English translation by Paul Legato

Sunday night, near National Highway 34 in Salta, just a few miles from Professor Salvador Mazza, the last Argentinian town before the border with Bolivia. Any time now, a truck from the “A Better World Is Possible Foundation” (called UMMEP, from its Spanish name “Fundación Un Mundo Mejor Es Posible”) will pass, carrying a group of Argentine opthamologists who will join their all-volunteer colleagues, Cubans and Bolivians, in “Mission: Operation Miracle.” At the Municipal Opthamological Center in the town of Yacuiba, on the other side of the border, they have been performing operations completely free of charge since last October.

When the time comes, Claudia Camba greets us from the truck’s window as it rides along the final stretch of Argentine road. Camba is responsible for coordinating the groups of people who will be operated on for cataracts and pterygium. Between the sounds of the motor and the sad croaks of the Chaco-Salta frogs, Claudia says, “It’s difficult to define Operation Miracle. We could summarize it like this: it’s a Cuban-Venezuelan proposal to restore sight to six million people through free operations, and to educate 100,000 doctors in the specialty of their choice.”

The idea came about because of an overwhelming statistic: according to the World Health Organization, there are some 5 million people in Latin America with problems seeing. 80% of them suffer from completely treatable illnesses, but lack access to opthamologic services.

“The beginning of this effort was closely related to another program, ‘Yes, I Can,’ a Cuban literacy program implemented in many places in the Americas,” says Camba. “When they started to do it in Venezuela in 2004, the teachers found many people who hadn’t learned to read or write simply because they couldn’t see. So they decided to create ‘The City of Miracles’ in Cuba, a center for free operations that has treated 500,000 people from various Latin American countries. “When they told us about it in Argentina, we sent about 800 people who we found through the literacy program in the cities of Jujuy and Buenos Aires for operations. Now we only send special cases to Cuba, about 10 patients per week.” After some time, the demand became so great that they decided to open a decentralized network of free surgery clinics in Ecuador, Haiti, Venezuela, and Bolivia.

“At Villazon and Yacuiba in Bolivia, they don’t only treat Bolivians, they treat Argentinians, too. We have formalized agreements with many provinces: Salta, La Rioja, Catamarca and Cordoba, through official government agencies or through foundations, so that they can also take an active part in this miracle,” adds Camba.

The lights of the Mazza customs station mark the end of the road in Argentina. The border crossing is done on foot, with passport in hand. On the Bolivian side, Ana Maria Alvarez, the coordinator of the UMMEP in Yacuiba, waits with open arms. The journey continues by taxi, through streets filled with intense commerical activity and open-air markets, to the Hotel Las Vegas. Felix, the owner, rushes down and eagerly opens the car doors, takes the luggage out, fills in the check-in forms, and shows the guests to their rooms. Donning a surgical mask, he talks to the patients while they’re eating dinner.

Ana Maria looks at Felix and says, “Like everything that is a part of Operation Miracle, the accomodations have to be done specially. To find the hotels, we had to survey many things both large and small: they must be absolutely clean, they have to be able to prepare special food for the large number of patients who are diabetic or have high blood pressure, there has to be a place we can make totally germ-free to serve as a recovery room for after the operations… In Yacuiba, we have six hotels under contract to take care of more than 300 patients at a time.”

IT’S HERE TO STAY

The day dawns brightly in Yacuiba, capital of the Bolivian province of Gran Chaco, even though a wet mist gives the eastern mountains the appearance of watercolors. Three flags flutter among the palm trees at the entrance of the hospital: the flag of Gran Chaco, green and white, and those of Bolivia and Cuba.

“Edesia, listen, Saint Peter is arriving with about 25 cataract patients, and we have a group from Cordoba at the border. Everything’s already arranged,” Ana Maria Alvarez says into her cell phone. The Opthamology Center is an enormous 100 year old complex, recycled and reopened in October, 2006 by the local mayor, the Cuban ambassador to Bolivia, and Bolivian President Evo Morales. Photographs of that day adorn the halls. Everything is painted a bright yellow and decorated with flowers.

