2014 VOSH-NECO Eye Care Trip to Dominican Republic

 

I was fortunate enough to be part of the 2014 VOSH trip to the Dominican Republic. The Volunteer Optometric Services for Humanity – NECO chapter has been going to DR for the past few years in an effort to create sustainable eye care in it’s underdeveloped areas. Collaborating with the Batey Relief Alliance (B.R.A.) , this year’s group consisted of 21 students and 5 Optometrists. Together we were able to see just under 1,000 patients in our makeshift eye clinic, running 5 days in Batey Gonzalo of Monte Plata. Bateys are known as villages of migrant farmers/sugarcane workers and their families. This particular Batey had approximately 4,000 residents. We’d work with approximately 175 patients per day. Since Spanish is the predominate language spoken, our team was forced to brush up on our Espanol. A few of the doctors on the trip were fluent in Spanish and had a lot of words/phrases to share with us! The majority of our patient referrals we made were for either bad diabetic retinopathy or severe cataracts.

Day 1 – 4/5/14 Saturday……..Our group arrived safely in Santo Domingo from Boston, sometime in the wee hours of the early morning. Our hotel accommodations were close by in Boca Chica, DR. After getting some sleep, we made a site visit to the Batey Village in Monte Plata where we’d be serving Sunday through Thursday. The clinic was just over an hour commute from where we were staying. Upon arrival, the village kids helped the team unload our supplies, equipment, and moved tables and furniture to accommodate the patients. It was neat to see how these people lived so simply. It was normal to be surrounded by stray dogs, chickens, cows, cats, and horses. Some locals would ride a horse into town as their means of transportation. Motorcycles were also abundant.

Thanks to Dr. Bill Sleight for building/donating these crates to us a while back.

Dr. Ana Celia helped us immensely by transitioning the line of patients into clinic. Taking brief case histories and blood pressure readings. 

Shown here is a field of decapitated palm trees, waiting to regrow. The oil is harvested and used for food products, cosmetics, detergents, and biofuel.

One of our group leaders, Kylie, gathered us together before clinic to give us a history and overview of Batey Gonzalo and it's residents.

Retinoscopy session w/ Lauren and Anita

Clockwise: Adrian gettin posterior pole views w/ the direct O. Luke hitting the periphery w/ the BIO. Kelly taking a thorough/bilingual case history, and Anita examining this guy's anterior segment w/ the handheld slitlamp!

 Day 2 – 4/6/14 Sunday…….First day of clinic. Since our group was fairly large, we were able to transition into the patient flow quite well. We had 9 trial frame refraction lanes going, an entrance testing station, dilation station, and the optical/checkout area. Patients would line up outside the building and be asked a case history about their eyes and systemic health. Pretty much all patients walked out with sun glasses (“lentes para el sol”), reading and/or distance glasses. All the kids got toys to bring home. Any glasses prescription that we couldn’t provide for was special ordered and sent back to the village a few months later. We also gave lots of artificial tears, and various eye drops for allergies, inflammation, glaucoma, and bacterial infections. Each of the 5 doctors would rotate around the stations to collaborate with students and facilitate patient flow.

The Doctors of the group! Jen Liao, Devina Patel, Kristin White, Bina Patel and Mina Sehizadeh

Day 3 – 4/7/14 Monday………….Today was great because our group got into the flow of what to expect with patient flow and how to multitask/help eachother between the stations. At this point we were also starting to improve on our Spanish phrases, and able to hold broken conversations with patients. We saw several patients with Glaucoma and Diabetic Retinopathy in their unfortunate advanced stages.

We saw a patient with Bell’s palsy secondary to a longstanding acoustic neuroma. He had told us of a growth by his ear which had affected his facial nerve (muscles of facial expression/eye closure are inactive on his whole right side). As eye doctors we’re concerned of the eyes being exposed/infected since the eyelids don’t completely close. Seen here, we’re asking him to close his lids tightly, smile, and puff out his cheeks, all of which are compromised on his right.

Thanks to Angelina, Julio and Kylie for being so helpful w/ their bilingual skills and translating for us all week. "Tengo mucho flow con mi rayas"

Today, Ting and Kristin took it upon themselves to do everyone's hair in variations of braids.

When an interesting case presented, Dr. Patel would pull some of the students aside for "teaching moments". There is some truth to say that you don't really see/learn a condition until you see it in clinic!

