Mission Diary by Dr Lewis, 2004, Chiapas, Mexico
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ROUND TWO
April 2004
Another mission to Ocotepec. Sitting on a plane to Mexico City. All the bags and boxes have made it on board, seventy pounds each to the ounce. Our surgical supplies are engulfed within, buried amongst clothes for the orphanage and scrubs for the volunteers. This time we are a group of seven, two ophthalmologists, one ophthalmic tech and four lay volunteers. Two of the volunteers are young teenage girls traveling with their parents. The first of the parents, Marcella, is Stephanie’s mom. She is vivacious, outgoing and fearlessly optimistic. Columbian born, her Spanish is eloquent and beautifully fluent. Stephanie is fourteen years old, quiet, reserved and mature beyond her years. She denies competency in Spanish, but I believe her to be modest and underestimating her skills. Jon is the dad of Becky, he is a leader in the local Rotary Club. Becky is sixteen years old, a gorgeous, leggy, pale-skinned blond. Jon has dragged her along on this mission to expose her to a lifestyle she’s never seen. Relaxed and easygoing, I don’t anticipate that Becky will struggle with the culture shock. If anything, Jon may struggle with the Mexican men, as they will not be able to take their eyes off his daughter.
Jose is our Puerto Rican ophthalmic tech, big and burly, straight from the hood. His Spanish is slangy but easily fluent, and his technical skills extend past ophthalmology to just about anything needing repair. He is going to be invaluable.
Judith and I are the two ophthalmologists, closer than sisters, constantly fighting like two cats in a burlap sack. We are used to being the commanders, the chiefs, giving orders, and doing everything our own way. Unfortunately, our ways are very different. We always manage to get past the anger and it blows by like a heavy storm cloud after the rain. We have settled into our different niches and while I handle the volunteer recruiting and supplemental funding, she manages to obtain all the necessary supplies.
We encounter a small glitch in Mexico City when our bags are found to be overweight. Although appropriate for weight in New Jersey, in Mexico City, the excess poundage requires hundreds of dollars to supplement the load. One cannot argue with the regulations of a foreign country, but we know we are being brutally extorted. Instead of paying the illegal funds, we leave three boxes of clothing behind. Sister Ernestina is here at the airport and will take the boxes to the orphanages of Mexico City. The airport officials seem slightly miffed but we don’t care. The clothing will be put to good use, regardless of the recipient orphanage.
Three boxes lighter, we fly uneventfully to Tuxtla and then head for the hotels from the airport. Dr. Estrada, our long time friend, is the local Tuxlan ophthalmologist and meets us with trucks for transportation. After checking in, he takes us to a traditional Mexican restaurant where we feast on chicken mole, pico de gallo, pork in a spicy broth, rice and tortillas. The Coronas keep coming and the food is outstanding. We all sleep well with full bellies.
Sunday morning, Georgio arrives from the convent in Ocotepec with two flatbed trucks. Two translators have also arrived, by bus from Mexico City. Daniel was with us on the last mission and has revolunteered his time and language skills. Juan Carlos is new and possibly conscripted, as Sister Ernestina is his aunt. All the luggage is piled into one truck. Nine of us pile into the other. We stop for beer before leaving Tuxtla, having forgotten this purchase when we bought food at the local Sam’s Club. Our spirits are high on this beautifully sunny, Mexican day and we are riding in an open truck with a blue plastic tarp for a roof. We crack the beers and appreciate the warm tropical breeze. The scenery and company encourage easy laughter. A mix of languages fills the cargo bay.
We stop once when we come upon our luggage truck ahead of us, stranded in the road with a flat tire. The guys pitch in and send it back on it’s way. Some of the girls take the opportunity to pee behind a tree in a cow field. I can just imagine the farmer’s view of some very pale, white, skinny behinds.
We reach the convent in Ocotepec around four in the afternoon. The clinic, pharmacy and OR are set up and the work gets finished around seven PM. We have hired a cook, Marianna, to prepare our breakfast and dinners for the week. Chicken stew, tortillas and salad await us after a final mopping of the OR floor.
At bedtime, all the girls sleep together, dormitory style in one room. The men are next door in another. Somehow, Judith and I forgot to inform the newcomers of the petulant church bells and blaring bus horn that commence to sound at 5:30 AM. Some angry roosters have joined in the act and are fighting violently beneath our windows. Two dogs menace one another across the street. No one is understandably cheery at six in the morning. The cold showers do nothing to appease the mood.
