Mission Report from Juan Carlos, a.k.a. Dr. Jonathan Wasserstein, OD

Para la traducción española, clic aquí

Greetings fellow VOSH members and others reading this message,

We have just returned from our annual mission to Central America. This year our clinic was located in La Concepcion, Nicaragua, which is around forty miles from the capital city of Managua. Enclosed is a list of our daily activities, interspersed with some of my observations, followed by anecdotes from many of the members of this year's mission.

Saturday, 15 January Many of us woke up extremely early to catch planes that would allow us to make our 11AM flight from Miami to Managua. We arrived in Managua at around 1PM Central Time, and were met by three of our hosts.

Dr. Moises Huete is the man in charge of the SILAIS Ministry of Health in the area for this mission and the two prior. Ana Adilia (Anita) Sanchez Nunez is a physical therapist who has been extremely helpful in all of our previous missions to Nicaragua. Dr. Vidal Ruiz runs the Ministry of Health in La Concepcion (also known as La Concha.)

After getting our luggage and clearing customs without incident, we boarded a bus and two vans and wet to Jinotepe, where our hotel was located. While not the Waldorf-Astoria, the hotel was quite nice by Central American standards. The big negative was the rooster outside my window which got up at 5AM. After arriving, we had a little time to explore, which I did. The hotel was located a couple of blocks from the square that marks the center of most Central American cities. Nearby was the local outdoor market. For those who have never been to Nicaragua, none of the streets have names, which can make navigation very tricky. Addresses are given by landmarks, such as two blocks north and one half block east of the new church. My favorite is the Peace Corps building in Managua, whose address is "Where IBM was before the earthquake" in 1971. It's maddening to a left-brained person like me.

That night we had a dinner with our entire group, followed by introductions from our executive director Carl Sakovits. This year our group had sixty people, so this took quite a long time.

Sunday, 16 January After breakfast, we set out to see our clinic site. The main road to the clinic was closed, so we had to take a detour along a one lane dirt road. By one lane, I do not mean one lane each way, but one lane, with traffic going in both directions. If another vehicle, such as a truck, was coming the other way, the two drivers had to find a relatively wider spot and roll up along the embankments on the side and hope they didn't scrape sides the whole way. I'm very happy my mother had no idea about this, otherwise she probably would have flown to Nicaragua herself to take me back.

The clinic was to be located in a school adjacent to the central square of La Concha. We occupied ten rooms in total, one for pre-testing before eye exams, five eye exam rooms, one for the eyeglass dispensary (which was unfortunately a little small, but they did great despite that,) two rooms for medical exams, and one more for our pharmacy. Guarding the entrance to the clinic was our registration area.

We all organized our rooms according to our specific needs, and then had meetings with our individual departments to educate everyone and determine how we would run our clinic. The medical group put together their pharmacy, which took up an entire room. It was quite impressive. The optometric group had a pharmacy of its own, which was by far the largest we ever had. We didn't start running out of anything until the last day. Special thanks to Alcon Laboratories for their generous donations. Also thanks to Esther Tursky of the SUNY College of Optometry, who gave us enough badly needed artificial tears that we could give to every person who needed them.

After leaving the clinic, we went to an overlook of a lagoon surrounded by an active volcano system. It's actually quite spectacular, though quite windy. Many of us had lunch right on the edge of the overlook. We could see the volcano spewing smoke and gas.

Next we went to the typical market in Masaya, a town of about 50,000 people. Masaya is known for its crafts, and many were on display in the market. Available were hammocks, pottery, woodcrafts, leatherworks, and more. There are usually many food and dry goods vendors, but few were there on a Sunday afternoon. One thing that stands out to me is the woman selling raw chicken parts. They were just sitting on the table, unrefrigerated and uncovered, while the woman continually swatted away the flies. Just a little different from what goes on here, huh. Outside were horse-drawn carriages offering rides. You never saw horses treated like this. All had their ribs sticking through their skin, and all were afflicted with sores from their bridles. Also outside here, as in many places, there were vendors selling various foods, including breads, pastries, nuts, and fruits. A parade passed by as well, featuring a float of young girls dressed and made up like princesses.

That night we had dinner at our hotel, and were surprised to find that a Cardinal of the Catholic Church was there. He blessed our mission, as well as a few of our members.

Captain's log, stardate 41153.7 Sorry, I always wanted to do that

Monday, 17 January On the dirt road on the way to the clinic we passed another parade. Now you'd expect a parade down a major road with people watching, but this was down a dirt road where few people lived. At least we didn't have to tilt the bus to let them through.

