Back to Work in Guatemala

 I have a lot to write about, starting with something I used to feel every day.  Being part of a larger whole, doing more with many than you can as one.

I retired ten years ago after thirty plus years of heading up a private nonprofit social service agency that served children and families.  Each day of my working life I was reminded that the work of keeping those children and families safe and healthy went way beyond my efforts as an individual.

Without good staff as partners, and foster parents, funders, volunteers, board members, and community supporters; my individual efforts would have produced next to nothing.  It was the group that mattered, the quality of that group, our connectedness, our ability to understand and communicate what was needed by those we served, our ability to plan and carry out those plans.  In the end I was a small part of that effort, but I felt so connected.

When I retired, I felt a loss.  Working as part of a group can be frustrating, but infinitely rewarding.  I was part of a common effort so long I took it for granted.  In retirement I re-create it occasionally, mostly at church.  Our church does more than worship.  We feed people.  We provide programs that help others outside of ourselves. 

While serving lunch on the second Sunday of every month for eighty community people I am reminded that while in theory it is possible to pull that off as an individual, it is wildly impractical.  You need people to set up the tables and put out the salt shakers.  Others to bake at home and provide desserts.  Still others to form a serving line, keep the platters and pitchers full, gather up the dirty dishes, put the tables and chairs back, clean up.  Someone might create the menu and prepare the main dish, but no one does Second Sunday lunch alone.  We do it together.  It feels good being part of that group.

Of course, all that went away during the pandemic.  So much changed.  Save for a very few efforts, all group activity ended.  It grew very quiet.  You could hear the crickets.  And feel the loneliness.

In the fall of 2019, while planning an I Care International optometry mission to El Salvador in early 2020, one of our volunteer optometrists brought up a concern.

“There’s a virus developing the medical community is very wary of, something like the SARS virus.  They’re calling it coronavirus.  Depending on how far and how fast it spreads, some say it could affect travel in 2020.  Anyone else concerned about it?”

“We’ll be home by the middle of March,” I said.  “I don’t think there’s any chance that could involve our trip.”

Others agreed.  We went ahead with our plans.  Forty some volunteers paid for plane tickets to San Salvador and assembled at airports in Illinois and California the first week of March 2020.  At O’Hare, we noticed more people than usual wearing blue surgical masks prior to departure.  When we arrived back at the airport ten days later it was chaos at customs.  There were rumors of temperature taking and denying flight access.  Within a week the whole world seemed to shut down.

Three years later in 2023, I Care International resumed its work with a mission to San Lucas Toliman in the Guatemalan highlands.  We partnered with a medical facility in that rural lake community which lent us the use of their small hospital to host a five-day clinic that served just over 1,500 people.  We masked up, as did our patients, required vaccinations of our volunteers, and proceeded cautiously as before providing free eye exams and used eyeglasses to those whose vision required correction.  There were no cases of COVID detected among our many volunteers or our patients as far as we knew.  It was business almost as usual, with a healthy dose of caution.  I hadn’t realized how much I missed it.

My work takes place at Station 6.  On that first day of the clinic someone is inevitably assigned to make six signs on sheets of white paper.  Equipped with a big black magic marker and masking tape a first-year volunteer from California sat among boxes holding over 7,000 pairs of glasses with a clipboard in her lap and laid down six numbers writ large along with the Spanish translation of the station.  Intake, Nurses, Acuity, Autorefractor, Doctors, Dispensary.   Soon they were taped up throughout the hospital, creating a path a person needing glasses followed to receive them.  Step by step, volunteers at each station worked with each person individually until they reached my station where, with eight or so other dispensary volunteers, we completed the process. 

Once again, I forgot how much I missed being part of a larger whole, doing more than I could possibly do myself.  It came back to me in a rush when I encountered the people we helped up close and personally.  Here’s two examples of the assistance I Care volunteers provided to some fifteen hundred people in San Lucas Toliman Guatemala earlier this month.

