MISSION REPORT

YEGUARIZO, PARAGUAY 2008

The Country:

Paraguay is a landlocked country surrounded by Argentina, Bolivia, and Brazil. It has a population of 6.5 million with more than one-third of its population living in poverty. The people of Paraguay are of mixed Spanish and Guarani Indian descent. Guarani and Spanish are the official languages of the country.

The Clinic:

The Clyde E. Bay Foundation was inaugurated in 1999 in Paraguay, South America. Clyde E. Bay and his wife, Celmira (Ellie) Bay utilized their life savings to start the medical clinic. In 2003, Clyde passed away leaving Ellie as Director of the clinic. Ellie is a registered nurse and retired from working for the Peace Corp in Paraguay. Since its opening, the foundation has grown and expanded to offer its services in general medicine, dentistry, gynecology, mental health, pediatrics, emergency medical transport services, and pharmacy. The foundation also has two technical nursing schools.

The Team:

Charles Covington, Mission Leader, is a native Virginian but now lives in Lake Mary, FL. He has two daughters, a son, and seven grandchildren; they live in Sanford, FL, Brookline, MA, and Langley, VA. Before retiring, Charlie worked as a postal inspector for the U. S. Postal Inspection Service and Auditor for the American Automobile Association. He is a member of Silver Springs, Florida Lions Club, Treasurer of VOSH International and a Director on the VOSH Southeast Board. Charlie co-founded the VOSH Southeast Chapter with John Gehrig and Harold Babine in 1996 and has led missions to Croatia, Bulgaria (2), Hungary, Dominican Republic (2), Peru, Paraguay (4), Vietnam, Ethiopia and Cameroon and also participated in missions to Brazil, Romania, Ukraine, Mexico, and Peru.

Dr. John Spencer, our tireless clinic director, graduated from the Illinois College of Optometry. He is an optometrist with Allina in West St. Paul, Minnesota where he practices in a multi-specialty group setting. Dr. Spencer has been on many VOSH missions and will continue to participate in many more in the months and years to come. This trip was especially special for him because he was accompanied by his daughter, Marie.

Dr. Nelson Rivera graduated from the Interamerican University School of Optometry in Puerto Rice in 1996. He now lives in Dallas, TX, but is originally from Puerto Rico. He has been on the VOSH International Board since 2005 and has always wanted to go on a Charlie Covington mission, but he could never afford it. However, this time he had to go to Buenos Aires for the International Association for Prevention of Blindness Congress (IAPB) and when Charlie changed his mission date, it was one week before his meeting, so it was perfect timing that he was able to fly to Paraguay early along with Laura Brusi from the VOSH UNLP (Argentina) Chapter. Dr. Rivera had several memorable patients, but one of the most memorable was an eight year old boy who needed a spectacle prescription of OD -4.50 and OS -3.75 and when he gave him a pair that was reasonable, the boy was all smiles afterwards.

Hunter Hill is an optometrist from New Zealand and lives in a small town called Alexandra. When he is not working, he is picking apples from his orchard to make ‘Papa Hill and Son’s Organic Apple Cider.’ Hunter had always wanted to visit South America and while on a VOSH mission with Charlie, John, and Cookie in Cameroon, he heard about the trip to Paraguay and made sure that we was going to be involved. There were many memorable moments from the trip for Hunter from the “swamp” lady who was the happiest patient that he had ever seen after receiving a pair of +1.25 spectacles to all the inspiring efforts of the Peace Corps translators. Hunter will definitely be returning for the next Paraguay mission.

Laura Brusi is an optometrist and professor at the Faculty of Exact Sciences (National University of La Plata) Argentina. She is the VOSH director of the school’s chapter UNLP-Cs Exactas and she serves as director of a project called “Visual Health for All.” “Visual Health for All” is comprised of students, professors, and community leaders that work together as a team to provide visual care to communities with limited resources. Since 2007, the students have practiced their professional skills for the service of others and have held prevention workshops for people. As if Laura were not busy enough, she also manages to have a private optometry practice as well. She really enjoyed the Paraguay mission and would like to give her thanks for everything.

