We are excited to be starting our good work here in the Sacred Valley of Peru!

This is a project that is constantly evolving, improving, and also struggling as we face challenges in helping improve the lives of people who live in medically underserved areas in the Sacred Valley and the Andes Mountain.

The project was started by Case Western Reserve University Medical School and the Cleveland Clinic in Ohio. Stony Brook Medical School in New York then became involved with the project and this will be their fourth year participating medical mission and the second year providing cataract surgery to the severely visually impaired. The project focuses on the hopes to collaborate with healthcare professionals in Peru to improve the lives of people living in the town of Lamay and the surrounding mountain villages. Furthermore, through screening patients for advanced cataracts and providing cataract surgery free of charge, the project continues to build and advance towards sustainable care.

Since its inception, this project has been made possible by hours of work and dedication by students, physicians, families and friends who have found a common goal of reaching out to those in need and also learning from them the challenges and the joy of providing care to a medically underserved populations.

We are truly grateful and humbled by the kindness and warmth we have received from the Peruvian communities both in Peru and in the U.S., and the friendships we have formed over the years.

Our hope is that you can bring your unique talents, skills, and passion to making this project even more fruitful and that you will gain invaluable experience through this effort.

Dates of the next trip:
July 1-12,  2013 / Deadline for participation decision February 25, 2013

Affiliated  NGOs: Peruvian Hearts, Peruvian Medical Society
Student contact 

Trip advisors: Debra Messina MD, John Shanley MD,  Natalie DiGioia MD Travis Kumph, Michael Cipoletti

Since this past summer, an exciting addition has been made to the basic medical mission. Under the leadership and guidance of Dr. Debra Messina, we have incorporated a one-­‐week cataract surgery mission to the trip. Patients from all over the region come to the clinic to be examined and evaluated for cataract surgery. Those that are eligible are sent to the operation room set up by the surgical team, after which they are provided with directions for proper care and requested to return for a follow-­‐up visit the following week. At the end of cataract surgery mission last year, we over 400 patients and performed close to 40 cataract surgeries.

Where are we  going?
You will be covering a large area of villages and towns in Sacred Valley Region – located in the Andes Mountain range.  The nearest major city is Cusco, which is about 1 – 1 ½ hours away by car.  It is close to where Machu Picchu, the beautiful Incan ruins and one of the Seven Wonders of the World is located. The image below is of the town of Urubamba, the Sacred Valley village that the trip is based out of whc.unesco.org

underserved, and so a project was initiated to work with them. Peruvian Hearts has introduced us to the mayor of Lamay, and community leaders in the area, such as Edwin Gonzales, who is our main contact person in Peru, owner of the hotel where we stay at, and also a generous philanthropist.  We have also received great help from Dr. Victor Rozas from the Peruvian American Medical Society in getting approval from the Medical Board in Peru to practice medicine in Peru. Helena Van Engelen and her team at Fundacion Niños Del Arco Iris have been instrumental in the cataract surgery mission. Her foundation provides education, medical care and daily meals to many uncared children in the Sacred Valley.

Patient Care

What   kind of  patient  population do we  serve?
The majority of patients who come to us are farmers with limited access to medical care.  We see a lot of chronic diseases, such as musculoskeletal pain, as well as malnutrition, gastrointestinal complaints, skin problems (warts, scabies), and vision problems.  Upper respiratory infections are also common during the season (winter in the Southern hemisphere). Unfortunately, we also face many psychosocial issues, such as depression, alcoholism and domestic violence. We manage these issues in collaboration with the local health care workers, who understand the local culture and can provide long-­‐term follow up. We also rely on local doctors and nurses for acutely ill patients who require hospitalization.

