Mission Diary by Dr Lewis 2003 Ocotepec, Mexico
THE CHIAPAS PROJECT, OCOTOPEC, CHIAPAS, MEXICO
SATURDAY AUGUST 16, 2003
I am not an adventurist. My idea of adventure is driving forty-five minutes to the Jersey Gardens Mall to see if I can get a great bargain on an evening gown. I manicure and pedicure once a week. I moisturize, exfoliate, self-tan, massage, excercise by climbing stairs once a day. I don’t like cold showers. I don’t like dirt. I cry when I break a nail. I do cosmetic eye surgery for fun because I like the environment and I can get my hair done for free at the spa next door.
Today I left Newark, NJ for Ocotopec, Chiapas, Mexico on a medical mission to help the Zoque Indians. I am not sure why I came other than a trace residual philanthropy or possibly a guilty side felt that some “giving back” was in order for the fortunes received in my life.
But, so far it has not been too bad. Coach flights are not my favorite, but I am small and the seats are pretty comfortable. They served surprisingly good food for a plane breakfast. There were muffins, coffee, eggs and juice. I slept and chatted, ate and slept some more. I could have been flying to Vegas.
When we arrived in Mexico City it was a little bit crazy. The corridors were crowded and the employees slipshod and disorganized. One of my suitcases arrived, but the box I brought with a surgical autoclave and medical supplies got lost in transit. This actually made it easier to manage because I didn’t have to carry the seventy pound weight through the airport. But god was it hot. Hot, Hot , Caliente Hot!!! Sweaty Hot. No air-conditioning hot. I think my deodorant was working but I sprayed on a little Chanel just to make sure.
Sister Ernestina, a nun from the local convent, was introduced to me in the airport. She was here to help smooth the transit through Customs that was coming up for the Chiapas Project group. Everything we were carrying was illegal. Syringes, medications, scalpels, sutures. Not your average toiletries. Customs became one big game of red light, green light. Hit the button. Green light meant Go. Red light meant stop. I got Red light. I passed anyway when no one was looking.
The next flight was to Tuxtla. All the way on the other side of the airport. For some silly reason, they needed my boarding pass from the last flight. I scrambled for about ten fearful minutes to find it. Dave DeRose, another ophthalmogist on the mission was ahead of me in line carrying an A-Scan in his overnighter. This is a machine used to measure the axial length of the eye, allowing us to determine what size lens a patient might need after cataract surgery. He got stopped at the luggage screener. They asked him in Spanish what the machine was for. I have a sneaking suspicion that they thought it was a bomb. He told them that it was a machine to examine los ojos (the eyes). They were skeptical and said that it didn’t look like a machine to examine eyes. He told them that he was an eye doctor. They looked skeptical and said that he didn’t look like an eye doctor. They asked him for his medical license. He told them that most doctors in the United States do not carry their licenses with them. They looked skeptical and said that ALL doctors in Mexico carry licenses. Finally he simply shrugged and stood there, both sides at a stalemate. After a few moments, they babbled something in Spanish and let him pass.
Flight #2 to Tuxtla, Gutierrez. Somewhat smaller but still very comfortable. They took my bulky carry-on and gate checked it so now I have even more leg room and less to carry. Lunch was a cheese sandwich on a croissant and pretty tasty. Until I reached the center. Then I bit into a giant, excruciatingly hot jalapeno. Eyes tearing everywhere. Short, painful breaths. Now I knew I was definitely in Mexico.
Arrival in Tuxtla was fine, one hour flight, no luggage lost. We had a well organized trip to the Camino Real Hotel. No mishaps with the bags. After checking in, dinner was served by the pool. The food was awesome, very fresh, all the mission members got to know one another and the hotel was above average in cleanliness. I had a relatively good night of sleep.
SUNDAY AUGUST 17, 2003
I awoke early the next morning to prepare for the overland trip to Ocotopec, a small Indian village of approximately 3000 people. It was four and a half hours away by bus, invisible on any published map. A major head cold had set in overnight and had traveled to my voice box and hypothalamus. I was rendered mute and feverish. Dave thought this was a great thing, as he has never seen me not vocalize my opinions in excess before.
In front of the hotel the bus pulled up to take us to our final destination. It was an interesting vehicle. Large breasted female stickers were smeared haphazardly across all the windows with dollar signs pasted above them. I later came to find that this bus was usually hired to sell women from the streets.
The luggage was piled high on top and secured with ropes. We were piled low within and not secured with seatbelts. I could feel right away that the shocks were non-existent. The smell of burnt brakes permeated the air.