Alvina Bissoon is from Calgary, Alberta Canada and is an ophthalmic technician at the Gimbel Eye Center. Her desire to serve others and utilize her skills gave her the motivation to join VOSH. She will always remember the feeling of experiencing how grateful all the patients were.

Beverly Curtis is a retired elementary school teacher, mother of two daughters, and grandmother of four. This mission to Paraguay was her second. Her first mission was in 1997 to Hungary and Croatia with VOSH Southeast. It was Dr. John Spencer’s first mission and Charlie was there too. She found the differences between the two trips to be astounding. Back in Hungary and Croatia, she remembers moving from village to village. Sometimes it was three villages a day and the group slept in a different place each night. There was never a hotel, but there was school dormitory, a private home, and a farm house with an outhouse so this was vastly different for her.

Caryl Mikrut (Cookie) is a retired elementary school teacher, mother of five, grandmother of seven, and recent widow. Her first mission was in 1997 to Hungary and Croatia and she has been going on VOSH missions ever since. She tries to get in at least two or more missions each year. This would be her third time to Paraguay and second to the Clyde E. Bay Clinic. She was interested to see how much Ellie has improved and enlarged the clinic. On a trip a couple of years ago to Ethiopia, there had only been three students and they spent a majority of the time with the doctors. So this time, having all of the “kids” out and about was a fantastic help especially in dispensing. She couldn’t imagine how they would have survived without the students’ help especially with Dr. John being the slave driver that he was. She got the ten year Paraguay Argentina visa, so she imagines that she would be back again as she finds it hard to say “no.”

SuEllen Brauer is a retired mathematics teacher from Decatur, Illinois. She participated in the VOSH Southeast mission at the Clyde E. Bay Clinic in 2005 and also participated in the VOSH Kentucky mission in Asuncion in 2006 in which Ellie Bay had coordinated all of the details of the mission. SuEllen was anxious to do this mission to see all that this amazing woman had accomplished at the clinic. Since being there in 2005, there had been many additions to the clinic such as an operating room, delivery room, as well as a nursing school being built and started. This was a particularly special mission having 12 optometry students involved.

Jerry and Joni Arvidson have lived all their lives in South St. Paul, Minnesota. They have been married for 51 years, have four grown sons and eight grandchildren that all live nearby. Jerry served as District Governor for Lions International in 1990-91. As all Governors do, he reported quarterly how many used eyeglasses were collected in his district. At one of those meetings, he asked the question, “What happens to all those glasses that are collected?” He laughs now and says, “The next thing we knew, we were in Nicaragua.” They have been members of VOSH Minnesota since then. As the years passed, they yearned to connect with other VOSH chapters (families) and decided to join VOSH Southeast to Paraguay. They have done missions in Central America, South America, Europe, Asia and Africa and this trip to Paraguay was their 15th mission. They always say that VOSH has changed their lives and most importantly, VOSH has changed millions of lives around the world.

Joanna Starmack (Jo) is an optician who works Allina Meical Clinics in Minnesota alongside Dr. John Spencer. This trip was her first VOSH mission trip. After hearing all the wonderful things that Dr. Spencer had to say about VOSH, she decided to go on a trip and chose Paraguay as her first trip, but hopefully not her last.

Marie Spencer currently lives and is originally from St. Paul, MN. She became interested in going to Paraguay when her father, John Spencer, the clinic director had told her about his previous experiences with VOSH missions. She had considered going with him on a previous mission to Cameroon. However, she did not make that trip, but was very glad to have the opportunity to go to Paraguay. The most memorable experience for her was getting to know everyone and helping all the patients.

Ian Beaumont grew up in Franklin, Manitoba Canada and is a third year student at the Illinois College of Optometry. He has been married since 2003 and is the father of two girls. After graduation, he plans to return to Manitoba to practice optometry. Ian has always wanted to do a VOSH trip even before applying to optometry school. In 2002, his mother was on a mission trip to Peru where she assisted ophthalmologists in cataract surgeries. Her experiences fueled his desire to go on a similar trip. Now that Ian knows what a VOSH trip is like, he will definitely continue going.

