NEVOSH Mission to Mus, Turkey

August 2005

 


l to r: Dr. Mustafa Atas, Nizamettin Buyukozer, Deni Robey, Irene Diep, Usha Vas, Shelly Agarwal, Anatole Hocek, Ali Hocek, Akin Omercikoglu, Sadi Dinlenc, uknown, Ibrahim Ozcimen, Marsha Sullivan, Bulent Solmaz, Roberta Lavarello, Rocco Robilotto, Kiyan Hocek, Cindy Hung, Altug Dinlenc, and Adam Hocek (Click on image to view full size)

 

Mission Report 

 

This past August we traveled to Mus, Turkey and setup a NEVOSH Optometry clinic in Mus, Turkey.  Initially, Harry Zeltzer, OD and Past President of Vosh International, suggested to me to do such a mission.  Beginning about two years ago, together with Sadi Dinlenc, we organized and lead the mission. 

 

Members of our team came from all over the United States, with Roberta travelling the furthest from Buenos Aires, Argentina.  In addition to myself and Sadi, our incredible team was:

 

Shelly S. Agarwal

Irene Diep

Adam S. Hocek

Anatole S.A. Hocek

Cindy Hung

Roberta Lavarello

Rocco Robilotto

Deni Robey

Marsha Sullivan

Usha Vas

 

In Turkey, we were assisted by two translators from Istanbul and several students from the Health Services High School (where we setup our clinic), in Mus.  These invaluable friends were:

 

Altug Dinlenc

Akin Omercikoglu

Ilknur Toplu

Leyla Bozyel

Zozan Almaz

Gulumay Yilmaz

Leyla Kaya

Nurdan Sahin

Berrin Ataman

 


 

Group in Istanbul, before leaving for Mus

 

Mus is one of the poorest areas in Turkey, located west of Lake Van it is in the region where the Pontus and Taurus Mountains converge.  The landscape is rugged and has severe winters.  Mount Ararat is located in this area.  The Mus Valley is a fertile basin and various rivers flow through it.  The region has a large Kurdish population. Many of the patients we saw, only spoke Kurdish, resulting in a string of translations from Kurdish, to Turkish, to English, and back again.

 

We left for Istanbul on August 12th, and set up the clinic in Mus three days later.  The mission lasted four days, after which most of us spent time traveling in Turkey.

 

Several months prior to our visit, our friend Nezaket Yavuzer, traveled to Mus to meet with the key people assigned as our contacts from the Ministry of Health in Ankara.  Sadi traveled a week ahead of the main group to finalize arrangements and to get the word out that we would soon be arriving.

 

One of our biggest concerns, up until our arrival in Mus, was news of sporadic terrorist actions throughout the country.  As the mission date came closer, several volunteers opted not to participate.  In the end, we lost about a quarter of our volunteers to these concerns.  While the possibility to abort our visit was always an option, it was having Nezaket and Sadi in Mus ahead of us that made it clear that there was no reasonable risk to us.  To alleviate any remaining concerns we might have, the Governor, Ibrahim Ozcimen, who was our host on our arrival at the airport and at a last day brunch in our honor, provided us with at least two plain clothed police officers for 24 hours each day we were there.  Their service and friendship during our visit was greatly appreciated.

 



Shelly Agarwal, Altug Dinlenc, Akin Omercikoglu, Rocco Robilotto, Irene Diep, Cindy Hung

 

Mus is a wonderful and peaceful city, with a population of about 60,000. The average annual income in the area is approximately $650.  While poor, most of the people of Mus are covered under a State health insurance.  This covers the cost of all medical visits and 80% of prescriptions. Mus also has several hospitals, including eye care and a women and children's hospital.  The eye hospital is headed by Ophthalmologist Dr. Mustafa Atas, who devoted much of his busy schedule to providing us support. Dr. Atas and his team are caring for hundreds of patients, often having to limit patient visits to a couple of minutes.  While we saw 600 patients with 4 examiners and our team working an average of 12 hours per day, we had the privilege of spending more time with many of those patients with particular conditions. We were seeing a lot of patients who, either were not covered by national health care, or for what ever reasons, had not used the medical services available to them, or were not aware of them.

