Masatepe, Nicaragua 1999

January 18 - 26, 1999. Written by Dr. Jonathan Wasserstein (a.k.a. Juan Carlos).

In January, 1999, a group of fifty volunteers assembled for a mission to the town of Masatepe, Nicaragua. This year's group was the largest that Northeast VOSH has ever assembled for a mission. Optometrists, Optometry students, Opticians, Medical Doctors, Registered Nurses, Physician's Assistants, and for the first time ever, a Doctor of Dental Surgery and crew of Dental Technicians made the journey with Northeast Volunteer Optometric Services to humanity. Over the four clinic days, this group collectively saw three thousand eleven individual patients. The library of glasses that made the vision mission possible was another record setter for a Northeast VOSH mission, totaling over twelve thousand pair.

Part One

Bienvenidos de Nicaragua:

Just wanted to send a message to those of you who were not able to make it. For those of you reading this after returning, this can be a reminder.
We are staying at the Alhambra hotel in Granada. Everything is very nice, unlike last year. The clinic site is the nicest anyone has ever seen. There are plenty of large rooms that can handle all of our needs and more. The glasses are here, and there are an awful lot of them. Another bonus is that we have more translators than ever. No room is without at least one at all times.
Today we saw over 600 patients. The medical and dental groups were overwhelmed. The optical staff saw 367 patients. There were scheduling problems, but we have been assured that we will have more tomorrow. With the group that we have, I think we can handle 600 in optical alone.
Everyone down here is very nice, from La Brigada VOSH to the local medical personnel to the workers. So far things are going very well.
I will attempt to give daily updates after each of the four clinic days. If you want to reach anyone here, please let me know at this address.

Part Two

Bienvenidos de Nicaragua,

Everything went very well at the clinic site today. We helped many more people than yesterday. The eye clinic saw over 550 people today.

The medical group had about 160, and the dental group was also busy all day, though their exact number was unavailable at press time.

The rumor that food prices are up is false. Yesterday, a group of 16 of us went to a restaurant about two blocks from our hotel. Most people had beverages and appetizers before dinner, and the total came to 1000 Cordobas for the group, or about 90 dollars. We were all amazed.

We are looking forward to more successful days in the clinic. I'll let you know tomorrow some wonderful stories some people want to share.

Part Three

Hola amigos,

Everything is going very well to this point. We are working very efficiently, seeing more patients than I thought we could. Today the optical staff saw 635 patients. I think we could have seen more, but the group was pretty beat, and it was very dark in the exam rooms.

The dental group saw more than 70 patients in the morning alone. They spent the afternoon doing procedures including fillings. They taught the local dentist a new procedure, which he said would make him a legend to his patients. The medical group was overwhelmed as usual, seeing 150 people.

A couple of stories to let you know what you're missing. The dental group had a girl with a tooth that needed to be pulled badly. It took 45 minutes, but when they finally removed it, it was unlike anything they had ever seen. Besides removing a little bone, and seeing a little blood, there was an abcess so bad that the pus did not stop coming out. This kid had to be in a lot of pain. We occasionally hear screams from their clinic. I don't want to trade jobs, that's for sure.

One patient I saw was a difficult one. She took her glasses off, and I immediately noticed that one eye was protruding about an inch further than the other. She probably has some form of tumor. The local Minister of Health, Dr. Aleman, arranged for her to be seen by a specialist tomorrow (not Nica time.) We hope we caught her in time to save her.

We have seen some very odd prescriptions here, including ones we don't normally carry. What the dispensary is doing, is finding lenses that match, but in different frames, and filing one lens to fit the other frame. We have a lot of pros with us, and they keep complaining that we aren't working fast enough.

We are seeing a lot more myopic people than we are used to. Vicky Weiss' first patient this morning was -19.00 OU, which we will fill when we get back and ship down, along with a few other special Rx’s.

We are seeing all kinds of odd diseases, from congenital cataracts to scars to some things none of us has ever seen. We could print a book from this year's mission.