Anne Eng is from Calgary, Alberta Canada and is a third year student at the Illinois College of Optometry. Going on a mission trip had always been on Anne’s list of “To-Do’s.” Signing up for the VOSH-Paraguay mission was definitely on a whim for her. She admits that the extent of her knowledge of Paraguay initially was restricted to which major continent it resided within. However, the amazing experience was much more than she had hoped for and she is thankful for her impulsiveness because it gave her the opportunity to travel to the amazing country. She will remember most the gratitude of all the patients. The appreciation that they showed towards her has led her to realize how fortunate she is to be receiving an education that gives her an invaluable gift of knowledge and skills to be able to universally help the quality of life of others. She is thankful to have met all the wonderful individuals on the Paraguay mission team and looks forward to future missions!

Amanda Kunowski is a second year student at the Waterloo School of Optometry located just an hour west of Toronto, Canada where she is from. She knew that she really wanted to go on a mission during some point of her academic career and decided that she was ready and eager to help after her first year of optometry school. She chose Paraguay for a number of reasons, which included that the mission was well organized, located in a safe area, and the team was made of many experienced volunteers and doctors. Most of her favorite memories came from working in the dispensary. Seeing the patients’ immediate happiness and appreciation showed her that the hard work of all of the mission volunteers will be remembered for years to come.

Shirley Oga is from California and is a third year student at the Illinois College of Optometry. The Paraguay mission was a great experience for her. Seeing patients be so appreciative of the glasses they were given was one of her favorite memories. She and her colleagues came together as a team and bonded as they saw hundreds of patients. Getting to meet and work with everyone that was part of the mission was a pleasure. She saw the VOSH mission to Paraguay as an opportunity to gain experience in a different type of clinical setting. What she gained was much more because she walked away from the trip with a sense of purpose, service, and pride in the profession that she had chosen to pursue.

Sonny Parikh is a third year student at the Illinois College of Optometry in Chicago, Illinois and is originally from Skokie, IL. One of the main reasons why he wanted to go on this mission was to really help the people who were in dire need of eye care. He really loved the aspect of dispensing glasses to patients during the mission because he witnessed the payoff of all the hard work that was being accomplished. The smile on the patient’s face when they received their glasses was worth a million dollars. The mission trip really opened his eyes to how important it is to give back to people that are less fortunate. He would definitely do a VOSH mission again!

Darshana Patel is a third year student at the Illinois College of Optometry and is originally from Indianapolis, IN. When she originally signed up for this trip, she had hopes of being able to not only learn more educationally, but also more about other people and cultures. This trip fell nothing short of those expectations and actually far exceeded them. In Paraguay, she was able to see many amazing clinical cases that she never thought that she would encounter. The gratitude that patients had was amazing. One particular man was so excited simply because he was able to get a pair of bifocals when he was expecting only a pair for reading. By interacting with the people, she was able to learn more about Paraguay’s culture and language that she would have never picked up otherwise. The teamwork of the group impressed Darshana. One memory that she will never forget about the trip would be all the laughs each night that she shared with her new found friends. She came on the mission trip not knowing many that well and came out feeling that she gained a new family. She looks forward to hopefully getting the chance to work with the same people on a future mission.

Hetal Patel is a third year student at the Illinois College of Optometry originally from Toronto, Ontario Canada. The reason why she wanted to do this mission was because she knew it was going to be a great learning experience and she wanted to take advantage of this opportunity to service less privileged people that are in need of eye healthcare. She found that the trip gave her the chance to meet new people and to learn about their lives. Everyday was a new and exciting adventure. It was an honor for her to work with the Peace Corps volunteers, Ellie, the staff and students at the clinic to give back to their communities and John, Charlie and the rest of the volunteers who dedicated their time to try to make the world a better place with each trip that they go on. Everyone was a pleasure to work with and she is grateful for all that she was taught because she learned so much. Paraguay was her first VOSH mission, but she can guarantee that it will not be her last.

