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This was the second collaborative mission between VOSH AL and VOSH FL. Our first was the October 2004 educational and healthcare mission to Peru. This was also a great trip. Nicaragua is a beautiful country with lovely people who have been subjected to unbelievable brutality and terror for many years. Granada is a beautiful, but badly damaged, old colonial town with fascinating architecture. We heard lots of stories about Somosa's reign, the Sandanistas, and the Contras from the people there. We visited a prison called Coyotepe located on top of a gorgeous mountain just outside Granada. It was donated to the Boy Scouts, who now give tours. Talk about haunting, terrifying, claustrophobic, torturous...too many emotions to describe. Blood is still visible on the walls of the torture chambers. Then go outside and get an incredible view of the area, with Lake Granada on the horizon. Of course, you have to climb to the top of one of the guard towers to do so. There is only enough room for a peak and a machine gun through the three to six foot thick walls. It was more secure than Alcatraz...no on ever escaped. Another prison in Granada is known for one of Somosa's other tactics for getting rid of political rivals. There, prisoners had to choose between death by lion or by tiger. The Nicaraguans are starting to pull out in a now democratic society, but they need a lot of help. Japan, Cuba, and China have a big presence there in that they own a lot of the manufacturing facilities. Japan has built roads and hospitals. Unemployment is 60%, and those who do work are highly underpaid. The average salary for a teacher, pretty high level, is $180 per month. The factory workers make less than $20 per day and are often treated as slaves, beaten and humiliated by some of the foreign, as well as local investors. It is all tolerated there, though the people are unionizing, striking, and making more demands for a better life. There was a teacher's strike and march through Granada when we were there. Many of the upper echelon, educated people who left during the times of the Somosas and the Sandanistas are now returning and bringing with them hopes for the future of their country. Many still only return to visit relatives or help the people, as is the case for Dr. Rudy Vargas, the leader of our group. Rudy is the founder of the group FOR Nicaraguan Health. FOR is the acronym for Friends of Rudy. He is an absolutely charming, caring, dedicated humanitarian. He is the reason 40 volunteers went on this trip. The medical team was comprised of top notch physicians and surgeons, mostly from UAB. There were five ophthalmologists who performed surgeries at the local hospitals, including cataract surgeries, corneal transplants, laser for diabetic retinopathy, vitrectomies, pediatric strabismus correction, and an enucleation (eye removal to save the life) for a baby with cancerous retinoblastoma. Rudy left Nicaragua in 1967 and has practiced Endocrinology here in Birmingham since then. He has taken a medical and surgical group back to Granada, his home town, for the last 5 years. He has done a lot of good for the health care of the community, most importantly establishing a health clinic where the poor can afford services and are provided medications free of charge. Our VOSH group (www.VOSH.org) worked in that clinic, the Alabama Granada Clinic of FOR Nicaraguan Health (www.fornicaraguanhealth.org). Our participants included Max Bruss, (VOSH Florida), Kim Zebehazy, an Orientation and Mobility Instructor from Pittsburgh (now working on her PhD, VOSH AL member) and I from the US. Max did autorefraction, oversaw the dispensary, and was responsible for overall patient flow. Kim dispensed eyeglasses, trained low vision patients with special low vision devices (high power glasses, pocket and stand magnifiers) and taught white cane skills for those who needed it. Four Nicaraguan volunteers who have worked with VOSH FL previously on VOSH missions to Nicaragua met us and spent the week helping their countrymen. Lester Orlleano speaks perfect English and was our go-to guy for anything that we needed. Sergio Romeo (a former Contra) ran the autorefractor and served as a high level translator. His daughter Maria Romeo (a law student) translated and did just about anything necessary in the clinic. Dr. Dunia Mendoza, a lovely, hard working Nicaraguan optometrist trained in Mexico, joined us Monday morning. Dunia has worked on a number of VOSH missions in Nicaragua before, including one with VOSH Florida a couple of weeks ago. VOSH stores equipment, medications, and glasses at her house for safe keeping. Suzy Bamberg, leader of VOSH FL, completed a mission in Nicaragua a couple of weeks before our arrival. Suzy had prepared an inventory of glasses left with Dunia, which allowed us to take necessary fill in prescriptions. This was an amazing help. Dr. Nelson Rivera of Texas, who also served with Suzy on that mission, helped us with all necessary translations before our mission. Unfortunately, our fearless leader, John Gehrig of VOSH Florida, Legal Counsel for VOSH International, and leader of many missions to Nicaragua, was unable to