Long Island Ophthalmologists Initiate Cataract Surgical Mission to Peru
By Michael Sable, M.D. and Debra Messina, M.D.

Peru?  Did I just say I’m going to Peru? I thought I was just going to dinner. I think I had shrimp something but it was last year and I don’t remember if I even ate breakfast this morning.  I loved medical school at Stony Brook and when I was invited to meet, eat and discuss the possibility of a first time cataract surgical mission to Peru with fellow alumni, how could I say no?  A ten day excursion to the Andes Mountains taking care of people who had no access to medical care.  A trip to take care of Americans? Yes, South Americans.  No NY Mets for ten days?  Ok, now I’m not so sure.  Luckily for me, Debbie Messina has OCD.   The good kind of OCD. All I had to do was brush up on my Spanish. Oh wait, they speak what?  Ketchup? What is Quechua? Incas? Didn’t they live in Mexico?  I had a lot to learn.  I always wanted to travel somewhere and care for those who needed it most.  I never realized how much until I actually did so. Imagine this. People who are so in need that they travel half a day from such remote places that the reality show “Survivor” wouldn’t consider filming. They walked hours in homemade shoes hoping for a chance to improve their health.  Many of their blind being led in by family members to see our doctors.  Complain about waiting? Mumble about copays? Entitlement?  Never.  Gratitude.  Innocence. Sincerity.  Always!  Ok sign me up.  July is winter in Peru. Leaving the Long Island summer to travel to winter? What? Ok, let’s not panic here. Peruvian winter means 70 during the day and a nice brisk 35 at night.  On my way! We all heard of Lima.  Some may recognize Cusco known for altitudes of about 14,000 feet above sea level. But extra credit for those who can spell let alone pick out Urubamba on the map.  That’s where we were headed.  A nine hour flight from JFK to the Peruvian capital, a 1.5 hour flight to Cusco and another 90 minute bus ride to our final destination. I always hated that phrase “final destination”.   Although July 2012 was our planned departure, this mission began a hell of a long time before. Debbie spent countless hours each day for months to organize and coordinate this monumental task.  This involved fund raising, working to secure donations, partnering with organizations and pharmaceutical companies, insuring proper documentation abroad and here in the US, packing some 25 crates of supplies, teaching medical students and worrying if our phacoemulsification machine would arrive in time from North Korea.

When the time came to finally leave, we were a formidable group. We were Team Messina representing ophthalmology, anesthesiology, nephrology, critical care, internal medicine and even radiation oncology.  No we didn’t bring CT guided needle biopsy equipment.   Who was going to mess with us? If they dared, I had my son Evan all 6’4″ 220+ lbs of amino acids along for the ride.

I’ll skip the details of travel as it was long enough living it but suffice to say, things moved along pretty smoothly throughout thankfully because of meticulous preparation and our Spanish speaking technician Lorena whom without I’d be writing a completely different account!  Fast forward, Urubamba.  No this wasn’t where Ritchie Valens was from.  Instead it was like a set out of a Sundance film scene. Nestled in what’s called the “Sacred Valley” and surrounded by the snow capped Andes, it was not exactly what I pictured.   It is small village where about ten thousand people call home.  Striking for me was the abundance of stray dogs living in the street and the lack of homeless.  In fact I didn’t see anyone living in the streets or begging for handouts.  Every block had small connected houses mostly consisting of one room held together strongly by dried mud bricks. Streets were wide enough for a horse and buggy to make a u-turn but they didn’t have horses. They maneuvered through town on foot or by vehicles that can be best described as half motorcycle -half golf cart.  Children with big smiles and little worries kicked a ball around and marveled at our Ipads and laughed when we took their photo and showed them their images. Each corner had some woman barbequing some mystery meat on a homemade grill.  They are still waiting for their George Formans to arrive.  Food in the restaurants were very tasty and interesting.  Anyone care for alpaca ravioli or guinea pig stew?  Interesting however was the Italian influence. I never ate so much pizza. Nor did I ever order Chinese food from an Asian woman in Spanish.  By the way, General Tso’s chicken doesn’t translate well.

With Machu Picchu and sightseeing behind us, it was time to begin the work that had been planned. Time to take our turn to make a difference in this world. Free from any selfish motivation, the journey began.  We arrived at our clinic site which was generously donated by a relocated Danish women who had adopted 15 Peruvian children and opened a school to help educate all ages.   Our operating room was actually better than I could have hoped for.  We had a dental chair that served as our operating table that reclined almost flat enough, almost low enough, almost comfortable enough but definitely good enough.  We had bottled water to wash our hands and almost enough electricity and battery power to supply our equipment. When something failed to work, a local electrician came right over to fix it. Kind of the way it happens when you call a handyman here in the states. Not!  I don’t think anyone of us had any idea of what to expect. We had advertised on the local radio in advance and had communicated with the local doctors to spread the word but we didn’t know how many people would come. Turns out word did get out and in 5 days 500 patients walked or were led through our clinic. 10% had sight restoring cataract surgery, many were given glasses but all were treated with compassion, respect and dignity.  We utilized a large majority of the one hundred thousand dollars worth of donated material.  We used verbal sedation and hand holding to comfort those during their procedures.  We kept charts and followed all standard protocol typical of developed nations with some deviations given our setting.

