TWECS Eye Care Mission 2011: Nicaragua, Central America

The following are dispatches sent by Dr. McDougall from a 2011 eye-care mission to Nicaragua. 


Auspicious Arrival

We have arrived safely, and already the promise of adventure has already begun.

Thanks to the work in advance of TWECS founders Marina and Derick, passing through customs with our equipment and donated glasses was an absolute breeze. Everyone was very supportive of us the whole way.

The ride to our camp was not such a breeze. We left the airport at about midnight, and headed for the beach camp which was about a three-hour bumpy ride. Thank God they stocked it with cerveza (beer)!. Halfway through the trip our bus collided with a horse, tearing the whole right front side off the bus! Luckily no one on the bus was hurt, but the horse had been badly injured, and our “host” Gerry (a big 300-pound Nicaraguan that we are already calling Tony Soprano amongst ourselves) had to get out and shoot the horse to put it out of it’s misery (thank goodness). Welcome, and Whoa! I guess its good to know our host is packing heat.


Sleeping under mosquito netting in a beach hut.

The beach camp is really cool, but “camp” is the right description. Cold-only showers, tons of bugs and sand fleas, wild dogs everywhere, beach huts with mosquito nets. Arriving late at night adds to the element surprise. One woman in our group had to brush two dead fetal mice out from under her pillow (mine was clear). We teased her that maybe she would get $2 from the dead-mouse-fairy.

My hut is 20 steps off the beach. I heard the surf all night and woke up and went for a swim first thing. Seems like a fair trade-off for some malarial threat and fetal mice?

We are riding a big bumpy school bus into Chinendega to scout our clinic site for an early start tomorrow. It is really warm and humid, and the area is very lush and tropical. We are also going to drop by the community that lives off the garbage dump to make sure we can bus some/all of the children in to our clinic site. We are being “hosted” right now by the Chinendega fire department, and the have agreed to take children and those in need from the dump to and from our clinic site on their fire trucks, so that should be fun for all.

Red beans and rice, sautéed bananas and high voltage Nicaraguian coffee for breakfast. Life feels good.


“See with your whole eyes, and act with integrity and kindness.”

That is kind of the guiding principal I am trying to keep in mind this trip. Sometimes it is hard to really believe where you are. I definitely had that feeling today when we spent time at the Chinendega dump and the community that has built up around it.

There are approximately 3,000 people that live in that community, and about 1,000 are children.The kids are not just dirty, it is many levels beyond that. More like dark black filth, I guess mostly from burning small bits of copper wire together.


It is visually staggering when you look at it as a whole, and heart breaking when you meet the kids and families that live by scouring the dump for metal scraps and sellable items.

But I remember from my last trip to Ethiopia that it is wrong and misleading to put your own value system on other people in the world, especially the developing world. Today, it was not lost on me how the families at the dump seem happy, and have formed a community despite the conditions they live in.

Note to self: big, big lesson in there.

What sticks out as most sad for me is that, for most of the kids, there really is no way out of that life. It is almost impossible, no matter how bright a child might be. Like other major problems in the world, I’m sure the situation is very complicated, and there is no easy answer. Even with lots of different groups trying to help. I was told that one group built houses for some of the families from the dump to move to, but ultimately the families moved back to the dump because that is what they are used to. That is what we all do: go back to what we are used to.

At the dump I met a 20-year-old guy, his wife, and their one-year-old daughter. He has lived in the dump his whole life. Probably his daughter will too He had a lot of muscles, probably from digging through garbage all the time. I told him I have a gym-rat friend who picks up heavy stuff over and over to try and look as muscular as him. He thought that was funny.

Maybe a part of an answer is to try to provide opportunities for the children that show promise: helping with school costs, or teaching trades to promising kids. One small step at a time. You really meet amazing people on a trip like this. For those of that have made donations, believe me, it will be money well spent. You can’t believe what even 10 dollars can do here.

I feel like it has been a full trip, and it is day one, and we haven’t even started clinic yet!


“Friday will involve machine guns.”

