Madeleine is so busy on Wednesdays now! She has school from 8:00 until 3:00, then my parents pick her up and take her to their house. Then Cyndi gets her from there and takes her to dance class from 4:30 until 7:00. Then finally she gets home for dinner and homework.
Today my parents were watching Lainey too when Maddy came over. Maddy did her usual school teaching - all about owls, according to my mom - and Lainey was an exemplary student and teacher's aide.
And Maddy's enrolled in ballet and competition, but the jazz class was full. Her teacher, Julie, was surprised that Maddy wasn't on the roll. But Maddy attended anyways, and will continue to do so, even if it's unofficial. They have her on a waiting list. She's the only one in the class who can do the splits, put her face on the floor, then move her legs behind her until she's prostrate!
As for me, I drove by the old abandoned high school out in Draper that I liked to explore last year. I don't know why, but I feared that it had been torn down. I went back just to make sure it was still there and still abandoned. Thankfully it's both. I was reminded of it by listening to the Zombies. I was really just getting in to their album last year when I explored the high school. I'm definitely going to have to go back in there. But I had things to do this morning.
As I drove away, I wondered how I discovered that school in the first place. I think I glimpsed it once from the nearby busier road, but whatever made me go investigate, I have no idea. Creepy.
Anyways, I had to go drop my car off to get repaired. Why, you ask? Well, I'll tell you. Back on August 4th, I was driving home on Bangerter Highway when I saw a guy pushing his car going the opposite way. I decided to help, so I U-turned and got up behind him. He told me that he had already called someone to bring him gas, but as the road had no shoulder and his kids were in the backseat, he just didn't feel safe being parked in the right lane. I told him I'd follow behind him to protect him. It only took a few minutes before I was rear-ended. The driver who hit me had slowed down considerably (it's a 60 mph road), and her car seemed entirely unharmed. My rear bumper just got a little bent out of shape, but was still drivable. She was insured, and no one was hurt, and things really turned out ok. Thank God for that, because if I hadn't been there, who knows what would have happened to the guy pushing his car?
So, I dropped my car off at ABRA and got a rental. A tan Fiat 500. I was so excited because I think they're pretty badass looking cars. I found out quickly though that they have NO guts whatsoever. I can't wait to get my little Fit back so I can drive fast again.
I finally got around to writing my reports on my trip to Peru. I wrote three of them. One is just a chronology, one is my "warm fuzzy" tale, and the last is my ideas of what we need to change. I'll include them all at the end of this blog.
After my reports were finished and Liam woke up from his nap, we went to Kohl's to look for some sort of storage solution for all our shoes by the front door. We found the perfect thing almost immediately.
The only problem is that that 80% sign isn't referring to the box, but to those rugs below. Isn't it obvious? We fought with the manager a little bit, but she wouldn't budge. We didn't buy it, out of principle. Thanks a lot, Kohl's.
Also, we tried to shop for my NEW FALL WARDROBE! but apparently we're still in summertime. Compounding the matter is the discovery that the clothes I really like are old man clothes. I didn't realize it until Emily pointed out, but I really want to dress like an old dude. I have to get over this desire, I suppose.
Here's the chronological report of Peru:
I arrived in Lima near midnight on the night of June 15th, along with fellow volunteer Jacob Hogan. We retrieved our suitcases and proceeded through customs. I passed without incident, but Jacob was selected for a random screening. After a quick inspection of his glasses-filled suitcase and a perusal of the letter from the Peruvian consulate, they allowed him to pass without any further questioning. Rosario and her driver met us outside - recognizing me from The Hope Alliance t-shirt I was wearing - and took us to the Hotel Del Sol. We were able to get a few hours of sleep before the driver returned at 4:00 am to take us back to the airport.
We then flew to Piura, and Cesar from the Lion's Club met us at the airport. He had chartered a bus for a group of volunteers from Loyola Marymount University who were also helping him in Chulucanas, and Jacob and I were along for the ride. We met up with the rest of our group at the Hotel Rio Grande and promptly went to breakfast, thn the basketball stadium to inspect it before the carnosidad awareness festival. After that, we had the rest of the day off.
