Volunteer Eye Mission to El Salvador, 2023

James Umlas, MD

At the end of January 2023, I will have the good fortune to participate in my twenty-fifth annual eye campaign in Santa Ana, El Salvador. As a senior Tufts ophthalmology resident in 1995, I became involved with ASAPROSAR (Salvadoran Association for Rural Health), which is a multifaceted clinic serving the medical and socioeconomic needs of underserved populations in El Salvador. This experience has been one of the most rewarding and satisfying of my professional and personal life. I look forward to the annual ten-day excursion all year long and I have formed great friendships in the process. Through my experience, it has become clear that the medical knowledge, skills, and resources that we have available here in the United States are extremely valuable and applicable across the world.

ASAPROSAR, which is based in Santa Ana, with satellite clinics in San Miguel and other locations, was founded by internist Dr. Vicky Guzman in the 1970s, before the Salvadoran Civil War (1979-1992). She has dedicated her life to bringing quality healthcare and social services to people in El Salvador. Dr. Guzman saw a great need for eye care, which was beyond the reach of most people in her country. She initially made connections with congregants of the United Church of Christ in Norwell and then with Dr. Joseph Bowlds, a now-retired Lahey Clinic ophthalmologist, who organized the first eye campaigns in the late 1980s. We have formed a 501c3 partner organization to ASAPROSAR, which is called Partners for Visual Health (PVH ).

The earliest mission trips were conducted in church halls and community buildings, and frequently involved house calls through difficult terrain during time of war. Eventually, surgical services were added.

Through donations and grants, Dr. Guzman was able to build her own surgical suite, which is used by our group each winter, but is utilized by local Salvadoran ophthalmologists throughout the year. During a typical PVH eye campaign, more than 150 procedures are performed, including cataract extractions, corneal transplants, pterygium excisions, eye muscle surgeries, and laser treatments for glaucoma.

A large medical eye clinic runs in parallel to the surgical campaign. Each year, approximately 2,000 patients are examined and most receive donated eyeglasses. The Lions Club of Lexington, Massachusetts has been especially generous in providing eyeglasses, but many individuals have contributed as well. Most volunteers are from the Boston area, but many areas of the United States and other countries are represented annually. The volunteers include ophthalmologists, optometrists, nurses, anesthesiologists, ophthalmic technicians, Spanish interpreters, and other lay people without specific medical expertise. We set up a “pop-up” dispensary to give out eyeglasses, which have been cataloged in a computer program and are accessible when the patient receives a prescription. When glaucoma is diagnosed, we attempt to give patients six-to-twelve months of glaucoma eye drops.

Although PVH has been able to make significant contributions to eye care in El Salvador, it has been crucial to partner with a local organization that is familiar with and entrenched in El Salvador. Local health promoters and eye doctors screen for surgical and medical eye issues that need attention and refer the patients to the PVH clinic. They have community outreach to alert the local population about the upcoming eye campaign. Patients travel from local communities, but also from the entire country of El Salvador, as well as from Guatemala and Honduras. Many patients travel for hours on local buses or packed in the beds of open pickup trucks. Upon arrival, the wait to see a doctor can be many hours but there are rarely complaints.

As with many clinics in the developing world, ASAPROSAR charges small sliding scale fees for surgical services provided, based on economic status. Patients with higher means pay approximately $25 for a cataract surgery to offset patients who are more indigent and have no resources to pay. No patient left is turned away. Our PVH services and supplies are completely free of charge, but the ASAPROSAR clinic needs to pay staff, and provide food and dormitory services for some patients… It has been felt by our hosts that requiring small fees for those who can contribute is a more equitable solution and helps ensure sustainability of their programs throughout the year.

Each year, upon arrival, the team of PVH volunteers unpacks equipment and supplies within a matter of hours and is ready to start work the next day. The campaign is intense, but the esprit de corps keeps everybody focused and motivated during 12–14-hour workdays in the operating room and clinic. The pathology is often severe, so the surgeries are sometimes challenging, but the rewards can be life altering. People who are blind from cataracts frequently walk out with vastly improved vision. Children and adults with strabismus (eye muscle imbalance) emerge with straight eyes, which can not only help them functionally, but also emotionally. Having crossed eyes is frequently a huge social stigma and can limit a person’s life prospects.

Although the work is hard, the group has time for relaxation in the evenings and at the end of the journey. Our hosts treat us extremely well and the Salvadoran delicacies served daily keep us well nourished. Many of the volunteers have logged more than ten missions because of the unity of purpose and joy involved in serving the patients. The group has no religious or political agenda. We work tirelessly throughout the year to acquire medications, glasses, and ophthalmic equipment to keep the mission going and to help the local doctors who staff the clinic for the rest of the year. We are always looking to recruit interested volunteers, especially those with medical, nursing, or anesthesia skills, but also lay people who want to help raise funds, pack supplies, or learn how to dispense glasses. In addition, donations continue to be crucial to maintain our mission.

The ultimate goal is to make our services obsolete, but the reality is that with economic inequities, PVH’s efforts will likely be needed for the near future. I look forward to participating for many years to come. +

James Umlas, MD, Lexington Eye Associates; Secretary, Partners for Visual Health. https://partnersforvisualhealth.org.