Following up

Today was dedicated to follow-ups of various kinds. Kathy Garcia and I drove up to Suchitoto to take a look at the new house and discovered that LOTS remained to be done before a move in would be possible. I sent the landlord a list and we had a good conversation about it all via Skype (he lives in San Diego) and I'm expecting a lot of action in the next two weeks.

Writing a follow-up report on our work for the year to date was a lot easier, except that it's April, the hottest month of the year here, and I kept dripping sweat onto the keyboard. We had a brief, intense rainstorm this evening without much cooling. I'm eager for the real rains to begin. I'm a bit homesick for the tulips and rhododendrons that should be blooming around St. Mary's now - but a strange and beautiful flower, a lily relative, has poked its head out of the earth bed in the patio of my soon-to-be-home, and a handsome lime tree shades the patio. New things to learn to love.

A good week's work

Yesterday we finished the cataract surgeries - today we'll return to Hospital San Rafael just for post-op checks of yesterday's patients, and then we'll head out for a weekend of exploration in San Salvador and Suchitoto.

It's been a grand week, working with the Comasagua community and helping to create new sight. Here's a photo of three great collaborators - Hernan, our driver, tour guide, and shopping expert; Rosa, who gave us and our patients joyful and loving care; and Alex, who delighted us with his shoes and smiles. We've all had a lot of fun, and the work and fun have been inseperable as it always is at the best of times.

Men and machines

Today was grand! We finally got the flow right in the mornings, starting with the post-op review of yesterday's patients and going on to the prep and surgeries for today's. Seven patients went home, seven more received cataract surgery (we always plan for 10 surgeries each day, and often book a few more, but there are always some who forget and others who are afraid to have surgery done on their eyes).

I suited up in scrubs to watch a couple of surgeries today - one by Dr. Bob Rea, one by Dr. Tony Pisacano. Tony is using the hospital's operating microscope, which has a teaching microscope attached - this means that I got to share Tony's view, up close, of the patient's eyeball. I had thought of these surgeries as fairly simple - I suppose because they are common surgeries - but it was astonishing to watch the intricate steps and careful process required to extract the clouded lens. Down here, we don't use the sophisticated Phacoemulsifier which uses ultrasonic vibrations to break up the cataract; PazSalud and See, Intl use an older, slower and less expensive direct method. It requires great focus and complete attention to detail: it was an honor to watch two excellent surgeons giving that focus and attention to people who couldn't imagine being able to pay for cataract surgery.

The other surgery today was performed on the Slit Lamp, an essential piece of equipment that had suffered an internal short circuit. After I watched the two surgeries, I saw the completely disassembled Slit Lamp, which looked to be ready for the junk pile. But Hernan Merino, who owns and drives the bus we travel in, got a list of needed tools and equipment, took it to the hardware store, and came back with the necessary bits. Then all the four men on our team, Mitch, Bob, Tony and Barry, collaborated on putting the machine back together. And the women, I have to confess, laughed at this great example of male bonding. But the slit lamp works again!

One more note from today: remember the fuss we had getting our anesthetics through customs? The customs agent was particularly exercised by the fact that we were bringing in Lidocaine. Lidocaine! he said, and showed us a packet of lidocaine that had been confiscated. Today we realized that we were running short on lidocaine and set Hernan out to buy more. With no prescription and no difficulty, he was able to buy a nice big bottle of injectable lidocaine at a local pharmacy. Surely a good thing that those customs folk were on their toes!

New sight

In the photo on the right three patients from Monday - you can tell them by their eye patches - are waiting for their post-op checkup, while two of today's patients wait to begin the process. New sight! We had seven very happy people from yesterday heading home to Comasagua, and for them the flowers were bright as they haven't been for years.

A much better day

Today, the customs office safely behind us, we began the week of cataract surgeries at Hospital San Rafael, and it was a good day, thanks in no small part to the work of Mercedes and Rosa (Rosa is making a V for Victory in honor of Mauricio Funes' election as President of El Salvador). Mercedes Arias is a community organizer for CIS (Centro de Intercambio y Solidaridad) and Rosa is a member of the Junta Directiva of Comasagua. They're both splendid organizers: a little microbus arrived at the hospital promptly at 6:30 this morning with our seven patients for today, all with their papers filled out and ready to go.

The other two photos are from the waiting room: Michelle Pisacano with four of our patients and me with one.

A quick introduction to the members of our surgical team: Dr. Tony Pisacano (from the Bronx, NY) and Dr. Bob Rea (from Indiana) are our two ophthalmologists. Mitch Costin (from the cardiac care center at Riverbend Hospital, Springfield, OR) and Dr. Silvia Pleitez (a Salvadoran, currently living in Los Angeles) assist with the surgeries. Shannon Updike, an RN from Ketchikan, is responsible for pre- and post-surgery care. Charo Sanchez, who is usually unit coordinator for the childbirth center at St. Joseph Hospital, Bellingham, is our interpreter. Barry West (whose day job involves IT in Eugene) is our photo journalist, and Michelle Pisacano, Tony's wife, has been helping with patients and supplies. Kathy Garcia, Manager of the PazSalud program, is the rock who keeps everyone steady, focused and cheerful. As always seems to be the case, it's a group of committed people who are very happy to be here, working hard, and giving the gift of their time and skills to bring new sight to those who are almost blind.