What would my role be in patient care?
This is flexible, depending on who else is there (or isn’t there) when you go, which communities we go to, and what the staffing needs are. We’d like everyone to use all your talents and make the patient care as efficient, safe, and comprehensive as possible.  To give you some idea, these are some examples of tasks you would do:

Pre-­‐clinicalmedstudents(1-­‐2nd  years): See patients Mon – Fri, help with vitals, intake, taking history and performing physical exam with either senior med student or a physician. Help with other areas such as the glasses clinic or the pharmacy. Present cases and help of an attending or a senior medical student

Seniormedicalstudents: They are precepted by a physician. They will supervise junior medical students. Organize case presentations and evening didactics.

Physicianadvisors: See patients in various settings, precept students in clinic, help coordinate didactics in the evenings, provide verbal/written feedback to students.

Nurses: Help with triage of patients, develop patient education material and programs, and help with patient record keeping.

Eyespecialists: Help with collecting and neutralizing donated glasses, perform limited eye exams (direct ophthalmoscopes), obtain donations of antibiotic eye drops and artificial tears, buy eye medications, provide training to students to perform a basic refraction and dispense distance and reading glasses, as well as non prescription sunglasses. Those  interested  in  participating  in the  cataract surgery  mission,  please  contact  Dr.  Debra  Messina  at  the  email provided  on   page  2.   

Studentcoordinators: Be a liaison between the Peruvian healthcare workers and the group. Coordinate travel details, transportation, and didactics in the evenings. Be involved in decision making on which communities to go when and assigning roles for the participants.

Non-­‐medicalsupportstaff: Assist with translating, record keeping, educational material, pharmacy, eyeglasses clinic, taking the vital signs, coordinating patient registration, providing basic arts and crafts to the children.

Please ask specific questions with regards to what your level of training and experiences are, and we can answer case by case what you can do.

What   are  the  requirements  for going  this  year?
- Attend as many scheduled meetings as possible

-  Join at least one of the committees / projects in preparation for the trip.
- Work on improving Spanish skills as much as you can
- Be nice to the coordinators and submit documents / deposits / travel itineraries on time… please!
- Act responsibly and professionally throughout the preparation, time in Peru, and afterwards   

Do   I  need   to  be  fluent in  Spanish?
The patients speak Spanish or a local language called Quechua. Although you do not have to be fluent, all students are required to have basic Spanish skills. There is no Spanish language requirement for physicians and other healthcare professionals. However, we strongly encourage you to study as much Spanish as you can prior to the trip to be able to provide the best care to patients.

How  much  would  it cost?
Donations for the project are suggested, but you are only responsible for the cost of your travel. The estimated cost of the trip for one week is $1,500, however this can vary if you decide to share a room with others. The prices are based on the presumption that the airfare is purchased in early spring. If you wait to book your flight in April, the cost may be as high as $1,400 for the airfare alone.

Airfare: $1,000 roundtrip from U.S – Lima $200 round trip airfare between Lima – Cusco

Accommodation $25-­‐60 / night if you pay ½ of the hotel cost as deposit by April 1st

Food: ~$20/day (breakfast, lunch, dinner)

Public Health Projects:
- Clean water Project
- Parasitic desease prevention
- Physical therapy for back pain

Patient education sessions:
- Back exercises
- Patient education sessions
- Dental care
- Women’s health
- General hygiene
- Pediatrics Project
- Record keeping/Patient data coordination
- Medication coordination
- Collecting medical equipment and supplies

Coordinators
- Clinic coordination and student education during the rotation
- Hotel coordination
- Packing supplies
-  Travel coordination
- Website management

Health  Professional   Organizers  (non-­students)
- Nursing Coordinator, Midwife, PT/OT
- Family Medicine Residency Coordinator
- Medical Supervisors

Preparation  classes
- Spanish classes and cultural sensitivity
- Patient interview simulation sessions

