Reflection by Sara Rondeau, D.O.

Sara, right, with Sister Amalia

*Somewhere in El Salvador, outside of San Salvador...that's all I've got. Geography is not my strong suit.

Well, here I am on the next to last day of my trip to El Salvador. I am here with a PeaceHealth group, providing medical care to the locals. The trip is 10 days, including travel, setup, 5 days of clinic and now two days of sort of downtime.
Internet time has been hard to come by as the group is 27 people and we have only ever had access to one computer at our lodgings. However, today the combination of an emerging head cold and not feeling quite right overall gave me a pass on joining everyone else on the bus to check out the town. So, I thought that I would take this opportunity to get down some experiences of the trip.

Our first night in El Salvador was interesting... We were staying at a Catholic retreat which housed nuns. Apparently this was an extremely luxurious set of accommodations by PeaceHealth mission trip standards. We were in dorm style rooms, so we each had our own room with a single bed and a bathroom. Bathrooms with toilet seats are as good as gold down here. Spares the quads. Right when we arrived and were unpacking, the power went out. Everywhere. For a long time. Somehow I missed the memo about bringing a flashlight, so I stuck close to the neurologist who had instantly whipped out his headlamp and appeared to be mining about the building. I bought a flashlight the next day, the power didn't ever go out again. Figures.

I was hot, sweaty, and icky from the long flight. After a late dinner, we went to take showers...oops. The nuns turn off the water at 10PM. It felt like Candid Camera- futile twisting of knobs...and, nothing. Additionally, you HAD to remember NOT to throw toilet paper into the toilet, which I for one found to be a deeply ingrained habit. So, there was always the threat of backing up your personal toilet, for which you would obviously be personally responsible. The water came back on in the morning. Sans heat. As it turned out, I was the only person all week who didn't get at least some semblance of a comfortable shower. I guess that my room was the furthest from the tank...or, that's just my karma. At our first breakfast, they told us that they were glad none of us tried to leave the dorm during the night since they had forgotten to tell us not to. Because they let the dogs out at night. Um, yeah, I'm glad I didn't try to leave, too. Bad perro!

After getting those few kinks sorted out, the rest of our stay there was very pleasant. The grounds were beautiful, the food was very good and the nuns took good care of us. Of course, I managed to put my foot in my mouth- a member of the group is Sister Amalia, based out of the Sisters of St. Joseph of Peace in Bellevue. I didn't realize that she was a nun at the airport, and a group of us got to talking about scratch tickets and then Vegas. I mentioned that I had plans to go there in April, and asked if she had ever been. "Is that the place they call Sin City?" Yes. Please forget that I ever mentioned it.

The clinic was housed in a parish center across from a Catholic church. We went to Mass on Sunday before setting up our clinic— that was definitely an interesting experience. Not only was there a sermon, but there were also two weddings and a quinceanera. All in all, it was two hours...not surprisingly, I didn't make it. My narcoleptic tendencies do come in handy- already I am admired for my ability to sleep on the bus, even on the little half seat in the aisle that the latecomers get stuck with.

Our clinic was reasonably comprehensive- we brought down a ton of tubs...seriously, at least 50, all packed with supplies and donated meds. There was a pharmacy, a women's clinic, a children's clinic, general medicine and then the eye clinic. All in all, our group was 27 people strong between MDs, ODs, translators and nurses. We started out with 28, including a third optometrist, but she was called home for a family emergency on the morning of our second day. That left me and Ken with quite a row to hoe...there were so many people, it was mind boggling. Every day the line would stretch down the hallway, with more in the waiting area, and even more waiting over in the church where they would send groups of 20 from. Every day we would work as fast as we could, and still have to send people away at the end of the day. I think that we could work that hard all day every day for years and never finish...it was still hard to not be able to help everyone.

Eye-wise, definitely saw a lot of interesting stuff. Lots of people were monocular, in that one eye has been blinded by infection, disease or injury so there was that much more need to make sure that the remaining eye was healthy and protected. A huge majority of people are farsighted, so just having even a pair of readers is huge. That was neat- they often think that they are simply going blind when their vision starts going downhill, and don't realize that it can be remedied with just a pair of glasses. Nice to be able to show them near vision for the first time in 10, 20, 30 years.

One thing that I learned to be careful about was asking "Can you see this?" instead of "Can you read this?" Illiteracy is common and embarassing. There were quite a few cases where nothing could be done for vision, and that was heartbreaking because we were the last hope. However, I think that I caught a few glaucoma cases and gave enough meds to help for at least a while, and hopefully there will be a local clinic that they know they need to visit...Cataracts are definitely an area where we will have a lasting impact. We put 75 people on the list for a group of ophthalmologists coming down in May, with the criteria being blind in one eye and can't see out of the other. I really hope that the surgeries go well and wish I could see the outcomes...oh, well. At least got the ball rolling.

Overall, the people were very gracious and appreciative. The populations varied in degree of poverty from day to day- you could kind of tell by looking at the notes from other clinics. The poorest don't have clean water, and have to drink from the river. They can't boil their water because it is not practical when you are using wood for fuel. So, many of them have parasites...we give them meds to take care of it, but the root of the problem is unfortunately not something that we can fix. Some of them traveled 3 hours to get to the clinic, then waited all day, then traveled all the way back...and yet, halfway through my ocular health exam of one elderly woman, Yankee Doodle suddenly started playing and she pulled her phone out of the woven pouch around her neck. And answered it. Why not? There were only a hundred people waiting in line. I made it into a water break.

I think that 5 days was about the right amount of time for the clinic, though- I was exhausted by Friday. Between early mornings, long days and the heat, plus the emotional toll, it adds up. Also, by the end it seemed like every patient wanted "gotas." Gotas are drops, in spanish. Most people just got a quick screening, but those that we suspected of disease or cataracts were also dilated with drops. One woman refused to even try her glasses until she got her gotas...I learned to just nip that in the bud and tell them that the gotas were only for people with very bad eyes, and that they had good eyes. I guess that word got around that the gotas were where it was at, and no one wanted to miss out.

Now, a nice, peaceful and relaxing day. We moved to a bona fide hotel last night, complete with pool. I am sharing a room with two delightful women, one of whom I will appreciate forever because she gave me her azithromycin. There is a TV and we watched the end of RV last night...it is a heartrending true story. No, it's a cheesy kid's movie that is surprisingly good thanks to Cheryl Hines, Robin Williams and Kirsten Chenoweth. I had a nice lunch, though I accidentally ordered about a day's worth of food because it was all so cheap I figured it was like tapas. When it arrived I understood why the waiter looked at me funny. I made a small dent in it, concentrating on the fried plantains. Super good.

Tomorrow is our last day, another day of shopping and hanging out. I'll probably get some cribbage in, too- I brought my board and have found some worthy opponents among the group. We would gather in the library at night to chat and play games, plus stealthily wait for our opportunity to hop on the internet. I'm ready to go home, ready for clean, wide roads, potable water and my own bed... I've definitely gained some perspective and renewed appreciation for all the things we take for granted- it is a different life down here. Even if it's only a drop in the bucket, we've made a difference to 1,677 people and that was the goal.