Written by Shuhan Wang, MS4 

Hey everyone! Today, we helped remove cataracts for 21 more patients and distribute 150 eye glasses in an abandoned school thirty minutes outside of Riobamba! I met two interesting young cousins in their early 40s, Jose and Carlos, who have retinitis pigmentosa (RP), a genetic condition that results in progressive loss of peripheral vision and night vision. Jose and Carlos presented with cataracts which affected their central visions. Sadly, cataract combined with RP means that their sight was steadily disappearing! Carlos suffered from sharp pain in his eye for 15 years with worsening blurry vision before he could finally find help and learn about his conditions. Our operations today would allow both cousins to regain some of their central visions and hopefully improve their daily life, independence, and functionality to be able to provide for their families again! Just in case you were wondering, our post-operative patients have been doing very very well! I am so happy for the progress they are making.

By the way, I have learned a new favorite term of endearment. It’s “doctorita”!Some of our patients refer to me as such, and I really like it because it makes me feel very familiar and personable to them! I have also been told that people are actually following these blog posts and like what they are seeing! Thank you so much for your continued interest and attention. It is really my honor to bring some of our stories from Ecuador to everyone. If you have any feedback, comments, or questions, please do not hesitate to get in touch! I gladly welcome all of them and would love to share more. Thank you again!

On a side note, due to the many time-consuming patient records problems that we encounter during the days, I have come to realize the usefulness of electronic medical record (EMR) systems in developing country settings and non-profit service platforms. Back in the United States, many medical professionals constantly complain about minor details or glitches regarding the EMRs, but we take for granted the many powerful tools of data capture, analysis, and even crucial safety measures they provide clinicians and neglect the importance of consolidating complex healthcare records methodically. Our Promise to Peru missions have created opportunities for a vast amount of clinical data that could be studied and analyzed to extract helpful clinical information. Looking forward, I would really love to help develop an easy-to-implement, mobile EMR system for medical/surgical missions in less resourceful places around the world. Just something I thought about before heading to sleep and begin dreaming about papa fritas in Spanish! Enjoy mas fotos por el momento, por favor (please enjoy more photos for now)!

When you love what you do, you never have to work a day in your life. This sentiment rings true for us during this mission. While the days can be more than 12 hours long and we are running on just a few hours of sleep, we feel very much invigorated and enormously satisfied at the clinic.

My favorite part of the day is the post-operative checks early in the morning, when we examine patients the day after their surgery to check on their recovery progress and detect any complications. It is incredible to see our patients doing well and even benefiting from immediate improvements in their visions. Many patients went from being able to only perceive hand motions to actually being able to count fingers or even distinguish and read letters on a screen or paper because of the surgery! Quite a few patients, just one day after surgery, were able to see with a 20/20 or 20/25 (near perfect) vision! I’m glad to say – that’s a better vision than me even, by a margin! It truly is magnificent!

As you can imagine, what infallibly keeps our team going is the unsurpassed gratefulness those patients have for what we do for them and for this community. Their gratitude is evident in their eyes, and when they offer us big long hugs, firm hearty handshakes, countless thanks and genuine blessings; it really is deeply fulfilling.

We had the chance to perform many more interesting cases today. The most memorable patient was a 32-year-old young gentleman, Juan, who sustained an ocular trauma at age 14 from a tire explosion. So for the past 18 years, Juan has suffered from severe cataract which seriously limited his quality of life. Due to the extent of his injury (Juan also had phacodonesis with partial lens subluxation due to damaged zonules), there were very high risks associated with his operation. Our three surgeons convened to strategize and considered potentially delaying the surgery until next year (our next mission) when we could return with more advanced equipments to help restore his vision while significantly minimizing his risks of complications. Upon hearing the option that we might not operate today due to missing the optimal tools for his complex condition, Juan could not hold back his tears. This strong young man broke down in front of all of us because he had been so looking forward to this day to finally regain his vision. For a minute, the room was filled with stifling silence and sadness. We thought perhaps we could order supplies right away from the US to have them shipped hopefully by the weekend, in time to still help him during this mission. However, it was not a solution good enough for us. I handed Juan a tissue, but his tears had already melted our hearts. Drs. Sable and Appel, unwilling to give up, thought again long and hard about an alternative. Dr. Krebs also felt strongly about pushing the boundaries of challenging surgical techniques and advocated for providing Juan with a maximum chance at a better vision today. After much consideration, our team had a plan to help Juan proceed with surgery with carefully prepared risk controls and contingency management. Juan and his whole family were thrilled by the decision. They could not be more thankful. Fortunately, the operation went extremely well! The family went around the room to hug us, thanking us again and again. I cannot wait to see Juan tomorrow at post-op check tomorrow!