 

 Juan, age 84, showed up in the dispensary with his wife and elderly son.   Their son was helping his mom and dad through the clinic, up and down stairs, through the six stations.  Neither of his parents saw well, particularly his mother.  She was functionally blind.  Juan had cataracts, his left eye was clouded, and he wore very old glasses, thick, which had been repaired by his family many times over. When I asked to see them, he removed them carefully and handed them to me.

Taped, wrapped in thread, sewn, secured by a cord, I could see how precious they were to him.  How important they were to his existence.

“Por cuantos anos tienes éstos”? (How many years have you had these?)

Juan looked away and thought for a moment.

“Mas or menos veinticinco.”  (Twenty-five more or less.)

“Pienso que es tiempo por otros.”  (I think it is time for another pair.)

“Sí,” his son said.

I dipped his old lenses in a basin of water we kept on our work table and dried them with a soft towel.  They were hopelessly scratched.  Fragile, but still working.  I laid them in his wife’s open hand.  She held them carefully.

I unwrapped the new glasses the pickers had chosen from our inventory for Juan.  They were high minus, -6.50 with a little cylinder.  I knew the left lens wasn’t of much consequence.  Juan relied on his right eye to see the world.

Wrapped around the plastic bag holding the new glasses was our one page form. On it was Juan’s name, address, occupation, and a self-report of his eye problems.  The nurses had taken Juan’s blood pressure and recorded it.  Not bad.  As I suspected his visual acuity, how well he read the eye chart, was negligible in the left eye without glasses and hardly improved with them.  His right eye without glasses was nearly the same but much improved with his old glasses.  He wouldn’t have passed his driver’s license exam in the states, but with the proper corrective lenses he could navigate his surroundings, see the faces of his family, and enjoy the sights in the world around him. 

His old glasses had been measured by the doc with a lensometer and found to be -8.0.  Advanced age and cataracts change things.  Sometimes less is better.  With the help of the autorefractor reading, the volunteer optometrist reduced his prescription.  I hoped for Juan that she was right.  We were about to find out.

I unfolded the temples on the “new” donated used glasses.  They were big round lenses set in a sturdy metal frame.  Expensive when new I guessed.  Perfect for Juan.  Now if he could see well through them.

“Prueba éstos.”  (Try these.)

I handed them to Juan.  He inspected them, turning them over slowly, then hooked them behind his ears.

“Mira allá.”  (Look away.)

He did.

“Mira el arbol.”  (Look at the tree.)

I pointed in the direction of a big broad leafed tree conveniently located across a courtyard near the street.  It was my crude eye test for near sighted patients.

“Mira las hojas?  Or simplemente verde?” (See the leaves?  Or just green.)

“Yo veo las hojas.”  (I see the leaves.)

Juan looked from the tree to me and smiled.

“Cómo es?”  (How is it?)

“Muy claro.” (Very clear.)

Juan continued to smile.  He looked at his wife and son.

“Son buenos?” (Are they good?) his wife asked.

“Si.”

“Felicidades,” I said.  (Congratulations.)

“Muchas gracias senor,” said Juan. (Many thanks sir.)

“De nada.” (You’re welcome.)  “Pienso que éstos serán buenos por veinticinco anos mas.”  (I think these will be good for another twenty-five years.)

Juan’s wife asked if we possibly had a new strap for the new glasses.  We did.  Megan, who worked beside me fitting glasses and whose Spanish was good, had thought to bring some.  Though with a small adjustment the glasses fit Juan snugly, I suspected his wife wanted the strap to make sure they were safe.  We forget how precious simple things in our lives can be.

Before they left, I asked “Con su permiso, una foto?”  (With your permission, a photo?)

As Juan left, helped by his wife and son, they each shook my hand.  Juan’s wife took my hand in both of hers and carried on a bit.  I didn’t understand it all but caught the word “bendiga.”  (Blessing.) 

 Slowly the small family walked away.  Juan with a new view of the world around him and me truly blessed, reminded of how gratifying it is to work with others who share my wish to accomplish important things.

