TWECS Eye Care Mission 2015: Return to Tacloban

The following are dispatches sent by Dr. McDougall from his eye care mission to the Philippines in November, 2015.

November 11, 2015:  Today is Remembrance Day

I feel even more grateful than usual. Grateful for the country I live in, grateful for health and peace, and grateful that I am free to make my own choices about how to live my life. But as I am packing up to leave for the next three weeks, I am particularly grateful for the comforts of my home, my friends and family, and of course my dog jackson :)

Tonight, Walley and I are headed to the Philippines with TWECS, for an eye care mission to the city of Tacloban, on the island of Leyte. It has been exactly two years since Super-Typhoon Haiyan hit Tacloban, killing thousands and displacing over one million people in the surrounding area.

I joined the TWECS trip that went to Tacloban two months after the disaster, and the images of destruction I saw, and the stories of loss that I heard from survivors will stay with me for life. Typhoon Haiyan, known in the Philippines as Typhoon Yolanda, was one of the strongest tropical cyclones ever recorded, devastating portions of Southeast Asia, particularly the Philippines, in early-November 2013. It will be an interesting return for me, to hopefully see progress and rebuilding; yet I know that there are still thousands of people living in makeshift homes, and large tent cities that were created as temporary housing.

The focus of this trip will be to help those who have not yet recovered from the effects of the natural disaster. Poor vision is not only a quality of life issue, but also an educational issue, an economic/work issue, and for many a safety issue. The moto of TWECS is “your old eyeglasses can make a world of difference”, and I have seen this myself over and over again.

One of my favorite memories from the last trip was of a young 13 year old girl that we saw in the last hour, of the last day of our clinic. She was from a small coastal village which had been largely destroyed by the hurricane. It turned out that she was highly myopic (on the order of -8.00 diopters, for those optometrists out there), and she had never had glasses before! It had nothing to do with the natural disaster at all, it was simply that this girl had no access to getting an eye exam or glasses. She had been functioning as nearly a blind person: barely able to make her way to school, or see anything once she got there. The change that a pair of glasses will make in her life is kind of immeasurable. I honestly felt blessed and honoured to be there at that moment in time. Thinking of her inspires me as I pack up to leave.

Another memory that I have been thinking about all day, occurred this same time of year in 2009, when I was in Ethiopia on an eye care mission. My father had just passed away a few months prior, and I had carried his glasses with me to donate to someone who needed them. One day in the clinic, I found a colorful goat farmer from rural Ethiopia that they were perfect for. My friend Charlene took a picture of us to show my mom and sister. It wasn’t until I got home that I realized I had a poppy on in the photo. Someone from our team had brought poppies for all of us to wear on Remembrance Day. What perfect synchronicity, and a great remembrance of my dad, and that trip to Africa. This will be Walley’s first eye care mission trip, and we are both excited and anxious to share this adventure. We will end some updates and photos as we go.

November 15, 2015:  A house is not a home

We have arrived safely in Tacloban, and have already put in our first clinic day, which is one of the most grueling days ever. We set up clinic outdoors, under full sun, in the center of a makeshift basketball court in the center of a illegally built shanty town.

It was a crazy introduction for Walley, sweat soaked clothes and full body heat rash! Almost like getting jumped into a gang. He was a trooper, always with a smile, and of course with candy in his pocket for the kids.

The clinic was in the Anibong neighborhood just outside of Tacloban, which is most notable for having been blasted by the tsunami, which washed several tankers ashore, landing in the middle of a fishing village.

When we were here just after the typhoon, it was surprising to see that the people of that village just continued to live in the middle of the debris and all around the stranded tankers. Google it. It is kind of crazy.

At the time I couldn’t really conceive that a person would continue to live amongst such wreckage, but I am starting to understand that your home is not just a building, it is so much more.

On the first day here we toured around the city and were happy to see that there has been relatively a lot of progress. It is so much greener, the vegetation has really rebounded. And now there are tons of businesses, and most of the debris has been cleared. Homes are being repaired and rebuilt, although the locals complain that it is still hard to source building materials, and you have to get in line to have builders help you.

We toured the resettlement areas, which are row style house that are built for people that were displaced from their homes due to the destruction of the storm. They are huge groupings of shack style houses on the outskirts of town. I know this sounds like a very “first world” perspective, but there seems to have been zero urban planning. It seems like there were houses built, but not homes.

Many of the people we spoke to are from fishing villages, and the resettlement areas are placed deep inland without transportation. There are no schools, markets, vendors, or job opportunities in these settlements. To send each kid into town for school is 20 pesos each way (not even one dollar, but a steep price to many of the displaced families).