When we reached the Tuxtla town limit, we accelerated to about 65 kilometers an hour with all the luggage on top. Everyone was chatting and didn’t seem to notice the excessive speed. I noticed, but since I was feverish and mute I was not up to the effort of complaining.
The ride was very smooth for the first two hours. We stopped at a local cantina to pee into a non-flushing hole in some porcelain and watch local women gut very large fish. Hungry dogs and starving flies were everywhere.
Back on the bus, many of us fell asleep. After two more hours the road ran out and we were traveling on a dirt track through the jungle. Here we were rudely awakened by the practically horizontal movement of the bus cabin as we maneuvered the sun hardened ruts in the path.
After ten or fifteen minutes more, the bus pulled over and stopped completely. Many people were asking the driver in Spanish why we had stopped. I was sitting quietly, at the back of the bus, looking to my left, horrified because there was about six inches of ground between the rear bus tire and a 1000 foot drop into a sheer canyon. No one else seemed to notice.
The bus driver said something in Spanish (of which I comprehend nothing) and six of the strongest guys got out. They climbed to the top of the bus and unloaded all the luggage. Many of the passengers took the delay as an opportunity to deboard and stretch. I, unfortunately, was frozen in my seat by my uncooperative sick body and paralyzed, fearful brain.
Then the bus began to back up. I was in a rear window seat, watching that six inches of space cliffside disappear rapidly to nothing. As we inched further backwards, I found myself suspended about four feet over the canyon, gazing down at nothing but air. Then the tire wheels began to spin. We were stuck in this position. I tried to scream but nothing came out (remember I had lost my voice). I was convinced that my husband back home would now reap the rewards of my vast life insurance policy and sell all of my good jewelry (or give it to my mother-in-law).
Finally after approximately six futile attempts to dislodge the bus, the driver told everyone on top to get off and me to get out (the front door obviously). Apparently this was to lighten the load. As I exited, the door closed practically on my jacket. As soon as I stepped away, the wheels began spinning and the bus screamed forward, then took off back into the direction we had just come from.
We were left stranded on a dirt road in the middle of the jungles of Mexico with 50 suitcases and 20 people.
Then it began to rain. Not rain like at home, but big, fat drops like egg yolks onto our heads. I was feverish again and had only my Sax Fifth Avenue silk jacket to keep me warm. I was freezing.
I couldn’t seem to spot the next route of transportation. I asked this silly question to the crowd who replied, “Well, I guess we should just start walking.”
I was not sure I had heard them right. “Walking, walking???” I stammered in my non-existent voice. “How far?” I cried, “How far, I don’t see where we are walking to!” No one answered, they just began to move. Someone shouted to each grab an extra suitcase. I could barely carry myself.
I was frozen. I couldn’t walk. Back home I don’t even walk to the mailbox. Suddenly I found myself being left behind. The rain began to come down harder. I felt horrible but decided to move, afraid that if I stayed where I was I would drown in my own tire rut.
“After about five minutes, someone shouted, “There’s the town!” and when I looked up I could see a little spot of white roofed huts about five miles away. To me it was an eternity. I put my head down and watched my feet go one in front of the other. I was wearing open toed flip-flops and my pedicure was a mess.
About a half mile down the road, our rescuers appeared. They were from the mission and had arrived ahead of us in four wheel drive trucks, having brought in food and bottled water earlier. They had assumed we would get stuck, having navigated the roads a few hours previously. The trucks were bouncing up the paths like balloons on wheels.
I expected all of us to pile into the flatbeds, saved at last. Instead, all the suitcases were piled into the flatbeds. We were left in the road to continue walking.
Finally, someone noticed how sick I was. Mercy was shown and I got to ride in the front seat of the truck. I was not sure if this was the better deal, since now, on top of the head cold/chest cough and fever, I developed extreme nausea from motion sickness.
The ride was five miles of sheer torture. I had the disconcerting feeling of being dragged further and further from civilization, reinforced by the chickens/roosters/barefoot children/dead puppies/pigs/sandbags and assorted other discarded items in the road.
We eventually arrived in town. If you could call it that. Dirt floors, wooden walls, open indoor firepits, swollen bellied children. All observed through the pouring rain, like god crying for his forsaken few.
