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!

Doing it right

Our eye surgery mission - a week of cataract and pterygium surgeries that follows up the general medical mission - always begins with a good long list of people who qualify for surgery, according to our optometrists, and who say that yes, they want to have the surgery.  But year after year, we've seen only half the people on our list show up, in spite of info calls and transportation provided.  We have gathered that people are frightened, and that often their families discourage them from going.

Last year we asked Iris Chacon, our wonderful coordinator for San Rafael Cedros, how she thought we could do better, and she suggested that we have a meeting for everyone on the list where they could ask questions and could hear from someone who had the surgery. 

So this year, we invited everyone who qualified for surgery to come to the meeting, held last Sunday in the biggest school in Estanzuelas - and we had a great crowd!  There were probably about 75 people there, 47 of them patients on our list, to hear Lito of San Rafael Cedros talk about his successful cataract surgery, to hear Iris talk about the importance of family support, to hear Darren sum up the steps they would be going through on their surgery day and to hear Marvin remind them where to gather on the morning of the surgery.

Here's Marvin with a very old gentleman who moved right up next to him to hear everything clearly:

And then we got the questions!  Can I still sleep in a hammock?  How long does my father have to wait after hernia surgery before he has eye surgery?  Do I have to keep my head turned up to the sky for two weeks?  Is there a special diet I have to follow?  We were able to put many fears to rest!
And there were a lot of internal conversations, for example among this group of women who checked up with each other about everything that was said:

This is a town where many of the seniors have never learned to read, so it was especially important to share all the information in a meeting - and to send them home with copies that their younger family members could read.

So thank you, Iris, for steering us in the right direction.  Having a pre-meeting for the surgery patients will be part of our practice from now on!

A grand week

Our mission team loved their long, hot, busy, happy and productive week of medical and eye clinics in Estanzuelas.  We saw 1467 Estanzuelans, most for two or more clinics.  Our providers prescribed for those who needed medications - and everyone went away with vitamins and a toothbrush, at minimum.  We referred many patients for specialty treatment or diagnosis within the National Health System.  We signed up our full list for cataract or pterygium surgeries in April in the Hospital Nacional at Santiago de Maria.  More than 100 families are being invited to our capacitation session for receiving a water filter. 

But most of all, we carried away with us bright memories of faces and voices, people who touched our hearts, smiling or howling children, beautiful seniors, hardworking men and women.  

Here are a few images from the week, bright memories:

Sister Beth and interpreter Lea worked at getting just the right glasses for this patient.

Schellie was kept very busy with ear cleanings; a speech therapist, she's had expert training in ear lavage, and we used her skill to the full.

Interpreter Rita, Dr. Gulrukh and nurse Julie focused on this beautiful woman.

Dra. Jakellyne Jimenez, Director of the Estanzuelas Unidad de Salud (medical clinic) was our gracious hostess.

Marvin Hernandez (standing, center) coordinated all the local volunteers and kept everything running smoothly.  He's a superb organizer and a great leader - it was a delight to work with him.

Fatima and Wendy, two of the scholarship students who were our local volunteers, brought their intelligence and cheerfulness to every task.

Rosa and Hernan, two Salvadoran members of our team.  Rosa explains the eye surgery process to prospective patients, and Hernan drives us safely wherever we need to go.

And finally, here's the new Health Mission leadership team - Kathy Garcia and Darren Streff.  I am so happy to be turning over the work of in-country coordination to Darren, though I plan to continue to be involved.  Can't imagine better guides for this work! 

Lookin' good

One of the joys last week was visiting with all our eye surgery patients as they came to Dra. Ana Vilma de Burgos' office for their final post-surgery checkups.  Most of them were doing beautifully and were delighted to let me take their photo in their new reading glasses:

A few patients had to go through more processes: one woman had an eye infection that had developed after the first post-op and needed surgical cleaning; one man's interocular lens had moved and had to be replaced; three needed minor laser treatments.  A couple of others will have to continue using glaucoma medications.  Eyes are complicated!  And to be seeing clearly once more - what a gift, thanks to our talented ophthalmologists, all our dedicated team, and Dra. de Burgos.

Checkups

It's been a long, long week with lots of meetings and events, little time for blogging.  The highlight of the week was seeing our eye surgery patients arrive in Dra. de Burgos' office for their post-surgery checkups.  I always worry about patients finding the office - I think because it's often hard for me to find places in El Salvador, and because the office is on the 2nd floor of a small building on a very busy street in Santa Tecla.  But no problem for our patients, who either got on the parish bus in San José Villanueva or had the good sense to phone Cecilia, Dra. de Burgos' friendly and capable assistant, for directions.  Everyone got there in good time, and almost all are doing very well.  As usual, a few will need additional laser surgery.

