Women for Direct Relief, a support group comprised of community member supporters and members of the board embarked on a trip to El Salvador to help distribute high-dose vitamin A tablets to children in rural areas. We visited FUDEM, a partner organization Direct Relief has worked with since 2000, providing them with ophthalmic sutures, eye antibiotics, and other eye medicines worth over $4 million.
Direct Relief has collaborated with Leiner Health Products to provide high-dose capsules of vitamin A over a three-year period to El Salvador 's FUDEM to distribute through their clinic systems in the country's poorest regions.
Under the partnership, Leiner will provide high-dose tablets of vitamin A that Direct Relief will deliver to FUDEM's eye clinics in El Salvador. FUDEM has an extensive mobile medical/visual program that I’ll see on Thursday. Through this program FUDEM will provide 63,000 dosages of vitamin A for El Salvadoran children once every six months for three years.
According to a USAID-funded national survey (ESANES), one out of every three children under five years of age in El Salvador is vitamin A deficient. Vitamin A Deficiency (VAD) is the most common global cause of preventable blindness in children worldwide and leads to increased morbidity and risk of mortality.
Tuesday - Izalco, El Salvador
The Women for Direct Relief arrived in matching orange t-shirts ready to put yesterday’s training into practice as part of FUDEM’s eye care campaign. But first we were led to an auditorium full of people, decorated with streamers and large bunches of pink, yellow, and orange balloons. The mayor, the physician who runs the health center at the school, representatives of the Ministries of Health and Education, as well as a representative of the National Guard were each called up to sit on stage, as were Nancy Walker Koppelman as representative of our group, and Nina Palomo, President of FUDEM.
After each dignitary said a few words the room stood for the Salvadoran National Anthem. A talented band of horns played several other songs too, including the old Sinatra favorite, “My Way.” Trip member Kate Firestone was offered the microphone and sang a phrase of the song before a surprised and appreciative crowd. After this very special opening ceremony we were taken to our respective stations to begin work.
More than 720 people of all ages received eye screenings, examinations, and when diagnosed, either a new pair of glasses on the spot (170 received reading glasses, 30 others prescription glasses), a prescription to be filled within the next few weeks, or an appointment for follow-up service. In addition, each child up to five years of age received a high-dose Vitamin A capsule and tablet of the antiparasitic medication albendazole.
Everyone seemed dressed for a special occasion; older women wore dresses and fine ruffled aprons with layer upon layer of lace; girls wore their best dresses and shoes and men wore button-down shirts and nice slacks. And perhaps it was a special occasion as more than twenty Direct Relief volunteers and FUDEM staff spent the day in their town providing eye care free of charge to families living on an average of $1,200 a year.
Dorothy Largay, Kate Firestone, and Dr. Ayesha Shaikh (an OB/GYN in practice in Santa Barbara), worked at the first station where preliminary visual acuity screening took place, directing people to cover one eye and read the letters from a chart. Ayisha was surprised at how many people simply could not see. In one group, three out of five did not make it past the second row of large letters. Sherry Villanueva, our group’s intrepid interpreter and photographer, observed that as the day progressed she began to appreciate how many layers of problems the families faced – the obvious vision problems being simply the top layer.
Many people had rotting or missing teeth – untreated oral infections can lead to other serious health problems, including heart disease as people age. After one troublesome screening the mother explained that her child has cerebral palsy. When asked if she could take him to the FUDEM clinic for further eye exams she explained that she could not afford the 55 cents it would cost to take the bus to San Salvador. Sherry offered to give her the 55 cents. The distraught mother explained that she has six other children she could not leave at home alone. Without a husband, without funds, her young son seemed to be without hope for improved health.
All Sherry could do was give the boy a Beanie Baby in hopes of comforting them both. When the boy gave Sherry a kiss, the mother began to cry.
The third stage was, thankfully, managed by competent and professional FUDEM staff, where comprehensive examinations took place.
Rita Moya and Mer James worked at the fourth station where the eyeglass prescriptions were prepared. With a stock of the most common lenses ready and only minor adjustments required, most people were able to walk away with their new pair of glasses within minutes of receiving their exam. A man who received a pair of reading glasses immediately sat down, pulled out a newspaper, and read it with a big smile on his face. How long had it been since he last read a paper?
Marisa Grimes worked at the vitamin A and albendazole distribution station. In the privileged place of meeting all of the youngest children, Marisa was particularly charmed by them – and struck by how different their lives are than those of her own children.
Jamie Gumins and Nancy Walker Koppelman worked at the final station where gifts of personal care packs were given out to each family that participated in the eye campaign. This was the place, not surprisingly, where the action seemed most anticipated; a group of boys with shy smiles lined the far wall waiting curiously for what might be about to happen as we set out the boxes of packs. Nancy chatted and laughed with the children, and by mid-day took one lively local woman up on her offer to help with crowd control. Jamie let three little girls put colorful Band-Aids on her arms for practice after explaining how to use them.
A man walked in the room with a purpose, but did not show the slip of paper authorizing his receipt of a gift. With his son in his arms he reached out and shook each of their hands, said, simply, “Gracias,” and instructed his little boy to do the same. The boy smiled, shook their hands, and offered his word of thanks. The man’s gesture seemed to reveal much beyond gratitude; honor, pride, and responsibility to provide important lessons for his young boy.