Neal Patel is a second year at the University of Waterloo Optometry from New Brunswick, Canada. He chose to do a VOSH mission in order to increase his knowledge in the field of ocular disease and optometry and to help a community that was in need of eye care. For Neal, this was an incredible trip that held many memorable experiences working with the doctors and fellow students in diagnosing and treating patients in need.

Craig Pew is originally from Texas and a third year student at the Illinois College of Optometry. He had always wanted to go on a mission trip ever since starting school at ICO and Paraguay seemed like a great opportunity. His favorite clinical case was a man who had a posterior synechia along with a massive cataract. The patient was nervous because all the students wanted to look at his eyes. He became worried and nervous that something awful was probably happening to him and he started to become emotional and cry. Craig was sympathetic and relieved his anxiety by telling him that he was going to be fine and referred him to the ophthalmologist. Despite the scare that the student’s actions gave him, the patient was really grateful for the care that he received. This case gave Craig the opportunity to experience a more personal interaction with a patient and get a sense of the Paraguayan culture.

Mailynn Pham is from Lawndale, California and is a third year student at the Illinois College of Optometry. She had wanted to do a VOSH mission trip even before she was accepted into optometry school. However, she was actually apprehensive the night before she was to leave to go on the trip. After meeting all the team members of the trip, all her anxieties were diminished. She realized that she was on the trip with the purpose of working together with others to help those in need of eye care. The trip to Paraguay was very special and memorable for her. She will always carry in her heart the kindness, love, and compassion that her Paraguayan “family” not only showed to the patients, but to each other as well. The dedication that she witnessed every day in Paraguay really resonated in her and she is sure that it will continue to even after much time has passed since the end of the trip.

Paul Rollett is from Calgary, AB, Canada and is a second year student at the University of Waterloo School of Optometry. Paul has personally always been very interested in and passionate about the opportunities that optometry creates for assistance in the developing world. There are not that many professions that allows a person to take a week out of ones schedule and use ones skills to make a tangible difference in the world. Paul was intrigued by the Paraguay mission in particular because of the opportunity that it presented to work on his Spanish as well as work with a team that appeared to be very well organized. His favorite memory of the clinic would have to be the kindness that was imparted to him on his birthday. It was very unexpected to get acknowledged and it meant a lot to be treated so well by our hosts and the team members.

Michelle Wong is originally from El Paso, Texas and is a third year student at the Illinois College of Optometry. The reason why she came on this trip was because she wanted in some way to give back and see what it would be like to serve others through optometry. Her favorite part of this mission was being able to witness true love. It was truly special to see people bringing in their neighbors from afar to receive an eye exam. Experiencing true humbling hospitality and love from our hosts is something she will never forget. The most memorable part of the mission was on a night when two women from a nearby town came and performed their cultural dances for the volunteers. One of the dancers handed Charlie a little flag at the end of the dance and what it represented was moving and embodied what this whole trip was about. Her hope for this trip was to be forever changed, this was accomplished and she is grateful for all the memories.

Our beginning:

Four airports, three planes, a bus ride, and over twenty-four hours later, our team arrives at the Clyde E. Bay clinic in Paraguay on August 16, 2008. After receiving our room assignments and settling in, Ellie, our wonderful host provided us with dinner accompanied with beautiful live music played by two people playing the harp and guitar.

The Set-up:

