2009 NEVOSH Mission Report

by Shahin Barzin

Once again, NEVOSH Medical Brigade was leaving for Central America. We were going to a new country, El Salvador. This year’s mission was hosted by Voices on the Border, an American NGO that we had never worked with before. They proved their efficiency by organizing the mission in a very short period of time since our original host backed out on us at the last minute. We were going to be guests at the community of Nueva Esperanza.

We arrived in San Salvador on Saturday, Jan. 24th. It was a beautiful, warm and sunny day. This was a sharp contrast from New England’s wintry, cold weather that we had left behind. We landed at Comalapa International, a characterless, but adequate airport. The procedures at Customs were very routine and uneventful, except for the 5 missing pieces of luggage filled
with medicine. Besides this, a few of our colleagues were stranded at Miami International Airport. Luckily both the lost baggage and our stranded colleagues all joined us the following day.

At the airport, we were greeted by the VOTB’s representative, Geoff Herzog, a man who we grew to appreciate for his contributions and efforts towards the mission and also for his laughter. He has been living in El Salvador for a number of years and had been working with the communities in the Lower Lempa region and Nueva Esperanza in particular. He had brought two mini buses and a colorful, well decorated truck for our luggage. This truck became our main source of transportation during our stay at Nueva Esperanza. The first interesting thing that I noticed was Geoff’s concern that one of the bus drivers was making too many rounds around the airport rather than parking on the street waiting for everyone to gather in one spot. “He is wasting the community’s gas” Geoff repeated a couple of times! They were actually keeping a tap on how much gas they were using. It was a simple and revealing note about how tight and organized this community would be.

Once everyone and everything were on board, we started our 1 1/2 hour journey to Nueva Esperanza. The roads were noticeably superior to the ones we traveled on in Nicaragua, while the lush and green landscapes were similar. We were all high-spirited and anxious about our upcoming experience in a new country. We made a short, mid-point stop at a market. This was our last chance to buy any necessary items for the next few days. It’s interesting to see how “necessary items” could have such a wide range of definitions. Bottles of Rum being one of them….

We continued on our journey and before long we arrived at the Lempa River which is one of the largest rivers in Central America. It flows southwards from Honduras to the Pacific Ocean and literally dissects the country into two regions. It was the dry season so the water level was quite low. During the rainy season, March to October, the water rises dramatically and floods the surrounding lands. There was a railroad bridge parallel to the bridge we were taking to cross the river. These two bridges were the main supply routes during the civil war and were badly damaged by guerillas fighting the army. During the civil war, the Lower Lempa River Basin was depopulated. After the war, former combatants from both sides of the conflict were offered land here for resettlement. Nueva Esperanza was one of these communities.

Soon our caravan was off the main paved road and on to a dirt one. The setting became even more rural. Small corrugated roof houses with barbed wire separating their yards. Cows, roosters and dogs were roaming around. Men walking back from farms with machetes in hands. White smoke was rising in the yards from the open fire where the women cooked. Children chasing each other, playing in the road. There was a fine layer of dust covering everything. We passed a simple church with murals of Archbishop Oscar Romero and his close friends painted on its walls. He is well respected and loved by the people here for what he stood for before he was assassinated back in 1980. Our bus came to a stop in front of a gate. There was a fenced off area with a building sitting in the middle of the site. To the right of the entry gate was a big pile of plastic recyclable trash. The place was being used as a transfer station. There were roosters and chickens running around along with a few Central American Generic dogs. The building in the middle was originally built as a clinic but it was never used as one. This was to be the site of our clinic.

After a tour of the building we concluded that it could not house all of our needs. It was decided that the Optometry, Audiology and the Gynecology exam room would be housed inside the building while General Medicine, Pharmacy and Eyeglass dispensary would be set up outside. The area adjacent to the building was picked to become the open air clinic. There were two very large trees and their branches were perfect canopies for protecting us from the hot sun during the day. Geoff was to provide us with a large role of white fabric and some rope in order to isolate these areas. After a brief discussion regarding the logistics, we all returned to the bus and headed to our guesthouse. The dirt road turned onto a narrow bridge with the words “Nueva Esperanza” written on the side railings and shortly after we were in front of our guesthouse, a simple cinder block building with metal roof. A chicken wire fence separated the yard and the dirt road where herds of cows would pass by on occasions. The building consisted of 8 rooms each containing 3 beds. There were 4 shower stalls & 3 outhouses a few yards away from the building. A modest accommodation, and yet very adequate. One very nice feature to the guesthouse was a covered pergola with a few hammocks and benches. The roof was made from palm leaves and the floor was covered with crushed volcanic rocks. This area became the social club during our stay. The guesthouse could only accommodate half of us. The rest of the group stayed at a convent a couple of hundred yards away. The convent building was of a similar construction as the guesthouse but the rooms were arranged around a courtyard with a flower garden, a very simple and pleasant setting. The only issue with this building was that it had a curfew of 9pm. The curfew created some challenges to the members who wanted to stay up passed that time. But it didn’t take long for them to come up with creative ways to get around the curfew.