I always enjoy watching the patients connect with each other - there's a cameraderie and cheerfulness that makes me think they are pleased with themselves for having the courage to have surgery and come out with better vision.  The two men in this photo were enjoying telling stories to Elvira Chicas, our volunteer coordinator at San José Villanueva:

One very special note this year: we included Cecilia's grandfather in our surgery list, and he came to the post-op with his daughter, Cecilia's mom, and great-grandson, Cecilia's son David.  Here's all four generations of Cecilia's family:

I'm awestruck by Cecilia: she gets up at 3:30 every morning to get on the bus at 5:30 so she can get to the office by 8:00 - she lives a long way away in Nahuizalco.  Then after the office closes, she reverses the process, getting home by 8 pm to put a quick meal on the table and fall into bed.  Her mom takes care of David and her daughter Camila.  But I can't imagine how she can manage this schedule and be - as she always is - cheerful, helpful, and upbeat.

Cristóbal

Getting to know Cristóbal has been one of my joys over the last couple of weeks.   He's a 20-year-old from San José Villanueva who showed up at our eye surgery mission one day in hopes of getting some help for his bad eye.  Our ophthalmologists quickly saw retinal damage, and recommended that he see a retinal specialist.  I made an appointment for him with Dr. Solorzano and met him in the doctor's office, which was a challenge to find (it's in an area where one-way streets and diagonals and dead-ends make nonsense of one's rational driving plan).  Once I got there, Cristóbal and I settled into conversation, and I quickly found out that he speaks excellent English.

It's not because he's lived in the states or had native speakers for teachers.  But a visitor from New Hampshire sent him a set of ESL CDs, and he worked and worked with them.  He must have done that work with great determination and great ability, because at this point, halfway through his first year at the University of El Salvador (he's majoring in modern languages, studying English and French as well as his native Spanish) he's very comfortable and skilled in conversational English.

We had a lot of time to speak English together, as Cristóbal had to get his eyes dilated, a process that always takes quite a bit of time, and then we waited for Dr. Solorzano - who turned out also to have excellent English, due to five years in the U.S. specializing in retinal and glaucoma problems.  He quickly diagnosed Cristóbal with a detached retina - but the damage had happened four years ago, and there wasn't much likelihood of recuperating sight in the damaged left eye.  He recommended a laser surgery to prevent any additional damage to the left eye and to insure that the retina in the right eye would not become detached. 

Happily, that meant coming back for the surgery itself, which happened in Dr. S's office,  and another two hours of English conversation with this talented young man (he also plays piano with a local group).  The surgery hurt, which I hadn't expected - Cristóbal had a fierce headache as well as pain in the eyes - so he was quiet as I drove him home.  But we'll connect again when he comes back next week for a checkup, and I look forward to more conversation in my own native tongue.

Cristóbal is one of eight children of a campesino family, the only person in his family who's ever been to a university.  There's neither TV nor a radio in his home, so it's not surprising that the family didn't have the resources to get him help when the retinal detachment happened (I gather he did see one doctor, who recommended glasses).  Dr. Solorzano is now one of my heroes - he waived his fee and charged only for the cost of the laser equipment.  Cristóbal was sad that his vision couldn't be restored - but for someone with his bright future possibilities, it was "vale la pena," worth the trouble, to make sure his other eye stayed good and strong - lots of books in his future, I suspect, and he'll want to enjoy reading them.

Surgery week

Our eye surgery week always brings us into the company of miracles.  It's good hard scientific medical work as our surgeons (Judith Newman and Tony Pisacano), scrub nurses (Sally Nelson and Rosy Melara) and circulator (Sarita Angulo) follow the protocols of any good surgery, maintaining the sterility of the surgical field, having all needed materials on hand and identified, creating an orderly pattern from first incision to closing.  There they are above, hard at work, gowned and gloved, standing over invisible patients.

But we know there's more to it when the patients come in the next day for their first post-op exam and are full of joy and gratitude at the gift of sight.  One woman said to Judith, "You have beautiful hands.  Thank you for using them to let me see again."  It's a joyful moment when the bandages come off.

In this photo one of our patients is testing her new vision while Selene Richardson, Tony, and Steve Scruggs delight in the moment.  There are few privileges greater than participating in a miracle like this one.

