Industry insiders will always pick up on things more than an outsider would, so it was an eye-opener to sit in on a recent presentation Dr. John Willer gave to his staff on his recent medical mission to Guatemala.
Willer is an ophthalmologist, a medical doctor who specializes in eye care.
Over the years he has joined numerous medical missions in places like India, Lebanon and Ecuador, and this was his second to Guatemala.
This time, he was joined by Brenda Muñoz, a technician and interpreter.
She interpreted English to Spanish, and other interpreters translated from the native Mayan spoken in the area to Spanish for her.
They spent an intense eight days working 10 hours a day at the Hospital de la Familia in Nuevo Progreso, doing endless cataract surgeries and other eye repairs.
A photo of medical personnel in the operating room was projected on the wall, and someone piped up: “I notice you’re wearing flip flops.”
They’re incredulous at this. Willer said it’s standard foot attire in Indian ORs.
He drops another fact regarding sedation. “No propofol [a sedative]. They just hold still. No sedation.”
Willer said he did some procedures he’d never done before. One he at least had someone explain to him first. “Another one I just kind of made it up as I went. That was a one-eyed guy with a silicone tube extruding from his eye.”
“I shoved the tube back in and covered it up with a corneal graft and sewed it up.”
Most of his work was on people with such mature cataracts in both eyes they were blind and had to be led in by someone.
He described them as “white cataracts,” which are challenging, high-risk cases.
He said the medical mission was the best equipped, best supplied and best staffed he’d ever worked in.
Even so, some standard equipment in American ORs was missing. It made for more challenging conditions and a more dangerous procedure. “You can’t use rings, you have to use hooks, so you have four more incisions,” he said in insider-speak that still conveyed a message to the uninitiated.
This different style of procedure was far lengthier. Each procedure was an hour. In contrast, he said, “Wednesday, I did a cataract in eight minutes.”
Muñoz noted that the patients all took off their shoes before they got on the operating table, and their shoes were usually in very worn condition.
Patients arrived, decked in colorful clothes, by foot and by car, some driving six hours.
She recounted one harrowing moment, as a picture came on the screen: “I had to tell this woman that this three-year-old was gonna die if she didn’t take her to be treated.” She had retina cancer.
Eye surgeons were in such demand that fully half the operating space was devoted to them.
The rest was shared by general surgeons, plastic surgeons, ear, nose and throat surgeons, obstetrics and pediatrics.
As a gruesome picture came on the screen, Willer said, “That was a giant squamous cell carcinoma on that guy’s eye.”
Willer said he “peeled it off. He was happy to get rid of it.”
Because the Guatemalans were used to 90 degree weather, the OR, where it was 75 degrees, struck them as cold. “They like it hot,” Willer said.
Muñoz said the clinic where they worked had excuses why the air conditioning either didn’t work, or wouldn’t turn off.
“So you either burned or froze,” Willer said.
And every day, Muñoz said, the area received one to two inches of rain.
The mission teams, assembled by invitation only, had all their meals prepared for them and their laundry done for them. They stayed in dorms and breakfast was at 7 a.m., and dinner at 7 p.m.
With him on the cataracts team were surgeons from America and Canada, Willer said.
Muñoz had the distinction of being the first member of the medical mission team to get an IV inserted, because she wasn’t feeling too great.
“Anybody that’s not feeling good gets an IV,” Willer said.
But, more than that, “the ultimate sin is if a guy wears a girl’s scrubs,” he said. If you did that, “you had to wear the turkey award as the idiot of the day.”
He managed to avoid that indignity.
Guatemala is on Mexico’s southern border, and when the missionaries visited the beach — the ocean itself was black and brown, Willer said — they saw migrants walking up the beach, heading to Mexico.
On work days, it was nose to the grindstone. They saw up to 100 people a day, between all the surgical specialties.
The deprivation of the patients was evident.
One infant “was four months and he looked like a newborn,” Muñoz said.