Once everyone was settled in their quarters, we were warmly greeted by the community leaders. They were eager to make us feel at home and expressed their appreciation and were looking forward to opening of the clinic. They also shared with us their painful, yet heroic strife during the war and how they came to settle in Nueva Esperanza. By the end of their talk, one had no choice but to have great admiration and respect for these people. It was around seven o’clock when we were directed to a small dining hall across the road where our first meal was served. By now we were all very hungry. A simple dish of rice and boiled vegetables never tasted so good…. When we returned to the guesthouse, the members of the local soccer team were waiting for us with a couple of coolers of beer. All the proceeds from the beer sales were to be used for the soccer team. Also, a local band was there to welcome and entertain us. Their simple efforts to make us feel comfortable and welcome were heart warming and humbling experiences. It was a beautiful, starry night and fatigue was taking over all of us. It didn’t take long before everyone headed to their beds (some covered with mosquito nets) for a good night’s sleep. But it was around 3am when we were all awakened to the sound of “The Roosters & The Nocturnals”- a nightly performance that we all grew to become accustomed to…(or not).

Sunday morning started early. The truck was loaded with all the supplies and materials needed for setting up the clinic. We also jumped on board since the truck was our only means of travel. It didn’t take long for the passengers standing behind the cab, “The Front Riders”, to realize that they had to dodge tree branches and warn everyone else behind them by calling “branch on the right or left”. This became a routine practice on all rides.

The task of setting up the clinic started without a delay as soon as we arrived at the site. I’ve been on VOSH missions since 2001 and have never seen a clinic to be setup as smoothly as this one. The veteran members knew exactly what to do and the new “awesome” young rookies followed suit with great energy. Using some of our Eagle Scout, nautical and architectural skills combined with great enthusiasm, we were able to set up the outdoor portion of the clinic using the fabric and the rope provided by Geoff. By noon, all was in order and soon the representatives from the Ministry of Health arrived at the site. Unlike previous missions, these people were not there to inspect our pharmacy but they were there to have an open discussion about the condition of the health system in El Salvador. They expressed their concerns and frustrations regarding the failed status of the health system in their country and also showed their gratitude towards our group with the hope of more collaboration in the future. They also informed us that they were going to use the clinic to vaccinate people who were coming for treatments. The VOTB representative, Rosie, who we had just met was acting as our translator during this session. Rosie is a young and serious individual who has a very good understanding of the local conditions and needs. She was instrumental in organizing this mission from the very first day when VOTB was to be our host. She proved to be a good friend and a great asset to our mission. The meeting was followed by the arrival of the lunch truck. We were served “Pupusas”, a delicious local dish.

We had the rest of the afternoon off. Part of the group went back to the guesthouse and the rest went to a nearby nature reserve. The head of the neighborhood security “Pedro” was our guide. He and a few other local men were in charge of protecting this area and were very proud to take us through the trails. It was another sign of how tight knit, organized and proud this community was. We had a pleasant walk through the forest and reached the shores of the Lempa River. It didn’t take long for most of the people in the group to take a plunge in the water, some fully dressed, spear headed by the truck driver and our own Dr. Rocco…! Once back at the guesthouse, a simple dinner followed by more live music while the soccer team provided us with more beer and the long day was brought to an end.

We arrived at the clinic the next morning not knowing what to expect. There was a moderate line formed by the people seeking treatment. The atmosphere was calm. It didn’t take long before everyone was settled in their working areas. There was a shortage of translators at the beginning but that didn’t become an obstacle for our registrars. Veterans Evan Pritchard and Jordan Hebert with the help of the rookies Alex Seidler, Daniel Solanky & Anya Wechsler started the registration process and directing the patients to the appropriate destinations in the clinic. They were assisted in translation by Julie, a VOTB volunteer, as well as Marvin, a local volunteer, who also happened to be a lead singer in one of the local bands. We were also able to spot a few bilingual people in the line who we asked to volunteer as translators. These local and unexpected volunteers, who were very happy to help, became an important component to the clinic during the next few days. It is important to add that we were told by the community leaders that all the volunteers will be working at the clinic for free. They had clearly requested that there should be no financial rewards for any of the volunteers and this we accepted respectfully.