We got to the clinic and saw at least 200 people waiting on line for us. In total, the eye clinic saw about 500 people, and there were another 200 in the medical clinic. Our ophthalmologist Steve Grimes performed cataract surgery on three people chosen for us by our hosts. Most of the rest during the week came from our clinic. Al Amerigian dispensed seven wheelchairs. This was by far our slowest day, but would pick up.

The weather this week was very windy, due to an unexpected weather pattern, and as such, there was a lot of dust flying around everywhere. Many of the patients in the eye clinic complained of "ojos sucios" or dirty eyes from the dust. Luckily for them, the wind subsided later in the week. A positive effect of the wind was the breeze we got through the clinic rooms, which have been oppressively hot in the past.

That night, there was no group dinner at the hotel, as the President of Nicaragua was expected to be meeting with members of the Rotary Club, but he didn't show. On the bright side, the Rotarians promised their support in future missions.

I went to dinner to a chicken place with about 20 people that night. Our dinner was delayed for a while, because two of their chickens escaped, and they needed to find them to feed all of us. Calling Frank Perdue.

Tuesday, 18 January In the clinic today we saw over 650 people in the eye department, and about 260 in the medical area. The rest of our wheelchairs were dispensed. Another five received cataract surgery, including two people we saw in the morning clinic. One man I originally examined. He had very poor vision in one eye because of a eye turn, and the other had a dense cataract that did not allow him to see the big E on the eye chart.

Something we've seen for years in the optometric clinic is the large number of kids complaining about blurry vision while reading. Many do not seem to have an apparent structural problem, but it seems almost like an epidemic. It has been theorized that this problem comes from reading in the dark over a period of years, or from a latent need for glasses. I still can't figure it out.

One thing that is indicative of this area of the world is something considered quite rude here. If you point your finger at someone, you can expect it broken (New Yor City only,) but down there, rather than saying no, or neither, someone may just shake their finger at you, in effect saying "no, no, no."

Wednesday, 19 January Once again, we saw over 650 in the optometric clinic, and an estimated 300 on the medical side. Five more received cataract surgery. We started doing the post-operative examinations. Every patient who had had the surgery came in the next day with a towel draped over their head. I'm not sure the reason for this, but we always knew why they were at the clinic.

After clinic, we went to the community center for Los Quinchos, which is an orphanage run by Brett Copple, an American expatriate. The children here are well taken care of, and made part of the family. None of the children are allowed to be adopted, as they don't want their family to be split up. The children were excited to see us, and showed us all around. They sold hammocks the children had made, which many people bought. The children were educated and trained in various trades. It was nice to see how happy and healthy these children were, especially after seeing so many street children last year. The center is supported largely by donations, many of which came from Italy. For anyone who wishes to help this great organization, you may send donations to:

Asociacion "Los Quinchos" Attn: Zelinda Roccia AP 3988 Managua, Nicaragua Central America

Donations of clothing and other supplies can be sent by boat to save money for you. It was requested that whatever you send, you declare has zero value, so they don't have to pay taxes on it. Obviously, donations of money will always be accepted.

Thursday, 20 January This was the final day of the clinic. Once again, over 650 people were seen in the eye clinic, and close to 300 went to the medical clinic. The hospital was busy, as seven people had cataract surgery. Ideally, we would have like to done more than this, but autoclaving took an hour between patients, and sometimes the equipment was in use by others in the hospital.

Unfortunately, we had to close the doors to the clinic. People kept coming in all day, but eventually we had to pack up. I'm sure that had we stayed open all night, we would have been busy the whole time.

In total, the eye clinic saw 2,580 patients, and the medical was over 1,000. Twenty received cataract surgery, and another fourteen got wheelchairs, with orders for six more. We estimated that we gave out over 3000 pairs of eyeglasses, and a retail value of over $10,000 worth of medications. By far our largest mission! A job well done to all of the VOSHers! You should all be very proud of your accomplishments!!!!!!!!

Back at the hotel, we had a group dinner, including thank yous to many of the people who helped us. Then we had a birthday party for three of our members, and a farewell celebration featuring pinatas (filled with interesting things) and a salsa band. There was also something called Thumper going on, which I'd prefer to leave as an inside story to the half of the group or so that was involved. The band played until midnight, and the party continued long past then.

Friday, 21 January A few members of the group went to the local hospital in Jinotepe, while others went to William and Rosi Smith's wood shop in Niquinohomo, followed by a quick stop in Masatepe for shopping. Masatepe has the most beautiful wooden furniture, including rocking chairs, bed frames, tables, and more. The only problem is getting them home.