Jon and Jose have wormed their way into the kitchen with Marianna and are preparing their desires for breakfast. For the rest of us, Marianna has laid out yogurt, granola, tortillas, fried plantains and scrambled eggs with ham. I sit next to Jose with a cup of coffee. He has made himself fried eggs with fried plantains. He is dipping the plantains into the yolks. It looks delicious. I am convinced. I fry two eggs and supplement them with the leftover plantains. Now I have found a new food addiction. This becomes my breakfast every day.
Clinic starts at nine AM, and the sisters have prescreened the patients over the past few weeks. The most serious eye problems will be seen today. We examine over one hundred twenty-five patients, most with very serious problems. Becky, Stephanie, Marcella, Jon and Daniel are on the front lines, checking vision, pupils and eye movements. In most cases, a Zoque interpreter is required to help communicate patient’s complaints into Spanish. Judith and I are at the back of the clinic examining the patients who have been found to have pathology. Juan Carlos is our interpreter. We have a rudimentary slit lamp and indirect ophthalmoscope. We sign up nine cataract surgeries for the next four days. All are dense, black, gigantic cataracts caused by the sun. Eyes with these cataracts are totally blind.
We also see a variety of pathology that we have only seen in textbooks. We see a case of microophthalmia, an entire family of autosomal recessive retinitis pigmentosa, bilateral severe ocular pemphigoid, possible congenital blindness and multiple traumas of all types. These are the patients we must turn away, the ones we cannot help even in the best hospitals in the United States. It’s very discouraging.
Jose becomes our jack of all trades. He refracts, interprets, vision screens and fixes all the broken equipment. He even fixes my satellite phone when the antenna falls off. Between the screeners and Jose, some serious eye doctoring is going on. After being examined, one patient sits for three hours outside the clinic, reading a Zoque novel for the first time in many years. His newly obtained reading glasses are a miracle to him, plastered indelibly to his face. He finally falls asleep in an upright position, his brain most likely not accustomed to so much stimulation.
Two young boys enter the clinic with their father. The boys are both under ten years of age and the father does not seem much older than twenty-five. He is totally blind. He says that he was traumatically injured during farm work in both eyes many years ago. His eye damage is irreparable. He is concerned that his children are also blind. He does not know why, as they have never been injured, but he reports that they do not see well. Jose diagnoses the problem instantly. They are both extremely nearsighted, one with significant bilateral astigmatism. He gives them glasses and they see clearly for the first time in their lives. They dance and frolic about the clinic, no longer stumbling, curious about everything. They create havoc as only young, exuberant boys can do. Their father is brought to tears.
Around four PM, Judith and I scrub for our first surgery of the mission. I go first, with Judith assisting. The patient is seventy-one years old and totally blind. I am operating on her left eye. All goes well until it is time to suture the eye closed. The nylon suture we have is old and expired and the needles will not penetrate the sclera. In a panic, we hunt for other suture and finally find some blue prolene. It is more difficult to see but the needles are sharp and the case is finally finished.
Judith performs the second surgery and again it is done beautifully. So far, so good, two blind people returned to the land of the sighted. We are exuberant and celebrate with a shot of tequila at dinner. Three surgeries await us tomorrow after clinic.
That night there is a fiesta in the town square for Saint Marco. The entire gang, minus Judith and myself, go out to explore and meet the people. (We are exhausted after operating and opt to go to bed early). Becky and Stephanie bring bags of candy for the children. Jon brings all the clothing he can carry. From my bed I hear chants of, “Go Jets!! Giants stink!!”, for Jon is bribing the children to scream. He is a Jets fan and knows I love the Giants. What a way to teach the kids English. They mimic like parrots with flawless pronunciation. The group returns empty-handed with huge smiles on their faces.
Day number two of clinic is not very different. Eye glasses are dispensed in large numbers and artificial tears are handed out to practically everyone. The smoke in their homes irritates like poison. In the afternoon, Judith and I do three more cataract surgeries, all without complication. We are starting to get pretty good at our jobs.