“If you’re looking for the director, check the halls. She’s never in her office,” says a friendly receptionist. In the middle of the main corridor, the patients don’t let Edesia Rios take a single step. They take her hands, they tell her things, they touch her lab coat. “Come, come, do you want to see the examination rooms?” she asks with an interesting accent. She adds, “I should explain that I’m not a doctor, I’m a nurse. I’m the interim director here, but it doesn’t seem strange to us that a nurse is in charge. We rotate our jobs so that nobody feels like they are the only one who can do something.”

She says that there are 28 Cuban medical professionals working in the clinic. “We have opthamologists, general practitioners, surgeons, optometrists, biochemists, lens technicians, and nurses who provide postoperative care. There are two teams operating in parallel. There are 80 operations every day, but we’re going to do more… I have to say, it’s something you just have to experience for yourself, otherwise you won’t understand what it means to take a bandage off and have a person seeing light for the first time after 20 or 30 years of blindness. Operation Miracle is here to stay, and I think we will be able to help more than six million people.”

I CAN SEE YOU AGAIN!

The patients leave the operationg room. Outside, volunteer companions and the doctor who diagnosed them are waiting, and, supervised by the coordinator of UMMEP in Yacuiba, they get into two vans to go back to their hotels, where the postoperative care takes 3 days.

In the hotel reception area, they share their stories. The patients relax, wait for the nurses to put in their eyedrops, and talk, talk, talk. They also laugh, laugh, and laugh… Maria Rosa Gonzales appears, holding a doctor’s hand. She’s from La Rioja province in Argentina, and she confesses that this is the first trip she has ever taken in her more than seven decades of life. “It turned out that I had cataracts in my right eye. I went to the doctor when everything I could see was already all blurry, but when they told me they had to operate, I just left and didn’t come back. Then, one day, I decided to test myself. I put my hand over my eye, and you know what? I was completely blind. Of course, this scared me, so I started to ask around, but there was nothing I could do. With my pension of 150 pesos a month [about $50] and a son to take care of, who was going to operate on me? Well, now I just don’t have any words to thank them. You don’t know how they treat me here!”

While they put Maria Rosa’s eyedrops in, it’s Jose Baron’s turn to talk. He’s 70 years old, from the Argentine province of Tucuman, and he squeezes a little hat in his hands from nervousness while he speaks. “I still can’t talk to my children because I start to cry, and I can’t tell them that I can see now… I’m from the town of Monteros in Tucuman. I worked in a metal shop for many years as an ironworker. Ever since I was 14 years old, I was hammering metal, without a blowtorch, right over the fire, and, well, I got a growth in my left eye from it. I couldn’t get an operation because I didn’t have any health insurance. I got by for a while as a chauffer, but I was dangerous as a driver. Then someone from the city government told me to add my name to a list to be operated on in Bolivia by Cuban surgeons, and I didn’t hesitate for a second, you know? My family took up a collection so that I would have some money to bring with me. They sacrificed a lot and came up with 120 pesos [about $40], and look here: I still have the 120 pesos to take back with me!”

Angel Dominguez, also from La Rioja province, tells his story passionately: “They wanted 3,000 pesos [about $1,000] to take the growths out of my eyes. How could I get that kind of money together? I’ve spent almost my whole life seeing spots. When my eyes hurt, I’d just have to put ice on them, there was nothing else I could do. One day, I found out that Cubans were doing free operations, and I said, when will it be the Argentinians’ turn? So, here I am. The operation took two minutes, and the next day I could see perfectly!”

Elba Ruiz and her daughter, Rosana, come from La Salta province, and they excuse themselves because they have to leave now to go back. But before they go, they want to greet Claudia Camba, the coordinator: “I’m incredibly thankful. All my life, I’ve had a problem with diabetes, and I’ve been all over Salta trying to see if someone could at least fix my eyes. I went from Aguaray to Tartagal, and from there to Salta City…” Elba trails off, overcome by emotion, and Rosana continues. “What my mom won’t say is that all the hospitals treated us like trash. Unless you have health insurance, they just don’t care… In my family, three of us have already been operated on in Yacuiba.” The voice of Marta, a nurse from the Caribbean, comes: “Bye, my little patients!” and the three of them fall together in an intense group hug. “I’ll see you later,” says Elba, “and at last I can actually say that!” She believes in miracles. Maybe they don’t exist, but sometimes they happen.