First, the patients had to complete a form that included some very basic information regarding their systemic conditions, and then they were registered and given a number. They would start off at a room where their visual acuities were taken and recorded. Beverly would then escort and guide the people finished with the visual acuity room to Charlie in the auto-refraction room. From there, the decision would be made whether or not the patient needed to be dilated or not. This was decided upon the patient’s positive history of diabetes, hypertension, glaucoma, or if their refractive error did not correlate to their visual acuities. If the patient was not to be dilated, they were directed to either Dr. Spencer or Hunter or to Dr. Rivera’s and Laura’s room. A quick history would be taken, retinoscopy for a spectacle prescription, and to exam ocular health, we used direct ophthalmoscopy to view the fundus. If anything suspicious was seen then the patient was directed to Alvina in the dilating room. If the decision was made to dilate initially, the patient was directed to Alvina’s room where intraocular pressures would be taken and drops of tropicamide instilled to dilate so that a wider picture of the fundus could be seen. Most patients walked out with a spectacle prescription and would wait in the courtyard for Cookie, Joni, and Jerry to dispense the spectacles. Adjustments to the spectacles were accomplished by Jo and SuEllen. Ian, Craig, Sonny, Mailynn, Michelle, Shirley, Anne, Darshana, Hetal, Amanda, Neal, Marie, and Paul had morning and afternoon rotations to either take visual acuities, auto-refract, see patients who were dilated, see patients with Dr. Spencer or Hunter, or was in the dispensary. The first day of clinic, translators included Ellie, her daughter Laura, Jose (Laura’s cousin), and a family of four from Asuncion who knew Ellie. Peace Corps volunteers came to help translate and they were a tremendous help the rest of our clinic days. Their services were invaluable.

Clinic happenings (a student’s perspective):

August 17, 2008: Day 1

Our team was up early as breakfast was at 7am and we still had to finish setting up before clinic opened at 8am. As we walked across the yard from the clinic and sleeping quarters to eat, to our surprise, there were many people already waiting to be seen by us. We had barely started clinic that morning when a very young crying and screaming boy was brought in by his mother. Upon observation, one eye was red, the eyelid swollen and thus the boy could not open his eyes due to the pronounced edema. The mother revealed that the young boy had been scratched by a cat, but only recently was the eye painful. There was also a mucopurulent discharge. Everything suggested that it was a preceptal cellulits, which is a bacterial infection of the eye anterior to the orbital septum so the patient was given Vigamox (broad spectrum antibiotic). If there was no improvement in two days, the patient was told to come back. This young boy set the tone of how clinic was going to be. It was going to be long, difficult, educational, but very rewarding. Other notable cases that were seen included retinal detachments, albinism, Toxoplasmosis, diabetic retinopathy, hypertensive retinopathy, glaucoma, cataracts, and eye turns.

August 18, 2008: Day 2

Our first day of clinic was interesting, but Day 2 proved to be even more exciting and rewarding. One man came in having been shot in the eye with the bullet having exited out of his head. We saw many pterygiums today, which are overgrowths of the conjunctiva that occur from ultraviolet radiation from the sun. When the pterygiums grow onto the cornea and line of sight, vision is impaired. There were more Toxoplasmosis cases one of which was actually in a nursing student of the clinic who was helping us translate. Toxoplasmosis occurs from a parasitic infection which can manifest in the eye to cause vision loss. The nursing student explained that his vision had been like that since he was very young so we wanted him to protect his good eye by prescribing spectacles for full time wear. Probably our most memorable occurrence of the day was an elderly woman who brought in a jar with a long worm in it. Earlier in the day, she had coughed it up out of her mouth and she was so proud showing it off to everyone and she even posed for pictures with it. One girl had very reduced vision in one eye and after dilation no one could find the answer to as why she had such reduced vision. However, a student walked by and noticed that her eye was turned in. Cover test was performed to check her eye alignment and it showed that she did have an eye turned in that probably led to suppression and amblyopia of that eye. One patient came in with intraocular pressures of OD 79 mmHg and OS 18 mmHg. This was especially alarming for us students because we had never seen pressures that high in a patient before. After instilling IOP lowering drugs (Travatan, Azopt, Alphagan P, and Pilocarpine) and repeating the installation, the pressures were brought down to OD 28. After clinic had closed for the day, most of us were relaxing when five more patients arrived explaining that they had driven quite awhile to come and see us at the clinic. After permission from Dr. Spencer, we were able to examine the patients even though the clinic had been shut down for the day.