Several patients stuck in my mind. Our very first, a middle aged man, by Peruvian standards, claimed to have poor vision was evaluated in the pre-operative area.  Vision was 20/50. Certainly not terrible and with supplies to operate on just 50 people we wanted to save for those who needed it most. Turns out this man was only complaining of difficulty reading.   After fitting him with reading glasses he cried out with joy.  “Aye, perfecto!” Followed by hugs for everyone in scrubs. Imagine a two dollar over the counter pair of spectacles and a new man was created.  Another patient, an 82 year old man (which is incredible in itself living in such conditions and still surviving) presented with vision equal to legal blindness in the US caused by the leading cause of treatable blindness in the world…cataracts. He consented to surgery but asked how soon can he return to work.   82 and working, amazing. 82 and blind and working, remarkable. 82, blind and a night watchman, priceless.

Now, although we had basically brought an entire operating room and did our best to keep things sterile, it did get quite hot in the operating room.  Normally windows and doors to the outside in operating rooms are as rare as windows and clocks in casinos.   At one point I felt the need for a breeze and when opening the window wasn’t enough, for cross ventilation, we opened the door.  I believe this would have been a violation back home but to keep me honest, a stray dog wondered in. Open windows I could live with. Open doors the same. But potentially rabid animals had to go.

To keep us all humble, on Wednesday morning, our third day our van hit a half golf cart-half motor cycle taxi. Here, we learned that no matter where in the world one is, it is always the other guys fault.  While the drivers argued we found a 9 year old boy with a deep laceration to his head just lateral to his brow luckily missing his temporal artery.  To add to his luck, if you’re going to get into an accident in the middle of nowhere, it’s probably best to be hit by a traveling group of docs. I had brought along some suture material “just in case”.  With no X-ray available to check for greater injury all we could do was feel for fractures as the laceration went down to his skull. Twenty plus sutures later, we escaped disaster.

We did get the aide of an ophthalmologist from Cusco.  He lent us his portable microscope; otherwise we would have had to carry that with us on the plane, along with the phaco machine and all the rest. Dr Frilo Silva came to observe. You see, he doesn’t do the modern cataract technique so in exchange for the scope, we agreed to show him phaco emulsification. Keep in mind the microscope had no assistant view so Dr. Silva would watch over my shoulder and at times glance into the scope while I moved to the side. After observing one case, he pulled me aside and asked “can you do this for my father-in- law?”  I had to make sure I didn’t miss this in translation and first responded, “do you like him?”.  The following day his in law had topical temporal clear corneal phacoemulsification surgery with post op day one uncorrected vision of 20/20. I have had many ophthalmologists refer their family for surgery here in the States but never have I performed one with their son watching over my shoulder.  That was fun!  To speak of validation, he’d  rather have us perform  the surgery in our make-shift OR instead of in his more professional set up in the larger city which by the way was heavily funded by a German company.

Our final day at the clinic was very memorable.  After packing everything back up, leaving some supplies for a future mission, the entire school’s students lined up and each individually thanked and kissed us goodbye.  For me, it was the most satisfied I had ever been as a physician. I’ m proud of our team not only for the quality of care we delivered but mostly for what they helped me achieved as a physician but more as a person. Many thanks to my new friends here and in Peru and of course mostly to my patients who always teach me how to be a better physician.  I’d travel anywhere in the world to participate in this mission again with Debbie and the team again. It’s been three months since our mission and we have already begun plans for the next. Special thanks to Debbie Messina, MD,  George Coritsidis, MD,  Farshad Lalehzarian, MD, Amanda Lehman MD, and to Michael Cipoletti ( who should be sainted)  Lorena chinchilla, all our medical and high school students. Till we meet again.

This one week cataract surgical mission is part of A Promise to Peru, an organization established in 2011 in an effort to provide the people in The Sacred Valley with health care and public health. The medical mission is two to three weeks in June and July and involves volunteer physicians, nurse practitioners, nurses, allied health professionals, medical students from the School of Medicine at Stony Brook. This past year’s surgical mission was supported by the generosity of many Long Island ophthalmic practices, surgicenters and hospitals. The next cataract surgical mission is scheduled for June 2013. We are looking for volunteer ophthalmologists, optometrists, ophthalmic technicians and surgical technicians to join us. If you are unable to devote your time, but are interested in supporting our effort, we are in need of portable instruments (either to borrow or keep) such as indirect ophthalmoscopes, direct ophthalmoscopes, portable slit lamp, trial lenses, artificial tears and other ophthalmic samples.

Visit our website apromisetoperu.com or contact Debra Messina, M.D. 631.871.7087 or contact Michael Sable, M.D.  516.766.5851 for comments and questions.