When we arrived at the local convent, I unpacked into a tiny two bedded room. Aside from these items of luxury, there was also a table and one rickety chair. It was obviously a cell for one of the various visiting foreign nuns. Upon closer inspection, I observed no box spring and a mattress as thin as a chair pad. There was no filtered water available to drink and hot water for showering was predicated on whether or not someone knew how to light an explosive pilot. I was feeling more and more angry at Judith, my Hungarian ophthalmologist friend, who talked me into coming with her on this horrific journey. She had been on the last mission in March and had insisted that the trip from Tuxtla would be a breeze (singing camp songs on the bus, comradeship, etc) and there would be comfortable beds and hot showers at the convent. None of the above, I REPEAT, none of the above, was true. She was a liar and a dog, a stinking Communist, I hated her, her whole family and the day she was born.
As an aside, it must be understood that I never live like this. I don’t even camp. I have a Duxiana mattress at home, down comforters, down pillows, air conditioning and hot water. Here there were signs in the toilet reminding us not to flush any (repeat ANY) paper down the hole. We were instructed to put all paper in the wastebasket (in both Spanish and English, and don’t think I wouldn’t have used my inability to speak Spanish as an excuse). “In the wastebasket?” I wondered, “Every piece? Front and back?” The smell was already permeating the windowless room.
“God,” I thought, “What have I done?”
There was no time for contemplation. The group had arrived from their refreshing walk and it was time to set up the clinics and operating rooms. There was one ophthalmology clinic, one OR, one medical clinic, a pharmacy, a tooth extraction room and an OB/GYN clinic. All requiring supplies and equipment. As I looked around the streets I questioned in my mind how we would maintain cleanliness and sterility, when the floors were dirt and the dogs and roosters defecated as they moved.
At the eye clinic, cleanliness was not even a consideration. Filth was beyond all description. Flies, cobwebs and crusted dirt coated the walls in the ten by twenty room that was to serve as the OR. The ceiling had gaping holes covered with rusted bars and fractured plaster. Apparently on the last mission, someone had the presence of mind to tape a sterile drape over the opening to prevent plaster from dripping onto the surgical field. It hung limply now, sagging as if feeling the futility.
We couldn’t possibly operate here. A rooster marched through the open doorway and I booted him out the other side. We couldn’t possibly operate here. We couldn’t. We couldn’t. But we did.
We began by setting up the clinic, outside the OR, opening boxes and boxes of supplies brought by us from the US. Judith had brought a slit lamp, operating microscope, indirect ophthalmoscope and eye charts. All the amenities of home. Except nothing worked as perfectly as at home. It was here because it was either second hand, expired or just outdated and obsolete in the world of modern medicine.
Make do was the theme of the day.
I worked setting up until about 8:30 PM and then my chest gave out and my fever skyrocketed. I went to see Dr. Bruce who gave me a z-pack of antibiotics and prescribed sleep. So off I went, no dinner, no conversation, do not pass go, do not collect $200.00.
The one concession was to call home on the satellite phone I had rented prior to coming. Hearing their voices, I started to cry, huge heavy tears, thicker than the rain drops. It was frank despair, for the people, the conditions, but mostly me, feeling sorry for me, sick and lonesome with a high fever overland four hours from the nearest town and hospital. And I had broken all my nails.
I felt terrible all night. Raging fevers alternated with bone aching chills. Every two hours I woke up.
MONDAY AUGUST 18, 2003
The ringing of the bells in the Convent began at 5:30 AM. Huge bursts of ear-splitting sound rocked the building, sending plaster from the walls and the bare light bulb swinging. Immediately following this auditory nightmare, the bus destined for Tuxtla began to sound its horn. Blaring, minute long blasts to call all the travelers in from the surrounding villages. I could not possibly imagine what the motive was behind such early disturbances. Later I came to find that if the bus did not leave before 6 AM, there was a distinct possibility that it wouldn’t leave at all. Rain, mud slides and avalanches were a common occurrence on the dirt paths most afternoons.
Breakfast was at 7 AM. I couldn’t eat a thing. Food nauseated me, my chest being tighter than a rubber band and my head clamped in a vice grip. Clinic awaited on an empty stomach.
Forty or fifty native Zoque Indians were lined up patiently outside the doors by eight AM. The clinic opened at nine. By ten o’clock there were over 200 people, all patiently waiting their turns in the hot, Mexican sun. The lines were no different at the medical or dental clinic. The children of the town waited as tolerantly as the adults.
