Granada, Nicaragua, January 31-February 8, 2014 By Optometry team leader, Joe D’Amico, od

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Granada, Nicaragua, January 31-February 8, 2014

By Optometry team leader, Joe D’Amico, OD

Our small team of 9 included 4 optometry students from the New England College of Optometry. Elise Berthieume and Aimee Mesenberg are both second year students; Tamara Ganner and Thu Nguyen are first year students. We had 3 ODs including VOSH-ONE president Karen Koumjian, Lucie Berthieume (an Ottowa OD and mother of student Elise) and myself. Our team was rounded out by Judith West of CA and my wife Zabelle both of whom did dispensing, frame selection and bifocal measurements. Jay Jordan, OD worked one day and Nicaraguan trained optometrist Grace Salinas worked alongside us for four days.
Our team was part of a much larger organization, For Nicaragua Health/Friends of Rudy, a group numbering some 80 or more individuals on this trip alone. Over the past 15 years, Alabama endocrinologist Dr. Rudy Vargas, who was born in Granada, has garnered the volunteer services of Alabama professionals and lay people to serve the people of Granada and the surrounding area on an annual basis. For more details, see or on facebook: Friends of Rudy Nicaraguan Health.
All equipment, drugs and medical supplies were sent ahead through official channels by Friends Of Rudy. Aside from our team, the group included various surgeons, dentists, and nurses who worked at the Japanese Hospital in Granada or at the hospital in Managua where they also taught procedures to native doctors. Eye surgeries provided included cornea transplants, cataracts, and ptyregia surgery. In addition, Friends of Rudy has also established and supports a small year-round permanent health facility near the center of Granada which is well-known to the people we encountered.
It’s been 3 years since I last was in Nicaragua because, like other VOSH teams, I was no longer able to get glasses, equipment and drugs into the country. I was surprised that Granada (and other parts of Nicaragua) were changing. We stayed in a comfortable hotel, enjoyed good restaurants and lovely vistas. There is a new road (almost completed) between Managua and Granada. The road to San Carlos from Managua is completed. There are clear signs of change: more automobiles, tourist services, locals enjoying evenings out and kids with modern bicycles. While I’m happy for the people of Nicaragua, I found myself nostalgic for the Nicaragua of the past.
Our first day of clinic, on Saturday, was spent screening individuals for eye surgeries for the week. Our eye clinic took place from Monday to Thursday in the second floor auditorium of the hospital . The room was large with ample room for both exam lanes and dispensary. Patients waited in the ample corridor outside the room. Local volunteers attended to crowd control and initial registration so there was not a frenzy of chatter and other noise. Patient flow was comfortable for all.
We attended 775 people in the four days. I have 39 pairs of glasses to be made up and forwarded to the permanent clinic in Nicaragua. All the other patients were given glasses from our inventory. We also gave out over 350 pairs of sunglasses.
As in every clinic there are always especially heartfelt stories to tell. One young woman had myopia over 15 diopters. She reacted with great joy as she read the letters on a dictionary cover some distance away. Further conversation revealed that this was her first pair of glasses. When we asked her what she used before, she explained that she could not afford glasses locally.
Among the prescriptions being made at home, a 17.00 diopters Rx for a beautiful young teen. When asked to write her address and telephone number on the exam form, I was surprised to see her bend her head at an angle about 1 inch from the sheet. It’s amazing that she was able to go to school and learn to read with the extremely high myopia.
Our group worked well together. It was a pleasure to work with the NECO students. I was impressed with them. They were able to do eye exams, knew when they needed help and were not shy about asking questions, it was fun helping point out things and answer their questions. I know I would not have been able to do what they were doing when I was in first or second year. It speaks well for my alma mater.
Among the many highlights of our week was the opportunity to participate in the evening English class of one of our interpreters, Jorge. Some 30 to 40 students in two classes attend 4 to 5 evenings a week for three full years to master English. They know that they have a chance at getting better jobs and having a better life by knowing the language.
Looking to the future, I would love to return to do a clinic in San Carlos and the Rio San Juan, now that the road is completed. A driver we worked with noted that it now takes just 4 ½ hours to travel by vehicle from Managua to San Carlos. In the old days the road trip was upwards of 24 hours due to the poor roads. While I’ll undoubtedly miss the small plane experience, it will be great to be able to take a minibus upon arriving at the airport and travel directly to San Carlos rather than wait until the next AM to catch a flight.
Attached here is an addendum filed by Karen Koumjian, OD, regarding statistics which team compiled from exam forms at the end of the last day of clinic:
We saw 775 people of which 275 were male, and 500 were female. The 41+ years was the largest age group in both sexes (62.5% for males, and 64.4% for females.), and in this age group hyperopes/presbyopes were the most common Rx's (no surprises there!): 76% of the males, and 91% of the females.The most common Rx's in both groups were Rx's between +2.00-+3.75(again no surprises) with 54% of females, and 70% of  males. Perhaps more interesting is that 20% of females in the 41+ needed Rx's of +4.00 and over, versus 11% of males aged 41+. I have more statistics, which will be very helpful in determining the percentage of Rx's to bring to this country in the future. I would assume that the stats for South American countries are similar. 
We do not know how many pterygia we saw, or how many were construction workers or farmers or " worked outside".) This would be very helpful for determining sunglasses, and recommending "sombreros".  My suggestion is that we modify the questionnaire and ask who works outdoors. I would also recommend that we have a section in which we can check off pterygia, cataracts, bad corneas, and maybe "other" for retinal/optic nerve diseases. We can discuss this at the next VOSH-ONE meeting. I would like to see more specific stats from the other VOSH-ONE missions, so we can compare. 
Specifics of this mission have been forwarded to Dr. Dr. Rudy Vargas/Friends of Rudy/For Nicaraguan Health of Birmingham, Alabama.


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