Cataract Surgery in Puerto Carmelo Peralta.

Carmelo is a remote, sleepy little village situated on the West Bank of the Paraguay River in Northern Paraguay, a region referred to as the Chaco. Famous for cattle and bird hunting, the area is very arid, relatively flat, and covered with scrub brush. Recently, the government built a small clinic in Carmelo, a village of 500 people without paved roads or automobiles, to attract a variety of medical teams in order to provide badly needed medical services to the region. The community and surrounding area are home to perhaps 10,000 people. We were the first medical team to use the new facility and the first team ever to perform cataract surgery in the region.

After a challenging 16-hour drive from the capitol, Asunción, over a potted dirt road replete with structurally fragile and washed-out bridges, we arrived in Carmelo to a warm welcome by the mayor and local officials. Since no suitable sleeping accommodations were available in Carmelo, we were housed in a small hotel across the Paraguay River in Brazil and were transported back and forth daily by boat.

Dr. Duerksen, with a keen eye for detail and obvious experience in outback missionary cataract surgery, quickly formulated a floor plan for the eye clinic. Our operating room was not the spacious operatory most of us are accustomed to but did offer a reliable and safe area to perform cataract surgery. In the absence of an autoclave, acetone was used to sterilize our instruments and hands. In the 95 degree heat, we were immensely thankful for a small wall-mounted room air conditioner in the operating room. After a goodnight’s sleep, we awakened refreshed, crossed the river and went to work. With the help of our wonderful and tolerant wives, neither of whom have formal medical training, we spent the first morning setting up our equipment and the afternoon examining patients. After a brief break for dinner, we performed our first 5 cataract operations, ultimately performing approximately 50 operations over the next 6 days.

Paraguay is considered the poorest nation in South America, and Carmelo reflects this assessment. With limited access to medical care, the people must make the long journey to Asunción for all but the simplest of medical care. The travel costs alone are beyond the financial means of all but a very few. Fully half our patients arrived at the clinic barefoot, some having walked for several days. It was astonishing to see postoperative patients leave the clinic traveling by foot, rowboat or on the back of a small motorcycle.

The first 5 patients examined were bilaterally blind from white, hypermature cataracts. Several of whom reported having only light perception for the past 5 to 8 years. Near words cannot express the joy and gratification on the faces of patients and surgeons alike with restoration of good vision. I must recount the story of one patient who insisted after removal of his bandage that his vision was perfect. I attempted to explain to him that over the next 10 days his vision would improve. He stated adamantly “Doctor that is impossible. My vision is perfect now,” as he identified objects and people around the room. Of course, when formerly tested, his vision was 20/60, not bad for postoperative day 1, but after 5 years of blindness, he was ecstatic and could not comprehend that his vision would further improve.

The original purpose of my trip to Paraguay was to learn manual small incision cataract surgery at the elbow of a master. May I compliment Dr. Duerksen. He is not only a master at MSICS, but an excellent mentor, indefatigable worker, and an imperturbable instructor. He is now also my good friend. Udo, in his polite, warm manner and obvious deep devotion to his people, has won my boundless admiration. He is a true son of Paraguay.

On leaving Paraguay, Amy and I were exhausted but exhilarated. The friendships established, the thankful patients, and the lives touched left us enthusiastic and looking forward to the next cataract mission and adventure.

George F. Hatch, M.D.

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