For lunch we’d eat mainly chicken, rice, beans, cassava root, salad and fruit. It was a nice spread. We’d get ~30 minutes to stop & recenter ourselves before the afternoon shift, ending around 6pm each evening. We’d get consistent afternoon thunderstorms each day. The Floridians on the trip were accustomed to this as well as to the “humidity”/roaches/lizards Haha. The tin roof over our building would leak in many areas, but never stopped us from seeing patients! On our way home tonight we stopped at the local grocery store to stock up on the country’s amazing coffee, chocolate and other goodies. It was neat to see the locals in the store insist that we cut to the front of the checkout line since they had much more groceries than some of us did.

Day 4 – 4/8/14 Tuesday……………Another day at clinic. Time was moving fast, and I couldn’t believe we were already into day 3 of our work. We had some down time on the bus ride each morning, so Ting decided to share her phone w/ all 26 of us, enabling us to make free international texts to our loved ones (T-mobile? Thanks!) From the back of the bus, I’d hear her yell “who’s number is 860xxxx or Kevin, Mom responded, haha).

After another long day, Julio had us stop on the way back and try some Empanadas and 40 ounces of the local beer. He risked his life running across a busy highway for us, holding arms full of these. Thanks again Julio! The group got out and walked down by the ocean together with our food. More memories and photo ops.

We had several Bday's on the trip, including Laura's. Here we're out @ dinner to celebrate!

Back @ our hotel, we had this awesome dude cuttin us up some fresh coconuts to drink

Day 5 – 4/9/14 Wednesday………We arrived at the site today to see a big line of people waiting to be seen. I think today was the day that was advertised as “kid’s day”. So we got to see lots of them! It was also this day that I finally started to feel confident with my direct ophthalmoscope, spotting several edematous and swollen optic nerves.

Later this evening, Kylie and I decided it would be fun to make a field trip to the local barber shop and get creative with my appearance. I just wanted to immerse myself in the culture, including the hair style. I ended up with 3 lines on the side of my head and a trimmed up beard. Thanks again, Luis the barber!

Docs, you guys rock!

Day 6 – 4/10/14 Thursday………..Our 5^th and final day : ( Went by too quick. The local baton ballet dancers came to perform for us at the end of our day. Consisting of intense drumming, whistles, dancing and gymnastics, it was quite a way to end our day. The president of the Batey Relief Alliance also made an appearance to thank us. 

I also got the chance to take this little guy for a walk. So hyper!

Day 7 - 4/11/14 Friday………… Today was our one off day set aside for some good ol’ R & R. After spending 5 clinic days going nonstop on our feet, most of us were content with hanging on the beach and doing absolutely nothing. Some of the group went exploring in the shops of downtown Boca Chica, some took a catamaran boat out to snorkel around a nearby island - Happy Bday Tamara! – while some of the girls decided to get their hair done up Dominican Style and get braids/beads in the side of their head.

We also ended up going for a short run along the beach that ended inside a big marina. We were lucky to have gotten a private tour of all the boats, and ended up hanging out on the M.V. Van Straelen with a group of hospitable sailors from the Netherlands. "Noordzeecharter, Volkerak"

I would first like to thank God for flooding our hearts with the desire to serve, and enabling us to use Optometry as a platform for it. I would like to thank of all of the Doctors of Optometry that led this trip including Bina Patel, Devina Patel, Mina Sehizadeh, Kristin White, and Jen Liao. Huge Thanks is owed to student VOSH presidents Jen Williams and Amy Burke for all the behind the scenes work leading up to the trip, and for keeping our group one cohesive unit. Big thanks to Kylie Culver, Julio, Dr. Ana Celia Carrero and everyone at the Batey Relief Alliance for helping orchestrate this trip, the clinic, and the logistics for once we showed up. www.bateyrelief.org Also, thanks to everyone who donated money, equipment, glasses, or eye drops to our group, including Alcon!

Back @ the airport awaiting our redeye flight back to Boston. Instead of glasses, our carry-on's are bringing back some Dominican warmth and sunshine to the northeast.

FCO/HSM Belize Eye-Care Mission 2013

So this trip wasn’t exactly a triathlon, marathon, or cycling event, but I thought it was definitely blog-worthy. In a lot of ways it was almost identical to an athletic event………………..Waking up very early, monitoring hydration/electrolytes, and constantly eating cliff bars, haha. This trip was put together through a collaborative effort between the Fellowship of Christian Optometrists, His Servants Ministry (HSM), and Kentucky Optometrist Dr. Lee Peplinski and his wife Rayanne Peplinski. Having led the trip for the last few years, the Peplinski’s had a lot of knowledge and experience to share with us. The team included The Peplinskis, Dr. Jim Luckett and his wife Lois, and two 1^st year students and eight 2^nd years from our school. We were thankful to have much of our required supplies for the trip donated to us from various companies. These included all of the medical eye drops (steroids, antibiotics, allergy, tears, and glaucoma), plus readers, sun and safety glasses. The HSM organization did a lot of the work organizing and promoting the clinic sites well in advance. Each clinic site was located at the main church building within each village we went to.