The mission in 2012 had an unprecedented response from volunteer faculty.  Some of the physicians that joined the mission this year were Stony Brook alumni, faculty and staff at Stony Brook Hospital and physicians from the metropolitan area.  The medical mission that traveled for four weeks to remote towns in the Sacred Valley included attending physicians, nurses, medical students, other health professionals and family members. The participants were John Shanley, MD, Robert Bobrow, MD and his wife,  Evelyn Marienberg, MD (’88) with her daughter, Traci Downs, MD( ’94), Miriam Maher, MD (’94), Tiffany Moadel, MD (’11), Glenn Sterling, MD (’88) with his son,  Paul Galstian, OD and his son, Joyce Quick, PA, Dorcas Casuala, RN, Candice Miller, RN, 18 medical students: Amanda Chu, Brendan Carr,  Neva Castro, James Connolly, Danielle Duhame, Justin Dredge, Jonathan Kristan, Saira Mehmood, Kaveh Moghbeli, Galaxy Mudda, Ruksana Rangwala, Amy Rumack, Elliot Schottland, Brianne Sullivan, Mari Yasunaga, Elizabeth Young, Jonathan Young, Ava Satnick, a Stony Brook Masters in Public Health student, Michael Yen and a college student Sean Kim from Emory University. They saw over 300 patients each week evaluating rashes, dyspepsia, musculoskeletal complaints, and other primary care related problems. Children received vitamins, worm treatment and had arts and crafts while waiting. As part of the medical mission for the 4 weeks, a traveling eye clinic examined hundreds of patients in remote Andes mountain towns with the aid of an optometrist from Long Island. The medical students were trained in basic refraction techniques and the clinic was able to dispense hundreds of pairs of donated eyeglasses.

The recent addition to A Promise to Peru is the cataract surgical mission.  What prompted Debra Messina, MD to initiate a cataract surgical mission was because of the prior medical mission to the Sacred Valley in Peru in June 2011.  The portable medical clinic had traveled to many remote towns and villages, sometimes a two hour bus ride each way. It was then that she realized a large percentage of patients had advanced cataracts that no pair of glasses could help to rehabilitate their poor vision.  Upon her return she was able to establish contacts with the former president of the Pan American Ophthalmological Society, Dr Francesco Morales who is Peruvian and Dr Shanley contacted the past president of the Peruvian America Medical Society, Dr Victor Rozas.  Through them she was able to obtain the letter of invitation from the Peruvian Minster of Health and the necessary temporary medical licenses for the physicians, technicians, nurses and medical students.  Dr Messina discovered a nonprofit organization, Surgical Eye Expeditions (SEE) from Santa Barbara, California seeintl.org and worked with them to lend the necessary surgical equipment and donate enough medical and surgical supplies for 50 cataract surgeries.  Close to $100,000 worth of donations were raised in the form of medications, intraocular implants, disposable surgical instruments and other necessary supplies to create an efficient operating room that was able to deliver quality eye surgery.  Some of the patients traveled up to eleven hours from the Amazon Jungle, traveling four of those hours on foot to come to the newly formed surgical center. Some of the patients who could hardly make out hand motion a foot in front of them had post-op vision so improved that they could pass their drivers license test here in the United States.  During the week of July 2, 2012 the surgical clinic evaluated close to 500 patients for ophthalmic complaints and 36 surgical procedures were performed. The surgical team consisted of five physicians (Debra Messina, MD (‘88) with her two children and husband George Coritsidis, MD, Michael Sable, MD (‘92) with his son, Farshad Lalehzarian, MD(‘88) with his son, and Amanda Lehman, MD), seven Stony Brook medical students, one operating room technician, Lorena Chinchilla, one college student and three high school students and from Peru we had an ophthalmologist, an internist, two nurses and four translators.  The two ophthalmologists Dr Sable and Dr Lehman examined the patients with the assistance of the medical students and performed the eye surgeries.  Dr Messina continued her role of administrator and supervisor to ensure that the highest quality of care was administered to the patients.  An eye clinic and an operating room were created in the midst of a school, Fundacion Ninos Del Arco Iris in the small town of Urubamba. kuychi.org The founder and director of the Arco Iris Helena Van Engelen provided the surgical team with the necessary support staff, such as translators, provided advertisement on the radio and housed patients overnight if it was necessary. Their assistance was really invaluable to our success. The following week our optometrist Dr. Paul Galstian worked with the medical students examining the 1 week post op patients.  Proper long term follow up for these surgical patients was provided by a Peruvian ophthalmologist Frilo Silva MD in Cuzco.  Having the opportunity to initiate, organize and work with such a talented and dedicated group of medical professionals and students to offer quality eye care to a group of individuals who otherwise would not have had this opportunity was extremely rewarding for all of the members of the mission.

