REPORT OF THE JANUARY 2010 NORTH

REPORT OF THE JANUARY 2010 NORTHEAST VOSH MISSION TO EL SALVADOR

By Kammie Lucas

VOSH, Volunteer Optometric Services to Humanity, is an organization dedicated to providing optometric and optical services around the globe. Without adequate vision in a third-world setting, independence is lost, gainful employment is hopeless, and even the simplest of household tasks are fraught with danger.

Over the years, most VOSH groups have expanded their services beyond the core mission of optometry/optical. Our chapter, the Northeast VOSH (NEVOSH) has expanded as well. Although NEVOSH had its roots in Maryland, the geographic center shifted north, to Rhode Island. The kernel of the Rhode Island group was Carl Sakovits, optometrist, who first joined VOSH when he was a student at State University of New York (SUNY). Carl salt-water fishes with Joe England, family practitioner. I imagine they were bobbing about in a rowboat when Carl asked Joe to look at the possibility of adding medical care to NEVOSH’s optometric care. Joe plays in a band with Steve Grimes, ophthalmic surgeon. It might have been during a “take five,” that Joe asked Steve to consider cataract surgery. And so it went, from little fingers everywhere to reach what we have become today.

NEVOSH has now expanded to include more optometrists and physicians, two eye surgeons, nurses, Nurse Practitioners, Physician’s Assistants, a pharmacist, a dietician, an Occupational Therapist, dentists and hearing specialists. Three of the more unusual professionals, at least as they relate to health care, are the medical illustrator, the architect and the high school teacher. Kevin Somerville, the illustrator, was invited for skills in statistics and comedic entertainment. The architects, Shahin Barzin and Ali Hocek, who alternate each year, repurpose existing space for new use, which is no small task. In El Salvador, the space to be repurposed into the Clinic is a splotchy plot of grass with scraggly trees and two little cinderblock buildings. Dave Pritchard, the teacher, is not only a problem solver but he has a sixth sense for what is needed – he is always there, just in time, to move something or catch something. He brings at least one student every year. Students of all sorts attend. Primary are the optometry students from SUNY, Carl’s alma mater. Many of the young adult spawns of NEVOSH members also attend. Carl Sakovits and Joe England became our group leaders.

My specialty is operating room nursing. I will leave the core NEVOSH group every morning with the eye surgeon, Steve Grimes, and an interpreter. We will spend the day performing cataract surgery in an operating room and return to the core group every evening. Two years ago, we were lucky to have a second eye surgeon and his nurse-wife with us in Nicaragua (Charlie and Sheila Collins). Charlie has lent us his portable eye microscope and his portable sterilizer for this trip. This year’s special treat is Cathy Kroon, a professional interpreter.

After many years in Nicaragua, NEVOSH changed its sphere of operation to El Salvador in 2009. We are returning to El Salvador now, in January 2010. Many of the NEVOSHers met at the airport in Providence, Rhode Island in the wee hours of a frosty morning. I had six suitcases with me, five for the operating room and one for me. Steve Grimes, the eye surgeon, had at least four with him. In addition to their own luggage, Joe and Maryann England had the three eye microscope carriers with them and other suitcases full of medical equipment and pharmaceuticals. When Nurse Practitioner, Sue Seidler, and nurse, Eileen Tiexiera arrived, they appeared to be casting long shadows behind them, which, on second glance, proved to be their taller, young adult daughters. ( I noticed that Maryann, Sue and Eileen seemed to have lost considerable weight by the time we reached San Salvador, which suggests they had been wearing a sort of Wanna-Buy-a-Watch trench coat with even more supplies inside secret compartments.) Carl Sakovits took charge of targeting anyone with only one suitcase and redistributing the overage bags. In the end, when everyone had as many cases as possible, the excess baggage fees levied on us rivaled any of the larger Harvard endowments.