Johnny, Emily, David sorting all of the sun and safety glasses

Kim & Erica sorting all of the drops that were donated

                                       

Within the villages we served, English and Spanish were mainly the languages spoken. At our 1^st clinic site in Maya Mopan, the patients spoke Mayan as well.

Throughout our week at clinic there was a trend in ocular findings within our patient population. This mainly included hyperopic astigmatism, pterygium, and nuclear sclerotic cataracts (all conditions associated with unprotected sun exposure). We also saw patients with diabetic retinopathy, and glaucoma, averaging over 140 patients per day overall. The entire country of Belize has only 4 practicing Optometrists, so many of these underprivileged people do not have access to eye care despite the progression of various sight threatening diseases. Patients with advanced cataracts, pterygium, and diabetes were referred/scheduled to have surgery the following month when an Ophthalmologist would be available. 

Belize 2013!

                  Day 1: Assembly Church - Maya Mopan

Our first day……………..not sure what to expect, we listened to the advice of both Dr. P and David (came on last year’s trip) and dove right in. Upon arrival, we already had a fairly large group waiting for us. 

We figured out how to arrange the layout to accommodate each of our stations. Our stations included a check in/dispensary, visual acuity, refraction, and ocular health. Some patients didn’t need to visit each station, so we always had a team member triaging the waiting area in order to provide care more efficiently.

Our check in/out as well as dispensary where patients picked up
their glasses and any eye drops they needed.

Dr. Luckett managed to find some Kentucky fans,
all the way down in Belize!

Binocular Indirect Ophthalmoscopy on a diabetic patient

Dr. Luckett holding down the refraction lane

Retinoscopes, lens racks, and trial frames oh my!

                                 

Quick slit lamp exam

Day 2: Nazarene Church – San Roman

Today went a lot smoother than last now that we had our rhythm down and a better understanding of teamwork & patient flow.

The Village of San Roman

Johnny & I hanging @ the dispensing station, a little slower pace
than our previous day @ ocular health

When the kids got out of school, we had a big group come to have their eyes looked at. Liz and Johnny making time to hang with a few of them...... 

Sunglasses separated by gender, artificial tears for all the dry eyes.

David taking a look in w/ the ophthalmoscope ".3 nerve, clear macula, good to go!"

Day 2's clinic was also about a 45 minute drive from where we were staying in Hopkins. Long, winding dirt roads, props to Dr. P for navigating less than ideal driving conditions!

Kim checking pressures

Dr. P doing a quick slit lamp exam

Day 2 down!

Day 3: Community Centers- Placencia and Seine Bright

(Team split @ 2 sites)

Today our team was divided in two, in order to serve @ 2 different clinic sites. Other than having to separate all of our limited equipment among the two groups, this day went very well.

"Team Marvelous"

Patients waiting for the next station........

Ok, what's the smallest number you can see w/ your right eye?

David checking visual acuity

Lots of massages were given on this trip, after spending long days in less-than ergonomic
positions giving eye exams..........

Yes, that's $12/gal for gas @ this particular marina in Belize ($6 U.S.)

Day 4: The Sentar – Independence

This day brought some of my most humbling clinic experiences. We dealt with several patients who had advanced Glaucoma (irreversible blindness), where all we could do was send them home w/ dozens of medical drops in hopes of preserving their last bit of sight for another few years. Had we seen them sooner, their slow loss of vision could have all been prevented. It was hard to tell these people their circumstances, especially because they were under the impression a simple pair of glasses was all they needed.

Upon arrival we had a nice crowd already lined up to greet us

Courtney taking case history

Johnny takin a closer look, getting far out into the periphery w/ the BIO. 

Emily taking pressures w/ the I-care Tonometer

Day 5: Pastor Herdie’s Church – Hopkins

This was our 5^th and final day, which we were all both happy and sad about. Seeing that we were staying in Hopkins, our commute time to clinic was all of 5 minutes, a good change from the 45min to an hour commute each day prior. One unfortunate case (interesting to us students) was a patient with Usher’s Syndrome (slow loss of peripheral vision accompanied w/ deafness). We also saw more severe glaucoma and diabetic patients as well.

