A glorious moment, captured

Here's Marta, one of the two patients who came to us blind, at the moment when the bandage removed and she could see again!  What a joy and what a privilege to be the person standing next to her at that moment.  It's even more special when you know a bit of Martha's story.  Literally blind in one eye, she couldn't see out of the other because of her cataract.  She had gone to FUDEM, the Salvadoran foundation that offers relatively low-cost eye care, but you still have to pay for eye surgery there, about $150, I think I remember, and that was more money than Marta could raise.

She lives in Estanzuelas, heard about our mission the week we started surgeries, and contacted Marvin Hernandez, who asked if we could possibly add her to our full list.  Well, we'll try, I said, bring her on the bus.  But we had a full patient load for Wednesday and again on Thursday, and for both of those days she sat there for about three hours and had to go back on the returning bus.  I never saw her smile once in all that time of waiting.  She sat hunched over, not communicating much at all except through her presence.  Then on Friday she came in again, for the third day, and finally we could fit her in.  She had her surgery - a huge, dense and dark cataract came out - and on Saturday morning I got to see Marta smile.  Isn't that a beautiful sight - in all senses of the word?

Our last patient, the newspaper vendor who like Marta was blind in one eye and couldn't see out of the other, also came out seeing and smiling after his surgery, but Mitch Costin wasn't there to photograph the great moment, and my attempt isn't worth posting.  You'll have to take my word on it.

Ah yes, and we completed 53 surgeries on 49 patients - (3 patients had both pterygium and cataract surgery, and one had to come back for a 2nd surgery as it hadn't been possible to implant the lens the first time).  Since 50 is our usual maximum, and one we've never reached before because we haven't had that many patients, this was a happy week that kept our surgeons - the Pisacano father and daughter team - well occupied.  Terry Clark, our optometrist, also gave about 130 eye exams and - when needed - reading glasses to all the hospital staff who showed up (and that was most of the hospital staff).

As a gift from our PeaceHealth hospitals, we gave some cool stuff to the hospital - scissors and forceps and tweezers (German made, the Director was delighted), wound dressings, sterile towels, patient gowns, and best of all a brand new EKG machine donated to us in Eugene, and made usable in Santiago de Maria by the manual en español that Darren found with great persistence on-line, printed and bound.  We were even able to promise them the donation needed to buy a new autoclave (I hate to think how they are making do right now) through the kindness of a very special donor.

But for me, Marta's smile says it all.  That's why we were in Santiago de Maria, Usulutan, El Salvador.

Photo by Mitch Costin

One glorious week

We're close to the end of a glorious week of eye surgeries at the Hospital Nacional de Santiago de Maria.  For the first time ever, in my experience, we've had more than 50 potential patients show up (50 being the maximum our surgeons and our materials will stretch to).  Several patients were not qualified for surgery - because the risk would be too high or because there were serious complications - so our ophthalmologists completed 50 surgeries, right on the number possible.

Usually our problem has been patients who don't show up because they're afraid or uncertain about the surgery.  This time, thanks to the amazing work of Marvin Hernandez, our coordinator in Estanzuelas - where our patients live - just about everybody came.  And the problem we had to solve was lack of some of the materials needed to complete our 50 surgeries - in midweek, we had to find more Viscoelastic, a fill used during surgery, and sutures.  But with a lot of cooperation and even more driving - both Darren and Hernan, our motorist, had to travel an hour to San Miguel on Thursday - we purchased just enough to get through.

What's been most beautiful, as always, is our patients, and the delight and gratitude they express when the bandage comes off the morning after surgery and they can see more clearly.  Lots of hugging and thanking and blessing happens then - it's the very best reward for us.  Here are a few of them ready to go home with new vision:

Tomorrow we'll check the patients from Friday, pack up and take off for San Salvador.  And there are two very special patients, our very last patients, whom everyone will be waiting to see.  One, Marta Elena, wasn't on our original list, but came in for three days with the group from Estanzuelas, hoping that we might find a space for her.  And on the last day, we did.  One of her eyes was blind, the other had a cataract so dense she could see nothing: the doctors expect that tomorrow she'll see for the first time in years.  The second, Calixto, heard about our mission because he sells papers in the hospital.  No one can quite figure out how he saw to sell papers or get around, but he did.  And he came to us and asked if we could look at his eyes.  He, too, is blind in one eye and the other had the largest, blackest cataract Dr. Tony Pisacano has ever seen.  We had just enough materials left for Calixto's surgery and we will all be waiting tomorrow as he wakes up to a very new and brighter day.

Mission in progress

Our eye surgery mission is off to a great start.  First of all, everyone arrived (though the plane was an hour late) and our franquicia (customs permission) also arrived in good time, so we moved through the immigration and customs process reasonably quickly.

And then we were off to Alegría, a very, very long 2.5 hours from the airport - in the dark, so we couldn't see anything, and with a group who'd mostly been up and travelling since the early hours of the day.  We tumbled into the Casa de Retiros (retreat center) about 12:30 AM, and most people were up and moving again when the sun came up at 6:00 AM (not me, I turned over and went back to sleep until 8:00).