Today, we also helped a 3-year-old girl who had congenital cataracts which with our surgical intervention and a period of careful patching with correct lens use to prevent amblyopia can have an excellent prognosis that would benefit her for the rest of her life. There was also a wonderfully bright 12-year-old with bilateral uveitic cataracts that resulted in posterior synechia, where her iris got stuck onto the lens of her eye causing a misshaped, almost nonexistent pupil. We were able to create a pupil that allows her to see. We also had 92-year-old patient who lived on the mountaintop without shoes who was nearly blind. We helped her remove her dense cataract, which had gradually made her life more difficult and reclusive over the past years. After her recovery, she would be able to get back to being more active and independent, and enjoy seeing the faces of her children and playing with her grandchildren once again. At the PACU area (post anesthesia recovery), she kept asking me over and over… “Quién es el doctor que me operó?” (Who is the doctor that operated on me?) “Puedes escribir su nombre por favor?” (Could you please write down his name?) “De dónde son?” (Where are you from?) I answered her each time with a bigger smile.

Perhaps our patients think our team was the only group providing positive values in this community, but they may not realize the positive impressions they have left in our mind. It is so beautiful to watch the heartwarming interactions between our patients and their families as they were there fully present for each other, holding each other close, and helping facilitate every step with great acts of love. It deeply moves us in a way that helps us render the best care for them in return.

By Wednesday night, we had completed 53 cataract surgeries. It is so rewarding to think that these are not just 53 lives that we have touched, but also their family members’ lives in which we have made a real impact.

And it’s always important to remember that these impacts we made would not have been possible without the help of so many countless other individuals…

May they all be blessed.

Written by Shuhan Wang, MS4

My eyes popped open with an inexpressible excitement before my alarm could go off this morning. My phone read 6:10am. Outside our window, the mountain town of Riobamba was just slowly waking up.

It was difficult to fall asleep last night, thinking about what was in store for us this coming week. With the clinic all set up, we are ready to operate today! Our goal is to complete 20 cataract surgeries each day, along with an outreach program to distribute 1000+ prescription reading glasses in the neighboring communities. Nevertheless, to David as well as our surgical team, it is not a quantity that we seek in making a difference, but truly the quality of care that we aim to provide for those in need.

By 7:15am, our bus had arrived at the clinic. Taking a deep breath as I stepped into the crisp morning air, I was greeted by the pleasant scent of the mountains that quickly saturated my lungs. Still, the moment David pushed open the gate to the clinic, I was stunned by yet another uplifting and plainly unforgettable greeting – in the small courtyard there had gathered more than fifty patients and families standing in lines for us to be seen! Fifty pairs of earnest dark eyes simultaneously cast on our faces the instance the door swung open… Everyone held their gaze with such heartfelt sincerity and profound respect. Although those eyes might suffer from poor sight, they spoke to us with so much fortitude, hope, and goodness. Not knowing for how long they had been waiting, we jumped into actions without further ado.

The first day of clinic is always a bit of a challenge before our team could develop a rhythm, settle into our roles, and get used to a workflow in a brand-new environment. Working with an unfamiliar set of tools and equipments that might be considered “obsolete” by developing country standards increased the difficulty. However, we quickly managed to function very well as a team, helping each other out wherever and whenever possible. Overall, we did an amazing job today, completing 19 surgeries non-stop. At around 7:40pm, I walked our last patient out of OR to her family after her blood pressure had normalized and sneaked an extra juice box into her pocket for her long trek home. Afterwards, we all gathered to debrief on what went well and what could be improved about today.

When we walked out of the clinic, a beautiful full moon hung low in the cloudless night sky. I was reminded that today was Mid-Autumn Festival! A traditional Chinese holiday where loved ones reunite to celebrate harmony and unity. I missed home. In particular, I thought about my grandpa, who suffered complications from an unsuccessful cataract surgery in China that left him blind in one eye many years ago. He is the reason why I came to Riobamba to help others who suffer from cataracts. He is the reason why I treat our patients the very way I would want him to have been treated. I found it comforting to know that despite being 10,000 miles apart (literally) and regardless of where we are in this world, I could always look up to admire the same moon that illuminates his sky tonight. I also found it consoling that many of our own patients would soon be able to enjoy the same beautiful view!