At work, at play

Two days into our eye surgery mission and we are at work and at play - with such a fine team it's sometimes blessedly hard to tell the difference. As is often the case, we lament the patients who were too afraid to show up, and rejoice in giving new sight to those who come to the hospital at 6 AM in the parish bus, driven by Padre Mario. Eye surgery is the focus of this mission, but we also found time to give vision checks (and reading glasses for those who need them) to staff at Hospital San Raphael. This afternoon nurses and janitors and cooks and x-ray techs lined up until we had to cut the line at 35 people. Those 35 waited with Salvadoran patience, laughing and joking and approving the new glasses of each one who emerged from the consulting room. It was a little fiesta. And we came back from the hospital to talk and laugh and play cards and share stories and eat mangoes and have our own fiesta here at the Centro Loyola. And now it's time to head for bed, to sleep until the little green parrots come flying and calling in the morning sky - and then back to work.

Feliz dia de San José

Happy St. Joseph's Day!  I've had a great double celebration of our community's patron saint.  Yesterday I took Kathy Garcia and Mitch Costin (they flew in Saturday night) out to San José Villanueva where we handed over twelve special prescription eyeglasses that were organized  by our February mission optician, Heather Downes, and made and donated by an optical lab.  Lots of happy eyeglass-wearing faces!  Then we helped out, a little, while Iris Chacon of San Rafael Cedros did a first workshop for the families who will be receiving one of the water filters we're donating, and we got a chance to exchange hugs with our San José friends.

Today was an even more special Dia de San José because I've had the great pleasure of watching while Mitch Costin of Eugene - a great stand-in for the saint - did an amazing lot of plumbing, carpentry, and electrical work to a) stabilize our operating microscope, b) fasten the handwashing sink firmly to the wall, c) install a toilet paper holder, d) put up a new lamp above the dishwashing sink, e) put up the new paper towel holder Donna gave me, f) re-hang all the mirrors at the right height and g) unstick my sticky kitchen table drawer.  This afternoon Mitch and Kathy and I went in and had a two-hour gambol through EPA, the new fancy hardware store here, that will lead to a few more things being done tomorrow.  We also bought a new super-sized toolbox to hold all the new and wonderful tools that Mitch has found for us so that our PazSalud toolbox is no longer a wussy and pathetic sight, full of curtain rods and odd lots of tape, but a proper manly St. Joseph sort of toolbox.  It was great fun!

On top of all that, Mitch took some wonderful photos - the two in this post are his.  Oh yes, and I began the day by teaching a computer class at the Centro Arte para la Paz with the help of Patti Moore and her Spanish teacher Beatriz, where the kids - ranging in age from about 11 to 18 - tore through the material I thought would take up two classes in the first hour.  St. Joseph come to my aid as I try to figure out what we'll do on Wednesday and oh yes, St. Joseph, a special blessing please for Mitch Costin who does your kind of work with such joy.

The path she chose

Things don't always work out the way you'd planned them, as we all know. On Thursday, I got up at 3 AM and drove to Ciudad Arce to pick up Sandra and her grandmother. Sandra was going to enter Hospital Bloom, the national pediatric hospital, for cataract surgery (she has congenital cataracts). Sandra and la abuela were on time at our meeting place, smiling happily at me. We got into San Salvador in time to be among the first entering Bloom, and after waiting an hour and a half for the doctors to arrive, were among the first in to see Dr. Dominguez, Sandra's surgeon, who said that yes, she would have her surgery the next day.

All seemed to be going well, and we had a little break to get breakfast in one of the busy comedors across from el Bloom. We came back in and waited for four hours for a pediatrician who would examine Sandra and other children waiting for admission. Then a nurse showed up with a hospital identification bracelet for Sandra, and we were suddenly in a very difficult situation. She refused the bracelet, ran to the hospital entrance and collapsed into a chair, very distressed. Two understanding nurses talked to her, and so did grandma and I, but she couldn't respond in words until finally she was able to say NO to the surgery. And, we all agreed, at 14 she had the right to say no.

And so I bought us some lunch and then took Sandra and grandma home. Sandra recovered on the way back and was chatting comfortably with her grandmother by the time we reached Ciudad Arce.

For me and for the donors who had generously purchased the interocular lens for her surgery (we'll ask Dr. Dominguez to find another child who needs it) it was a disappointment. But, as so often happens, someone had sent me the right thoughts for dealing with this situation. The someone is Cheryl Sesnon, the new Executive Director of Jubilee Women's Center in Seattle, where I once worked and once served on the Board of this great housing program for homeless women. I'd stopped by to get to know her while I was back in the States, and we'd talked a bit about our times of discouragement as well as our joy in the work. She recently e-mailed me, "Each time I feel despair I just have to remember that I am not in control of others. They each have their own path to follow. and I have my own path, as well."