This is a family’s home – at the edge of the water in Anibong

As a result many people, like the people of Anibong that we saw today, are not going to the resettlement areas, but living back in the original areas they were displaced from. The government has set no-building zones all along the waterfront as a reaction to the destruction of the storm, but people continue to build in the areas they are accustomed to.

It reminds me of what I experienced in Central America where we saw families living in garbage dump settlements. A year prior a group of humanitarians from the UK had build homes a few kilometers out of the garbage dump and moved families to much these new, much cleaner and safer environments. But the families abandoned these new homes and moved back to live at the dump. It is what they knew. Their parents and grandparents had lived there, their livelihood and community was there. It was their home.

One thing I have learned over the years with these trips is that you cannot place your own values and beliefs on someone else’s life.

So with that perspective, this time I viewed the the people living in Anibong with new eyes. What last time looked to me to be terrible conditions, this time looked like community. Where I previously saw filth and squalor, this time I noticed the homey touches like house plants and decoration…a pride of place.

The day of work in the clinic is hard, but rewarding. I saw a young guy today with a really high prescription, and when I found him a new pair of glasses he said it felt like an early Christmas, and I was like Santa Claus, though I suspect what he really meant was I looked like an old white guy with a red/burned nose.

Tomorrow we set up a more permanent clinic (indoors!!) at the tacloban hospital. No air conditioning, but at least not full sun.

Full of gratitude for the life we get to live at home, and a new appreciation of what home really means.

November 17, 2015: The heat is on

We have just finished our second day at the Tacloban City Hospital, and it feels like we have been doing this for weeks already. It takes a while for the flow and the team to gel into precision, and so the first few days are a little extra challenging. And the heat! Oh my God the heat! We are mostly working inside now, so not in direct sun, but the alternate challenge is packing hundreds of people in line into the hallways of an in-air-conditioned hospital. The humidity, and the human-heat/smell is not really something that can be described.

What stands out, as always, is the patience of the people waiting to see us. It can take up to six hours for someone to move through the whole process of examination and eyewear dispensing, and there is never a complaint. The patients wait for hours on end, in nasty heat, and no one is ever anything but thankful and patient. There is a lesson for me to hold onto in that.

The only real upset that ever happens is when people feel like they might not have a chance to get in to see us. Yesterday, the bulk of the people we saw were from far-off communities that had heard about our clinic, who had travelled a long distance. When they arrived, and saw that there were already several hundred people waiting in line, there was some pushing and shoving just to try and take a place. Many of the first people arrived before 4am. We committed to registering as many people as possible, the limit being the light of day. We need to be able to make sure we finish before dark so it is safe for the patients (and our volunteers) to get home.

We over estimated a bit on our first day, and after working straight for twelve hours, we ended up staying past dark to finish with the last few. It was a marathon in both a physical and mental sense.

But, even despite the heat and the fatigue, after you get back to the hotel and shower and have a beer (or two, three…) you feel gratified, fulfilled, and oddly at peace.

Each day so far we have seen people that desperately have needed our care. Today there was a 30 year old woman who was a -19.00 diopter myope (!) who had never had glasses. She had heard months ago that we were coming, and after several hours (and a lot of waiting and sweat), she got her first pair of glasses. After overcoming the shock from moving from essential blindness to vision, she insisted on coming back to see Marina, just to touch her, and thank her. They both cried without really exchanging any words. It is hard to imagine both what that woman’s life has been like up to this point without glasses, and what will change for her going forward.

And that is not an isolated story, though it is an extreme one.

There have been so many people with huge refractive errors that have never been corrected. Or maybe that had glasses before, but have not been able to get a new pair since the typhoon.

Walley remains shocked that this is the case, though I have seen it consistently over the course of several of these trips. The World Health Organization notes that the leading cause of functional blindness in the world is uncorrected refractive error (basically not having glasses). Simply not having access to getting glasses is the main cause of people living blind. Seems unbelievable, but it is a reality here, and many places in the world. Glasses are such a simple, but effective thing.

Walley, and myself (before having laser eye surgery) both had had high prescriptions, so we can empathize with people in a real way. Walley, who continues to grind through the auto-refraction station, is amazed at the readings he gets and keeps asking people “so you have really never had glasses?!?”

We do one more day of clinic here at the Tacloban hospital, the we move to more remote clinics in coastal villages on other islands still recovering from the storm. It is a bitter sweet move, because while we all appreciate the need to help the rural people we have a ton of stuff to move with us. And when I say a ton, it is not a gross exaggeration. We have traveled here with 35 fifty pound boxes plus 20 carry-ons, which as a whole weighs in at over three-quarters of one ton! That is a lot of stuff to carry on and off the trucks, and in and out of our hotel. Wally and I are looking at it like a good fitness regime.

