Buenas Noches,

We have returned home. My apologies for not giving a report sooner, but I didn't have time to write on Friday, and we haven't had internet access since. I hope you weren't worried about us. This should more than make up for it.

In our four days at Masatepe, we saw 2151 people in the eye clinic, and 3011 in all of our clinics, according to Marlee Ulm who worked at our registration desk. That's not counting the people we saw that didn't register. You really can't imagine that kind of volume unless you've experienced it first hand.

I will share with you some of our experiences. Many patients complained about eye problems.

A list of them with their English translations:

Me arden They burn me

Me duele They pain me

Me pica They itch me

Me llora They tear

Me molesta They bother me

Turbio Blurry

Most of the above problems can obviously be atributed to years in the sun. However, it was put forth that when the masses found out we were distributing artificial tears and sunglasses, that if those symptoms were mentioned, they would get something. A special thanks goes to Marchon for donating 400 pairs of plano sunglasses, which we didn't run out of until late on the last clinic day.

One thing many of us found very surprising is that everyone who came for an exam wanted eyeglasses, even if they were not warranted. It was considered an insult by some who were told they were healthy and had no problems. Here no one wants to wear glasses, and there being "normal" was not acceptable.

I did see a few people actually wearing the glasses we gave them. I hadn't seen that on prior missions. We saw a lot more myopes this year as compared to last, especially high myopes (-6.00 and up) and high anisometropes ( Plano OD and -8.00 OS, for example.) Todd DeMario had a couple of these, and just prescribed Plano lenses OU for protection. We even found polycarbonates in our library.

Below are some highlights of the trip, as reported by some of the people who came.

Purvi Shah and Beth Jacowitz both found high myopes, neither of whom had ever worn glasses. The looks of joy on the patient's faces because they were able to see for the first time really touched the examiners.

Stephanie Schwarz examined a woman, who then mentioned that she wanted her son examined by us, but couldn't register him. She saw him, and noticed immediately that he had a congenital cataract, and give him protective plano lenses. The woman was so happy that she gave Stephanie six oranges. You'll see the gift theme prevailing.

Probably the most interesting story was offered by Curtis Akerman. At our mission to Niquinohomo last year, Curtis diagnosed a man with glaucoma, gave him medications, and told him to go to a local ophthalmologist for long term care, including visual fields. This year, the gentleman found us, waited for Curtis, and brought in the visual fields he had done. His pressure was 14 in both eyes, and the fields showed mild losses, but not terrible. But if we weren't there this year and last, thisman probably never goes to an eye doctor, and goes blind in the near future. Thanks to us, his vision will not be stolen from him.

I personally saw a 62 year old man who said he just needed reading glasses, and that his distance was OK. I took his word for it, and gave him +2.50 for reading. When I did ophthalmoscopy, it showed that he was probably hyperopic. His final prescription was +6.00 and +7.00 with a +2.50 add. That just reminded me to not always trust what they tell you.

Peter Eudenbach had something happen to him that hadn't happened in 30 years of practice--a patient sneezed in his eye while he was doing ophthalmoscopy! Luckily we had a supply of anti-infectives for him.  Peter didn't have that many new stories, as he had been on multiple missions before. The same goes for our other optometrists, including Greg Rios, Hernando Alfonso, Joe D'Amico, and our MD Stu Zipper, though I was touched when one of Joe's patient's (a little girl) hugged him.

Joe spent a day in a really poor area of the country, and saw 50 people by himself. We may take his idea and set up satellite sites for a day for those people in these areas who can not get to where we are.  Bob Plass was working with a woman in the dispensary with a woman who had glasses, which were -19.00 and falling apart. We didn't have glasses that matched her Rx, but he offered to give her a new frame for her lenses. She was very nervous, because she was completely blind without them. But she left very happy, with the sturdiest frame we had. Larry Ulm, being a veteran of the dispensary, didn't see much at the site he hadn't seen before, but he wanted me to tell you about some of the street kids in town. There were a handful of boys, between the ages of around 6-12, that were always begging for money. We were explicitly told not to give them money, because a lot of them use it to buy glue to sniff. Larry gave a boy a yoyo, and sure enough, he traded it for some glue. Shelley Zipper gave one boy a box of raisins one night while we were at dinner. He didn't eat it immediately, but put it in his pocket for later. The boy then went to sleep, and had his pocket picked by another boy. How awful is this?!?!