That night, Jose comes down to dinner looking ever so slightly green. He has succumbed to what I call the dreaded Ocotepec barfy-poopies, a disease I suffered from without respite on the last trip. I prescribe him Cipro and compazine but I fear he thinks tequila is a better cure. Daniel joins him in his self-treatment, more in sympathy as he is not sick. Again Judith and I go to bed early but are benefactors of descriptions of the night before as we sip our coffee at breakfast the next morning. Apparently Daniel can do an unbelievable imitation of a rooster. What that entails we will never really know, as no one wished to tell the full story and some of it was lost in translation.
Today the clinic is winding down and only about half the number of patients show up. Dr. Estrada has driven out with some medical students to show them what can be done in the field. We have prepped the OR and are starting our surgeries early today. We have four cases scheduled to go. I operate first, with medical students breathing through their masks down my neck. Everything goes smoothly.
Dr. Estrada asks if he may perform the second case. Judith and I agree without hesitation. We are curious to see the differences in technique between our two countries. Perhaps unfairly, although unknown to us prior to surgery, we have given Dr. Estrada a difficult case. The cataract is so horribly mature that it has subluxed into the vitreous towards the back of the eye. It will need careful removal so as not to be dropped onto the retina. A different type of prosthetic lens will need to be inserted, one requiring more skillful technique.
Initially, the surgery goes well, but soon I notice that Dr. Estrada is sweating. He has managed to remove the cataracatous lens but cannot insert the prosthetic lens back into the eye. Bits and pieces of ocular anatomy begin to spill out of the incision. Judith looks at me fearfully over her mask.
Diplomatically, I mention to Dr. Estrada that it is getting late. I tell him that if he doesn’t leave for Tuxtla immediately, he will not be able to get his students home in the dark. Gratefully, he breaks scrub and allows me to finish the case. He leaves quietly, medical students in tow. I insert the lens, snip the iris and close the eye quickly. Obviously, there is a great deal of difference in technique between our two countries. Judith and I gratefully contemplate our luck at being trained in the United States. We complete the other two cases easily.
A fifth patient has been waiting all day, hoping we can remove the cataract from his second eye. On the last mission we removed his first cataract and he desperately wants to see bilaterally. With heavy hearts, we ask Marcella to interpret for us. She explains to him that we have run out of supplies and it would be dangerous to attempt the surgery with what we have left. He is disappointed but understanding. We promise to do his surgery first, on the next mission.
That night we invite the Sisters and Padres to join us for dinner. The food is a mishmash of different leftovers, spaghetti with meatballs, chicken stew, beef soup and salsa but the nuns and priests are happy to have it. A normal dinner for them consists of a bowl of broth and a tortilla. Marcella strikes up a conversation about the stance of the Catholic Church on contraception. I, for one, am waiting for the lightning bolt to come through the roof and strike us blasphemers instantly dead. No such catastrophe occurs even when the word condom is used. Instead, an insightful, intelligent conversation ensues about the body as a holy temple versus raging hormones and teenagers. The tequila mellows everyone’s views. We conclude that we are all allowed to disagree.
The next morning we see the post-ops and pack up the clinic. Everyone looks good. Dr. Estrada will check them all in a week’s time to insure that no infections develop and the healing is going well. As is our usual routine, we finish our mission work with yearly exams for the nuns, priests and convent staff. Everyone’s eyes are healthy.
Many suitcases lighter, we all board the truck for the trip back to Tuxtla. Judith and Daniel have opted to stay another day in Ocotepec, to wander the waterfalls and mingle with the natives. The rest of us are more than happy to hop our transportation home. We have worked hard with little sleep and cannot wait for civilization. Jose is still nauseated and feeling feverish. The mood is less frivolous on the ride back, partially because the weather isn’t cooperating. Storm clouds hover the entire trip home. At one point I casually say to the group, “You know, God is probably grateful for all you have done. I cannot believe what we have accomplished together.” After a few seconds, Marcella smiles gently and quietly replies. “All I’d ask Him for, in return right now, is a shower. I’m feeling pretty grungy.”
I am touched and awed by her generous spirit.
Not more than one minute later, the storm clouds above us break with a vengeance. Rain thunders down onto the truck tarp and the wind hurls water through every gap. In seconds, we are all drenched to the skin and freezing cold. A pause ensues as we look at each other. Then we begin to laugh hysterically.
As the old saying goes, “Be careful what you wish for.”
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