So as I drove back to Suchitoto, more than 12 hours after leaving, I blessed Sandra on her path, and gave thanks that she was able to express her will so unmistakably. I don't know if I can say this clearly, but it's good for me, a gringa with access to much that's unavailable to most Salvadorans, to be reminded that the path I and my fellow norteamericanos might want to help someone choose isn't always their path.

Noise and silence

Apologies for the blog silence...it's only because I've been in the United States - in Bellevue, Washington - since early June, so I haven't had much fresh info about El Salvador to post. Strange things have been happening there: a big constitutional crisis has heated up with the legislature passing a law to require the judges of the country's Constitutional Court to be unanimous in any decision about the constitutionality of a law (many recent votes of this five person court have been 4-1 decisions), and there's been a strong popular protest. The court, perhaps predictably, declared the law unconstitutional. You can read about it in Tim's El Salvador blog, but it's pretty hard to understand the dynamics at a distance (like someone in El Salvador trying to understand the current dynamics around the debt ceiling crisis in the United States).

Meanwhile, blessedly, my own health crisis has been resolved with great medical skill and lots of prayer. I am able to enjoy long walks for the first time in six months - what a joy! - and I will be heading back to El Salvador on July 25th, most thankfully. Perhaps I will find someone there who can help me understand the constitutional crisis.

And also, meanwhile: I've been assembling photos from the last year for our PazSalud calendar selection, and here's a favorite from the May eye surgery mission - left to right, Dr. George Sesson, our optometrist; a happy patient; Dr. Tony Pisacano, our ophthalmologist, and Dra. Silvia Pleitez, our circulator.

A week well spent

Sometimes in the last few weeks it looked as if our cataract surgery week would never happen. We hadn't registered as many patients as usual in San Rafael Cedros in February and half of the patients we registered didn't go to Hospital Cojutepeque for the required pre-surgery tests. One of our surgeons was unable to get the required Apostille (look it up on the internet!) for his license and curriculum vitae in time, and he couldn't come. The other surgeon mistakenly sent in last year's license, duly Apostilled, and I didn't even notice until the Medical Board called me. The paperwork for our franquisia (permission to import medications and supplies) was delayed in the Archdiocese because of a staffing change until too late. In the last couple of days before the mission team arrived on May 14th, it felt like a recipe for disaster.

Instead, it's been a wonderful and inspiring week, and a reminder to me that trust and patience are such necessary elements in this work. The hospital found us enough additional patients to keep our team busy each day of the week. The customs officers at the airport very kindly helped us find a way around the franquisia problem. And while we brought only one ophthalmologist, the amazing Dr. Tony Piscano (the Medical Board kindly said he could work as long as he had his current license with him), Dra. Ana Vilma de Burgos, a local ophthalmologist and our sponsor for SEE, International, worked with him for three of our five days. Our team performed 40 surgeries on 33 patients (we had a number who required more than one surgery). Our patients came away smiling, delighted with their new vision.

Our mission team had three Salvadoran members this time: Silvia Pleitez, a Salvadoran doctor now studying for a medical license in the U.S., has been on most of our mission trips; Rosy Melara, a recently retired scrub nurse, volunteered her time for the week; and Rosa Aguiar, a community organizer from Comasagua, joined us as patient coordinator for the third time. Here's Rosa wheeling a patient in for his post-op check.

I'm grateful to the Sisters and friends who responded to my urgent calls for prayer for this mission: as you can tell, they were abundantly answered. Thanks be to God!

Amazing Amate

Today I drove early in the morning to the port of La Libertad, where some of our November patients from San Juan Opico were going through an eye clinic to see if they would qualify for surgery. There in the courtyard of the Casa Emiliani retreat house was this most amazing tree, an amate, that had put down a secondary trunk and flung up a main limb in midair. It's a tree with the lines of a dancer, a tree with circles and arches and great flowing lines of timber, a tree that hardly seems possible, and is surely unforgettable.

Alas, our three patients did not qualify for this surgery, but all did receive glasses and thorough eye checks. And I am glad to have made the acquaintance of this ancient and glorious tree.

Visions

Here are a few photos from the two very good days of our eye clinic in San Juan Opico on November 8th and 9th. We did vision screening and provided glasses, plus vitamins, tylenol, toothbrushes and hand lotion to 250 Opicans, who were pretty happy with the results as these photos show (top left, Dr. Denis Holmes and Andrea Garcia with a patient; top right, Terry Williams looks for just the right glasses for a small girl; bottom, Angie Wolle gets a thank-you handshake). Our two M.D.s, Dr. Jim Boschler and Dr. Steve Cabrales gave talks and answered questions - as well as running our small pharmacy. Dr. Gustavo Peña told Opico children and their moms about the importance of toothbrushing and a healthy diet - and then he cleaned the teeth of about 30 children. And we had demonstrations of the Sawyer water filter and the Ecocina, a wood stove that uses less wood and produces almost no smoke.