The carnosidad festival was held the next morning, and extended until noon. The Lion's Club had arranged for the entertainment, and we provided free sunglasses to the crowd assembled there. When it was over, we set up for the next day's clinic. We were treated to a lunch afterward, then again rested the remainder of that day.
Monday, June 18th, I worked at my first clinic. As I was still very new to the process, I was not aware of the number of patients we saw. I was more concerned with learning how to work each station. I do recall hearing that we had been able to see all 300 ticketed patients. That night we checked out of our hotel and took a bus to the Hotel Bayovar in Piura.
Our next clinic was at a resort or health club in La Union. With the bus ride and some confusion as to where we should set up, our clinic started a little late. But we were still able to see many people. Again, I am not aware of the numbers, but there appeared to be more people asking to be seen at the end of this clinic that we were not able to help.
The third clinic was at a basketball stadium in Paita, and this time I was becoming more aware of our issues with being able to see everyone who had been given a ticket. Again, there was a crowd assembled outside when we finished. We remained inside, however, to be honored with plaques from the Mayor. We were then treated to a very fine dinner with the President of the National University in Piura.
The fourth clinic was held over two days at a medical facility in Piura. A banner outside declared that we would see more than 350 people per day, but at the end of the first, we had only seen 200. I was approached by a number of the volunteers with the request of allowing more to be seen. I estimated that given the speed with which we were moving, we could add 50. Unfortunately, that was not my decision to make. We did see the additional patients, and left for the day. The crowd outside was understandably upset, but we asked them to return the next day.
The next day, we could only see about 100 people before we needed to leave for Trujillo. To try to ameliorate the situation for those who had been waiting outside (some said they had been there since 4:00 am), I decided to tell them that we had reached capacity and that we were very sorry. I was not asked to do this by anyone, and instead chose to of my own accord. It was not received well by the crowd outside. We heard later than some of them had later pushed through the gates and began rushing into the main building of the facility. The police were called and the situation halted before they reached the area where our clinic was being held. The police were also on hand to help us as we made out exit.
Thanks to the National University of Piura, we were provided with a very nice bus for the ride to Trujillo. We stayed at the Hotel Pullman, right in the heart of the old city.
Our first clinic in Trujillo was at the DanPer agricultural factory. Our clinic was split between two levels, with stations 4 through 10 in an upper office space, accessible only by staircase from stations 1 through 3 in the cafeteria. Fortunately, we had no difficulty as I recall with anyone being unable to climb the stairs. This is due to the fact that we saw exclusively DanPer employees, and all were in good enough health. Unfortunately, this clinic also ran over our budgeted time, and we were unable to see everyone who had been given a ticket. As the only non-local volunteer on the cafeteria floor (where the extra patients were assembled), the job of telling them "no" fell to me. It was a difficult experience.
Sunday, June 24, was another day off. We toured the Huaca de la Luna and the Chan Chan archaeological sites, and then Richard, JoAn, Rosario, and myself were treated to a dinner with the Mayor of Casa Grande and his wife.
Monday we were back to work, this time in Casa Grande. As in La Union, the drive time and set up confusion again led to a late start. Also, this was the first of our clinics in a city municipal building, and for the first time we had to be conscious of the everyday business also being conducted there. Rosario, the Mayor, his wife, and I appeared on the local television station to raise awareness of what we were doing for the city. Later in the afternoon it was once again apparent that we were not going to be able to see the full amount of pre-ticketed patients, nor the volunteer staff. I have to admit, I was overwhelmed with sympathy for those who could not be seen, and could not help myself from crying for quite a while.
Our next clinic was to be held at some sort of building in El Milagro, but the facility was far below our standards and we were forced to seek another place. The LDS missionaries who had accompanied us as translators were able to secure us the use of the local LDS church. Near the middle of the day, Rosario and I were driven to the locations of our future clinics at the municipal buildings of Miramar, Alto Trujillo, and El Tropico. Here I was able to sketch out the grounds and plan our set up accordingly, as well as make the staff aware of our needs. Our clinic in El Milagro closed without incident, and all ticketed patients who had been waiting outside were able to be seen. I do not believe all 300 arrived, but I could be mistaken.
The clinic at Miramar was without incident except for the fact that again we closed at 250 patients, and the police were necessary to disperse the remaining 50 ticketed and countless non-ticketed patients waiting outside.