After some stickiness in the red tape of the Transportation Security Administration, we were on our way to Atlanta. Once we were on board and buckled in, an audible sigh came from the direction of optometrist, Larry Ginsburg. It was Larry who had taken charge of coordinating all the plane arrangements, from all over the United States, so that everyone could meet in San Salvador on the same afternoon. In Atlanta, we met up with more members, and in San Salvador, the finalists arrived to complete our group of fifty. They had come from New York, Baltimore, Florida, Kansas and California. Larry looked particularly happy once the last of the NEVOSHers rumbled their luggage over to our bus stop.

Loading our luggage into a panel truck was the first of our formal group activities. Pass it down, pass it down, pass it down and then into the hands of NEVOSH’s el gigantes (men over six feet) and up into the hands of the El Salvadorans in the truck bed. What absolutely did not fit into the truck was made to fit anyway and roped into place. We watched as the truck left the airport, groaning and swaying under the load. Although our bus would be hours behind the luggage truck, the time was more than filled by reconnecting with each other.

The bus trip was most remarkable for the stop at the Super Mercado. Last year, when some of the luggage went missing, this was the place to buy underwear. If the Mercado staff had no warning of our arrival, they were certainly unflappable in their management of 50 Gringos who might as well have been auditioning for “Supermarket Sweep.” After being advised that we were staying at a convent with no stores nearby, people concentrated on necessities. I bought bottled water and paper cups. And, although I do not drink rum, I bought it because it was Nicaraguan and many other people seemed to be considering it indispensable. Necessaries for the young adults included Chitos and chips.

All were timely in reboarding the bus and we continued our trip. After a while, the bus left the highway and rumbled over the dirt road that led to the Convent where most of us would stay. Lee Arnold, a Physician’s Assistant from Florida, was my roommate. Lee had already staked our claim on the Convent real estate, which was conveniently, albeit not aesthetically, located nearest the sinks and toilets. Light green cinderblock walls and cots of wood and canvas. The cots, while unwieldy for the short-legged, were surprisingly comfortable once the legs were heaved up and over the side rail. Lee is a genius when it comes to bringing conveniences to Spartan surroundings. One of her best this year was a portable reading light.

The front of the Convent faced the dirt road. Gardens surrounded the sides and the back. Some of the rooms were arranged around little gardens of shrubs, which became the clothes drying area. (Is it a female-thing to bring enough undies to last the week or is it just me?) There were four shower rooms from which screams could be heard every morning. (There was no hot water.) I promised not to go into detail about the composting toilets but there were whimpers coming from that direction as well. We are bathroom-spoiled in the United States. Finally, there was a classroom surrounded by a garden, which became my private place.

Every morning at 0400 I followed my headlight beam into the classroom in the garden. There, until sunrise, I drank espresso, Sudokued and journaled. The espresso was my own chemistry project, a baggie of finely honed proportions of instant espresso, sugar and powdered milk. It did not matter at all that the water was not hot.

After securing our room in the Convent, we walked a short distance over a dirt road to the Guest House. The Guest House was a small building of five or so bedrooms where some of our group stayed. Command Central was the canopied dirt yard in front of the Guest House. There were hammocks with sufficient room around each one to arrange plastic chairs for conversation. Old kitchen chairs, a wooden plank-on-cinderblocks bench and low stone walls provided additional seating. Hors d’oeuvres of health foods, Cheetos and chips were offered on a rusty folding table. It was here that the group briefs and debriefs were held. Also here was music, rum or beer, and backgammon for some of us. I learned how to play backgammon last year because Steve Grimes plays it and I want to beat him at it. There are at least five other backgammoners in the group. While roommates Steve Grimes and Steve Burney played, internist, Bruce Fischer, and I played our board beside them.