Baptism by fire

Saturday Hernan and I set off for the airport in Hernan's beautiful red coaster with an operating microscope and stand, a slit lamp (don't ask me what it does!), an autoclave (sterilizer), and boxes full of sterilized water, scrub soap, and snacks. We were on our way to pick up our crew of 8 for the coming week of cataract surgeries, and I got so preoccupied with all the preparations that I forgot to check the plane status. Folly! When we got to the airport, we soon found that the plane (normally due at 7:45 PM) had been delayed and was now scheduled for 11 PM. We settled down to wait, which is such an ongoing part of life in El Salvador, and I checked in with the airport authority police from time to time about whether and when they would let me go in to meet our passengers (and their baggage). I waved my set of franquisia papers around a lot - these allow us to import the medications we were bringing in without paying any customs duty, and I was of the opinion that it was going to make it easy to get our equipment and medications through customs. I was wrong.

The plane finally did arrive - at about 1 AM - and our group assembled at the customs line. I waved my franquisia again, and the customs agent started going through it with a fine tooth comb. He looked through the list, written in English (and already approved by the body that approves medicine imports), and wanted to know the translation for every term. Charo Sanchez from Bellingham, our interpreter for this mission, gamely went through the list as he made notes. Then he started looking up the medications on his computer. Then he told us that because we were bringing in anesthetics (the local anesthetics used to numb the eye for surgery), our import would have to be approved by the anti-narcotic division, but they were not at the airport at this hour (by now it was 2:30 AM), and furthermore the import would have to be approved by the anti-narcotics division chemist, and he only worked Monday through Friday, but maybe he would come in tomorrow to take a look at our anesthetics.

OK, we said, gritting our teeth (much toothgrinding going on), OK, keep the medications and we'll come back for them tomorrow, but let us take the rest of the things we need to have tomorrow to set up the operating room - the scrubs and patient gowns and sutures and eye patches and sterile gloves, and so on. No, he said, it's all on the one franquisia, so nothing in the whole shipment can be taken until it all has been approved.

We were a shell-shocked and completely exhausted bunch by now and it was clear that nothing was going to budge our customs agent, so we climbed wearily into Hernan's bus and went to the Hotel Novo, where a very sleepy looking night clerk let the group in at 3:30. I went back home and slept (blissfully) for four short hours.

We had managed to come away with a phone number and name to call the next day. When Charo called she talked to someone who said oh yes, no problem, everything's approved, come on down and get it. So Charo and Dra. Silvia Pleitez and I climbed on to Hernan's bus and rode down to the airport. The woman Charo had talked to said we didn't need to go to the Port Authority police to get permission to enter the Customs area - but we did. Another lengthy set of explanations, and we were back in customs, and the same customs agent was there, glumly filling out yet more forms. Can we pick the boxes up now? we said. It's going to be another 20 minutes, they said. Finally, after a half hour that felt like eternity, they had Charo sign her name on about 15 different pieces of paper, and they turned loose our equipment, and we loaded it into the bus and headed back to San Salvador.

Finally, today, we did get to the hospital, we did set up the surgery suite, we are ready for patients tomorrow - but I hope never to go through anything quite like the last 48 hours again. You can probably see the accumulated strain in the tired face of Charo, sitting on the right next to Silvia in the photo above. Behind them are the liberated boxes and duffel bags and tubes, taking up more than half of the coaster. Behind us, for this time anyway, is the customs office.

Getting ready

Today began with the best of tasks. Ana, who two years ago was one of our patients in Panchimalco, was having her last checkup. She had gone through a hard labor and delivery without help, and ended up with a severe fistula and incontinent. Correcting that was beyond the scope of our medical mission, but we are able to use our donated funds to follow up on cases like Ana's. She had successful surgery last year, and today I drove her and Walther, the Promotor de Salud in her community, to Dr. Trebanino's office, where she was pronounced well healed. On the way back to her bus stop, she asked me to say thank you to la niña Leonora (la niña/el niño are affectionate terms of honor for elders) - to Sister Eleanor who had made this healing possible.

Then I had to turn my attention to this year's mission. The eye surgery group arrives tomorrow evening, and most of this week has been devoted to the business of getting ready - getting food for snacks, purchasing some heavy supplies like distilled water for the sterilizer, pulling out the equipment that's stored here, meeting with hospital staff, organizing the schedule. Today's chore was the biggest - getting the Customs Office permission to bring in all our equipment and medications. Ordinarily that would have been in hand earlier, but Semana Santa threw off everyone's timing and I ended up going to the Aduana office with Licenciada Vasquez, who handles customs work for everyone connected with the Archdiocese. We spent four and a half hours there, moving from office to office and back again, mostly sitting. Finally, about 2 minutes before the office closed for the day, triumph! I have a franquisia to take to the airport.