The facilities at Alto Trujillo were impeccable and the staff did a marvelous job of providing and arranging everything I had requested two days prior. They also set up a stage and PA, and the Mayor addressed the ticketed patients, and Richard and I gave speeches, thanking them for coming, and thanking the city for having us. This may have set us back too far in our schedule though, as again we were unable to see all 300 patients that day.
Our final clinic in El Tropico was a success. We only had a half day, and had arranged for only 150 ticketed patients. We were able to see them all, as well as our volunteer staff, and even the mayor herself. It was a wonderful note on which to end my experience in Peru.
Here's the warm fuzzy report:
In many ways, my experience in Peru exceeded my expectations. I was already quite excited to be working with the people and helping to solve vision problems, but I never could have been properly prepared for the overwhelming emotions that a journey of this type can stir. The adventure of visiting a foreign land, the challenge of the language barrier, and the reward of overcoming that barrier, as well as the unmistakable sense of genuine welcoming you get from the people are enough to make the trip worth it. And the exhausting work and long hours are made enjoyable by the loving gratitude you receive from the patients, as well as the sense of pride from a job well done. But these are the things you expect to feel.
More surprising are the times you find a much stronger emotional connection with someone. You could get five or ten patients in a row that were each genial and thankful, but then suddenly someone stands out from the rest. Quite often it was an elderly person, with cataracts and pterygium so advanced that you knew that the glasses you gave them would barely make a difference. But that difference was noticeable enough to them, and a wide smile would spread across their weathered face. And they look at you, maybe gently put their hand on yours, and without words you are able to know the joy they feel inside.
As you could imagine, the young children were great fun as well. They had been waiting for a very long time for their chance, and are quite nervous to be working with a stranger who speaks only a little Spanish, and even then with an accent. They don't quite understand why they're being asked to perform all these silly little tests, and look suspiciously at the glasses when you first present them. The breakthrough isn't until you ask them to look again at that chart across the room, now wearing the glasses, and you witness the shock as they realize that it's clearer! Many Peruvian children seem to desire to appear stoic though, and quickly regain their composure. This is fun to watch as well, since it is often hard for them to contain their wonder and excitement. Anything you try to say to them afterwards is ignored, as they are looking around at everything.
Sometimes, just finding *anything* that helps a patient can feel like a great victory - or a great relief. Especially towards the end of our mission, as our selection began to dwindle, the right prescription in the right frame became harder and harder to find. And although nearly all our patients were quite gracious, their occasional frustration was understandable. Sometimes the wait time could be quite long, and to have a volunteer return with glasses that didn't help or didn't fit could be upsetting. On only a few occasions did someone get impatient and leave, either with glasses they didn't like or without any at all. Every other time though, through trial and error, we came up with solutions to each problem. And you have only a moment to relish the achievement before the next patient is before you, ready to start the process again.
All our volunteers each had a favorite moment, a specific patient they were able to help and whose gratitude was overwhelming. Mine was a young woman with a very difficult prescription for our Retinomax machine to pin down. She was one of those I just described, where I would have her try on a pair of glasses, find out what worked or didn't, then go back to the computers to track down more prescriptions to try. We could only barely speak to each other, but we managed well enough. I did get the sense that all of my scurrying back and forth, and all of her times having to tell me that the glasses weren't working was making her feel as though she was a bother to me. I tried to reassure her that she presented a fun and interesting challenge, and that I didn't want to give up. She was starting to try to make me feel better by saying that the glasses I would bring her were working, when I could tell they still weren't quite right. When I finally did present her with a pair, and watched her eyes light up as she tried them on and read the chart, I knew for sure that we had done it. Although I was my typical boisterous American self, and cheered at our success, she was far more demure and thanked me sweetly before continuing on to the final station of the clinic.
I went about my business as usual, helping more patients and running from place to place, when about an hour later, she grabbed gently at my elbow, and handed me a note. She said "gracias" once more, hugged me, then left. The note read (in Spanish): "Thank you for bringing the Light of God to my life."
My time in Peru will always be fondly remembered. For all of the thousands of thanks I received over the course of two weeks, I would instead thank each patient tenfold in return for allowing me the opportunity to work amongst them and to bring light to their lives.
