Catholic Diocese of Spokane, Washington



From the

Official News Magazine of the Diocese of Spokane

Deacon Eric Meisfjord, Editor
P.O. Box 48, Spokane WA 99210
(509) 358-7340; FAX: (509) 358-7302


Spokane medical team helps restore sight to Mayan Indians in Guatemala mission

by Jerry Monks, for the Inland Register

(From the March 18, 2004 edition of the Inland Register)

Patients returned to the Novillero Clinic for follow-up examinations after cataract surgery on the previous day. All patients were given protective glasses and a cap to shield them from direct sunlight. Caps were provided by Catholic Charities of Spokane. (IR photo from the Guatemala Commission)

Faby Turuel, a translator from Guatemala City, holds Isabel, the 6-month-old daughter of Carmelita Chavez Morales. After her surgery in Novillero, Carmelita was able to see her baby for the first time. Isabel’s sister is in the background. (IR photo from the Guatemala Commission)

Santos Guachiac could hardly see well enough to stay on the steep mountain trails. Nevertheless, he was grateful for the opportunity to undertake his second six-hour journey from remote Pacatumah to the Guatemala Mission Clinic in Novillero.

On his first visit two weeks earlier, a team of four optometrists had screened and qualified him as one of 41 candidates for cataract surgery. Now, his son Salvador was again leading him back to Novillero. This time it was for his much-anticipated eye surgery.

Santos had a very bad cataract (2+) that severely blurred the vision in his right eye, but the “white cataract” in his left eye was worse. At 4+, it was so dense that he had essentially no sight from it at all. The optometrists’ recommendation was to operate on the 4+ cataract in hopes of restoring enough vision so the 75 year old man could once again begin to function on his own.

Team personnel and procedures

Preparations for cataract surgery in Novillero had been underway for nearly a year. The clinic floor layout was adapted to accommodate pre-operation, surgical, and post-operation work stations. Much of the essential equipment, including a dental chair to be used for operations, microscope, and sterilizer, had been procured and installed. An emergency generator was also in place.

The Spokane medical team had come together amazingly quickly. Joining the surgeon, Dr. Craig Wilkerson, were his office and operating room technicians, Shawn Shepherd and Dori Buechler. Molly Shine, Mary Zimmerman, and Dorothy Rebholtz volunteered for nursing duties, and Maureen O’Keefe handled anesthesia. Sister Eileen Judge and Clara Monks worked with local staff to prepare patients. Roy Munyan signed on for what turned out to be a critical engineering role of keeping numerous pieces of vital equipment functioning.

The resident Guatemala staff proved to be both talented and versatile. Dr. Jose Miguel, the resident physician at Novillero, along with Sister Immaculata Burke, managed overall clinic activities. In addition to translating in the operating room, Dr. Miguel also instructed patients in follow-up care. His staff assistants, Manuel Carac Lopez, Gregario Casildo Joj Cux, and Delores Lucila Yac Chevez, helped manage patient flow through the system, by assisting in a myriad of patient care activities. Faby Turuel, a Boise State University student from Guatemala City, also joined the staff to help with translations.

Patient record forms had already been computerized and included personal photos to guard against any identification error. Customized lenses had been procured for each patient and a carefully collected supply of drugs and medicines was available.

Clearing customs

In anticipation of inspection by Guatemalan customs agents, the team came equipped with six letters of invitation. Their papers also included 15 pages listing over 315 medicines and supplies, complete with expiration dates on all drugs.

Fifteen oversize bags were needed to transport everything from scrubs and surgical knives to syringes and betadine solution. Some of the temperature-sensitive drugs had even been packed in insulated containers. The nurses’ bags contained such items as needles and IV solutions, while Roy Munyan’s had wrenches, wire cutters, and a voltage meter.

Customs agents at the Guatemala City airport had been fully alerted to the team’s arrival and its humanitarian objectives. There was no delay in passing through customs. Even the ultra-sensitive phacoemul-sifying machine, which was so essential for the surgeries, was passed without question.

After a Sunday morning breakfast meeting in Guatemala City, team members loaded their gear into two large vans and settled in for the three hour drive up the mountains to Novillero.

Problems

Equipment malfunctions required creativity and adaptation on the part of the team. The phaco machine, purchased used, and the Zeiss microscope both developed problems. When it was discovered that the team’s sterilizer was too small to accommodate equipment trays, the equipment was borrowed from an organization in Guatemala City.

White cataracts

Standing first in line in the freezing Monday morning temperatures of Novillero was Bonifacio Garcia Mendez, 43 years old, with severe cataracts in both eyes.

Pre-op preparations included the washing of every patient’s feet and having them change into hospital gowns. Each patient also got a blanket or two. (There was no heat in the clinic.) The surgery schedule had been set a week earlier so that the team could work on some of the easier cataracts first. Surgeries were expected to take about 15 to 20 minutes each.

Surgery on Bonifacio took much longer than expected. When Dr. Wilkerson finally emerged from the OR, he noted that it was “very difficult,” because the cataract was so hard to break up. He hoped the next one would be easier.

Alejandro Garcia was the next patient. After about an hour in surgery, Dr. Wilkerson came out of the OR and said Alejandro’s was worse than Bonifacio’s. His first two cases lent credence to research that cataracts tend to be worse at higher elevations.

Herminda Dominguez came in as patient # 4. Herminda was totally blind. A botched operation 10 years earlier had left her with no sight in her left eye. She could have brought legal action against the surgeon, but that would have sent him to prison and she preferred to “leave it to God.”

When Dr. Wilkerson operated on Herminda’s right eye, he found that the retina was already so badly damaged that he could not restore her sight. Nevertheless, she left in good spirits, thanking God for the opportunity to be there.

Results

Follow-up exams revealed that Santos Guachiac and Bonifacio Garcia, like many others, both got substantially improved sight from the surgery.

Edgar Manuel Coj is a 14-year-old-boy who had no sight in his right eye and a 4+ cataract in his left. Dr. Wilkerson determined that the probability of successful surgery in his left eye was high. He operated on Edgar on Tuesday. Staff members were elated on Wednesday when Edgar’s follow-up exam revealed that he should have very good vision in his left eye after the swelling from surgery goes down.

Carmelita Chavez Morales is a 38 year old mother of 5 children from Santa Lucia Utitlan. With 4+ cataracts in both eyes, Carmelita was almost totally blind. Her 17-year-old daughter, Estelita, helped her with tasks like cooking and laundry. Carmelita could not see well enough to go to the river to wash clothes on her own. She had never seen her 6-month-old daughter, Isabel.

Carmelita had surgery on Thursday and came in for her follow-up exam on Friday. When her exam result was announced to the medical team on Friday, there was no need for artificial tears anywhere in the clinic. The vision in her right eye was going to be 20/20. Now, she could see her beautiful baby, Isabel, for the first time.


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