 

During the Governor's brunch, he gave us each certificates expressing their appreciation for our efforts.  In a bit of comic relief, I asked the Governor to also pin mock medals I had made up on each of our volunteers, which read "…for services to humanity beyond the call of duty".  Although comic, the gesture was one of my deep appreciation for the incredibly hard work and long hours everyone put in.

 

In my view, (and I will share the views of others from our group later in this report), one of our greatest contributions to the patients in Mus, aside from the examinations and prescriptions, was conveying and encouraging a patient's own culture of health care.  Simply being there was an acknowledgement that health matters. Often our examiners were providing a second opinion, from that of Dr. Atas and his hospital.  In doing so, I believe we were raising awareness in the local population of the facilities and services available to most of them.  In more complicated cases, the time we spent with the patients, provided them with a better understanding of their condition, its prognosis and treatment.


Shelly Agarwal with young patient

 

Unlike our missions to Nicaragua, during Screening, we took the blood pressure of everyone over 45 years old.  This not only informed the patient and examiners, but provided an opportunity for us to talk about diet and healthy habits.  Although the dental component of our mission fell through in the last few weeks before we left, in retrospect, our contribution to dental care may have been better served by providing brushes and toothpaste with a short tutorial in dental hygiene during Registration.  During a casual conversation with Dr. Atas, I also learned that there are no facilities or programs in Mus to educate people with low to no eyesight, which would support their independence.  In this area, we might have provided training for others in Mus to provide basic skills for these patients.


 

Leyla Bozyel, Usha Vas, Ilknur Toplu

 

We were also in charge of crowd control, which Sadi took the brunt of.  The first two days were quite out of control, in spite of efforts by both us and the visitors to organize the situation better.  The second half was much calmer, but many had to be turned away.  To those people we apologize and wish  that we could have seen all of them if it were within our means.

 

Of the 600 patients we saw, we gave 400 pairs of eyeglasses. The remaining glasses were donated to Umut Feneri (Hope's Lantern), which is a Mus based non-for-profit organization providing assistance to the poor, particularly those whose needs are not covered by the national health system. 

 

The following are notes and comments from some of the others in our group:

 

Sadi Dinlenc:

 

I must remember, with appreciation, the welcome we saw at every level of the City Government of Mus, starting with the Governor down to the Schoolmaster where we setup our clinic. The support, help and forthcoming attitudes of all the civil servants, including the local radio station employees, where I was given a 45 minutes long live interview, was unbelievable and heartwarming.


Patients waiting to enter the clinic

 

As this is my first and only mission with Vosh, I must admit I had not expected so much reward despite so tiring two weeks I had to spend in Mus. One might say that I personally felt some obligation to these people as they are the citizens of my birth country, but for the volunteers who came from so far, it was a purely a selfless and humanitarian service.

 

Regarding future missions to Turkey, I think we should improve our skills in crowd control where I personally had very hard time and contributed partially to the crowd mismanagement outside the building. Looking back, I cannot help but smile at my attempts to control several hundred people at the door of the school and also at the helplessness of the two police officers we called in for assistance.

 

Deni Robey:

 

This was my first VOSH mission and a very interesting experience as I don’t speak Turkish and the extent of my optometry experience is choosing new glasses every few years. I work for an NGO that supports international aid and I find such efforts to be fraught with moral ambiguity. For the most part I felt good about what we were doing, though sometimes I felt that we were undermining the doctors and opticians in Mus. Ultimately, I believe we did good work and provided eye care to Mus that many residents were not getting either because they could not afford it or because they did not understand the nature of the public health system.