After everyone returned, we all loaded us our buses and headed for Montelimar, which is a place on the west coast of Nicaragua along a black sand beach. It has the most beautiful sunsets right over the water. We stayed for two days.

Sunday, 23 January Most of us left to go home. We packed the buses and went to the airport in Managua. One of the buses had to be seen to be believed. The floor had numerous holes, through which we could see the road and the exhaust system. To their credit, the larger holes were patched. This bus was having mechanical trouble, and we had to stop once for repairs. This is called the "obligatory flat tire"--an unforseen delay that always seems to happen in Central America. Luckily, we left ourselves enough time, and got home fine.

Following are some stories from some of our various members. I asked everyone to tell me something that affected them, whether glad or sad, to share with the group.

Geherly Gomez noticed how most of the patients would look into his (and others) eyes looking for hope, because they had so little of their own.

Harry Eudenbach observed a patient being able to see for the first time in a long time following surgery for a cataract, and the look on her face explained everything

Christin Clark saw a boy with blisters which were treated with peroxide, which was obviously painful. The rash then had to be dressed, and the patient was obviously apprehensive. She was able to appease him by squirting Bacitracin all over it, as if it was a game. They then played with a latex glove inflated like a balloon. She said "A little reward is all I need."

Jessica Andreozzi was touched by the heartfelt response of many of the children, especially those who hugged her at the end.

Shelly Ross concurred, saying "I just love the kids."

Walter Jacobs saw a woman right after she had her patch removed following cataract surgery. He was afraid that it didn't work because she said he looked 15. For those who don't know Jake, he's actually closer to 35.

Maryann England had a streetwise boy come to her with a prescription for medication on at least three occasions. He said they were for his grandfather, who couldn't make it to the clinic because he was ill. He thought he wouldn't be recognized among all of the others there, but Maryann caught him.

Darlene Boch saw a woman come in with a dog. When the woman went to be examined, the dog was left outside. The dog went nuts, it was sniffing absolutely everyone's leg, hoping to find his owner. Luckily he found her without a lethal amount of canine anxiety.

Matt Grimes said that what stands out in his mind is one little girl who came out of the clinic with her first pair of glasses, which were of an unusually high power. She was smiling and laughing, as if given a new world.

David Hart noticed how smoothly everything ran, and wanted to give credit to our Executive Director Carl Sakovits, and our Medical Director Stu Zipper, as well as our local hosts, for all of their hard work.

Brady Hart fit a patient with glasses right after he had a patch removed following cataract surgery. The man saw so well that he said he wanted to jump on his motorcycle again and ride, which he hadn't done for many years. He then turned and looked at his wife and said "Now I have to get a new wife!" which gave everyone a chuckle.

Bob Plass has been on quite a few missions, and while nothing specifically stood out for him, he said "It was a pleasure to work with everyone again."

Larry Ulm was amazed that some patients waited on line starting at 3AM, even though he clinic didn't open until 8:30AM.

The infamous Tim Kennedy was surprised at how easy some patients adapted to strong prescriptions, more so than in past years.

Both Al Amerigian and Stu Zipper said the most memorable part of the mission was the first patient to whom Al gave a wheelchair. She was independent for the first time in years, as her legs had been amputated long ago. She was crying profusely as she left the clinic.

Marie Seitz told me about a 70ish year old woman who was crying profusely about how her inability to see was ruining her life, and how happy she was that she was going to get that back.

Diana Adams was working in the Masaya hospital assisting with the cataract surgeries. During some down time, she went into the maternity ward, and was talking to the new mothers. One woman had just recently had a girl, and Diana asked the mother what the baby's name was. The mother replied that she had not yet named the baby, and asked Diana her name. When told, the mother said, "Well, that's my baby's name, too."

Michele Morin was with a baby with Down's Syndrome who she was able to make laugh out loud for a long time, about which she said "It was so cute."

Diane Brown-King just enjoyed blowing bubbles for the kids--something they had never seen before.

Sue Seidler was amazed at one woman who started out from her house at midnight to get to our clinic. The woman was from a town that was more than a few miles away, and definitely walked all night.

Eileen Tiexiera was with a pregnant woman who was obviously having a miscarriage. The local doctor told the woman to go to a hospital three blocks away. The woman started walking. Eileen was appalled, and put her in a wheelchair and took her there herself. She did get a little lost on the way back (love that lack of street signs) but made it back just fine. This case shows you one of the many differences in how things are down there.

Diane Forest was humbled by the sheer number of people that were examined and how many we couldn't get to. She said it made her want to minimalize, and to be happy with what she has.