How I came to accompany Steve Grimes on these missions is worth mentioning. In the early years, one of Newport Hospital’s operating room nurses had accompanied Steve to Nicaragua. In the fall of 2006, when I was the coordinator of the eye surgery service, Steve approached me, looked into my eyes, and asked if I would consider coming to Nicaragua to assist him with eye surgery in January 2007. Just as I was puffing up with pride over his obvious recognition of my professional talent, he added, “I need a good myope to see the suture.” I then realized it was not my eyes, but rather, my eyeglasses, that he had been peering into. Once I recovered from the sting, I accompanied him to Nicaragua. I returned to Nicaragua the next year and now, in a third year, we are in a new place, in El Salvador.

The third building that completed our “compound” was the dining hall, another short distance away. Dinner was served nightly in this little camp-style building. Utensils whacking away on portable griddles, and, suddenly, a five-star aroma as our dinner bell. Breakfasts and lunches, which were served at the Clinic, were catered by two young women. All week long, they would ferry food, plates, utensils and coffee by motor scooter and work the Miracle of the Loaves and Fishes.
Following dinner, everyone gathered at Command Central for our first formal meeting. Although he was not with us in El Salvador, we acknowledged Roddy Hughes, the executive Director of Voices on the Border in Washington, D.C. and all of the behind-the-scenes international arrangements he was able to execute. We were introduced to Rosie, our contact with Voices on the Border in El Salvador. We were introduced to Pedro and Carmen the El Salvadoran logicians/magicians. Pedro drove the luggage truck; Carmen drove a Volkswagen. Pedro was serious and quiet; Carmen was talkative and quick-to-laugh. Toward the end of the evenings, Pedro was more likely to escort little groups to the Convent while Carmen entertained those who stayed behind. We were introduced to Matthew (“Mateo” on his name tag), an American who was beginning a lengthy stay in El Salvador with Voices on the Border. We were also introduced to some of the interpreters who would work in the Clinic.

Rosie talked about the history of the community, the local governing structure and the needs the community has identified for itself. We were located in the Baja Lempa, the region at the lower Lempa River. It is an agricultural area from which people fled during the El Salvadoran civil war (1980-1992). When the war ended, refugees from all parts of El Salvador repopulated this area and established a community they named, Nueva Esperanza. Nueva Esperanza has grown steadily, from shabby tents into sturdy houses. Each smaller community has representation in the large community’s self governance. Women are active members of the leadership. The realization that the country’s government cannot solve all of the community’s problems fosters a spirit of self-sufficiency. Once the community identifies a need, organizations like Voices on the Border aid in finding resources. The resources do not offer simple gifts; rather, they educate the community how to manage and sustain its own resources. Among the problems tackled so far are irrigation and composting. The other need, which is medical care, is why we are here.

The walk back to the Convent was not so easy because it was made in utter darkness, save a narrow beam from the flashlight held by the leader of the group. Bruegel’s painting, “The Blind Leading the Blind,” is an apt description. On subsequent nights, I regained independence by remembering my headlight.

On Sunday morning, everyone was to gather at the Guest House. The local livestock, apparently shy yesterday, mingled among us today - horses, cattle, roosters, hens and chicks, pigs and piglets. The uber-present Central American dogs also made their appearance, ruled by two uncharacteristically handsome, well-fed, all-black dogs that belonged to a nearby neighbor. When we arrived at the Guest House, we renewed our acquaintance with the luggage truck and loaded it with supplies needed for the Clinic set-up. As a special surprise, all of us were loaded into the truck bed as well. During the trips up down the hand-made ladder, I resolved to stay on my diet, step up the Zumba sessions and seek treatment for what heretofore had seemed to be only mild acrophobia. The ride down the tree-line dirt road to the Clinic site included significant lurching over a little bridge and a lively dance of ducking every minute or so in response to ,“BRANCH!” shouted by those in the front of the truck bed.

Following breakfast, Ali, the architect, began his deliberative trek around the grounds. A loose planning committee followed him. (I pictured Obama and his advisors.) Ali made notes of his consultations with each group. The medical providers wanted light, the optometrists needed darkness, the midwife required privacy, those working outside requested shade. Once it was clear to me that I would be of minimal assistance here, I stole back to the Convent and spent the remainder of the day in solitude, “Ali-ing” my operating room supplies and re-working lists for our set-up at the hospital the following day. My screams from the shower reached no one’s ears.

