of the week. This was basically a review for the veterans, but very important for the new people. I introduced our “jefitos,” or underbosses in New York City parlance. I also commended those members of the group who had been on a large number of missions—what we call lifers. This year’s high was Ken Cottrell, who was on his 20th mission. We discussed safety and health matters, and everyone got a brief overview of life in Nicaragua and the city of Jinotepe.
For your information, Jinotepe is the capital of the Carazo division (or state) of Nicaragua. Carazo is home to approximately 175,000 people, and takes up about 1000 square kilometers (roughly 370 square miles.) It is in the western part of Nicaragua, which is more fertile and densely populated than the rest of the country. You can read more about it (in Spanish only, unfortunately) at http://www.manfut.org/carazo/jinotepe.html
After breakfast, we went to the clinic site. This year we were fortunate, as the school we used for the clinic was walking distance (about 1 mile/1.6 kilometers) from the hotel. We were able to cut down on clinic expenses by not having to rent a bus to transport us to the clinic site and back. Those people unwilling to walk were able to take a taxi for three Nicaraguan cordobas (about 20 cents) each. This year the school was like no other we had seen in the past. This was actually a pre-university school. It was far larger and more developed than we expected. There was a large indoor auditorium where our eyeglasses and wheelchairs were dispensed. A cafeteria was available for our lunch break. There was a library (with quite a few books) where our dental clinic operated, though there was some open space there—the team did not work between the stacks. There were more than enough classrooms for all of our examiners to work. There was a gate at the entrance to the clinic that was manned by the national police, which we used to monitor patient flow. Our pharmacy was in a little nook between the exam rooms and the entrance/exit, and looked a little bit like a bar.
Once
we arrived at the clinic, we began setting up our rooms. Normally we place most
of the chairs outside of our rooms for the patients to sit on. However, the
principal of the school did not let us leave chairs out overnight, lest they get
stolen. Never mind that we had thousands of dollars of equipment and medications
there—the chairs were what she was afraid of having stolen. Así es Nicaragua.
Besides that, we arranged our exam rooms, and put up black plastic to darken the
eye examiners’ rooms. The medications in the pharmacy were organized, and many
pills were divided into individual portions to allow for easier dispensing later
on. The dental group organized their equipment, which included for the first
time a portable dental chair and equipment to perform some procedures. Our
wheelchairs and braces were put into place for easy dispensing. The eyeglass
dispensary was organized. We brought 13,000 pairs of glasses, and they were
arranged so that proper eyewear could be found quickly when needed. I don’t think I’ve mentioned where our extensive collection of eyeglasses comes from in previous reports. The majority of them come from recycling centers sponsored by the Lions Club International. The Lions collect eyeglasses from various locations and bring them to central processing centers. At these centers, the spectacles are cleaned and sorted. The prescriptions are then read off the glasses, which are then placed in bags and labeled. Once they are processed, they are then sent to groups like ours. The remaining eyewear comes from our members. This year I was able to bring about 250 pairs of non-prescription sunglasses, courtesy of my parents and aunt & uncle in Florida (hey—when you write the report, you can give a “shout-out” to whomever you want.) Non-prescription sunglasses are extremely valuable. As I’m sure you can imagine, the sun is very bothersome, and a pair of sunglasses can make a big difference in someone’s life. A few years ago, we decided to stop bringing prescription sunglasses. The need for them is great, but we never had enough to give everyone. I was told that we had a near riot one year due to patients who were envious of others who had received them.
Once we receive the glasses, the job is not nearly done. Months before the mission, our optical specialists, including Larry Ulm, Marty Fair, and Tim Kennedy, gather at Larry’s place in Pennsylvania for a long weekend to organize all of the glasses. They are sorted by prescription, gender, and type of lens. Once everything is organized as desired, the glasses are placed into large boxes. Larry then trucks them to New Haven, where they are put aboard a shipping container bound for Nicaragua. They arrive after a few weeks, and one of our friends picks them up and stores them until our arrival.
This year, there were thirteen patients that we did not have glasses for in our extensive library. For these patients, we made glasses here in the U.S. and sent them down to Nicaragua. Thanks to Dr. Jeff Smith of Pearle Vision and Liz Martinez DeFranco of VOSH-New York for making the lenses for us.