In summary, this year’s A Promise to Peru medical and cataract surgical missions was successful on many levels. On behalf of the co coordinators we would like to express our appreciation to the 12 medical doctors, the one physician’s assistant, the two registered nurses, the one optometrist, the one surgical technician, the 18 Stony Brook medical students, 1 Masters in Public Health student, 1 college student and the 8 family members.   Our goal is to continue to improve the sustainability of this mission with each year, as evidenced by the addition f the cataract mission. We are looking forward to planning next year’s missions already!

A special thanks to the designer of the A Promise to Peru website, Paula DiGioia who volunteers her time and skills to create and up keep the website. This website reflects our mission goals, creates awareness and helps us collect needed donations.

Trying on Toms shoes

Trying on Toms shoes

Receiving Toms shoes

Post Op

Evan Sable with the kids

Dr Leeman assessing a patient 1 day after his cataract surgery

Waiting in the train station while heading to Machu Picchu

Machu picchu from above

Local doctors, students bring medical care to Peru

Times of Smithtown

While a car accident about 10 years ago left ophthalmologist Debra Messina Coritsidis unable to go back to work due to chronic back spasms, she recently found another way to help others receive medical care. Coritsidis, who had a practice in Setauket before the accident, coordinated the cataract surgical mission, part of A Promise to Peru, Stony Brook University School of Medicine’s medical mission to the Sacred Valley of Peru.

“I was at such a loss because I loved doing what I was doing,” Coritsidis said. “I thought this would be a great opportunity for me to still provide care through others on an optometric level.”

This year 19 medical students from Stony Brook, accompanied by physicians, medical professionals and their family members, will work out of Arco Iris Clinic in Urubamba, Sacred Valley, Peru from June 25 to July 20.

This is the first year the mission will provide cataract surgery, thanks to doctors Michael Sable, Farshad Lalehzarian, Amanda Lehman, George Coritsidis, and certified surgical technician, Lorena Chinchilla.

The cataract surgical mission is a five-day mission within A Promise to Peru, with enough resources to allow doctors to perform 50 surgeries. Coritsidis a Fort Salonga resident, worked tirelessly for months, partnering with Peruvian physicians, and getting approval from the Peruvian Minister of Health to bring medical equipment into the country.

“It’s such a thrill when you take someone who can barely see, and the day after surgery they come back and they are reading the eye charts,” she said.

The idea for A Promise to Peru originated three years ago when a SBU medical school student, accompanied by Dr. John Shanley, associate dean for international programs at SBU’s medical school, participated in a medical mission to Peru organized by Case Western Reserve University School of Medicine in Ohio.

This year each school will visit Peru for four weeks, with Case Western students’ last week overlapping Stony Brook students’ first week. During the overlapping week American physicians will present lectures to Peruvian physicians and nurses.

Shanley has seen the mission grow and witnessed the affect it has had on students.

“It has been a life transforming experience for the medical students,” he said.

Coritsidis said last year the month-long clinic saw 100 to 150 patients a day, five days a week, and expects this year’s numbers to be the same if not more, as the number of Peruvians that anticipate this medical care grows.

Shanley said a large majority of the Peruvians they see complain about back problems and poor vision.