When everyone returned, I joined them at the Guest House. It was then that I began nightly sessions with Michael Terry, a Physician’s Assistant (PA) from California. Mike-the-PA is a generation behind me. While my social conscience was formed around Viet Nam, his was formed around human rights injustices in Central America in the early 1980s. He was an Emergency Medical Technician when the El Salvadoran civil war broke out. He left the United States and joined the guerillas in the fight, traveling with them by night and in camouflage. Indeed the camouflage must have been effective to hide this tall, strawberry-blond in the group. During the war, he functioned as anesthetist for surgeries on kitchen tables under bare light bulbs. This year, he has traveled to El Salvador once more, to facilitate our interface with the El Salvadorans who need medical care. One of his compatriots during the civil war lost one eye in the conflict and was now blind with a cataract in the other eye. Because the man had traveled a considerable distance, Mike-the-PA made arrangements for this man to stay with him. (We performed this grizzled veteran’s surgery without complications.) Every night was another “Tale from the El Salvadoran Nights,” all for the cost of a little rum in a paper cup. So, as it happened, the rum from the Super Mercado was indeed a necessity.

On Monday morning we were to meet our driver at the Clinic. But first, to the Guest House, up the ladder into the truck bed, branch-and-duck dance to the Clinic and down the ladder on to the grass plot that – presto! - had indeed become a Clinic.

Shady accommodations had been achieved with ropes and sheets tied to trees. Table tops had become the pharmacy. In a photograph of the Clinic set-up, Tim Baker, our pharmacist, is putting the finishing touches on organizing hundreds and hundreds of meds. The smaller building became the library for eyeglasses. Linda Carpentier, OPT, and Deb Imondi were captured on camera in the midst of neatening rows and rows and rows of eyeglasses. In the second building, optometric equipment had been set up in the windowless central area. A wonderful Whistle-While-You-Work snapshot documents the optometrists washing the walls and swabbing the floor of their new quarters. In the periphery of the second building, a private exam room with a high window had been outfitted by Ann Mason, our midwife. Eye charts were mounted outside, on the shady side of the building. Patients had already queued up in an orderly waiting line.

We then met Freddy, our driver back and forth to the hospital. Freddy had the nicest truck in the community and seemed to be known and liked by all. In the course of the week, we picked up and dropped off many of his friends on the way to and from the hospital. The hospital was located an hour away, in Jiquilisco (pronounced “hee kee LEE koh” (thank you, Cathy Kroon)). The major highway to the hospital was as good as any in the United States. For our initial hospital visit, Carmen, our El Salvadoran interface, accompanied us. She sat in the front seat with Freddy. Cathy, Steve and I sat in the back seat, me in the middle. Cathy took the opportunity to explain, in great detail, how to utilize the services of a professional interpreter. I stole an occasional glance at Steve, who slept through the entire lesson. Oh, oh.

Carmen introduced us to the hospital president, impeccable and gracious. We met the operating room supervisor, impeccable and stern. We were then introduced to Luz (pronounced “loose”), our stand-by anesthesiologist, and to Maria, a member of the housekeeping department, selected by the hospital president to work with us for the week. Throughout the week, talents emerged in each of these individuals that rival the best professionally trained operating room teams in the United States.

We made a tentative plan to begin surgery in the afternoon, assuming things went swimmingly in outfitting the operating room for eye surgery. Communication was to be achieved by cell phone between Cathy, who stayed with us, and Carmen, who had returned to the Clinic with Freddy. Although it sounds simple, each time Cathy called Carmen during the week, she had to leave the hospital to get reception.