These boys were all filthy, had no shoes, and never changed clothes.  One of the locals told us that they have families, but they can dobetter on the street because there families are so poor. A few of us gave them clothes and hats. It just tears your heart out.

Joe England, a physician, told a patient that he had an infection of the seno, which he thought meant sinus, but actually means breast. The patient (male) was in shock, and Joe was a little embarassed.

John Kerwin, our dentist, oversaw a woman who had 16 (out of a possible 32) of her teeth extracted. That'll teach her to see a dentist.

Another patient, a boy, needed a tooth pulled, but it was painful. The woman who was to be the next patient ran away!

Liz Harvey, one of our dental assistants, told me that one family was soimpressed that they brought the dental group to their home, and brought sodas to them every day at they clinic.

One woman came to the clinic site with her mother, who needed help walking around. Hilary Zipper took them around for the better part of the morning. The woman was so thankful that she made Hilary a shirt and gave it to her the next day.

There are many more stories I can relay, but I think you get the idea. I did want to pass something along that I think is of excellent value is some of the ocular diseases that we saw. Debi Pian and the other third year students compiled a list of all of the things they had never seen before. I promised them that they would get more experience in one week than in their entire first year in the school clinic. Here is the list, in no particular order:

hypertensive retinopathy, arteriosclerosis, Drance hemorrhage, chalazion, traumatic cataract, nuclear cataract, posterior subcapsular cataract, ectoptic pupils, anterior synechiae, hard exudates, posterior vitreal detachments, vitreous traction, epiretinal membranes, prosthetic eyes, macular holes, vascular sheathing, nystagmus, iris coloboma, microcornea, microphthalmia, Bell's palsy, asteroid hyalosis, toxoplasmosis (both active and inactive lesions,) macular degeneration, retinal detachment (both with and without vitritis,) space occupying lesion behind and eye with an afferent pupillary defect, peripapillary atrophy, staphyloma, IV cranial nerve palsy, bilateral III cranial nerve palsy without pil involvement in a diabetc, diabetic retinopathy, full diamter corneal scars, retinitis pigmentosa, optic atrophy, severe glaucoma in one eye more than the other, end stage glaucoma in both eyes, amblyopia, bacterial conjunctivitis, lots of pterygia, woman born with a shunt in her eye, high anisometropes (mentioned above,) high myopes (up to the aforementioned -19.00,) high hyperopia (up to +13.00,) and high strabismics (up to 40 prism diopters.) Don't forget, there are probably a bunch they forgot.

For anyone practicing for a long time, this may not seem impressive, but taken into the context of where they are in their careers, they showed themselves well.

Now I would like to give special thanks to Carl Sakovits, who for the last few years has been the leader of this group, which is now known as VOSH Northeast. He puts in an inordinate amount of time, but doesn't consider it work. Ts year he oversaw the delivery of 200 tons of supplies for the relief effort for Hurricane Mitch. He doesn't get nearly the credit, nor reward, that he should.

For anyone wanting to see pictures of the week, the place to check it out, as of later this week, is www.nevosh.com. If this doesn't work, try www.hartbrothers.com. We will also be doing a group chat in two weeks (Sunday the 7th) on one of the same URLs. It was an excellent trip. May all of you who went this year join us next year. May any of you who missed this year join us next year. Please feel free to pass this message on to raise awareness of our group. Donations of glasses and especially money are always appreiated. Contact me for more info.

Hasta proximo ano,

Jon Wasserstein AKA Juan Carlos

PS If there any typos I apologize, but wireless keyboards occasionally