Diary: Visit to Guatemala with Stephen Saxe, MD

January 13-19, 2009

I have just returned from a mission trip to Guatemala City under the auspices of the World Eye Mission, where I spent a week teaching, examining patients and performing vitreoretinal surgery in conjunction with local ophthalmologists and specialists.  The following is a report of this experience.

I did not know exactly what to expect prior to my arrival in Guatemala.  I had imagined a number of scenarios, mostly revolving around a situation that was very primitive and third world in nature.  To my surprise, this was not at all the case, as Guatemala is a country of great contrasts with many of the conveniences we would consider state of the art contrasted with a majority of the population who have great socioeconomic needs.  Guatemala is a Central American country comprised of 22 “states or departments”.  The country has a population of 12.7 million people, of whom nearly 75% live below the poverty line and 25% live in destitute poverty with an average daily salary of $1.00/day.  The main barriers to eye care are poor geographic distribution of eye care providers, cost, distance to the nearest facility, poor education and lack of governmental programs.  One group trying to make a difference is Visualiza and this is where my encounters begin.              

My first introduction was with Dr. Nicholás Yee Melgar, who with his brother Dr. Mariano Yee Melgar, formed an organization known as the Pescatore Eye Association in honor of an American missionary, Vincent Pescatore who had envisioned establishing eye care in Guatemala for those without adequate access to care.  This association is currently comprised of 3 eye care facilities:  Visualiza Clinic and Surgery Center, in Guatemala City which was founded by the Yee Melgar brothers, both ophthalmologists;  the Vincent Pescatore Eye Clinic in the department of the El Petén, the northern most region of Guatemala, which is staffed on a rotational basis by the ophthalmologists from Visualiza and the Jutiapa Eye Clinic which is the final member of this association.  The Jutiapa Eye Clinic is located in St. John the Baptist Hospital in Jalpatagua in the department (state) of Jutiapa.  This clinic was established by Dr. Antonio Hernández.    The goal of the Pescatore Eye Association is to work towards the “elimination of all avoidable blindness” in Guatemala by 2020.

Drs. Mariano and Nicholas Yee Melgar arranged a robust week of activity during my stay which included early morning lectures at the Unidad Nacional de Oftamologica of Roosevelt Hospital, one of two main public hospitals in Guatemala City associated with the San Carlos University School of Medicine with a large department of ophthalmology and residency program.  It presented a great opportunity to lecture to at least 30 residents and fellows with many of the faculty and local ophthalmologists in attendance. 

The mornings were then followed by seeing patients at the Visualiza Clinic where the Yee Melgar brothers have developed a unique arrangement of caring for both private and “social” patients based on the Arvind Hospital model in India.  The paradigm of seeing patients in this manner has allowed them to subsidize the “social” patients through income earned from seeing private patients.  It was in the “social” clinic that I saw and consulted with the Visualiza ophthalmologists (Dr. Mariano Yee Melgar, Dr. Nicholás Yee Melgar, Dr. Edwin Arias, Dr. Claudia Gordillo) and a local retinal specialist (Dr. Armando Anguiano Penã) who would regularly give up his mornings from his private practice to assist the Visualiza ophthalmologists with retinal care.  This was an extraordinary opportunity to get a first hand assessment of the needs on the ground.  I would typically see between 10-15 patients every morning to discuss practical ways of assisting these patients with their care.  One substantial change was made in the treatment of patients requiring the use of intravitreal injections of Avastin.  This is a drug that is used to treat the “wet” form of macular degeneration and is now being used in other vascular diseases, such as diabetic retinopathy, to slow down the progression of vascular complications.  In Guatemala, a concentration double that being used in the United States had been the standard practice.  By recommending a lower concentration of this drug, a practical adjustment to patient care had been made allowing even more patients to benefit from this type of intervention. 

Out of the group of patients seen every morning, those needing surgical intervention were carefully selected for surgery to be done in the afternoon. These operations took place at Laser Vision, a private surgery center in Guatemala City, with the help of local retinal specialists Dr. Sergio Byron Deutschmann Villatoro and Dr. Armando Anguiano Penã.  Donations from the Kellogg Eye Center at the University of Michigan as well as corporate sponsors Alcon and Synergetics were instrumental in providing needed supplies for these “social” patients who had limited means of covering the cost of these procedures.  We had the opportunity to help a patient who had severe ocular trauma from a gunshot wound to the face involving the eye, to helping several diabetics with advanced diabetic retinopathy.  One additional case that stood out to me was of an indigenous native elderly patient, who presented with complete blindness in one eye and evidence of a retinal detachment secondary to a macular hole in her only remaining eye.  She had no knowledge of Spanish and an interpreter was required to translate from her native language to Spanish and then to English for my benefit.  We were able to successfully repair her detachment, so that hopefully she will regain some useful visual function.  It was having an opportunity to help patients like this that not only made this entire experience extremely gratifying, but also inspirational, as I was able to also benefit from the dedication of these ophthalmologists who have given a significant amount of their career and livelihood to promoting and helping others who need so much, but have so little to give back in return.

I wish to thank the World Eye Mission’s Board members, Dr. Jeevak Lal, President of World Eye Mission, and Dr. Bartley R. Frueh, Professor of Ophthalmology at the Kellogg Eye Center at the University of Michigan Health Services for their instrumental role in recruiting me for this mission.  It is my hope that my experiences will inspire others to participate with World Eye Mission in the work they are doing to help educate and provide eye care for the underprivileged in developing countries.

Patrick Commiskey