Trujillo Honduras

I Care International, a volunteer organization that brings large scale vision clinics to parts of the world where eye care is desperately needed, went back to Trujillo, Honduras for the second year in a row. We just returned from a ten day trip in the early last Sunday, February 16th. I’m just now rested up and reflecting on our experience.

It was our third recent mission to Honduras. In 2011 we operated in a large urban city in the north, San Pedro Sula, and after encountering crushing numbers of citizens seeking care, asked our Honduran hosts to find a more rural community on our return. In 2013 we were asked to serve Trujillo, the last large town on the Honduras’ Caribbean shore before the relatively unpopulated Miskitia coast sets in. Trujillo is seven hours of bad road by bus from San Pedro Sula and a far different community; smaller, poorer, with less access to eye care. There are no eye care professionals in Trujillo. After our experience there last year we added a team of surgeons equipped to perform cataract and other basic vision saving procedures during our clinic.

There’s risk in traveling to Central America, particularly Honduras. If you’re prone to worry, you’ll find plenty to occupy your time. There’s the State Department warnings for one thing, which are in effect virtually all the time and change little, relating the troubles encountered by Americans travelling in the area. Then there’s the murder rate. In 2012 the murder rate in Honduras was 86 murders reported for every 1,000 citizens. That made Honduras the murder capital of the world that year. One disturbing trend is the growing number of murders among journalists reporting criminal activity. Not that we collectively take much notice. You have to go looking for that story in the media. We’re much more alarmed about politics in the Middle East than the woes of our neighbors in Central America. Most in the know, including Jesuits who live and work in Honduras, attribute the violence mainly to drug trafficking and the cartels that control it, along with an underfunded and ill equipped army and police presence. That’s the national back drop.

What we encountered as volunteers in Honduras on a personal level was far different. We were invited to the community by the city, its Rotary Club, and the Catholic Church. We worked in the local hospital and municipal facilities. I Care is a non denominational, non political organization with a single focus, providing eye care to those who need it. And despite a few individual experiences that ranged from sketchy to alarming, the forty six I Care volunteers who made the trip were free to do just that throughout their stay in Honduras.

Not that it was easy. Finding a suitable place to work was our first problem. Large building space is at a premium in Trujillo. After placing our surgical team at last year’s clinic site in the hospital, we rejected their first location, a public building in the town square that was too small, as well as a second, a church facility that was too disjointed. We eventually set up our six station optometry clinic in city hall. On Thursday and Friday, the first two days of our four day clinic, visitors to the mayor’s office walked right through our dispensary, located just outside his office, to keep their appointments. Other staff relocated to give the doctors a room with less light and air conditioning. They mayor gave us that great Spanish line “Mi casa es su casa.” He also gave us most of his bi lingual staff, who helped as interpreters.

The local private bi lingual school, as they did last year, sent their ninth grade students to help translate and they worked tirelessly, even on Saturday and Sunday when school was out. Lois, their principal, an American woman who has been part of the Trujillo community for seventeen years, came with them and was our go to person for community information. Across the board the community provided great support and did all they could to accommodate us.

We saw 1,188 persons in four days in our clinic. Most of those people received glasses which improved their vision greatly. And while we do not have an exact number, upwards of 55 persons were the recipients of vision saving surgical procedures, mostly cataract operations. For a person living in poverty to walk into a free clinic in a third world country, have a serious eye condition diagnosed, and emerge the next day with clear vision following the removal, for example, of a dense cataract, is amazing. Their efforts, and the efforts of the optometrists and third year optometry students working with them to identify those individuals, made this mission nothing short of miraculous.