Here's the stuff I want to change:
t was the best of times, it was the worst of times. My hour long crying scene at Casa Grande is my strongest memory of the entire trip. It felt so good to help people and to solve problems that you almost get euphoric from it. But you get brought down pretty harshly when you have to turn people away. Especially people who have been waiting for hours with a ticket that was supposed to guarantee them eyecare. It's not just that I don't like having people angry with me, it's that I know that I'm in the wrong, and they have every right to be upset. I was upset, in fact, and had fought for them each time before I had to go tell them to leave. I felt as though we should have honored our promise to see them all, and if it meant we stayed late, we should stay late. Or, we should have worked harder and smarter to get it all done on time. I won't let this happen on my watch.
So, what do we do differently? Starting from the very beginning, we should try our best to all fly down and back together. Or at least as together as we can be. We should also be issued matching THA t-shirts, probably a couple each, to wear on the journey and at the clinics (instead of scrubs). Many other missions also in Peru had done this; you could see them together all over the Lima airport. From the outside looking in, it presented them as a cohesive team and provided a little PR for the group they were there with. I would like to see that for us.
Also, no sleeping in airports. It was a complaint from a couple anonymous volunteers.
Logistically, it would make much more sense for us to focus on one city of municipality and not have to move between hotels very much. Even better, if we could get more than one day at each of our locations, we could save literally hours of work by not having to set up, break down, and transport everything every day.
One small change I already implemented down there was to give everyone a quick rundown of where every station would be, who would be working there, and what they would be doing (especially the new volunteers for the day, such as LDS missionaries or USU students).
Another change I was able to introduce for the last three clinics was pre-planning the arrangement of the stations. We might not always get the chance to see each site ahead of time, but if we can, it would benefit us with the chance to think ahead what would be the best locations.
Also, the arrangement doesn't work well when it's thrown together by different people with no consideration for each other or for patient flow. Some days were purely chaotic, which again leads to a loss of time.
Probably the biggest and most important and most difficult thing I can recommend is purchasing more autorefractors. In truth, it simply won't make any difference how much we streamline the process, or how many volunteers we have, or anything else, if everyone still has to filter through only three retinomax machines. The handheld units are obviously preferable for many reasons, but they are also prohibitively expensive. Larger tabletop autorefractors are more affordable, but far less portable. Not impossibly so, but transportation and set up will be a new challenge. And hand helds will still be necessary for disabled patients who will find it difficult to rest their chins and foreheads comfortably at the tabletop. And if it's entirely impossible to get our hands on any more autorefractors, I may have more ideas to get around this.
If we had people doing the refractions as quickly as possible, and not trying to analyze the results on a case-by-case basis, we could get the patients through that station quicker. There was a lot of redundancy built in to the process that I insist upon removing. I understand fully why Richard saw the need for it, but I suspect it's slowing down our clinic. Even with the redundancy supposed to catch problems before they reach the fitting table, many problems were still showing up there. We don't need a needle & thread station, nor a 20 foot Snellen chart, if we are filtering everyone through the retinomax station. The retinomax can tell us what we need to know without those. More reliably so, even. So I would do away with stations 2 & 3, and take the analysis process out of station 4.
The volunteers at station 5 will then be able to quickly assess if the refraction results are compliant with the patient-reported needs. They can then assign the patient to stations 7, 8, or 9.
Station 10 should de-emphasize pterygium cataloging, and focus instead on pterygium, cataract, and dry eye prevention, rudimentary cataract consultation when needed, and eye drop dispensation. Other than pterygia, these medically important eye health needs have been ignored.
We need to have a doctor on hand at this station, and as a strategy to attract doctors to volunteer their time, I recommend we offer to print 400 business cards with their name, address, and phone number on them. On the day they are at our clinic, not a single patient will exit without receiving a card. Not only is this beneficial to the doctor for advertising purposes, and to our clinic for having a local professional on hand, it's beneficial to our patients. Now they know who their local eyecare professional is, what he or she is like, and not to hesitate to call. Dispensation of eyeglasses alone does not have a lasting, sustainable effect, but perhaps this will.