Promptly at nine AM Monday morning we opened the doors. Exams consisted of a vision check, pupil check, and if abnormalities were detected, they were triaged to the slit lamp and indirect ophthalmoscope. It was an assembly line of humanity from morning until night. Two potential surgical cases arose that day that we could possibly handle in our makeshift OR in the evening. Judith and Dave removed a cataract from a patient’s eye while I finished the entire clinic (with unbelievable help from dedicated volunteers). It was not a very smooth surgery but an anterior intraocular lens went in and we would know tomorrow if the patient could see.
After the clinic closed, we brought in a woman whose eyelashes turned inward from scarring. Her corneas were covered in irritation and she could not open her eyes. We prepped her for surgery and began with the left eye. The procedure went smoothly and we were able to turn the lashes outward.
The right eye was a problem from the start. Bleeding was uncontrollable. We cauterized, applied pressure, sponged and cauterized again. Nothing seemed to work. After speaking with Dr. Bruce I now understand that all the natives have coagulopathies due to vitamin deficiencies. In desperation we finished the case through pools of blood, suturing with the hope of tamponade. Miraculously the bleeding stopped.
Another night of collapse. Echoes of my heartbeat in my ears. My fever still hasn’t broken despite antibiotics.
TUESDAY AUGUST 19, 2003
Day 2 of clinic. Repeat of day one. No breakfast, hoards of humanity. All had eye complaints from the smoke in their homes and the sunlight in their streets. Nothing to treat with but artificial tears and sunglasses. Reading glasses were also dispensed in vast quantities. The one star on the horizon was that the post-op cataract case had vision. He could count fingers and see the big E.
Through the day we must have seen over fifty cataracts. Not the kinds of cataracts we are used to seeing in the United States (which are small and hazy but vision is still pretty good). These were white, opaque giant cataracts with dark brown centers, developed over years of exposure to sunlight. We began to have to triage. If someone could see from one eye, we could not operate. They would need to wait until the next mission in March.
By the end of the day we had eight patients scheduled for surgery. All eight were bilaterally blind, only able to see changes in light, using long tree branches as makeshift canes to maneuver about. Clinic had run so late that we could only do one case that night. It was my first cataract surgery of the mission. It was not pretty. The eye was tiny. The microscope was unfocusable. The sutures broke again and again because they were old and outdated. Halfway through the case I asked Judith to switch because I could not get the eye closed. No sutures would stay in. We switched to bigger sutures. Good for us but not so good for the patient. They were more irritating and reactive. Finally we placed a lens in the eye and managed to close. How tightly closed I didn’t know but would see the next day. The case took three and a half hours.
That night, we dragged ourselves to dinner. Nothing feels better than a surgical case gone well and nothing feels worse than one gone bad. Never mind the conditions. Never mind the sutures. I was the surgeon and the patient was my responsibility.
Three cases were scheduled to be operated on the next evening. The clinic was so packed we could by no means spare two ophthalmologists to scrub in the OR during the day. Judith then broke the news to me that we would either need to stay another day or choose to leave the remaining four patients blind until the next mission. The ophthalmology group agreed to stay. Against all my better instincts, I agreed to stay too since I was an integral part of the group.
In bed that night my fever went up again and I began to hallucinate. I thought I was home but I could not find my children. All I could find were native Indians and roosters. I talked to God and he talked back. Maybe it was the hallucinations but we had some great conversations where he promised to get me home if I finished the work.
About 3 AM my stomach began to really hurt. Aching pain radiated to my back and sides. A feeling of impending nausea and diarrhea overcame me.
WEDNESDAY AUGUST 20, 2003
I went to the medical clinic the next morning and asked my savior Dr. Bruce what to treat myself with for diarrhea. He put me on Flagyl because I had been on antibiotics. I had never taken Flagyl before. Ten minutes after the first pill went down, a rash, not unlike a giant relief map began to sequentially cover my entire body. Hugh wheals of hives spread from my thighs to my torso.
Clinic was no different that day. The pathology was beyond all I had seen and only what I had read in textbooks. I had to tell some patients that there was no hope for them. Not in Ocotopec, not in Tuxtla, not even in the United States. Their problems were either congenital or retinal. No treatment.
Faces expressed resigned disappointment. Families guided the helpless away. Prior to leaving, they still hugged me and thanked me for my time.
That morning the post-op patient came in, walking on her own. She had taken off the eye patch over night. I saw her lean down and fix her shoe from across the room. She fixed her shoe. It was then that it registered to me that she could see. If she could fix her shoe, she could see. My heart began to skip beats. I stopped itching. I ran over and lifted her lid. She could see my face and see my hand moving. The eye was not pretty but it could see. If she didn’t get an infection over the next week or so, I may have accomplished something.