join us for this mission due the health problems. We saw 678 patients (plus all of the volunteers) during the five clinic days. We were also helped by Cheryl and Shorty Williams, FOR volunteers from Birmingham who last year set up the computer and phone systems in the Alabama Granada Clinic. This year they continued that work and also helped with dispensing glasses. On the first day of the clinic we were also joined by Lowell Smith, a registered nurse from North Carolina who has been visiting Central America since he retired in November, volunteering and basically seeing "what I can do to help" in his words. He was living in a hostel in Granada, was an unbelievable asset to the clinic, and translated for me on a routine basis. The physician who practices at the clinic, Dr. Claudia Cajina Mora organized the volunteers, took visual acuities, and learned as much as she could about our operation. We left reading glasses for her to dispense at the clinic. The director of the clinic, Fatima, made arrangements to meet any of our needs, and organized her volunteers (who included some Lions Club members). The clinic volunteers were among the most dedicated and conscientious with whom we have ever worked. VOSH International recognizes that in order to make best use of resources, it is necessary to learn as much as possible about local health and eye care availability and needs. While we were in Nicaragua, Max and I arranged to visit as many NGO eye clinics as we could. Max can talk to anyone and has a gift for meeting people and gathering information. The clinics we visited included the VOSH NECO permanent clinic in San Juan del Sur, the Louisiana Optometric Association Clinic located in a Catholic School in Granada, and the Decano Lions Club Health and Eye Clinic in Granada. The VOSH NECO clinic has eye, medical and dental services. The clinic was seeing medical and dental patients that day. The eye lanes had been disassembled. We were told that the clinic area is undergoing renovations. The Louisiana Optometric Association Clinic has two eye lanes. The Dental Association has four dental lanes. The dental lanes were being used while we were there. The eye lanes were not being used. They also have a well-equiped lab that is used when volunteers from their group come to use the clinic. Dr. Jim Sandfeur (OD) and Dr. Bill Wayman (DDS) generously offered us the use of their lanes, which were very well equipped. That did not work out for us this year, but we did borrow some equipment from the clinic, and were able to donate some equipment to their clinic on our departure. The Decano Lions Club has built a clinic with a reception area, an eye exam lane, a small optical dispensary, and a medical lane in Granada. The whole group of Decano Lions met us Saturday morning at their clinic and gave us a tour of the clinic of which they are so rightfully proud. They have received much help and guidance from InFOCUS, a non-profit organization formed by Drs. Ian Berger and Larry Spitzberg of University of Houston College of Optometry. They are in need of more recycled glasses and readers. Dr. Dunia Mendoza will take an inventory of needs, and we plan to help them with those needs as we are able. The successes of this mission included examination and dispensing of eyeglasses to 678 needy in Granada, collaboration between FOR Nicaraguan Health and VOSH, surgical intervention for some of the patients seen by VOSH, and future collaborative efforts with ongoing clinics already established in Nicaragua. On completion of this mission, the Alabama Granada Clinic and Decano Lions Club have each invited Dr. Dunia Mendoza to work in their clinics at least two days per month. We hope that the LA Optom Association will consider doing the same. Having a local doctor with a routine presence in the clinics will yield a much better continuum of care for the local community and is a good use of existing resources. This can, and for now, must be supplemented with eyecare brigades such as VOSH. Permanent clinics have been a goal of many VOSHers, and certainly one of John Gehrig’s goals. Dunia’s position with each of the organizations was achieved through his guidance, though he was not physically present on this mission. Dunia was delighted with the arrangements, as she is still in the process of setting up her own practice, and she loves to work with those most needy. Nicaragua is much like Costa Rica was 20 years ago, natural and luxurious in its flora and fauna. It is rich in history, poor in economy, and its people are struggling to make a better life. The Board of Regulators in Costa Rica recently determined it is not in the best interest of their country to host eye care missions any more, and have ruled it illegal for foreigners to practice in Costa Rica without a Costa Rican license. Costa Rica has reached a point where the local professionals can serve their communities, and that is a wonderful thing. Nicaragua still needs help, and we were honored to be able to do so. Perhaps over the next decade they, too, will become self-sufficient in their health care services. This was one opportunity to help them work toward that goal.
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