At the beginning, we had some concerns that not enough people knew about our clinic. But soon we learned otherwise. Our host had a very well organized way of getting people to the clinic. There were some 4000 families living in the surrounding communities and they were assigned a specific time and day to arrive at the clinic. This process eliminated any confusion and chaos at the gate while a comfortable flow of people continued all day.

There was a $1 donation request for registration, which most people paid without hesitation. There were times when our fee collector, Julie, would be focused on other things, and people would go out of their way to put the neatly folded dollar bill in her collection bag. The money collected at the registration was going into a community fund and was to be spent for the community as a whole. Another interesting point was that, unlike the previous missions, there were no signs of armed guards, which revealed so much to us about the community.

Despite the unusual setting, the clinic started to function with great ease. The General Medicine Team consisted of Joe England, MD; Geoff Burns, MD; Rocco Andreozzi, DO; Lee Arnold, PAC; Jason Donovan, PAC; and Sue Seidler, NP. They each were assisted with a translator. Also working with this group was Michael Terry , PAC, a very warm and gentle man. He had a long history of working in El Salvador and as a VOTB volunteer. He had arrived from California specifically to assist us for the week. The process was very organized. Julie Seidler would allow the patients to enter in an orderly fashion. Katherine Bucci, RN and Joy Fisher, RN would take their vital signs and have them ready for the consultation by the medical staff. They also, with the help of Mary Berthelot, RN, conducted all the tests and helped with respiratory treatments and flushing ears. The General Medicine Team treated the total of 1607 patients for the duration of the clinic. Most common cases were Parasites, Diabetes, Arthritis and low back pain. There were also a good number of common colds (La Gripe) and a few Asthma cases. The doctors also performed some minor surgeries, removal of Sebaceous Cyst, on the big table that was set in the middle of General Medicine area.

Aside from these common cases there were a few that were a vivid reminder of the bloody civil war that had engulfed this country not too long ago; A man who had the scars of five bullet wounds across his chest and had to live with the effects. Another man who had lost one eye and part of his face, and a woman who had been tortured with electric shock & was still jolting from the experience.

There was also a house call visit. This was requested by a woman seeking help for her son in-law, who had been bed-ridden for the past 9 years. The patient was visited by Rocco and Michael. He was severely anemic and suffering from chronic kidney failure and continuous diarrhea. He was in pain and had parasites. He was in need of a weekly dialyses which was beyond our abilities. The nearest hospital could provide the needed treatment but at the cost of $200 per session which was way beyond the means of his family. We left him with enough medicine for one year to treat and ease some of his symptoms. We were told the next day that his diarrhea had subsided and he was in less pain. Whether he would live long enough to finish his medicine remains to be seen.

The Pharmacy was set up within the same area as the General Medicine. This allowed an immediate and easy way to dispense the medicine. Most of the medicines were purchased by NEVOSH using the money collected from donations during the past year. The rest of the medications and supplies were donated by drug companies and other sources. This year we had Pharmacist Tim Baker, working in the Pharmacy along with Eileen Tiexiera, RN. They were also assisted by Catherine DeShelter and Becky Tiexiera, RD. Becky also consulted the patients regarding nutrition and diet. The curtained off area of General Medicine and Pharmacy was very crowded and busy but that didn’t stop the chicken from laying her eggs on top of the desk with the medical supplies. There was a basket in the kitchen where all the collected eggs were placed during the day, and they were probably part of our next morning’s breakfast!!!

There was an educational talk on Diabetes by Rocco Andreozzi & Becky Tiexiera with the help of our own translator, Roberta Lavarello. There were about 30 very attentive listeners and some were even taking notes. The talk was followed by a short question and answer session. It was interesting to see how engaged some of the participants were in the discussion. At the end of the talk, it was also interesting to see that all the attendees neatly stacked up their chairs and put them aside rather than to leave the work for the clinic staff. This may be a small gesture but it shows respect, solidarity towards their own community and appreciation to us who were there to help their community.

