In early 2018, Dr. Ciszek took his annual trip with VOSH International to provide examinations, medication, and eye care for populations who do not have access to such care. This time, it was to Bolivia. What follows is his diary entries for the trip, helping us all to get a better sense of the work and careful practice that goes into treating people around the world who are desperately in need of healthcare. Dr. Ciszek serves on the Board of Directors for VOSH International.
Early January 2018
After the frantic, “I have to use my benefits before they expire in December,” and amidst the “I have to get in now because my benefits just renewed in January,” I realized that our next VOSH trip was in mid-March. This realization was quickly followed by an “oh crap” moment because I had offered to request medication donations. The pharmaceutical companies require a minimum of 6 weeks lead time.
I completed the requests from Valeant / Bausch and Lomb, Alcon and Allergan in a few days, between patients and VOSH meetings, during lunch breaks and a couple of long evenings. Of course, each company requests different information, in different formats and the are some hurdles to jump, but getting through the little bit of red tape is worth it: the estimated value of the medications I am carrying for this trip is over $300,000.
Mid-February 2018
Time to pack the glasses. Mel Muchnik, Randall Jackson, Sandy Bury, and our friend Mark Christnacht head to the VOSH Illinois warehouse in Oak Lawn to pack the glasses. While Sandy was in the VOSH Illinois meeting, I busy myself doing the easy part: deciding what readers to bring and packing them. Sandy Bury took on the organization of the donated glasses and, with Mel’s help, packed the rest of the glasses. They spend many hours over several days making sure they had the best selection of glasses and that they were organized properly.
Early March 2018
The medication shipments start arriving. It comes packaged beautifully in cellophane-wrapped boxes by the dozens. While it’s pretty, it’s impractical for travel. My intern and I, between patients, break the cellophane and then open each box one by one, taking out the bottles. The bottles are then put in a marked heavy duty baggie with one package insert in each bag. The list that gets sent to our leader extraordinaire Natalie Venezia has to include the medication, percentage, form (suspension/solution/ointment etc), lot number, quantity, and expiration date.
The week beginning March 12, 2018
It’s time to start organizing the packing. From the packing party, we have one 50 lb bag of readers. Randall and I also have the 50 lb “supply bag” with the salt pan, vision charts, adjusting tools, as well as sundries like garbage bags (we always need black garbage bags to block windows etc), various types of tape, pens, markers, and on and on. Because, sadly, our friend Jimmy Gwillim will not be joining us this year, I am carrying my equipment and the auto-refractor in a third 50 lb bag. The medications make up the fourth 50 lb bag. And this is before two gay men pack their clothes and accouterments.
March 14, 2018
The medications from Alcon have not arrived. I send a polite timid message to Alcon and they quickly respond that there was a delay between packaging and shipping. The medications will arrive by end of business day Friday. The day before we leave.
March 15, 2018
Plugged in the auto-refractor to make sure it charges and that I know how to use it. After a couple of references to the manual, we are a go. Plug in the wall charger, the thing that charges the battery handles for transilluminator, direct ophthalmoscope and retinoscope…and it is not charging. Damn. Cannot function without that equipment. Go on Amazon and find one that can be delivered next day for $200.
March 16, 2018
I am downtown and the medications from Alcon arrive in Andersonville. The most wonderful Jeff, Beth, Tim, and Nate package up all of the meds, while doing their normal work as well. Plus, they’re short-handed as Matt, Brian, and Jamar are in New York for Vision Expo East. I finish packing the four 50 lb bags and drag them home. That evening, clothes, toiletries etc are laid out for easy packing in the morning.
March 17, 2018
Our flight is not until 2:00 pm, so we got to avoid the traditional crazed, pack-in-a-rush morning. We had to run a few errands for some last minute things: get more pet food, labels for the luggage, stickers for the kids, and emergency Starbucks Via coffee.