We are, as always, grateful to the Bellingham Lions - we had seven on this trip, headed by Ken and Janet Henderson - and the Lions Eyeglass Recycling Center which provides all the prescription glasses for our eye clinics. The Lions also brought walkers, canes for mobility for the blind, used hearing aids for recycling, and low vision magnifiers. Today they've visited the School for the Blind and School for the Deaf in San Salvador, and touched base with the San Salvador Lions Club.

Our PeaceHealth Mission Immersion Group came back to Suchitoto with me and are staying at the Centro Arte para la Paz, where they're learning more about El Salvador's past and present realities and making connections between those realities and their mission as PeaceHealth leaders. It may be a matter of seeing the world through different lenses.

Guests, expected and unexpected

My expected guests this weekend were Dra. Ana Vilma de Burgos, her husband Ernesto and their daughter Camila. Ana Vilma has been our host ophthalmologist (there's a word to spell!) for our eye surgery missions in 2007, 2009 and 2010, and she has been wonderful and generous to us and to our patients. It was great to welcome them to the house for lunch and to Suchitoto - though every fly in town seemed to have decided to visit as well, probably because I had been cooking through the morning and had put all these interesting smells in the air. We waved one hand in the air to keep the flies away and ate with the other, and enjoyed conversation, some of it in English, as Ana Vilma is fluent and Camila is studying English in the American School of San Salvador.

My unexpected guest showed up later that evening, during a downpour. I looked out from my bedroom door and saw the unmistakable shape of a frog or toad hopping across my patio. I have no idea how he could have got there - the patio's surrounded on all sides by high walls - or where he could have gone, as there was no sign of him the next morning. But there he was, beyond question, part of the wild life that keeps reminding me I'm living in the tropics.

Light and darkness

Thursday was a day of disappointment for a 37-year-old man, José Adán, who had received cataract surgeries during our May eye surgery mission. The day before he was scheduled for surgery, José Adán got a required blood glucose test, and discovered that he is a diabetic. The doctors chose to do the surgery anyway, in hopes that his vision could be restored. Because he had a young man's lens - it's gooier, I gather, not a medical term! - all of the clouded lens couldn't be removed, and he needed followup laser surgery. The surgeons thought his chances of having his vision restored by the laser surgery were very good. Meanwhile, José Adán got into treatment for his diabetes and got his blood sugar levels down to normal. Yesterday I gave José Adán and his faithful friend Carlos, who has been acting as his guide, a ride to an eye clinic for the laser surgery. I hoped to see him walking out without needing Carlos' guidance, but that did not happen. Because of the condition of his eyes, probably affected by the undiagnosed diabetes, the laser surgery will give him, at best, a minor improvement in vision.

José Adán is a true gentle man, and in spite of his great disappointment he had nothing but thanks to give the doctors who tried to save his sight.

I was primed for this technological miracle that was going to restore his sight. Like so many North Americans, I love those flashy solutions that have been my people's specialty for more than a century. Again, again, El Salvador is teaching me to put my faith in God, where it belongs, and not in "the work of our hands." It does matter that we tried to help José Adán, even if we were not successful. Success isn't what really counts.

All this was underscored for me when I read yesterday's gospel, from the 6th chapter of Matthew:

Jesus said to his disciples:

“Do not store up for yourselves treasures on earth,

where moth and decay destroy, and thieves break in and steal.

But store up treasures in heaven,

where neither moth nor decay destroys, nor thieves break in and steal.

For where your treasure is, there also will your heart be.

“The lamp of the body is the eye.

If your eye is sound, your whole body will be filled with light;

but if your eye is bad, your whole body will be in darkness.

And if the light in you is darkness, how great will the darkness be.”

José Adán's eyes are not sound, but still he is filled with light. I ask your prayers for him, that he may get as much improvement of vision as possible, and that he may continue to walk in the light.

Looking good

A joyful community of seniors (mostly) came to Dra. de Burgos' office yesterday from San Juan Opico for the final post-cataract-surgery checkup - and another group will come today . In this final checkup they receive reading glasses, which they are happily showing off in this photo. Three of the 42 patients need follow-up laser surgery, which Dra. de Burgos has scheduled for Thursday.

One woman told me yesterday how wonderful it is to be able to recognize her family and friends at a distance, how good it is to be able to see what's on the other side of a room. A man said he rejoiced in being able to read the Bible again. Everyone asked me to say a big THANK YOU to the doctors and the team. I just wish I could transmit all the hugs I got.