While being away from our own families, we had each other here in Riobamba. In the late evening, our team ventured out into town and rewarded ourselves for a full day of hard work with some delicious pizza and entertaining impromptu dancing. Indeed, between bus rides, chifas, scalpels, slit lamps, and overdoses of positive vibes all around the clock, our mission team is transforming into a small family unit that we are all growing to know and genuinely care about.

Before I close my computer and go to bed tonight, I just want to give a special shout-out to our entire nursing staff, OR techs, administrators, and sterilization personnel who barely had a chance to sit down or have lunch today in order to perform what was necessary to care for our patients. And I wish to express my respect to our surgeons whose technical expertise, patience, finesse and grace under pressure I find truly inspiring. Needless to say, I am in complete awe of each of my team member’s diligence and dedication.

Tomorrow morning, those 19 patients we operated on today will return for post-operative checks and we plan to perform 23 more cataract surgeries. I cannot wait to see our patients again soon and find out about how they are doing! Goodnight for now. Hasta mañana!

Written by Shuhan Wang, MS4

Buenos dias from the Andean highlands of Ecuador! After more than 24 hours of traveling, our 2018 cataract surgical mission team has finally arrived in Riobamba, a city known locally as the “Sultan of the Andes”. Situated at 2758m above sea level, Riobamba rests in a valley surrounded by five snowcapped volcanos, the nearest one being Chimborazo, which is the highest mountain (6268m peak elevation) in Ecuador.

While enjoying a traditional Ecuadorian lunch complete with chugchucaras, our team learned about the healthcare system in Ecuador, the history and treatment of indigenous peoples, Liberal Revolution and the making of modern Ecuador, the founder and mission of our host organization Fibuspam, a wonderful humanitarian Marjorie Sablow who made possible this mission, and the inception and growth of A Promise to Peru. Perhaps the most memorable meeting for me today was with David Guacho, the executive director of the Fibuspam health clinic in Riobamba.

After David lost his infant son in an understaffed public rural hospital which rendered unsatisfactory care, as a result of an enormous backlog and a pervasive neglect of the indigenous populations, he is convinced that the people of his heritage deserve equal access to quality care so tragedies like his own could be avoided. Since then he has dedicated his life to bringing better healthcare services to his village and the mountain regions by recruiting help from well-trained and highly competent physicians across the country and the world. This is how today our surgical team ended up here in Riobamba to serve 100 carefully pre-screened patients who are in dire need of sight-saving surgeries. In Ecuador, the average price of a cataract surgery is $3000 per eye, but the typical earning of this population is merely $350 a month (and that is if they are healthy and hold a formal job). For many people, this truly is an opportunity of a lifetime! We learned that our patients will be coming from different provinces all over the country to receive care, some as far as requiring a 14-hour bus ride each way.

For the whole afternoon extending into the evening, our team unpacked 1000-lb of surgical supplies, set up our operating rooms for this week, made sure all equipments are up and running, and sterilized all instruments. Although clinic day does not officially start until tomorrow, some patients have already heard the news and showed up today for eye exams.

I met Andrés tonight after he patiently waited for us to set up our clinic. He is a very pleasant 60-year-old dressed in a neat wool poncho and straw hat who suffers from complete blindness in his left eye due to either herpes zoster ophthalmicus leading to corneal ulcer and perforation (with complete lack of light perception) or corneal melting secondary to long-standing rheumatoid arthritis. Andrés also suffers from severe cataract in his right eye, making him practically unable to see. Dr. Krebs, Dr. Sable’s great friend hailing from Michigan who joined our team in Fort Lauderdale, took a careful look under the slit lamp and to my delight concluded that cataract surgery of his right eye would be of great benefit to Andrés! We scheduled him right away for surgery on Friday. Andrés was elated to hear that something indeed can be done to help him see again! He jumped out of the chair and held each of our hands in tremendous gratitude. As much as I would love to savor our experience here in Riobamba, for a moment, Friday could not come soon enough…