Our reward for a full day of eye campaigning was a visit to a Mayan cave further out in the lush green environs of Sonsonate District. We walked in to the opening of a cave formed by lava from a volcano that erupted hundreds of years ago. In this dark place the Mayans carried out rituals to honor the four elements of air, water, earth, and fire. The Women for Direct Relief were privileged to witness a demonstration of this ceremony, which is said to cleanse and rejuvenate the spirit.
Wednesday - Isla Tarajeram, El Salvador
A thirty-minute bus ride from our hotel in San Salvador took us to a port village where we met a local man that was home visiting from North Carolina, where he has lived for twenty years working as a chef at a Chinese restaurant. After a wait of about half an hour we set out for the island on a boat comfortably seating all of the Women for Direct Relief and two FUDEM staff members. Our new friend and other townsmen kindly helped us into the boat and we were off.
It was a beautiful, bright morning that found us bumping along the bay toward Tarajera. The boat ride was about another twenty minutes, which took us past resort islands with large homes, anchored sail boats and yachts, and the Hotel del Sol where, we were told, people come from all over the world to stay.
There are an estimated 5,000 inhabitants on Tarajera. This was the first FUDEM eye campaign to be held here, and people came from all over the island, as well as from many neighboring islands. Some people traveled two hours by boat or canoe. Through another well-organized (and exhausting) campaign day, the women and FUDEM saw a total of 680 people and provided 120 people with new eyeglasses. At the end of the day we were treated to ceviche, compliments of the mayor, brought all the way from the Hotel del Sol.
In comparison to the people seen yesterday at Izalco, the populations of the islands seemed healthier; the results of the eye exams revealed fewer eye and vision problems, the condition of people’s teeth were better, and people looked well nourished. It would seem that their better health is attributable to a diet that includes fresh fish. One predominant health problem, however, is parasites due to the practice of eating contaminated clams.
The populations of the islands were also younger than that of Izalco. Senior women dominated the eye campaign at Izalco, while today there were more men in general, and more women of childbearing age and middle age. The children of the islands seemed livelier, less passive and shy.
Today, in addition to the eye exams, Ayesha Shaikh provided free “toma de citología” (the Spanish phrase for a Pap smear) for 15 women. Ayesha was pleasantly surprised at how well-informed and healthy she found the women. She was also surprised to learn that many of the women practiced birth control using Depo-Provera, which requires a visit to the doctor every two months. She said it is especially impressive knowing how difficult it is to get women in Santa Barbara to faithfully make their Depo appointments. The average number of pregnancies among the women Ayesha saw was four – with one having had 10 while in surprisingly excellent condition (she had had a hysterectomy).
Sherry Villanueva, our intrepid photographer, had the opportunity to speak with several women who had had only one child. We later learned that the local doctor, who works with the Ministry of Health, has a close collaborative relationship with the local priest. The priest, demonstrating progressiveness in extreme contrast to most clergy in Latin America, actually encourages birth control and participates in home visits with the physician to promote health among the families they both serve.
Another evident difference in the two population groups was the incidence of strabismus, a condition causing crossed eyes. This genetic condition was evident in at least 15 children in Izalco while only one child was seen with the condition on the island.
The women found today’s campaign quite a bit easier than yesterday’s, as they fell into the routine of their stage assignments (even though some alternated to work a new stage), and developed a greater coherence as a group and as a team with the dedicated FUDEM staff.
Though the homes on the island were constructed of simple wooden sticks and thatched roofs – and dirt floors – the women felt that the poverty seemed less severe than they had imagined because the island folks were so much healthier in comparison to people they had met in their other travels in the developing world.
And yet, the isolation, illiteracy, and structural poverty were certainly real and very much evident. It was a privilege to have the opportunity to bring eye examinations to the people of Tarajera Island and its neighbors, many of whom received ophthalmic service for the very first time.
Thursday - Candelaria, El Salvador
The location of each of the previous campaigns was the local school of a remote, rural community. The location of today’s campaign was a beautiful retreat center overlooking Lago Ilapango in a semi-urban setting. Majestic and serene, the view belied the poverty surrounding it – though it did seem less severe than the poverty of the communities of Izalco and Isla Tasajera, perhaps due to its greater accessibility to building materials and other consumer goods.
An estimated 300 people received free vision screenings, high-dose vitamin A, and antiparasitic medications. Dr. Shaikh provided another 25 women with free Pap smears as well. Unfortunately, the women seen today presented many more complications, including four who required referral to the local clinic. The Ministry of Health also provided free TB and tetanus shots to the campaign participants today, which demonstrates another instance of excellent collaboration on the part of FUDEM with the local MoH officials.
Overall, the Women have been extremely impressed with the professionalism, efficiency, and dedication of the FUDEM staff, particularly to Rural Outreach team responsible for the eye campaigns. The campaigns themselves become community events that bring local officials, the Ministry of Health and other government departments, as well as community leaders and volunteers such as local health promoters together to serve people of on a completely nondiscriminatory basis.