I'm going to let you go back to your lives. We wish you were here.

Start to make plans for next year's trip. We have already begun scouting sites.

Part Four

Buenas Noches,

We have returned home. My apologies for not giving a report sooner, but I didn't have time to write on Friday, and we haven't had internet access since. I hope you weren't worried about us. This should more than make up for it.

In our four days at Masatepe, we saw 2151 people in the eye clinic, and 3011 in all of our clinics, according to Marlee Ulm who worked at our registration desk. That's not counting the people we saw that didn't register. You really can't imagine that kind of volume unless you've experienced it first hand.

I will share with you some of our experiences. Many patients complained about eye problems.

A list of them with their English translations:

Me arden - They burn me

Me duele - They pain me

Me pica - They itch me

Me llora - They tear

Me molesta - They bother me

Turbio - Blurry

Most of the above problems can obviously be attributed to years in the sun. However, it was put forth that when the masses found out we were distributing artificial tears and sunglasses, that if those symptoms were mentioned, they would get something. A special thanks goes to Marchon for donating 400 pairs of plano sunglasses, which we didn't run out of until late on the last clinic day.

One thing many of us found very surprising is that everyone who came for an exam wanted eyeglasses, even if they were not warranted. It was considered an insult by some who were told they were healthy and had no problems. Here no one wants to wear glasses, and there being "normal" was not acceptable.

I did see a few people actually wearing the glasses we gave them. I hadn't seen that on prior missions. We saw a lot more myopes this year as compared to last, especially high myopes (-6.00 and up) and high anisometropes (Plano OD and -8.00 OS, for example). Todd DeMario had a couple of these, and just prescribed Plano lenses OU for protection. We even found polycarbonates in our library.

Below are some highlights of the trip, as reported by some of the people who came.

Purvi Shah and Beth Jacowitz both found high myopes, neither of whom had ever worn glasses. The looks of joy on the patient's faces because they were able to see for the first time really touched the examiners.

Stephanie Schwarz examined a woman, who then mentioned that she wanted her son examined by us, but couldn't register him. She saw him, and noticed immediately that he had a congenital cataract, and give him protective plano lenses. The woman was so happy that she gave Stephanie six oranges. You'll see the gift theme prevailing.

Probably the most interesting story was offered by Curtis Akerman. At our mission to Niquinohomo last year, Curtis diagnosed a man with glaucoma, gave him medications, and told him to go to a local ophthalmologist for long term care, including visual fields. This year, the gentleman found us, waited for Curtis, and brought in the visual fields he had done. His pressure was 14 in both eyes, and the fields showed mild losses, but not terrible. But if we weren't there this year and last, this man probably never goes to an eye doctor, and goes blind in the near future. Thanks to us, his vision will not be stolen from him.

I personally saw a 62 year old man who said he just needed reading glasses, and that his distance was OK. I took his word for it, and gave him +2.50 for reading. When I did ophthalmoscopy, it showed that he was probably hyperopic. His final prescription was +6.00 and +7.00 with a +2.50 add. That just reminded me to not always trust what they tell you.

Peter Eudenbach had something happen to him that hadn't happened in 30 years of practice--a patient sneezed in his eye while he was doing ophthalmoscopy! Luckily, we had a supply of antibiotics for him. Peter didn't have that many new stories, as he had been on multiple missions before. The same goes for our other optometrists, including Greg Rios, Hernando Alfonso, Joe D'Amico, and our MD Stu Zipper, though I was touched when one of Joe's patient's (a little girl) hugged him.