The first snafu of the day. Due to an embargo, we are only allowed to check two bags to Bolivia. Due to some strategic packing by Randall, we had just the four VOSH bags to check. The rest was carry-on. However, the cataract surgeon had to cancel because he had more than two bags. Without his equipment, he couldn’t do surgery. Super disappointing, but we will adapt. That is what VOSHers do.
We made it remarkably smoothly through security. The carry-on with the auto-refractor and my hand-held equipment got some special attention from TSA, but we made it through fine. A glass of wine at the Admiral’s club and it was time to board.
Randall had the aisle seat and I had the middle seat on the way to Miami. For the first half the…less than elegant…guy next to me burped and had his right elbow practically in my face. Fortunately for me, he had a small bladder and eventually decided to sit in an empty aisle seat in front of his excessively tanned wife. Americana. We landed early but then had to wait 15 minutes for a gate to open.
It is 4:30 pm. The next flight leaves about 10:00 pm. So much time to get to know the most pleasant and lovely Miami airport! Even though I speak Spanish, the airport confuses even me. I think my brain is programmed to hear English first and then Spanish. At this airport, the order is often reversed, leaving my brain scrambling to make sense of it all.
Sandy invited us to the Centurion lounge so we could spend the five-hour layover in relative peace. I got a complimentary 15-minute chair massage, and Sandy got a hand massage.
Then we met up with the rest of the group a little prior to boarding for the next flight. Boarding at 10:00. Unfortunately, Randall and I both had middle seats for the flight to La Paz. We got virtually no sleep.
March 18, 2018
We had a short layover in La Paz and then on the next leg to Santa Cruz. Thanks to the preparatory work of Natalie and CRE, our hosts, the visa and customs process was not painful. Kudos all around!
Next, we loaded onto a really nice bus with reclining seats and air conditioning! Headed to Samaipata for lunch, about a three hour ride. The countryside is beautiful and super green. We see signs “hay patasca” (pork stew with corn) everywhere on this Sunday morning, and I actually recognize some of the landmarks. We were stopped at a police roadblock and had to show letters of invitation. The police opened the bus storage and did a cursory glance. They obviously did not check the latch when they closed it, as about 20 minutes later, we sped around a serious curve and three bags went flying across the roadway. It’s not a VOSH trip until luggage goes flying.
ProTravel reached out to the surgeon, sorted out the luggage issue and he agreed to get on the plane today to join us. He will be one day behind, but, yay! Cataract surgeries are back on.
We finally arrive in Vallegrande about 6:00 pm, approximately 31 hours after we left our house. We drop off the equipment at the hotel and then walk a short couple of blocks to where the clinic is going to be. Natalie surveys the large room and puts a plan in motion. We do a basic set up of equipment and get back at the hotel for dinner at 8:00.
We are using a new form that will allow us to gather pertinent data easily on prescriptions, medical conditions, eye conditions, and glasses and medications dispensed. This will allow us to better prepare for future clinics to the same region and to have data to present to potential donors.
Off to bed because breakfast is at 7:00, we are going to the clinic at 8:00 to finish the set-up, and the first patient is at 8:30.
Monday, March 19, 2018
Woke up momentarily at 3:30 am to thunder and lightning.
Up at 6:00 am to get ready for breakfast. Turn on the shower. No hot water. The system here is to have an electric heater that goes before the shower head to heat the water. Electricity and water so close together make me nervous. We turned switches, we turned dials, we let the water run. No hot water. We tried everything because we did not want to appear to be stupid American tourists before deciding to go downstairs to ask for help. Yep, everybody was in the same boat. 20 some odd Americans that cannot take a warm shower. A recipe for disaster, but everyone took it in stride and no complaints.
We walked the two short blocks on cobblestone streets to the municipal center at 8:00 to finish setting up. There was water in the center of the room because there is a skylight in the center of the building. Of course, water came in.
Patients started coming in at 8:30. The start is always slow because we are still figuring out all of the logistics…including using a new form.
The day was a pretty typical VOSH Illinois day. I did less direct patient care and a whole lot of floating to help translate and pitch in wherever there was a backup in flow. My oldest patient was 97 years old.