Still, it was easy to see what a great team we have - no one grumping, no one complaining about the cold water or the lack of sleep, everyone eager to get on with the mission.  It's a big group this time.  We have father and daughter ophthalmologists, Tony and Kristin Pisacano; our optometrist, Terry Clark; two scrub techs, Rosy Melara and Jennifer Woodland; two circulators, Silvia Pleitez and Sarita Angulo; interpreter Gloria Campuzano; nurse Dawn Fisher; patient coordinator Rosa Aguiar; photo-journalist and keeper of the autoclave, Mitch Costin; our beloved driver, Hernan Merino; and Darren Streff, Kathy Garcia and me.

Sunday we enjoyed lunch at an Alegría restaurant, looking out over a valley full of mist, and went to Santiago de Maria - the next town to the east, about 15 minutes away - to set up our surgery at the small National Hospital there.  As always, our first surgery was practiced on some of the machinery - here's a photo of Darren, Terry and Mitch Costin working on our slit lamp, used to calculate the power of the interocular lens:

Unfortunately, the frozen knob resisted all efforts to free it, but Terry figured out a work-around that involves raising and lowering the patients, rather than turning the knob in the machine.  A nice Salvadoran solution, that!

Today, in our first day of surgeries, we saw 11 surgery patients, which is just about unprecedented - the fruit of Marvin Hernandez' hard work in the Estanzuelas community.  Often before we've had days with four to six patients, so this felt wonderful to all of us, and our surgical team kept fully occupied.  And in the afternoon Terry, Dawn, Darren and Gloria gave eye exams and reading glasses when needed to about 75 hospital employees. 

A fine first day all round!

Ready to go

Hard to believe, but this is the last time I'm going to be responsible for one of our PazSalud missions.  I hope to be part of many more, but I'm passing the responsibility, very joyfully, to Darren Streff.  Today's the day our team arrives at the airport (at 7:45 pm) and I'm feeling like everything really is ready:

• We have our franquicia, the most important piece of paper, that allows us to bring in the medications and supplies without paying customs.  We also had an extra bit of drama - which almost seems inevitable - when we discovered at the end of our first time through the process that the group we were working with didn't have the right kind of license to support a franquicia.  Thankfully, our friends at the Archdiocese came to the rescue, and our amazing customs manager, José Manuel Gonzalez, got the papers through their second round in record time.
• We have piles of tubs, a tower of water bottles, boxes of heavy instruments, snack food, fans, wood tables made by Mitch Costin for our optometric equipment, plastic shelving, etcetera ready to be loaded on the truck in a few minutes.
• And I have washed and ironed the necessary shirts and pants, showered, packed my bag.  As soon as this is posted, I'll put the computer in its travelling bag.
• But more important than any of this, we have a great group of patients waiting for their surgeries, and a great team coming to offer them.  

May it be a week of good work, good health, new friendships and great joy!

Along the road

Usually when I drive to San Martin and beyond I’m going as fast as I can and not paying much attention to what’s around me.  Often I’m listening to podcasts and thinking about, oh any great number of things.  Today I was moved to go much more slowly and to pay attention, and because of that attention it was an amazing drive both ways.  

Driving by in my air-conditioned bubble, and there were all the people getting about their ordinary daily lives, living along the street – making bricks, taking corn to the mill, working on the drainage ditches, waiting for the bus, getting breakfast at one of the little ramshackle pupuserias, herding cattle,  carrying children and running after children, going to the fields.  

It was like driving along beside one of the Books of Hours that shows people at work in their daily lives, like driving along a Brueghel painting.  All those ordinary, holy lives being lived in plain view, all involved with the sweat of their hands and the weight of the earth.  I see them every time I drive this road, which is lots, but today, today I saw them and am humbled by them, and I know how much I am going to miss them.  And how beautiful and solid are these lives lived in deep connection with earth and water and families.  Looking from here, our lives feel transient, transparent, shadowy and concerned with shadows.

I know this is only a part of the story.  I know that people live under great stress here, the stress of not having enough money to pay for education or needed medications, the stress of having some of the little they do have extorted from them, the sheer stress of physical labor in this heat.  And yet how beautiful they are, how full of the goodness of God.

(thanks to Mitch Costin for the photos)

April miseries, April beauties

For me, "April is the cruelest month" here in El Salvador - not because of the lilacs that T.S. Eliot wrote about, but because the combination of heat, dust and the smoke from burning cane fields makes moving and breathing heavy, hard. 

April is the month before the rains start.  Everything is dry: the big trees still keep their green, but the fields and sides of the road are dust-colored.  It's the sixth month without rain.  Besides the burning cane fields (they are burned to clear away the tough out leaves and leave the juicy interior stalk to be cut and carried off for processing into cane sugar), trash is burned and spontaneous fires start on hillsides and volcano slopes.  They never seem to turn into wild fires: I suppose there must still be  deep moisture under the dry surfaces that keep them from exploding.

One of the pleasures, then, in this cruelest heat, is getting into the air-conditioned car and driving down the road to San Martin and San Salvador, encased in a bubble of cool.  And one of the great pleasures along that drive is the new face of San Bartolomé Perulapía, the town just before San Martin.  When I first moved to Suchitoto, Perulapía was no fun to drive through.  Lots of gang graffiti, signs that suggested deep quarrels between political and religious sectors.  But since a new mayor was elected in 2012, a beautiful change has come upon Perulapía.  All along the main street, house fronts have been turned into vivid, lively murals, like this one honoring San Romero of the Americas:

Or this one, where I caught the painter in the act:

And Perulapía, which once seemed dangerous and drab now invites visitors and makes a high point for my escapes from the heat of April.