By Roberto San Martin, MD, MS, FACS
Two years ago, Dr. Maria Antonieta Gonzalez wrote an article for this magazine describing the yearly medical mission trip to Mexico by “Los Quijotes.”
This group, sponsored by Christus Santa Rosa Hospital, has made the trip for 18 years, with the last 10 trips being to Oaxaca, Mexico.
It was in this same spirit that our group of 55 ambassadors was prepared to travel to Oaxaca over the 2006 Labor Day week. However, the political climate in Oaxaca was such that the safety of the group could not be guaranteed. The difficult decision was made to cancel the trip.
Needless to say, we all understood but were still disappointed. The dilemma was what to do with more than seven full duffel bags of donated medicines worth close to $100,000 with approaching expiration dates and soon-to-expire governmental permission to bring them into Oaxaca. In addition, we had more than $30,000 worth of surgical supplies for 24 cataract surgeries that were stored in my office.
After prayerful deliberation, it was decided that a small group of six Quijotes would make the trip in late December. Reservations were made at a time when the peoples’ protest was at its peak, at a time when several deaths had occurred, and no local law enforcement were on-hand to protect the community.
Daily checks on the Internet and Mexican TV reports were the norm. Our friends, families and co-workers begged us to cancel the trip until next year. Patients and supporters prayed for peace in the region.
Almost as if on cue, the week before we left, tranquility and peace fell over the city of Oaxaca. The local physicians finally gave us the “all clear,” and on December 17, 2006, we left for our surgical mission.
Six months of efforts with a customs broker in Laredo, Texas along with a superhuman effort from the director of La Clinica del Pueblo de Oaxaca were needed to get all of our surgical supplies and equipment transported to the clinic one day ahead of our arrival.
The donated Alcon Phaco 20,000 Legacy made it in one piece, along with an assistant microscope and a video system. By some miracle, we set up the OR on Sunday night and were able to successfully begin cataract operations on Monday and continue through Friday.
Months of preparation paid off. We were ready to perform surgery much like we do at Christus Santa Rosa. It quickly became apparent that our procedures, while worthy of any JCAHO scrutiny, were met with some concerns.
In a country where surgical supplies are scarce, the need to care for as many patients as possible with each disposable item outweighs the need to adhere to American JCAHO standards.
Our Oaxacan surgical colleagues politely asked us to “save” the leftover supplies for the next patient. “No se preocupe, doctor” they said. “We do this by necessity all the time.
“Do not worry, doctor. Everything will be all right, trust us. Since this clinic opened four years ago, we have had no problems with infections
or complications.”
Coming from a hospital that threw away 12 packs of viscoelastic worth close to $1,000 because the refrigerator was 2 degrees too warm for JCAHO standards, this request not to worry required a giant leap of faith. Incidentally, we used these very same packs in the OR in Oaxaca.
Memories of an endophthalmitis breakout in the Rio Grande Valley from the use of a single balanced salt solution bottle spun through my head. We not only were using the same bottle, but the same tubing, instruments and Phaco hand pieces without resterilization.
“What about HIV, hepatitis, bacteria and heaven knows what else?” our nurses questioned. Again, a quiet and reassuring physician voice reminded us that we were NOT in the U.S. and that here in this Oaxacan clinic, it was the way it HAD to be done to serve the most patients with very limited resources.
The next morning and each morning, I carefully examined each patient with a slit lamp for any signs of infection or inflammation. A total of 15 cataract surgeries were done with five local ophthalmologists in attendance.
The patients all looked great and did well with no problems or infections, just like our host said they would. Were we just lucky, or was God watching out for us? I suspect a little bit of both.
A well-known saying, “When in Rome do as the Romans do” applies here. For those of us who continue to help in medical missions outside of the U.S. and for those of us thinking of joining these missions, a word of caution is in order.
We must not force our values and procedures on our hosts if it is not appropriate for their particular conditions. While we can teach and show our current techniques, we must show understanding if our hosts cannot maintain our standards due to monetary constraints.
We are not right and they are not wrong. Our needs are just different. “No se preocupe, doctor.”
Please consider donating your time, money, equipment or medicines to Los Quijotes for our next trip in September, 2007.
Dr. San Martin is the Vice President of the Bexar County Medical Society and can be reached at (210) 271-7575.