Now
back to the mission. After a few hours of setting up, we crammed all 80 of us
onto a bus, van and pickup trick and went out for a group lunch (though we
didn’t actually eat until 5PM.) While there we were met by our old friend Donna
Tabor, an American who has chosen to spend most of her time in Nicaragua helping
the street kids I’ve mentioned in the past. She brought us a troupe of young
male performance artists who put on a show for us. After the meal was over, the
group was on its own. Some members went to the town of Diriamba (which is next
to Jinotepe,) because it was celebrating its patron saint with a big party, and
some others went to a sporting event. The remainder of us went back to the hotel
to rest up for the start of clinic. At about 10:00PM we greeted Carl Sakovits,
our President emeritus, who was the final member of the group to arrive.This year I did not get to spend much time at the clinic seeing patients, as I had to be involved more in the administration of the group. This started on Monday morning. I went with Dr. Payáso to the offices of MINSA, in Managua. We had to deliver a notarized copy of everyone’s license. Before we got to Nicaragua, we were told that if this was not done, that we would not be allowed to see patients. Everything there went smoothly enough, though, like everything else when dealing with government organizations (in any country,) it seemed to take far longer than it should have. While there, we ran into Dr. Martha Galo, who was our host for our first mission to Nicaragua five years ago.
Meanwhile, back at the clinic, things seemed to be going well to start with. Our group has a lot of capable and experienced people, so the fact that the director wasn’t there was not a problem. Each area (eye, medical, dental, optical, mobility, language, general clinic) had a team leader, who basically handled everything—thanks to Larry Ginsburg, Joe England, John Kerwin, Larry Ulm, Al Amerigian, Ed Greenan, and Marie Rondeau for doing that.
One additional service we offered this year was hearing aids, though only on a very limited basis. Rocco Andreozzi (who could not join us this year) and Shahin Barzin have a family member who sells hearing aids, and offered to donate eight to patients of ours. We did not advertise this service in advance, but when we walked in on Monday, 20 people were waiting for just this. Unfortunately, we were not able to help everyone. We could have done nothing but hearing aids all day, and still not satisfied the demand. We took audiograms and made molds of the ears of the lucky few to bring back home, where they would be made.
One problem was yet to be resolved. As in past years, Steve Grimes, an ophthalmologist and cataract surgeon, joined us to literally restore sight to the blind. We had made arrangements before we arrived to use the hospital in the aforementioned town of Diriamba. Right before we arrived, we were informed that the festival for their patron saint would force closure of the hospital on Monday. Steve and his staff got to spend a day in the clinic for the first time because of this. As there was a problem with a relief group at this hospital last year, we still had to clear everything with the hospital administrator in person before starting our work. That afternoon, I visited her with Dr. Payáso and Miguel Silva, a retired optometrist who has resettled in Nicaragua. She informed us of the need for additional testing, which would be a severe impediment to performing surgery, and give us a lot of extra work. We had to then go to the hospital in Jinotepe, where the administrator agreed to perform these additional tests. So at this point, in order to get surgery, patients had to first go to our clinic, then get transported to one hospital for tests, then to a second hospital for surgery, and then back to the clinic so they could get home. Luckily, by the end of the week, we were able to streamline slightly, and the administrator was so thrilled with our people that she invited them back for next year.
After we returned from the hospitals, Dr. Payáso took some members of our group who are architects to a new village the Rotarians were building, called Villa Rotaria. Our members were asked to make observations on the design and development of this village, which would be built by their future residents to specifications. In this village, as many as 100 new homes will be created, some of them are nearly done. Our members commented on potential environmental problems, construction issues, and waste management. A full copy of their report, written by Ali Hocek, will also be available to everyone on the Northeast VOSH website.
When I returned to the clinic in the afternoon, most patients were already gone. I was assured that we’d see far more patients the next day. After we finished for the day, we returned to the hotel for a group dinner, and celebrated the birthdays of Bob Plass and Shelly Ross.
The
next morning arrived, and there were huge lines of people waiting to see us. By
lunchtime we had seen as many patients as we had the day before. I actually got
to spend most of the day at the clinic site. Despite the heavy patient volume, I
didn’t observe any major problems while “making rounds,” which is a credit to
all of our people and our Nica volunteers. I even got to examine ten patients
over the course of the day. The cataract surgeries didn’t start until late
morning, but once they did everything went smoothly.The architects went for a three-day excursion to the city of Granada to work with Donna Tabor. They would determine how to improve ventilation in the homes of some of the poorest people. Our team found in previous years that there is a significant problem with lingering smoke from cooking in many dwellings. This is likely a cause of asthma, eye irritation, and other health problems. Their first objective was to show the people how to properly direct smoke out of their homes. In the first home that they worked on, smoke was allowed to linger after cooking. Using locally purchased products, they were able to construct a ventilation system that would not pollute the home. The second home they worked in had a stove that could direct smoke away, but it was in a state of disrepair. It was fixed using locally procured materials. On their final day, our team held a class in the construction of stoves from discarded cans. They also gave a lesson in creating a solar oven from cardboard boxes, a sheet of glass, crumpled newspaper, and aluminum foil. All of these items could be found locally. Some are waste materials (in the case of the boxes and newspaper,) and the rest can be purchased for a total of about $3. Again, their full report can be found on the Northeast VOSH website.