Today we set up a new clinic location at a fairly rural hospital in El Veijo. It doesn’t really look like what you would think of as a hospital, but is really closer to something like a farm, and we set up in the main barn. Crazy. We all worked ourselves at maximum capacity, and it is inspiring to watch people work so hard just to try and be of service to as many people as possible. We saw 750 patients today.

nicaragua2011-3-2Most of the people we saw have never had glasses before, and you never really lose the joy in helping someone see for the first time in a long time. One of the most touching moments of the day was when an elderly couple, both in their 70s, found their way back to me in the chaos of the clinic just to thank me and touch my head and ask God to bless me. They both only needed reading glasses, which really is quite simple from my perspective, but to them the ability to see was amazing, and the dignity they felt at being individually seen was unusual enough for them to be really touched by the experience. When they both touched my head they looked so happy, and i felt very touched (and blessed actually) by the experience myself. They left me holding hands, and all of a sudden I felt a wave of my Dad’s presence.
Something about how the two of them, and how they were taking care of each other reminded me of my mom and dad, and it made me feel honored to be part of taking card of them. It was an added bonus of this whole experience to remember my dad so vividly at that moment, and feel his presence in such a far away place.

Tomorrow we move our clinic into the city of Chinendega for the last few days. We have been told it is the “hottest city in central America”, and we will be working out of a Red Cross centre right in the middle of the city. They are expecting over 1000 people to be there in the morning, and our local “host” Gerry said that every person that leaves the clinic with a free pair of glasses and new clear vision will create 30 more people that will want to get in. We are going to be there for two days in a row so he said the second day will be really crazy, and will “involve machine guns.” While that was funny, and we all laughed, we also felt it settle in that maybe he wasn’t really kidding. The next few days are going to really test our nerves, our stamina, and our patience.


One of the great things about this trip is not only being able to help people in their day to day lives, but it is also a great opportunity to feel proud of yourself in a meaningful way. Today not only did I practice optometry in a language I don’t really speak, but at one point (by channelling the power of Marina from afar) I controlled a group of about 200 people that were getting very unruly with our line up system using only 3 of the dozen or so words I know in Spanish. “Sientisay por favor, muchas gracia” ….a few words can go a long way, as long as people feel you are in control, but it is hard to feel in control of the situation when you can access a very limited vocabulary!

Uno mas

There is only one more clinic day (“Uno mas,” and expression most Canadians only know from ordering another beer!). On one hand we are happy because we are all getting pretty tired, but on the other hand we have really bonded as a group, and are feeling really good about the effect we are having on people’s lives. Plus like any team, we have each found the place where we can be most effective, and are enjoying the fact that we are starting to look and feel like a well-oiled machine.

Two of them most memorable patients from today were both little children. The first little boy and his mother didn’t arrive early enough to be included in our cut off point, which was the first 650 people as that is really the max we can see in a day. Especially on the last day, we are very careful to make sure to tell people waiting past the 650 in line to not wait all day in the sun, and still not get in…really one of the worst jobs for one of our team members to police this policy all day.

But this little seven-year-old boy was obviously blind, and essentially the whole line of people waiting begged our group to please let this boy and his nicaragua2011-1mother in to be seen. It is inspiring to see people empathize with each other, and his mother was crying just from the support of the line up.

The boy has been blind since birth, from hydrocephalus (pressure on his brain) and congenital cataracts and nystagmus. The is no surgery in the world to help his vision, and regular glasses will also be of no help at any point. We are fortunate as group to have a supply of donated low vision equipment (magnifiers and other rehabilitative vision devices donated by blind Canadians who can no longer use them). I was able to find some incredible devices that he may be able to use, particularly when he is older, to provide him with some near vision out of one eye.

This is where the magic (or spirit, or God, or karma) really happens on this kind of trip… His right eye is completely black-blind, and his left eye only has what we call “hand motion” meaning he can only perceive movement at about 3feet from his face. Only the left eye. When I went to our box of supplies I found and incredibly strong device called an 8X spectacle-mounted microscope, for the LEFT eye!!!, in a frame with is perfectly suited for him. Likely from a Canadian child with a similar condition.

Unbelievable!! In Canada this would cost about $1500.

Because he is so young (and we are so pressed time) we taught his mother how to use the devices, and a couple other magnifiers we found for him. We also did our best to explain what is called “orientation and mobility” training, which is how to use a white cane to get around outside of the house (he will start with a stick)… And she said he is already ok around his own house with his arms out stretched, so that is a very good sign that he could pick up the use of a cane, with some coaching from his mom.