August 19, 2008: Day 3

The clinic saw almost twice as many patients today as was seen on Day 2. There were more cases of retinal detachments, cataracts, hypertensive and diabetic retinopathy, and glaucoma, but there were also cases of optic atrophy, posterior synechia, and a foreign body removal procedure done. An interesting case was of a young boy who came in with his sclera grown over his iris and pupil of his right eye. His mother told us that he had a machete accident when he was just a few years old. One student was dilating a patient when it was noticed that while one eye was dilating normally, in the fellow eye, the horizontal meridian seemed to be dilating, but not the vertical meridian of the pupil. Upon closer evaluation, it was observed that the lens had attached itself to the iris and the patient had a posterior synechia. The patient was cyclopleged to attempt to separate the adhesion, but that caused angle closure and the patient’s intraocular pressure elevated so drops were given to lower the pressure. One student noticed a small abnormality of a patient’s cornea, but it was not apparent what it was. It turned out to be a metallic foreign body, which was removed by Dr. Spencer. The visual acuity room also had its share of excitement when a patient had a seizure while trying to do visual acuities. The clinic’s doctor was immediately there and she was taken to the hospital in Asuncion.

August 20, 2008: Day 4

Even more patients arrived on this day. We saw patients with the same types of complications as the days preceding such as retinal detachments, cataracts, hypertensive and diabetic retinopathy, etc. However, a different case presented in a young girl who arrived with an ocular motility dysfunction and found that she had the exact signs and symptoms of Duane’s Retraction Syndrome. During her exam, she did not want to be dilated, but we wanted to give her an accurate spectacle prescription so we needed to cyclopege her. After a while she was more calm and relaxed in our presence. One of the more notable case for this day was after clinic was closed. A patient was brought in by his friend who had a scratched cornea from barb wire. He was in much pain so he was given an NSAID, fluoroquinolone, and was cyclopleged for some relief of the pain. After treating the patient, the friend looked worried when he wanted to ask us a question. However, we all laughed after hearing the question. He just wanted to know if his friend was allowed to drink alcohol. That night, after dinner, local dancers came to dance for us in their cultural dresses. We were all touched by their offer of appreciation.

August 21, 2008: Day 5

This last day, we had the most people register to be seen at the clinic compared to the previous days that we had been here. So far, each and everyday had been new and exciting with all of us being pushed to our abilities. Day 5 was not any different. One memorable case was with a young man who was not initially sent to be dilated, but when a student looked into his fundus, there was something dark and black attached to his optic nerve. It was not evident what it was so he was sent to be dilated. The young man also had a history of eye trauma so we were curious to find out what the dark abnormality was. After dilation, it appeared as though the patient had a Cloquet’s canal running from his optic disc to his lens. One young girl had the complaint that she was looking under the black board. This raised a couple of eyebrows because no one knew what that really meant, but upon observation, it could be seen that she had a little ptosis and her chin was tilted up, but that was not the answer as to why she was seeing “under the board.” It turned out, she had an ocular motility problem and was having problems raising her eye leading us to believe that she had a superior rectus or inferior oblique complication.

The end:

After servicing all the patients in Paraguay, it was difficult to comprehend how they all walked around in their daily lives with no refractive correction. Imagine a world without your glasses and imagine seeing a blurry image of your child every time you look at him/her. One of the most rewarding experiences from the mission occurred in dispensing where patients received their glasses. Each VOSH member working in the dispensary tried their hardest to find the exact prescription the patient needed, but it was difficult to find the exact prescription in the many boxes of donated glasses. Even though we could not provide the exact prescription, they were given the closest prescription that we could find. When the patients put on the glasses, they were immediately ecstatic and grateful for the improvement in their vision. Something so simple such as clear vision that is taken for granted daily was so greatly appreciated by these patients. Witnessing their gratitude and appreciation for the difference that we made in their vision was incredibly rewarding.

Approximately 2500 patients later and 139 cataract referrals of which 42 received eye glasses, we all leave with the knowledge that the memories that we made in Paraguay will always be a part of who we all are now. We hopefully made a difference and enhanced vision in many. We ended our time in Paraguay, but continued our time together as a new family in Buenos Aires, Argentina for our R&R.

Respectfully submitted,

Mailynn H Pham