 

 

 
 

Sosa, Ilknur Toplu, Gulumay Yilmaz, Leyla Bozyel, Anatole Hocek, Akti, Ayse, Roberta Lavarello 

Mus, while one of the poorest towns in Turkey, doesn’t make you feel that you’re in the midst of crushing poverty. Despite free public health care for the poorest in Turkey, there were many more patients than we could see. The doctors were amazing. I don’t know how they saw so many people so many days in a row. The people I met, while often frustrated by long waits, were almost universally pleasant and ready to laugh. It really made me wish I could understand Turkish and Kurdish so that I could hear more of their stories. I believe that the experience was instructive to those of us who participated in the mission as much as for the people of Mus with whom we interacted so I find this “cultural exchange” to be as valuable as the eye care. The doctors likely felt that the service they provided far outweighed the “experience.”

 

I was fortunate to work in the Dispensary with Marsha Sullivan, who had participated in three previous VOSH missions. For those not trained in optometry, it was crucial to have someone who had already worked in a dispensary, particularly because the schedule did not permit one of the doctors to train for any significant amount of time. Of the glasses we had with us, another 500-1,000 bifocal prescriptions would probably have significantly increased our ability to fill such prescriptions.  In addition, we did not see many children but we had very few small glasses and had trouble filling many prescriptions. I understood from one of the doctors that it is especially important to match a child’s prescription as closely as possible so 200-300 more children’s glasses probably would have been beneficial.

 

 

 

Marsha Sullivan, Deni Robey, and patients

 

Highlights for me were a girl about nine we called Kardesh, who was independent and bold. She needed a prescription stronger than we had, but she understood that we would try to send it and understood that we might not be able to. There was a little cross-eyed boy who drove me crazy, crying and whining for hours in the hall. We had his exact prescription and when I put the glasses on him, his eyes uncrossed and he smiled. A guy in his early 20s was so blind he took a pair of glasses that weren’t strong enough. He was very poor so I offered him a second pair in case the first broke, but he said somebody else should have them. Ufuk was an English teacher who told us he came to practice his English. He offered to stay to translate for a few hours and stayed two days. Dinner in the home of our appointed contact from the local hospital, Nizamettin and his wife, was also a highlight for me. We were exhausted after a long day, but she was lovely and made us a great (and huge) vegetarian meal.

 

Rocco Robilotto:

 

“In service beyond the call of duty” goes a long way describing the week of August 15, 2005.  In the 8 VOSH missions I have had the pleasure to participate in, I have never seen a group of people come together and work so hard, under such long hours, to accomplish what we set out to do.  Now that a few weeks have past, it's easier to look back on the entire experience and appreciate how much reward came with that effort.  We were fortunate to have the opportunity to provide so much help to those who were so grateful and so welcoming.

 

The pace of each workday was incredibly fast, and for me, most of the exams seemed to blur into one long endless patient.  There were however, distinct and memorable moments punctuated by great joy, relief, humor, and sadness.  Joy in the many patients who's vision was drastically improved with the simple act of giving the correct prescription.  These were the smiles seen in children who could now read the eye chart across the room, and in the elderly patients who could now read the Koran again or start sowing once more.  Relief came in the teenagers with severe ocular allergies, or bacterial infections, who simply needed the right medication.  It also came in the parents who were reassured that they have not inherited their mother's macular degeneration, or that the scar on their child's cornea from an accident was not going to grow and they were

not going to loss their sight.

 

Humor also punctuated each day and kept us going much longer than we could have otherwise.  One notable such moment came when Altug, finally decide to vent some pent-up steam during the lunch break of the last day.  He had us literally almost rolling out of our chairs.  Among the many happy stories we were able to witness, there were also a handful painful ones.  The most difficult time for me was when I had to tell a father that his four-year old son had a congenital corneal dystrophy and was beginning to lose his vision.  The father was beginning to notice this and was desperate for a chance to do something.  Although we could do nothing to directly help his son’s condition, we were able to offer him an explanation of what was happening, and give him a chance to properly prepare for the future.  We were also able to convince the father to put his son on a corneal donor list in hopes that a transplant will one day be able to restore his vision.  What impressed me most was that often the people we could help the least were the ones that expressed the most sense of gratefulness.

