Santiago Mission

In this special edition of Eye Spy, I wanted to share some of my experiences with a medical mission to the Dominican Republic. Every March, ILAC (Institute for Latin American Concern) hosts a group of ophthalmologists, opticians, nurses, scrub technicians, administrators, and other volunteers in a small town outside of Santiago. This group, largely from New York, is headed by founder Dr. Robert Della Rocca and loyal recruits who return for one week of volunteer work each year. ILAC's mission is to perform sight-saving surgeries and ocular reconstructive operations for indigent farmers with little to no access to health-care. This year has had the largest showing of volunteers with a team of seventy that settled on Santiago de Cabelleros for the week, paying their own plane fares and accommodations.

Some arrived early to set up the operating rooms, pharmacy, clinics, eye-glass fitting room, and screening areas. In each of three operating rooms, three operating stations were established, so that nine surgeries could proceed simultaneously. U.S. drug companies such as AMO-Abbott, Alcon, Allergan, and Bausch & Lomb donated cataract machines, eye drops, and OR equipment, and some sales representatives even arrived to act as surgical assistants. Thanks to the Peace Corps, we also enjoyed the luxury of computerized booking this year, which streamlined the arrivals in an orderly fashion. Over 200 patients registered daily for screening, many of them already pre-screened in their mountain communities, so that only those necessitating medical attention were triaged to the mission (not just presbyopes in need of reading glasses). In the next few days, we would work in our designated specialties ten- to fourteen-hour days.

The Oculoplastics team performed dozens of reconstructive ocular procedures for patients with blind painful eyes, droopy lids, facial traumas, and burns. They implanted prostheses after careful reconstruction of the ocular sockets with fat grafts from the thighs, and removed tumors and large masses from the lids and orbits. In children, eyelid lesions and droopy lids can lead to life-long vision loss due to amblyopia (normal wiring for the visual system does not develop because the brain is deprived of vision from a young age).

Meanwhile, the pediatric team set cross-eyed children (and even some adults) straight -- the proper term for misaligned eyes is strabismus. This team really put in everything they had and worked from very early in the morning until long after sundown, barely pausing for lunch. Having the eyes properly aligned at a young age, gives children a chance at good vision for life, and helps to prevent amblyopia. Some of the children, having never seen a physician before, were not nearly as scared of us as their American counterparts. For the most part, they were cooperative to perfection and even curious!

As an anterior segment surgeon, I had the pleasure of performing surgery on patients who arrived with bilateral blindness from cataracts so white and dense we called them "coconut cataracts." Anticipating their ability to regain sight, patients danced their way to the operating room, accompanied by claps and singing of family members in the pre-operative area. What a contrast from the anxious waiting areas of American operating rooms! The next day, these country-folk who had not seen better than motions of objects or light, were able to clearly distinguish small letters on the eye chart. They were delighted to be able to see again, and we were even more so (secretly).

In addition to cataracts surgery, I performed pterygium removals (growths on the cornea) so large that they occluded the visual axis. I had never seen pterygia grow so large in the U.S., and was amazed that even access to this relatively simple procedure was not available to these Dominican communities. While removal of this growth in America amounts to no more than a cosmetic procedure for most patients, in the Dominican Republic, it is truly a sight-saving operation.

The screening rooms were an eye-opening experience onto themselves. The amount of pathology that ran through the slit lamps and ophthalmoscopes was astounding. Rare genetic syndromes, uncommon infectious diseases, and other eye afflictions we rarely encounter in training were the norm in the ILAC clinic. Although we were unable to offer help to many of the patients with chronic or congenital illnesses, they were grateful for their care, and blessed us for our efforts.

The spirit of camaraderie ran high amongst the volunteers, and the mission home kept the troops going with home-cooked meals from the kitchen. At night, the crew, together with Peace Corps volunteers, would usually go out for some meringue dancing, dinner, or karaoke at local bodegas or downtown Santiago.  New connections and friendships rapidely formed amongst the nurses, doctors, and technicians. Many of the volunteers are long time participants who began their work with this mission ten or fifteen years ago. Some are sons or daughters of volunteer parents, and were now joining the force on their own. If it were not for the incredible esprit de corps that ran through this enterprise, it would not have survived so many years.

This mission was inspirational for me in so many ways. I consider the ability to restore sight to be truly a godsend.  It made me ever so grateful for my training, the long hours of study and busy call nights. The gratification that came from smiling patients who saw their grandchildren for the first time made it all worthwhile. In the end of the day, though, I could not help but feel we had only touched the tip of the iceberg. We came for one week to help a small community in a rural portion of one country, while hundreds of underdeveloped countries remain bereft of any type of health-care. The thousands of patients for whom surgery was not a sight-saving solution returned to their homes without the hope of regular follow-ups and care for their chronic diseases. Our ability to help seemed so limited in scope in the grand scheme of things, and left me with a feeling of sadness and frustration. I can only hope that for every patient whose quality of life improved as a result of surgery at ILAC, a small window was opened to the world.