Not your typical Optometrist's office : )

David double checking things w/ Dr. P 

Emily takin a look inside with her Oscope

Emily, Kim, Johnny, Erica, Kevin, Laura

Erica & her new friends

After our 5th and final day of clinic, looking forward to taking a breather!

Day 6 : Fun/Rest/Relax Day

So we ended up having the last day of our trip (Saturday) as an opportunity to explore Belize and partake in any fun activities we wanted. Some of the team went zip lining, some went rappelling down a 1000ft waterfall, and some of us just stayed at the beach and relaxed. 

David, Kim, Courtney, Johnny, and Dr. P, after their waterfall repelling adventure

After a week straight of 16 hour days, I opted to sit still on the beach and do absolutely nothing, haha. I wasn’t alone and joined a few others from our group doing the same. We also came across a few rare hamburger seabeans and which are “good luck” tokens washed in from sea, also used to make jewelry www.seabean.com . 

Sometimes the best activity to do is nothing at all : )

Later that afternoon, the ocean was very calm, almost glass-like, which made it hard to resist going for a swim (and trying out my new Garmin triathlon watch). I recruited Emily to be my kayak chaperone as I proposed a 1 mile ocean swim, parallel to shore (.5mi out, .5 back)

Map uploaded from watch, after the swim!

The 1^st half of the swim went great! I stopped to stretch and hit the Gatorade before heading back, all was well. Within just a few moments of swimming back out to meet my kayak leader, I felt a sudden, intense stinging sensation across my face, ear, and left arm. JELLYFISH!!! There was no second guessing if I was getting stung or not, this thing was as obvious (and invisible) as possible. Determined to finish, I continued to swim back, luckily avoiding any of his siblings. For the remainder of the night, I walked around looking like Rudolph the red nosed reindeer………..not cool!

Carla, thanks for cooking for us each night!

Overall, we had an amazing experience on this trip. Despite the relentless mosquitoes, sand fleas, scorpions and geckos, I feel like we all came back with new perspective. Several members of our team had asked me what I learned in the last week. Aside from the confidence boost in my clinical skills and judgment (and the fact that you can never carry enough cliff bars!), I walked away learning how to better appreciate life. 99% of the 700+ patients we saw, despite how poor or unhealthy, were always smiling and seemed so content, and happy.

The place we stayed @ was called "Jungle Jeanie's by the sea", here's our team w/ Jeanie herself, a former marathon runner. Also here is her husband John. Thanks for all the hospitality! And thanks Mrs. P for designing our awesome team shirts!

My front yard for a week.........

Another one of the beach huts our team stayed in

David, Johnny, and I on our 1st day there, Naive to all mosquitoes & sand fleas as we wear shorts. All proceeding days we wore pants and sweatshirts for protection..........

As a treat for our last night in Belize, the Peplinskis brought in some authentic Garifuna musicians to perform for
us

Dr. Luckett & Emily shopping with some of the locals selling their  jewelry and pottery
"Will you accept sunglasses & artificial tears over cash?"

We took a detour en route to one of our clinic sites and stopped to see what coconuts tasted like......

Care to try some coconut?

                                    

Sure! 

One just wasn't enough for Emily!

Back @ the airport on our way back, Kim coping w/ bug bites head to toe while
I embrace an extra large philly cheesesteak w/ fries

 I just wanted to thank both the Peplinskis and the Lucketts for all of their hard work in orchestrating a trip like this. Without them none of this would have been possible! Also a big thanks to all of the companies who donated supplies and/or money to support us!

Dr. Jamara, Tiffany Khong, Dr. Patel, Brian Nguyen and
VOSH, Heine, Keeler, Dr. Scott, Dr. Fisch, Barbara
McGinley, Camille Ruan, Dr. Farkash, Dr. Comerford,
Dr. Thorn, Dr. Potaznick, Dr. Contardo, Dr. Haney,
Hilary Mota (Absolutely Delicious), Matt & Kim©, Diana
Vivirito, Jungle Jeanie’s Hotel and Resort, Cindy Grant,
Kathy Kantor and Lombart Instruments, The Lions Club
and District 33K, Restoring Vision, Bausch & Lomb,
Alcon Laboratories, Allergan USA, Merck, The Home
Depot, The National Braille Press, Hilco/Wilson
Ophthalmic, Jennifer Daugherty/Thirty-One Gifts,
Chipotle, Starbucks, Zinga, Cafeteria on Newbury, our
classmates and fellow optometry students, the previous
teams and their leaders, the supporting friends, families,
and loved ones. Thank you for believing in this trip!