Speaking of those students, we were fortunate enough to have four third year students and one fourth year student from the University of Missouri at St. Louis accompany us to Trujillo. They worked hard. I Care operates on something of a triage model. When we encounter persons with healthy eyes and relatively normal vision problems our docs quickly write a prescription that allows those dispensing glasses to match them with the best used glasses possible and move on to the next patient. That flies in the face of all the students' training in America which demands they be as thorough as possible with each and every person they see. Students in an I Care clinic struggle to reconcile the conflict inherent to those two approaches. They have to trust their instincts, maybe develop them along the way, ask for help only when it is needed, and spend their limited time on those patients who need further care. This group of students did that extremely well. And they did it with great care. I look for kindness and compassion in persons new to an I Care clinic. These five women topped the charts in that regard. Let me give you an example.

After clinic was over the students stayed in Trujillo while some of us left town on side trips. After paying a visit to their translators at their bi lingual school, the student docs made their way about the city and discovered an orphanage we were not aware of with seventy children in residence. As they visited the facility they asked those in charge if they could bring equipment in and test the children’s vision. The next day they set up a mini clinic, tested every child’s vision, discovered seventeen children who needed glasses, and went back to our stock of glasses and filled their needs. They didn’t have to do that. Clinic was over. That’s the kind of volunteers they were.

That’s the way it works on these trips. You start out wary of the environment, worried about the politics, and perhaps apprehensive for your safety. Then you find yourself face to face, nose to nose, or knees to knees, depending on your function in the clinic, with real people. You get caught up in them, their fears, their questions, their concerns. What starts out as a trip to a third world country with a questionable record on human rights turns into an encounter with a community of individual people. Pretty soon the local volunteers are introducing you to their families, you are seeing familiar faces not only every day in the clinic but on the streets in town in the evening. Some of them are wearing the glasses you gave them. They see you and wave. You wave back and smile. You forget the murder rate.

Am I painting the experience as all goodness and light? That’s not right. To illustrate another side of life in Trujillo let me tell you about two women who came to the clinic, which could have taken place in any town, really, in rural Central America. Americans take so much for granted.

We were crammed for space. Each station had people waiting to be seen. Doorways became logjams. Achieving a smooth flow of patients through the clinic was nearly impossible. One of our veteran eye docs who practices in Illinois set up her exam station in the corner of the dispensary. She carved out a dark corner, spread out her equipment, and began her hectic four day schedule of helping the students and examining patients herself in a space that was at best 6 x 6’. She had an especially bright and hard working translator, a ninth grade student from the bi lingual school, who helped her each of the four days.

I dispense glasses. I know enough Spanish to work on my own and I have done enough missions that I know how to make glasses fit a face. My office, as it were consisted of two folding chairs and a piece of newspaper. Four fitters worked side by side on eight chairs. I balanced glasses on my lap, or the patient did, and together we found the glasses that helped him or her see the best, both up close and far away. I was a knees to knees guy. When I needed to adjust the glasses to fit there was a folding table of tools. Pretty simple deal. While I worked I often listened to the doc in the corner. She explained in English, plainly and compassionately, what was happening with her patients’ eyes and her young translator did the same in Spanish. This doc also knew enough Spanish to understand some of their questions and concerns. Here’s one conversation.

“How long ago did you lose vision in your right eye?” The doctor was addressing her question to an older woman whose daughter led her into the clinic. Our vision tests, the acuity chart and the auto refractor, revealed she was seeing little or nothing, distinguishing only fingers at two feet in her left eye, and no light perception in the right. Her right eye was obviously long gone, most likely due to trauma.

Her daughter answered. “It happened when she was a girl, chopping wood. A machete accident. But the left eye, it has a cataract. And you have doctors here who can remove it correct? My mother is so excited. With the cataract gone she will be able to see again, yes?” The woman’s left eye had the tell tale milky appearance of a dense cataract.

The doctor turned her attention, and her hand held instrument, to the left eye. She leaned in to the woman, nose to nose, and looked for a long time, then turned and took a few steps away, towards me.

“Something wrong?” I asked.

“Yeah. This woman does have a cataract. But in addition she has severe glaucoma. Even if the cataract were removed, her optic nerve is shot. Had she had even the simplest eye care during her life they would have diagnosed the glaucoma and with proper medication and treatment, preserved her ability to see. Now it’s too late. She’s gone blind.”