Thank God we have some incredibly bright young interpreters with us to help explain all this to his mom. I actually hold quite abit of hope for this really cute, happy (!), young boy.

nicaragua2011-2Another memorable encounter was again with a mom and child, but this time the child was a cute four-year-old girl with a majorly turned in left eye. This is called strabismic esotropia, and some times the eye just turns inwards a bit, or maybe just occasionally. But this little girl had a defect (overly short) in her medial rectus eye muscle that made her eye turn in all the way to her nose. Constantly, since the day she was born.

Everyone she knows thinks it makes her look “crazy”, and otherwise she is such a cute happy little girl. But because of how she looks the stigma for her is already great, and will only get worse as she ages and goes to school. Kids are mean universally. Some of you might remember a similar story from my trip to Ethiopia, where we found a young boy with a similar look, but in his case (accommodative esotropia) it only required a strong pair of glasses to correct his turned eye, and that was resolved in a matter of 30 minutes of him wearing glasses. This girls situation in Nicaragua is different in thy surgery is the only option to re-position the muscle on her eye (sounds gross but is really pretty basic). But the stigma she would face is the same as in Ethiopia, where it is relatively common belief that she is either crazy, or that the devil has cursed her or her mother in some way! No!! Simply, her left medial rectus muscle is 2 mm too short.

We learned through the interpreters that the mother had paid a significant amount of money a year ago to see a surgeon to see if anything could be done, and he told her no. That is simply not true. Although that eye may never be able to actually work, it could be aligned.  It may be considered a “cosmetic” procedure, because the goal is just to normalize the look… but that would be like considering a cleft palate repair simply cosmetic. Looking like all the other girls could make all the difference in the world, in so many ways.

Today like the other days, each one of us saw several dramatic cases where people’s lives have the chance to improve directly because of what we have done. So far (with the money you have all donated) we have arranged for 30 or so cataract surgeries for profoundly blind people who are still young enough to be productive and provide for themselves and their families. It changes lives.

Also with your donations, we have also made many glasses for patients we have examined who have such complex problems that their glasses are not in our inventory. Most of these are for children from the schools that we have examined who desperately need glasses to have any chance at success in school. With any luck, some of the children we touch with the process will end up be future leaders in their communities, or maybe even in their countries. Giving hope is a big part of the whole mission.IMG_2326

Outside of what we are doing at the clinic, your donated money has also gone to support the groups we have been working with here. Water purification systems to the communities surrounding the garbage dumps, school supplies for children, and sponsoring supplies to sustain the community health centers that have be built by the people of our base camp.

My brother-in-law Drew arranged for two huge bags of used baseball equipment (from my nephew Connor’s little league) to be brought over with us. I didn’t realize at the time how perfect that would turn out to be. Nicaragua loves baseball! Ask anyone on the street and they will be quick to tell you that Nicaragua has more players in the national baseball league than any other country in central America, or in the Latin world for that matter. Baseball is a source of national pride here, kind of like long-distance running was in Ethiopia. It is one thing where they are on par, or better than other countries in the world.

The donated equipment is going to go to a rural community center that has never had equipment. The kids there play with sticks and rocks. We are not going to be able to take the stuff there ourselves, but it is easy to imagine how excited that community is going to be. Again, some hope. Maybe the next Nicaraguan major league player will come from there.

Although I am loving this experience, I am going to be very happy to get home. No question I have an incredible life at home, and I don’t just mean the warm showers and lack of fleas in the bed.  Having such an incredible partner, family, and group of friends (and yes, dog) is what makes life great. This trip has proved the community that supports you is what allows you to be happy no matter the conditions.


So, again thank you for your donations, because this is an example of how we can use our discretion to help find the right surgeon, and pay for the costs of the surgery to change this girls life. No matter how tired I was at that point, and the fact that I had to head right back to the backlog of the line, I felt like I had a little more gas in the tank.

This mission is done, and we are all tired, bruised, injured, rashed, flea-bitten, sick and burned. But after a few days enjoying the luxury of my home and friends I’m sure I will be ready to sign up for another one of these amazing, inspiring missions.

To end on a funny note (because as a group we all see the benefit of laughing as much as possible), the last few days our host and some of the firemen have been teasing me because of my twisted Spanish (personally, I thought I was doing great). After looking into most peoples eyes I would say something like: “Tus ojos es bien sano” which I thought meant your eyes are in good health. With my pronunciation and also pluralizing it (they do have two eyes, right?) I guess I was coming dangerously close to saying “your eyes have a good anus.” It was cracking everybody up so much, it was the hit of the camp for the interpreters and bombaros. Language can be very subtle.