After a couple of hours of set-up, at times under the watchful eye of the operating room supervisor, we looked at each other and shrugged, “Bring it on.” Cathy called Carmen, who gathered the patients and gave them over to Freddy, who drove them to us. When the patients arrived, Freddy handed over the “operating room schedule,” which had been prepared by Carl’s optometry group and Joe’s medical group. The “schedule,” which was handwritten on lined yellow paper, set forth the patient’s name, the correct eye and any pertinent medical problems. On subsequent days, the means of contacting the patient – usually a cell phone number - was also included.

Steve taught Cathy, Luz and Maria how to administer preoperative dilating eye drops and explained the schedule of different drops every five minutes. Maria, our housekeeper, became the absolute best at it. She was able to coordinate the drops in between trips to the lab refrigerator, which the hospital president had designated as our “viscoelastic” storage site.

Use of the term, “viscoelastic”, reminds me that it would be helpful at this point to provide a “Cataract Surgery for Dummies” explanation of the procedure. Cataract refers to the lens inside the eye that was once clear but has now become either opacified or dark. When the cataract becomes so severe that light can no longer pass through the lens, the person becomes blind in that eye. The rate of severe cataract formation is high in Central America partly because of the relentless sunshine. Almost all of the Central American patients we see for surgery are blind in both eyes from cataracts. Cataract surgery is performed under a microscope. During the surgery, the natural lens is removed and an acrylic lens inserted in its place. Light is now able to pass through the clear acrylic lens and sight is restored.

The surgery is carried out under local anesthesia injected into the tissues under the eye. In the United States, we render patients unconscious with intravenous (IV) medication for the local injection. When the local injection is complete, the patient wakes up and surgery is performed while the patient is awake, able to cooperate and pain-free. In Central America, no IV access is established and thus, no IV medication is given prior to the local anesthetic injection. Their stoicism is stunning, as is their unwavering willingness to obey our warnings, en Espanol, to stay calm, stay still and stay quiet.

In the United States, the surgery is performed through a tiny incision, which is made possible by a “phacoemulsifier”, a machine as costly as a Maserati. The natural lens is emulsified with a needle-like wand attached to the phacoemulsifier. Once the lens has been emulsified and the fragments irrigated out of the eye, the eye is ready for the acrylic lens. The acrylic lens is folded inside a cartridge, the nose of which fits into the tiny incision. The acrylic lens is then nudged out of the cartridge and into the eye. Once inside the eye, the new lens unfolds itself and seats in place. The surgery is essentially over at that point.

In Central America, because there are more Maseratis than phacoemulsifiers, a different technique is necessary. Steve uses the pre-phacoemulsifier technique, a technique similar to the one used by his father, who was also an eye surgeon. That surgical technique involves a large incision, removal of the natural lens intact, insertion of the acrylic lens and suture closure. The services of the myope are required for the 10-0 nylon suture, which is finer than a strand of kitten fur. There are scary points along the way, mostly relating to intraocular pressure and the propensity for the back of the eye to come hurtling forward once the incision is made. This brings us back to the viscoelastic, which is the goo used to keep the back of the eye where it belongs. Do not try this at home – it is only a thumbnail sketch.

We completed four surgeries on Monday afternoon. The consequences of the nap-through-the-interpreter-instructions were realized, when Steve became incredulous at what he believed were orders to him to take the wheel and drive the patients back to their houses. Equilibrium was restored with a recap of this morning’s interpreter instructions.

By the beginning of the second day (Tuesday), the five of us (Steve, Cathy, Luz, Maria and I) developed a rhythm of impeccable timing, interdependence and language exchange that would serve us well all week.

There were highlights and lowlights during the week. Among the highlights was the occasional appearance of a teensy bundle of joy in the inner core, right in the middle of our preoperative patients. (The operating room shared space with the Labor and Delivery suite.) The newborns seemed to have the same quiet and calm of the adults we met.