“Optic nerve?” I asked.

“Yeah. Think of a camera. The cornea is the lens cover protecting the lens itself, where cataracts develop. The retina has the pixels that hold the image, and the optic nerve is the computer cord you use to download the pictures to your laptop. In the eye the optic nerve connects the eye to the brain. Without that connection, the optic nerve, nothing happens, no matter how good the rest of the equipment. This woman will never see again. One eye lost to a random accident, the other to a completely treatable condition. Didn’t have to happen.”
She turned back to the woman and her daughter, and with the help of her young translator, gave them the bad news that she had just discovered. Our clinic did not produce the result these Honduran women had anticipated. There was nothing more to be done. Before leaving both mother and daughter thanked the doctor repeatedly. They left the clinic, walking arm and arm, one blind and one leading, through the mean streets of Honduras.

Later that day, another similar conversation took place.

“Ask her what caused this injury to her eye,” the doctor told the young Honduran translator after peering into the patient’s eye with her instrument. The patient hesitated. She looked down. We both heard and understood her response in Spanish.

“Mi Esposito me dio un punetazo.” (I was punched by my husband.)

It was an angry looking eye, red and scarred.

“How long ago?”

“Tres mes.” (Three months.)

The doctor turned away. She is a young woman herself. Sometime pain, reflected in the face of one who suddenly imagines and then understands the experience of another, can be just as great as the victim’s pain. She looked at me.

“Did you hear that?” she asked.

“Yes.” We looked at each other. “Will her eye be all right?”

“No. The retina is completely detached. If not completely, bad enough that it can’t be repaired. Our surgeons can’t do retinas here. The nearest retina guy is in Tegucigalpa. But that retina won’t recover. It’s been too long. Her eye is lost. And I have to tell her.”
She turned to her interpreter and they talked quietly. The interpreter took a deep breath and began to speak to the patient in Spanish. The patient began to cry. Then the interpreter cried, and last the doctor. They put their hands on the young woman’s shoulders to comfort her. I went straight to Lois the school principal.

“Lois, who helps abused women in this community?”

“No one.”

“There’s no agency? No shelter?”

“No.”

“How about the church?”

“The church? What would the church do? What do churches do in the states?”

“They offer support. They connect people to someone who can help them.”

“But there is no one to help them.”

“What about the police? Can’t a battered woman file a report and get a restraining order?”

“People don’t go to the police with those problems here. You can’t predict the result. It matters who her husband is, what kind of standing his family has in the community. And a restraining order? That could take months. You have to appear before a judge and no one appears before a judge without a lawyer, and that costs money. The system is too unpredictable. It’s corrupt.”

“So women are beaten by their husbands, injured, and have no recourse.”

“You’re being a naïve American. This woman’s only hope is to leave this situation and hope her family takes her in. If she has children she risks losing them. If her family protects her, she has a chance. If she has no family support, and reports the crime, she could well find herself homeless, or beaten more badly, or killed.”

“Jesus Christ.”

“Well there is his help too of course. You have to understand, these problems between families often get worse. They result in retaliation. Vengeance is strong in these communities. You have no idea.”

“I’m sure I don’t.” Sometimes the world hits you right between the eyes.

I went back to the corner where the young woman continued to cry and our volunteers continued to help her. Another woman had joined them. I took the doc aside.

“Urge her to tell her family what has happened if she hasn’t already. Tell her she does not have to stay in that situation and continue to be beaten.”

“I’ve done that already. Her sister is with her now. She left her husband and is living with her family.”

“That’s good. I’m glad it was you that was here to help her.”

I Care International and its volunteers invest their time and their dollars to go where they can help others see more clearly. In the process a world we didn’t or couldn’t imagine often comes into focus. It works both ways. These trips are not for the faint of heart. I can’t wait till next year.