 

My last patient at the end of our busiest day caught me unaware.  Sara, at the opposite end of the age spectrum from Juan, was five.   Like him, she was myopic.  Near sighted.  In some cases, optometrists choose to delay correcting myopia at an early age if it is not severe, suggesting instead to move those children to the front row of desks at school to see the board.  Glasses at an early age can cause young eyes to lag in their development.  Universal vision screening is typically done around third grade, age nine.  But Sara was seeing very little.  She needed glasses now.

I Care International has recently come to keep an optometrist at the dispensing station to help volunteers like me, who are not eye care professionals, with cases like Sara’s and others.  It’s so helpful to have someone to consult with who knows more than you.  When I looked over Sara’s sheet, I immediately talked to Dr. Julie.

“Oh boy, look at this one.”

Sara’s young age and the severity of the prescription the optometrist had written was daunting.  I was afraid we wouldn’t have anything to help her.  I was also worried about getting accurate feedback.  Sometimes it is hard to discern if the lenses are truly helpful or if a young child simply wants to please the adults around them and says yes to anything.

Julie looked it over.  “Let me pick this one myself.  We’ll give her a range of choices.  See if you can tell by her expression which one is best.”

“I’ll try.”

“Let’s look at her first so I can see what size frame is going to work.” 

Heads at any age vary greatly in size.  I called Sara’s name and a very small face, along with her mother’s, turned towards us.  Sara’s face was tiny and cute.

Soon Julie returned with four pairs of small glasses.  She pointed to a pair with red frames. 

“That’s my first choice.  Good luck.”

I invited Sara and her mom into my office, two plastic lawn chairs in a crowd of people, and went to work.

“Buenas tardes Sara, como está?”  (Good afternoon, Sara, how are you?)

She looked right at me and not at her mother.

“Bien.  Y usted?”  (Good. And you?)

That she responded so quickly, and clearly, was encouraging.  I shook her little hand.

“Mi nombre es David, y nosotros esperamos ayudar a usted ver mejor.” (My name is David, and we hope to help you see better.)

Sara smiled.  Her eyes may have needed correction, but they did not want for brightness and expression.

“Tengo cuatro pares de gafas aquí.  Uno es major que los otros.  Es necessario que usted me diga cual es.”  (I have four glasses here.  One is better than the rest.  You need to tell me which it is.)

She nodded.

“Los primeros.”  (The first.)

I hung the red framed glasses on her ears.  She immediately smiled.  I pointed to my tree.

“Mira el arbol.”  (Look at the tree.)

“Claro.  Muy claro.  Yo miro los hojas.”  (Clear.  Very clear.  I can see the leaves.)

Sara was way ahead of me.  Any fears I had of her not reporting accurately how well she was seeing vanished.  We tried the second, third, and fourth pairs and as she looked at the tree each time she repeated “Los primeros son mejores.” (The first are best.)  She had no doubt and neither did I.  I put the first pair of glasses back on her.

I gave both Sara and her mom my prepared raps in Spanish about glasses.  I explained how the lenses are plastic and best cleaned with soap and water, then dried with a soft cloth.  Don’t rub them dry with your shirt.  I told them Sara’s glasses are for seeing far away and will most likely not be needed for reading.  When you read, take off your glasses.  General advice.

Sara looked and listened intently.  She was an engaging little girl.  I have a two-year-old granddaughter named June who has a lot in common with Sara; a winning smile and bright eyes that, when they meet yours, convince you she understands way more than she lets on.

I gave Sara’s mom the pair of glasses closest to her preferred pair’s prescription as a backup in case she lost or broke the first pair.  I gave Sara a Pez dispenser, which she liked a lot.  We stood up.  Sara’s mom reminded her to thank me, and Sara hugged my leg.  They disappeared, Sara wearing her new glasses, down the stairs. 

The clinic was over for the day.  My co-workers were gathering their things and leaving.  I went down the hall and found a chair away from everyone.  My feet hurt and I was tired.  I felt tears well up in my eyes and let them flow.

As I get older, I get more emotional.  I feel blessed to be part of an organization that made its way through the pandemic to a small town in Guatemala.  I was grateful that Sara and her mom, and Juan and his family, and all the others we served found us.  It is good for your soul to be part of something bigger than yourself.  I recommend it.  Thanks for reading all the way to the end.