Gathering our first patient of the day was always a highlight. We picked up the patient at “the crossroads,” the place where the dirt road joins the paved highway. It seemed to be a gathering place, perhaps for a panel truck “bus,” if not a real bus. Freddy was able to echo-locate the patient in the crowd with his cell phone. Cathy decided it would be best to start the eye drops at the crossroads so that the first patient would be dilated by the time we reached the hospital. Cathy, Freddy and the patient would stand outside the truck for the procedure. Once Cathy administered one drop, she handed the bottle to Freddy so that the same drop would not be re-administered. Once all the bottles were in Freddy’s hands, the three climbed into the truck and we left for the hospital. We repeated the procedure on a shoulder of the highway halfway to the hospital. One morning, Cathy administered the drops while being jostled by fifty cows that were being herded up to and then around either side of our truck. (Bicycles are the cattle rustlers’ “horses.”)

The first patient of the day sat beside me for the ride to Jiquilisco. Our conversations were highlights, but not because of their intellectual gravitas. It was amazing me that, in spite of the blockhead nature of some of my questions, the patients appeared willing to trust me in the operating room. Consider this: “Is the lead cow always the same cow?” His answer, “No, it is the hungriest cow.” It was a good laugh for both of us. I surmised that his choice to meet me again in the operating room was based on his belief that although I wasn’t very bright, at least I had a sense of humor.

The rides back home from the hospital were highlights because all of the postoperative patients rode back with us. Before my grandmother could have said, “Jack Robinson,” each patient had scrambled up into the truck bed. All were standing, holding on to the rails and ready to roll. Eye patches - right, left, left, right, right, left. 10-0 nylon suture must be stronger than one would imagine. While most of the patients disembarked at the crossroads, we had to drive some directly to their homes.

Another highlight was the El Salvadoran general surgeon, who came to watch our surgery and practice English with us. Once a week, he drove four hours each way to perform surgery at this little hospital. Having the SUNY optometry students observe in the operating room was a highlight because of their enthusiasm. Yogi Patel, one of the SUNY optometry students, made a video and took photographs. When not with us, he was photographing back at the Clinic. He ran the pictures on his computer every evening at Command Central. Now, each NEVOSH group was able to appreciate what the other groups had been doing all day.

Among the thrills each year is to hear the stories of the postoperative checks, at the moment the patch is removed and it is determined whether eyesight has been restored. We see very few of these moments ourselves because we are usually already working at the hospital. Everyone, especially the students, takes a turn at observing these happenings. Yogi was able to capture many of these moments on camera. One particularly memorable patient was a tall, thin, wiry lady whose hands were calloused from some sort of hard work, despite her blindness. On the day of surgery, she was grim and said little. During the picture show the next evening, Yogi had captured her in newly issued sunglasses, with a wide, edentulous grin, her left arm raised toward the heavens and her fingers in a V-sign. Throat-catching.

Among other highlights was ability of a demented man to cooperate fully for an uneventful surgery. Another patient, a no-show for two days, was cajoled out of her fright by Mike-the-PA, who went to her home to get her. Her surgery was also uneventful. One day, the hospital president came to our operating room and asked Steve to consult in the Emergency Room for a child who had chlorine splashed into his eyes. Steve left with a big bottle of Balanced Salt Solution and a little tube of ophthalmic ointment. The child did well.

Two lowlights stand out. The first was the sound of Steve’s head whacking the immovable surgical light. It was horrible, especially because he did it a number of times. It was not funny and we should not have laughed. At various times, he could be seen gauging the size of the lump on his head and performing a sort of rudimentary vision test on himself. The problem was finally solved with a telltale fashioned from a roll of gauze tied to the light. (Note to self: Bring crime scene tape next year.)