Joe England and Ed Greenan mentioned a thirteen year old boy that the parents said needed a sex change, which was puzzling. It turned out that the boy had an undescended testicle, and only one developed. It took the parents about 45 minutes to believe that their son was not actually a woman, and would grow up normally, and father his own children. The boy was the happiest person they ever saw. It was as if the weight of the world was lifted off his shoulders, and that he no longer had to be confused about his identity. Joe then almost ruined it, when he said "adios amiga (goodbye female friend)" when they boy left.

Rick Clark discovered a throat tumor in a patient. He wanted to strongly tell the patient to see a local doctor ASAP so that he could have surgery. His translator Geherly said "If you don't see a doctor soon, you'll go to see St. Peter."

Rocco Andreozzi saw a pair of sisters, ages 18 and 19, who were deaf, and couldn't afford hearing aids. It turns out that he has a family member who has a business that makes them, and will send them down.

Lauren Fox had a woman with severe double vision related to trauma. She helped fit the woman with glasses which had one lens completely taped up. This ended her double vision which had plagued her for years.

Frank Siringo told me about a patient he said was typical of everyone. The man was 55, and a teacher. He couldn't read anymore, nor could he grade papers. After getting his glasses, the man was "psyched."

Debi Pian had a girl with a corneal disorder we couldn't diagnose. Debi saw her for a long time one day and had her come back the next day. When the girl came back she gave Debi a bracelet she had made.

Anita Patel was offered a baby to take home as her own. Sad, isn't it, that a woman would give her baby to a complete stranger (though a really nice one in this case) to hopefully give her child a better life.

Scott Colonna saw a six year old with optic atrophy, which normally would leave a patient blind or nearly so. However, he somehow could see a little better with the glasses prescribed.

Tony Fusco examined a woman who thought she was going to lose her sight. She had a case of chronic scleritis. She was already on medication, but it was not the best for her. She was put on proper drugs, and we educated the local doctor about what to do at certain times.

Beth Jacowitz saw a woman who had been rendered virtually blind due to retinal scars from toxoplasmosis. The woman said it was from when she got Wesson oil in her eyes. You can't make this stuff up.

Stephanie Schwartz was in the park across the street from the clinic site with Lauren Fox and they started talking to a little girl, who then wound up being Lauren's patient. What incredible irony!

Steve Grimes was at the hospital performing cataract surgery, and after he finished his first patient, he found out that the man was not sent by our clinic, but just walked in off the street and got the surgery. I was told that he badly needed it, so it wasn't a bad thing.

Peter Eudenbach had a man who was being considered for cataract surgery, but had to wait around for a while, and he had already been there a long time. He asked the man if he had to use the bathroom, but the man said no. A little while later, he was brought to a wall in the clinic to do just that. Can't figure some things out, I guess

Hernando Alfonso examined a boy who stopped going to school because he said his brain was "cooked." To which Hernando responded "If yours is cooked, then mine must be deep fried." The boy was given reading glasses, and promised he'd go back to school.

Larry Ginsburg was with a 19 year old patient who had one eye that was legally blind from cataracts and virtually blind in the other from corneal ulcers, for which he needs a transplant. We are trying to do that here.

Carl Sakovits saw a man that was coming for his examination the day after cataract surgery. When Carl took off his patch, amazingly, the guy spoke English for the first time. It's amazing what a good surgeon can do.

As for me, I was asked to see a deaf-mute patient, because I know a little bit of sign language. However, I know American sign language, and Nicaraguan sign language is quite different. I got by somehow, though the only word I know he understood was hello.

This is just a sampling of the stories. The pictures taken will add to them, but a better way to find out a little is to hear directly from a participant. For those who haven't gone, it's truly a wonderful experience, unlike anything else. To those who have gone, I hope to see you on next year's mission

Juan Carlos


2012 Panama & Tennessee | 2010 Nueva Esperanza | 2009 Nueva Esperanza | 2008 Nandaime | 2007 Monimbo | 2006 Nandasmo | 2005 Catarina | 2005 Mus | 2004 Nindiri | 2003 Jinotepe | 2002 Ticuantepe | 2001 Monimbo | 2000 La Concepción | 1999 Masatepe | 1998 Niquinohomo | 1997 Lake Yohoa | 1996 Jutiapa | 1995 Omoa | 1994 Vera Paz | 1993 Coatepeque | 1993 Salama | 1992 Chimeltenango | 1991 Chichicastenango | 1990 Comayagua | 1989 San Manuel | 1988 Omoa | 1987 Santa Rosa

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