 

“The first person I ever saw”

Neri Antonio Flores’ story isn’t just another one among the many stories of Yacuiba. “My mom was born with cataracts. I was too, and so was my daughter. She’s a year and a half old now. When I was a boy, I was dying to go to school, but in the first grade, the teacher told my parents that I couldn’t learn with cataracts, that they should take me to a doctor, but they were very poor and they couldn’t pay for it. So they took me out of school… I’ve managed to survive my whole life by being clever. I have some friends who work in construction, and since they know I always need work, they’ll find me something mixing concrete, filling up the buckets, but it’s always just temporary labor, nothing more than a day or two at a time… One day, I heard that they were screening people at the hospital to get operations in Bolivia, so I went, and that was it… Could you take a picture of me with Lucia? Lucia Ruarte. She’s the nurse who took off the bandage, the first person I ever saw. She made me laugh so much, because she was so excited and yelling, ‘What do you see? What do you see?’ I wanted to read some signs to show her that I could see, but I just said, ‘I don’t know, I guess those are letters.’

“From pioneer to screener”

Dinner at the Hotel Las Vegas is a big common affair. With their distinctive white eye patches, the guests arrive in a friendly mood, laughing and telling jokes. Doctor Mariel Sturzenegger arrives. She is introduced as a true pioneer of Operation Miracle. She says, “What made me a pioneer is that I was part of the first group of students who entered the Latin American School (ELAM, from the Spanish “Escuela Latinoamericana”) in Cuba. I’m from Bariloche [in the south of Argentina]. I was studying biology at the University of Comahue, and I won a scholarship to study in Cuba. That was in 1999, and there were 54 of us Argentinians going to study in Cuba. I switched to medicine, got my medical degree, and decided to return to Argentina in July of 2005.”

When UMMEP decided to put together a team to perform the operations in Bolivia, they needed doctors who could do the initial screenings to determine whether patients had a disease that could be successfully operated on at the center. “I didn’t hesitate. I got together with 7 other graduates of ELAM, the ‘pioneers of screening.’ We went to the city of Sucre in Bolivia, and received advanced instruction in opthamologic disorders, especially cataracts and pterygium. We began to search for patients who could be operated on in Bolivia, people from all over the country. This was July of last year. Afterwards, we continued our travelling work, going from town to town everywhere.”

Today, there are about 30 doctors doing diagnostics for the program, volunteers who donate hours and hours of work. They go to municipal hospitals with which they have previous agreements to meet with patients. Sturzenegger’s work isn’t over after that. She accompanies her group to the center where they’ll be operated on, where they will do further tests and make a final diagnosis. Then, Sturzenegger administers postoperative care in the hotels and returns with the patients to their home towns, where she arranges followup treatment with local opthamologists.

“An interesting story? There are many. For example, seeing doctors who operate on nearly blind grandparents on stretchers or in wheelbarrows when the borders are closed by protesters.”

 

Cataracts and Pterygium

These are two of the diseases that can be treated in Yacuiba. Cataracts occur when the lens of the eye becomes opaque. The lens must be transparent in order for the retina to receive a clear image. After many years, protein accumulates in the lens, causing it to become cloudy. This can also occur because of other conditions (diabetes, long-term tobacco use, alcoholism, etc.) or injuries. The cataract can occur in either one or both eyes, and does not spread from one eye to the other.

After the cataract operation, the patient being operated on in Yacuiba is examined by a specialist 24 hours later, after 7 and 15 days, and at 1 and 3 months, when the patient is given free eyeglasses.

The other treatable disorder is pterygium, a degeneration of the conjunctiva (the membrane that covers the white part of the eye and the inside of the eyelid). In cases of pterygium, the conjunctiva begins growing over the cornea and obstructing the patient’s line of sight. This excessive fibrous tissue growth over the cornea occurs because of exposure to ultraviolet light, wind, sources of extreme heat, etc.

The followup treatment for pterygium patients is performed after 24 hours, at 15 days (when the stitches are removed), and after 1 month, when they receive free eyeglasses.

During the preoperative phase, all patients receive complete tests of their hemoglobin, hematocrit, glycemia, and refraction; an electrocardiogram; and a visual acuity test.

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