The lowest of the lowlights was the failure of our operating room’s air conditioner on Wednesday. Lest anyone get the wrong impression as to whether we were in cushy surroundings, the purpose of air conditioning in an operating room is infection control, not comfort. (Cooties thrive in warmth and humidity.) We tried to run the unit intermittently, such that two unsatisfactory extremes were reached – either silence with sweat beads on the sterile field or kitty-fur suture devil-dancing in a noisy whirlwind. We finally had to stop for risk of infection to the patients and dehydration to us. In a Herculean effort on the part of the hospital, the air conditioner was fixed by the next morning and we resumed surgery. I am convinced the task was accomplished quickly as a gesture of appreciation for the service we were providing.

When we left the hospital on the day the air conditioner broke, it was 2:00 P.M. and we had done only four surgeries that day. I don’t know why we decided to get off at the Clinic rather than the Convent but it was my good fortune to do so. For the first time, I was able to see the NEVOSHers in full swing. A buzz of activity everywhere I looked. Spanish, English, English, Spanish, men, women, teens, children, babies, stethoscopes, otoscopes, ophthalmoscopes, thermometers, glucometers, sphygmomanometers, reflex hammers, prescriptions, medications, sunglasses, eyeglasses, inhalers, massages. I slid into a seat in the shade and watched Ali Hocek, architect, and Cynthia Corsiglia, attorney, conduct eye chart testing with four-to-six-year olds. Cynthia’s encouraging cries of “excelente!” delighted the children and their mothers (and me.)

In all, NEVOSH saw 2,600 El Salvadoran patients in four days, half for optometry services and for half medical services. Steve and I operated on nineteen cataract patients. We are devising ways for a significant increase in the cataract surgeries next year, especially if Charlie and Sheila Collins join us again.

I have four best memories of our final evening in Nueva Esperanza while we were entertained by a fabulous El Salvadoran band. The first was Ann Mason, our midwife, leading El Salvadoran children and other NEVOSHers in a dance early in the evening. Second was my own dance performance with Freddy later in the evening, which was more fun and more exercise than any of my Zumba classes. The third was Steve Grimes’ “thank you,” which never comes until the final night has arrived and he is able to relax. (I wonder if I ever tell him HE has done a good job.) Finally, at the end of the evening, Dave Pritchard’s high school student, Mike, led a “break dancing” (an old term?) exhibition with El Salvadorans his age.

In closing, I will say that the nightly debriefs are always the best part of the mission. It is a time when the day’s activities are formally recapped by Joe and Carl. Each group gives a report, including our little surgery group. Rosie, Pedro and Carmen seemed to have supernatural powers in responding to a request to change something. The session is open to feedback from anyone. Bruce Fischer, internist, described the back pain of “Machete Man,” and suggested referrals to Sarah Chirnside, our Occupational Therapist (OT). Sarah is a delicate homecoming queen with the strength of a Bulgarian weightlifter. Her talents are equally opposite. At one minute, she is teaching a mother how to stretch out her little baby’s contracted legs and in the next, she is showing a laborer how to machete sugar cane without hurting his back. Rocco Andeozzi, Rhode Island physician, has paid special attention to fairly widespread depression, and what our approach might be next year. Larry Ginsburg, optometrist, is wondering how we can get a supply of glaucoma meds to last a year. Pacqui Motyl, Emergency Medicine physician, who came for the first time this year, was particularly interested in chronic renal failure and whether we could do anything about it in the future. All the best minds at work, creative suggestions from every quarter.

Finally, a special salute to my indefatigable dance partners, Bruce Fischer and Carol Peltier. See you next year, everyone.

Kammie Lucas

Yogesh Patel provided links to photos he took during the 2010 mission:

Hey Everyone,

I put some photos up online earlier this week. I still need to work on getting the videos processed and put online...that may take some time.

http://picasaweb.google.com/ypatel9/ElSalvadorSVOSHJanuary2010SelectPics?authkey=Gv1sRgCLf8vu3GodPKKw#

Cataract Surgery:
http://picasaweb.google.com/ypatel9/DrGrimesCataractSurgeryElSalvador?authkey=Gv1sRgCK-J-om0gpLb-AE#

Yogi

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