Due to lack of space, the first stage of the eye screening was also done outdoors. Patrick Dutton and Ryan Ferraro were in charge of the process. They worked, without the help of any translators, to prep the patients before being seen by the optometrists. In the middle of the main building, there was a good size open space with no windows. With the doors closed, it provided a semi-dark area which was occupied by our optometrists. The optometry group consisted of Carl Sakovits, OD; Larry Ginsberg, OD; Jane Bucci, OD; Jackson Lau, OD; and Kim Nolan, OD. This year we were able to include some SUNY students in our group again. Dina Solansky, Susan Elizondo, Lacey Dustin, Katya Zelaya and Shephali Patel were the participating students. They worked side by side with the OD’s and gained a well-deserved and valuable experience at the clinic. Overall, the optometry clinic received 1115 patients. Unfortunately we didn’t have our eye surgeons with us this year so we couldn’t provide surgery to patients with cataracts. During future missions, we can hopefully coordinate with a regional hospital in order to perform eye surgery. It is important to note that Julie from the VOTB is going to compile a database from the registration forms of all the people who attended the clinic. This way we can have a history of the patients and doctors can do follow-ups. This data-base would allow us to identify current patients with cataracts and provide them with surgery during a future mission.

The audiology team occupied three rooms within the building. Fully computerized, this group utilized one room for testing and a larger room for making ear molds & fittings. The third room was used for programming the ear-pieces. The audiology group saw 154 patients and dispensed 137 hearing aids. Many of the recipients were children who had never heard the voices of their parents before. It is always a very moving experience to watch the expression of a child when they hear voices or the beat of music for the first time.( http://www.youtube.com/watch?v=owpDDdtnfsI) The group consisted of Ken Startz, Sue Burns and Carolyn Hesselton. Also working with this group were Lisa Ross, RDH, Sarah Andreozzi & Dave Pritchard.

A private room was dedicated to gynecology. For most of these patients, this was the first time that they were treated by a female doctor. Ann Mason, CNM & Donna Tabor were a perfect team to attend this task & provide tender care to this group of patients. Some of these patients have lived through some very unpleasant physical abuse and experiences before. By the end of the week, the Gynecology team had seen 102 patients.

Eyeglass dispensary was set up outside and unfortunately not in the most shady area. Despite the heat and dust, the dispensary team including Opticians Linda Carpentier, OPT and Deb Imondi, along with Maryann England and Steve Burney conducted their work with great efficiency while searching through the boxes of eyeglasses. Bringing the eyeglass library from Nicaragua was no easy task. In fact, the boxes were delivered to us right before we opened our clinic gates to the public. Many of the boxes had become homes to bugs and creepy-crawlers during their storage and the dispensary team had to repack and organize a good portion of the eyeglass library. There was a large number of old sunglasses in the collection. The dispensary team had made a deal with the children who were hanging out at the clinic. They were to clean up the clinic site of all floating trash and in return each could have a pair of sunglasses. So at the end of each day, an army of children would go around the clinic to cleanup and would look pretty cool as a result.

Everyday our breakfast & lunch was brought to the clinic in the back of a pickup truck and served to all the members of the group. It was good to see that the food was not being served in Styrofoam boxes with plastic utensils. Although it wasn’t certain if the silverware was washed under the most sanitary conditions, it was comforting to know that we were not contributing to the landfills.

By 2 O’clock on Thursday afternoon, the clinic gates were closed and the last patient was finished by 4:00. Taking down the clinic was as smooth of a process as it was setting it up. All the extra medicine and supplies were left with the VOTB’s representatives in order that they would be distributed at the right locations. It was easy to sense the joy and satisfaction in everyone’s faces as we climbed up to the back of the truck and drove away. On our way to the guesthouse we passed the soccer field for the last time. As it had become our tradition, we cheered the soccer teams by singing “Olay Olay,…”. I wondered what they thought of these screaming Americans, Canadians, Salvadorian, Argentinean and Iranian…..

That night, the community of Nueva Esperanza organized festivities for us. They expressed their gratitude for our solidarity towards their community and we thanked them for their hospitality and by embracing us as friends. We all celebrated and danced into the late hours of night with the hope of seeing each other again.

The next morning, the two mini buses and truck were waiting for us in front of the guesthouse. As I stepped through the gate into the dusty street I noticed Donna talking to an old lady who was holding a framed picture of her son. It was a photograph of a young man in a combat fatigues taken in some forested location. The old lady was gesturing to her neck as she was talking. She told the story of how during the war they found the headless body of her son. A troubling tale to say the least. In my feeble attempt to comfort her all I could offer was an embrace and a kiss on her forehead. She took my hand and looked at me with her glassy sad eyes and smiled. She told me that the people of this community have had “tears of joy” in their eyes because we came to help them and she thanked me. At that moment I was certain that we would be coming back.

Many thanks to Joe England and Carl Sakovits, the co-presidents of VOSHNE and the rest of the Board members who worked tirelessly for months to overcome all the obstacles in order to organize this mission. Also, to the rest of the members of our group who contributed so selflessly in order to make this mission a reality. It was a pleasure and an honor to work along side such a group of people.

Shahin Barzin

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