Judith did the one cataract case that came back that afternoon. Dave was unable to operate at all, due to a recent neck surgery. The angle of the optics on our prehistoric microscope was too vertical for him to move into position. Fortunately for us (not the patients), the other cases scheduled for Wednesday never showed up. They had originally walked four hours in either direction from their surrounding villages and probably did not have the stamina to repeat the journey.
This surgery was a marvel. It seemed we had ironed out all the glitches after yesterday. Newer sutures had arrived (along with the missing autoclave) and combined with a readjustment of the optics on the microscope and better organization we had a perfect case. Judith operated, I assisted. When the cataract came out we practically clapped. Until we saw the retina. Just behind the cataract. Where it did not belong. This meant she would most likely not see. Ever. Cataracts were not her only problem. Long standing diabetes had ravaged her retina. There was no way of knowing this beforehand. In the US, we can tell using ultrasound before surgery. Here, the only ultra-sound was the noise of the honking bus horn.
The medical clinics packed up that night. Everyone was leaving in the AM but us. Mournfully, we watched them pack up and stow away all the supplies knowing that tomorrow would leave us stranded in this small area of hell. The sisters of the convent promised us a ride back to Tuxtla on Friday via Georgio, the handyman who lived at the convent. Georgio was willing but told us that the road might not be able. Landslides, washouts and avalanches seemed to be getting more frequent.
Dinner that night was somewhat subdued. Tequila flowed for those who needed it. For those who didn’t, bed beckoned like a mirage because sleep was elusive. My stomach still hurt so I continued to take Flagyl even with the rash. It just got progressively worse.
THURSDAY AUGUST 21, 2003
Again the bells and horns sounded in the morning at 5:30 AM. Why oh why did I come on this trip? The bus driver needed to be beaten on the head with a big stick.
I threw up twice overnight. Came to find out from Dr. Bruce that alcohol and Flagyl do not mix. An enzyme gets inhibited and the alcohol turns to formaldehyde. I hadn’t drunk any alcohol but I had been brushing my teeth with Listerine twice a day because there was no potable water. Turns out that Listerine is full of alcohol. My body has never been so sick.
This morning everyone left. We were alone. Pharmaceuticals were no longer available and we were the only doctors left (to care for ourselves if the need arose).
Two of our four scheduled cataract cases arrived and were guided into the now bare bones clinic. Again, the other two did not show.
I scrubbed after we laid the patient on the operating table. Judith was assisting me and Dave was circulating. Barry, a nurse, had decided to stay with us and Daniel, an interpreter was accidentally left behind.
The case could not have gone better. By this time, we knew all the instruments and all the glitches with the microscope. Dave played Frank Sinatra on his battery powered computer laptop. My hands worked with muscle memory, remembering the movements better than my mind.
After the cataract came out I knew this one would see. I knew I had taken one patient from total blindness into the functioning world. She was taken from only being able to see light to 20/20 vision. Hopefully, she would beat up the Tuxtla bus driver with her now obsolete walking stick.
One other case was performed that day. Judith operated just as well and we had another return from the world of the blind.
I left the operating room ecstatic. Two paces out I crashed and swooned against the wall. All my adrenalin had left me and only my fever remained. Enough was enough. I went out to find Georgio. Judith agreed to see the post-op patient for me the next day. It was 2 PM but Georgio said we were lucky and it hadn’t rained all day. He would take me home that afternoon.
Dave returned in the truck to Tuxtla with me, leaving Barry and Daniel to help Judith with the final packing. Being a doctor (albeit an Ophthalmologist), he was concerned about anaphylaxis since I had taken another Flagyl to prevent multiple pit stops along the drive back. The rash was now no longer discernable as to where it began on my legs and where it ended. I was wheezing softly. He brought epinephrine and syringes just in case.
The road leaving Ocotopec was even worse than when we arrived, ruts as large as small swimming pools. Faces watched us as we passed, some from doorways, some from the street, all with the same quiet, resigned passivity. It took four hours to return to civilization. I had never thought a traffic light could look so beautiful.
Many people, both on the mission and at home have asked me if I would do this again. I wonder if I made a difference. I did make one and most likely two people see again after years and years of darkness. Would their lives be better? The hardships still existed. They still lived with dirt floors and smoky cooking fires in their homes. They still drank filthy water and never learned how to read.
So would I go again to Ocotopec, Chiapas, Mexico?
Definitely.