Joe spent a day in a really poor area of the country, and saw 50 people by himself. We may take his idea and set up satellite sites for a day for those people in these areas who cannot get to where we are. Bob Plass was working with a woman in the dispensary with a woman who had glasses, which were -19.00 and falling apart. We didn't have glasses that matched her Rx, but he offered to give her a new frame for her lenses. She was very nervous, because se was completely blind without them. But she left very happy, with the sturdiest frame we had. Larry Ulm, being a veteran of the dispensary, didn't see much at the site he hadn't seen before, but he wanted me to tell you about some of the street kids in town. There were a handful of boys, between the ages of around 6-12, that were always begging for money. We were explicitly told not to give them money, because a lot of them use it to buy glue to sniff. Larry gave a boy a yoyo, and sure enough, he traded it for some glue. Shelley Zipper gave one boy a box of raisins one night while we were at dinner. He didn't eat it immediately, but put it in his pocket for later. The boy then went to sleep, and had his pocket picked by another boy. How awful is this?!?!

These boys were all filthy, had no shoes, and never changed clothes. One of the locals told us that they have families, but they can do better on the street because their families are so poor. A few of us gave them clothes and hats. It just tears your heart out.

Joe England, a physician, told a patient that he had an infection of the seno, which he thought meant sinus, but actually means breast. The patient (male) was in shock, and Joe was a little embarrassed.
John Kerwin, our dentist, oversaw a woman who had 16 (out of a possible 32) of her teeth extracted. That'll teach her to see a dentist.

Another patient, a boy, needed a tooth pulled, but it was painful. The woman who was to be the next patient ran away!

Liz Harvey, one of our dental assistants, told me that one family was so impressed that they brought the dental group to their home, and brought sodas to them every day at the clinic.

One woman came to the clinic site with her mother, who needed help walking around. Hilary Zipper took them around for the better part of the morning. The woman was so thankful that she made Hilary a shirt and gave it to her the next day.

There are many more stories I can relay, but I think you get the idea. I did want to pass something along that I think is of excellent value is some of the ocular diseases that we saw. Debi Pian and the other third year students compiled a list of all of the things they had never seen before. I promised them that they would get more experience in one week than in their entire first year in the school clinic. Here is the list, in no particular order:

hypertensive retinopathy, arteriosclerosis, Drance hemorrhage, chalazion, traumatic cataract, nuclear cataract, posterior subcapsular cataract, ectoptic pupils, anterior synechiae, hard exudates, posterior vitreal detachments, vitreous traction, epiretinal membranes, prosthetic eyes, macular holes, vascular sheathing, nystagmus, iris coloboma, microcornea, microphthalmia, Bell's palsy, asteroid hyalosis, toxoplasmosis (both active and inactive lesions,) macular degeneration, retinal detachment (both with and without vitritis,) space occupying lesion behind and eye with an afferent pupillary defect, peripapillary atrophy, staphyloma, IV cranial nerve palsy, bilateral III cranial nerve palsy without pil involvement in a diabetc, diabetic retinopathy, full diamter corneal scars, retinitis pigmentosa, optic atrophy, severe glaucoma in one eye more than the other, end stage glaucoma in both eyes, amblyopia, bacterial conjunctivitis, lots of pterygia, woman born with a shunt in her eye, high anisometropes (mentioned above,) high myopes (up to the aforementioned -19.00,) high hyperopia (up to +13.00,) and high strabismics (up to 40 prism diopters.) Don't forget, there are probably a bunch they forgot.

For anyone practicing for a long time, this may not seem impressive, but taken into the context of where they are in their careers, they showed themselves well.

Now I would like to give special thanks to Carl Sakovits, who for the last few years has been the leader of this group, which is now known as VOSH Northeast. He puts in an inordinate amount of time, but doesn't consider it work. This year he oversaw the delivery of 200 tons of supplies for the relief effort for Hurricane Mitch. He doesn't get nearly the credit, nor reward, that he should.

For anyone wanting to see pictures of the week, the place to check it out, as of later this week, is www.nevosh.com. If this doesn't work, try www.hartbrothers.com. We will also be doing a group chat in two weeks (Sunday the 7th) on one of the same URLs. It was an excellent trip. May all of you who went this year join us next year. May any of you who missed this year join us next year. Please feel free to pass this message on to raise awareness of our group. Donations of glasses and especially money are always appreciated. Contact me for more info.

Hasta proximo ano,

Jon Wasserstein, AKA Juan Carlos