On Tuesday evening, we went to dinner on our own, and wound down from a long day at the clinic. The bulk of my leadership this evening was to direct people to the ice cream shop around the corner.
Before leaving for the clinic the next morning, we had a mini-clinic in the hotel. As a courtesy, every year we examine the staff of the hotel and their families. The medical part went well, but unfortunately I forgot to bring the eye charts back to the hotel, so we had to improvise. Obviously, that made our work last longer than it should have. That being said, everything was successful. In the clinic that day, we gave out the last of our 55 wheelchairs, which made the last day of the clinic anti-climactic for our mobility team. I actually got to see ten patients before being called out to take care of something. As mission director, the one thing I missed was getting to see patients (though I didn’t really miss sitting on hard chairs for ten hours a day.) We were as busy as we were the day before, and most of us did not leave until it was dark.
That evening, the “jefitos” got together for an informal discussion about how things were going and potential plans for next year. This will be discussed in depth in the near future, and our thoughts will be shared with the group. We distributed glasses and medications from the morning’s clinic at the hotel to our patients, and prepared for one last day of seeing patients.
On
Thursday morning, everyone was a little tired from the entire week, but many
patients awaited us. Before getting to the mission site, Carl Sakovits and I
took care of the group’s bill at the hotel and took care of some business at the
bank before going to the clinic. Upon arrival, the Nicaraguan newspaper La
Prensa interviewed me. For those who don’t remember, La Prensa was the newspaper
whose owner, Violetta Barrios de Chamorro, became president of Nicaragua in 1990
partly as a result of her work with La Prensa. Anyway, the
story on our group
was printed in La Prensa on January 27, the day after we got back. A
copy
A copy will be made available on the Northeast VOSH website. I was also
interviewed for Nicaraguan television, but never got to see how much I stammered
while trying to answer the questions in Spanish.Immediately after, Miguel Silva took me to inspect potential locations for the future. We arrived back at the clinic just in time for nacatamales, a Nicaraguan specialty food, normally only served on weekend mornings but made especially for us on this day. Unfortunately, by the time we returned to the clinic, registration of new patients had been closed, as we were running low on medications for the pharmacy. At the end of the day, we packed up our equipment, extra medications, unneeded eyeglasses, and other supplies. The eyeglasses were given to the Rotary Club to be dispersed, eye medications were sent to a local ophthalmologist, and the remainder of the pharmacy was donated to the Jinotepe hospital, which badly needed it.
That evening, we had a farewell dinner at the Social Club of Jinotepe, sponsored by the mayor of Jinotepe and the Rotarians. We were treated to a dance performance by the group Milauf, which was rather impressive. The dinner served that evening was very impressive. The food was served from large, ornate ceramic urns instead of trays heated by sterno cans. Instead of plates, there were clay bowls with a banana leaf on top. I had not seen anything like this before in my previous missions, and was very impressed with the presentation. After dinner, we handed out certificates of appreciation, and reflected upon a job well done.
The next morning we split up to enjoy various recreational activities. Some of us met a man named Marvin Benard. He is a centerfielder for the San Francisco Giants baseball team, and the only Nicaraguan currently playing in the major leagues; he currently has a lifetime batting average of .274. He was interested in our commitment to Nicaragua and has offered to help us in the future. Brady Hart will keep him informed. For those interested, a history of Nicaraguan baseball can be found at http://www.nicanews.com.ni/nn12/bball.html.
Two days later, most of us headed home, assured that we had made a difference in the lives of over 4000 people.
As is customary, following the mission report are individual anecdotes from the members of the group. Normally I ask everyone about the trip and paraphrase their remarks, but this year I had too many other responsibilities. Therefore all stories will be in the person’s own words. Thanks for your interest in the group. I hope you’re able to support us or work with us in the future
Juan Carlos
“I
was witness to the dispensing of a pair of glasses by Larry Ulm to a woman with
severe myopia. I've seen many patients like this with a high, double-digit
refractive error the years, and they all tend to have the same reserved,
insecure mannerisms you'd expect. Larry found an excellent match from our
library for her. "Welcome to your new world," he exclaimed to a woman who was
once indifferent and beaten by her visual condition. As he fit the frames on her
face, I saw the instantaneous blossoming of a smile, and the melting away of a
lifetime of fear.” Bob Plass
“Again
we ran out of wheelchairs too soon. I think the most memorable moment was when I
witnessed the one that got away. On Thursday we had no chairs left. Of course,
one of the neediest was dropped off at 8AM. A very contracted young man who sat
rather quietly the entire day in this propped up wooden chair. This makes me all
the more determined to come back with even more chairs with the hope it will
help.” Ellie Santoro