 

While we were there, news of our service spread more than we thought.  In fact, the day after the mission ended, I set out traveling by myself.  On a bus to Ankara’s central station, I was seated next to a young woman who spoke a little English and was eager to practice.  After a few minutes of conversation I found out that she was teacher in the capital, but was originally from Mus.  She heard all about our group from her aunt and uncle who still live there and wanted to thank us all.  She told me that we were all very 'sugar' (I think she meant sweet).


Rocco Robilotto with patient

 

Concerning specific points of mission logistics, I felt that almost everything ran smoothly under the circumstances.  My perspective is a little skewed given that that I rarely left the exam room over the course of the 12-14 hour days with the exception of an occasional bathroom break and lunch.  I never really got a chance (thankfully) to see the lines outside or deal with registration downstairs.

 

Of anything I could have asked for that we didn’t have, it would have been additional examiners.  Given how much time needed to be put into a mission like this, more examiners would have made the effort more effective.  Although, I have to say, given our small numbers, we did pretty well.  Of course, a huge part of that is due to the fact that we had effective translators who worked as hard, if not harder, than we did.  It also helped that Cindy, Irene, and Shelly were troopers.  I don’t think many other VOSH examiners I’ve ever worked with could have put up with that many number of non-stop work hours for 4 days in a row.  By the end of each day, our brains were not functioning anywhere near peak level.  Although we all survived, future missions should be cut back if possible, at least to 10 hour days.

 

Adam Hocek:

 

Building on the relationships that grew out of the mission: it would be wonderful to see if there would be a continued involvement with the people of Mus and the region and the group of volunteers.  This could be through future missions to the area, but could also be through a continued dialog.  In my opinion any assistance we could provide that lets the people we worked with in Mus help others would serve the goals of the mission.

 

Leyla Bozyel (student from the local high school, who assisted us):

 

The people of Mus are very happy as a  result of your work in Mus.  Your efforts to help the poor who have  little means, has inspired us. Your  views and attitudes towards everyone was sincere and heartfelt.  That your organization has come from a foreign country to support us, has deeply effected us.  We hope you will again come to Mus.  On behalf of all the people of Mus, we thank you.

 

 

Students from Alparslan Saglik Meslek Lisesi, the school director Fatih Bingolbali, and Ali and Anatole Hocek

 

Acknowledgements and thanks:

 

Vosh and NEVOSH: 

Harry Zeltzer, Stanley Sagara, Joseph and Maryann England, Carl Sakovits, Steven Grimes, John Kerwin, Frank Casarella, Jonathan Wasserstein, Bob Plass, Larry Ulm, Marty Fair, Tim Kennedy, Rocco Robilotto, and many others.

 

Fundraising and Other Support:

Maia Meyhane, Call It Kismet, Smile Forever, and the many people who donated to the mission and supported our efforts.

 

Support in Turkey:

Ministry of Health: Honorable Recep Akdag

Ministry of Foreign Affairs:  Tunc Ugdul, Levent Sahinkaya

Governor's Office: Governor Ibrahim Ozcimen, Bulent Solmaz

Mus State Hospital: Op. Dr. Mustafa Atas, Nizamettin Buyukozer

Local High School: Fatih Bingolbali

 

Lastly, in organizing this mission, many people expressed a sincere interest to participate in future missions to Turkey.  While at this time, it is too early to say whether and when a next mission will be, I wish to encourage them, as well as others who have not yet expressed an interest, to please keep in touch with me and express their willingness and interest in any future missions to Turkey. 

 

Thank you for this opportunity to serve.

 

Ali C. Hocek, co-organizer of the NEVOSH mission to Turkey, ach@hocekarchitecture.com

 

More info from the Mus mission:  Pre departure message including itinerary

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