“We do a lot of pain management and try to teach them how to lift properly, so that they don’t hurt themselves,” Shanley said. He said last year the mission’s volunteers handed out more than 1,000 pairs of eyeglasses.

Ruksana Rangwala, a medical student who just completed her first year at Stony Brook, said she instantly became interested in the mission after hearing about it from students who went last year.

“What drew me to this mission was the opportunity for students to shadow physicians, who get past cultural barriers to provide care,” she said.

Rangwala said the students pay about 85 percent of the expenses for the trip out of pocket. The 23-year-old, whose goal has always been to serve underprivileged countries, said she believes this trip will be well worth it.

“I know this will drive my passion for medicine further,” she said.

Urubamba from a high

Advert for eye clinic

Kids on line for shoes at a clinic close to 12000 ft near Pisac, Peru

Urubamba sign

Driving to Urubamba, the town where we are staying.

Clinica de salud in Chinchero, where we volunteered.

Children who came to our clinic in Chinchero for a doctors visit.

Members of Team 2012 walking to clinic in the town of Chinchero.

Peruvian woman weaving alpaca wool.

Alpaca wool and the natural sources used to color it.

Children from Cataraqui Clinic

People being triaged in our clinic in Ccototaqui.

Children from Cataraqui Clinic

More to come!

- Gene Romaska has donated numerous surgical supplies in order to assist in giving sight to people with advanced cataracts from remote villages in the Andes mountains. His extreme generosity is appreciated.

- Garden City Surgicenter, NY is sponsoring the trip of one of their certified ophthalmic surgical technician to assist our surgical team in performing 50 cataract surgeries, as well as donating countless instruments and supplies.  Their generosity is greatly appreciated.

- Ophthalmic Consultants of Long Island, NY have donated many supplies for the traveling eye clinic and for the cataract surgical mission to ensure that quality care is delivered…many thanks! www.ocli.net

 - We give our sincere thank you to Blanca’s House is a nonprofit organization of volunteer healthcare professionals who donate their time to provide free, invaluable medical treatment to children and their families in South America and Central America. They donated many surgical supplies to us that will ensure comprehensive monitoring of our surgical patients. www.blancashouse.com

- The Ophthalmic Center of East Setauket, NY have donated many surgical supplies to ensure the success of the cataract mission, thank you for your continued support. www.toceye.com

- J.T. Mather Memorial Hospital, Port Jefferson, NY has donated many surgical supplies to our effort, thank you.

- Folsom Project for the Visually Impaired, Lion’s Club of Folsom California donated 500 pairs of distance glasses to our traveling eye clinic…thank you Don Ring, Ciro Morales and friends!

- Thank you to Island Eye Surgicenter in Carle Place, NY for their donation of surgical supplies. www.islandeye.net

- Ruhof Corporation has donated all of the necessary cleaning supplies for the operating room and cataract surgical instruments for our mission…thank you for your support.

- Thank you to all of the families of St Anthony’s High School, S. Huntington, NY for 300 pairs of eyeglasses.

- Thank you to Southampton Elementary School, Southampton, NY for their collection of many children’s eyeglasses.

- Northport Centerport Lion’s Club, NY has made a generous monetary donation to our mission, thank you Lion’s Club members.

- The parishioners of Blessed Trinity Parish in Breezy Point, NY donated over 100 pairs of glasses, thank you.

- Thank you and the staff at LNK International, Inc for their very generous donation of over the counter medications to help relieve back pain, a very common complaint seen in the clinic. www.lnkintl.com

- Thank you Country Village Chemists in Huntington, NY for once again supporting our medical mission to Peru.  Your generous donation of three automated blood pressure machines and two glucometer devices with all of the necessary accessories will be put to good use on our mission.

- Thank you to Rachel Edmisson-Smith at T.Group/ Safilo Group & Max Leather Belts for their donation of sunglasses for the traveling eye clinic.