We continue to have a deep sense of gratitude of our life, our country, and for all of you.

November 19, 2015:  The sweat is all worth it

The last couple days at the clinic have passed really quickly, yet each day feels epic and cinematic. And super sweaty! So many things happen in almost every moment, and over the course of a day you go through a full range of emotions.

Ready to see the cutest kid ever?

He is 5 years old, and is already a -12 diopter myope. We actually saw him when we were here last time directly after the typhoon, and gave him his first pair of glasses. His mom (who of course is also highly myopic) brought him in this time to show us just how well he is doing. She waited in line all day with him, to have him checked again, to thank us, and to deliver a handwritten letter she prepared to express her feelings. Since getting his glasses he is excelling socially and is one of the top pupils in his elementary school. He is blossoming. In a way that would never have been possible. His presence was so refreshing to the team, and inspired us in the middle of a hot, challenging day.

The same day we saw a man with the most horrifically gnarly glasses tied around his neck. The people I work with will particularly appreciate the appearance of the nose pad/bridge area of his frame!

At first glance, of course, the first reaction is: oh, gross! But with some reflection, it highlights the importance of those glasses in his life. They have been repaired and torqued so many times they are almost unrecognizable as the frames they once were, but to this man they are of vital importance. Of course we provided him a couple of replacements, and will hold onto the photo as a memory of the importance of vision correction in daily life.

Today I had one of the most amazing experiences of my entire professional career. A 28 year old woman, named Cherita (very close derivative of my own sister’s name) went through Walley’s station of auto refraction and he brought her to my attention. She lost her glasses in the typhoon two years ago, and her uncorrected distance vision is what we call “counting fingers”, which means quite literally she can only tell how many fingers you are holding up 2 feet from her eyes.

Glasses are only one small part of what she lost in the typhoon: she lost both her parents, her husband, and her three year old child. Her life had been literally stripped bare of everything. She feels the only reason she survived is that she is a good swimmer. It is essentially impossible to imagine how she must feel.

In addition to all of the heartache she has had to endure, she has been living functionally blind over the last two years. She had a complicated prescription, -9 in one eye and -11 in the other with oblique astigmatism in both. It is a very unlikely Rx to find in our inventory, but I found an absolutely perfect match for this woman. And I found it, amongst the thousands in our inventory, almost effortlessly. This has happened on several previous occasions on these trips, and I cannot describe the experience as anything but a spiritual moment.

The glasses that someone back in Canada had donated were not only the exact complicated prescription, but fit her face so perfectly that they instantly appeared to be her own. I will hang onto that moment for the rest of my life. In an instant the entire effort of this trip was made completely worthwhile.

November 23, 2015:  Universal family

“Shah ahn, ecca du ha?”

I am sure that is not how it is written, but basically that is how it sounds to me all day: “one or two, which is better?” I can’t seem to get away from that phrase even ten thousand miles from my office. My interpreter / assistant on this whole trip so far, a young registered nurse named Lynn, says it all day, and it is ringing in my ears as I write this. Here is a picture of me and Lynn at the Tacloban Hospital.  Lynn has been amazing!

When we arrived this morning to our clinic site in Tinauan, there were already hundreds and hundreds of people lined up outside. The mass of bodies is a little daunting when we arrive. But this is our seventh straight day, and so our team is starting to get comfortable with what to do and what their roles are. So within minutes of arrival the day is off and running.  We examine people in a stage by stage setting. The first stage is registering people with their name, age, chief compliant, etc, and measuring their visual acuity at distance and near.

The next station, which is primarily where I work, is called triage. I assess each person’s complaints and the acuity measurements and then divert people on to different paths- either prescribing simple reading glasses on the spot or sending them on to more extensive testing for refraction, or eye health problems. I enjoy this area, but it means I essentially interact with hundreds and hundreds of people each day- at least once in triage, sometimes twice when I refract, and occasionally three times when I help dispensing glasses. The level of human interaction is very intense, and the effect can be kind of mind-numbing.

my line up at the ‘triage station’ at one point today

I try my best to remember that I am treating individuals, and not get into a factory line mentality- but it is difficult when working with these numbers. For example here is a picture of my “line up” in triage at one point this morning. As much as I can, I try to remind myself of a Tibetan Buddhist mental exercise I have heard of, where you look at whomever you meet as someone who in a previous life was your mother. And I try to treat each person with that in mind. If I find myself in auto-mode, I stand back, take a deep breath, look into the next person’s eyes directly and try to remember this principle. What if this was my mom standing before me. It keeps me in the moment, and being in the moment of contact with people who are suffering is what makes this exhausting work actually refreshing in the long run.

It is not hard for any of us to imagine ourselves in a reversed position. As humans we all have a similar nature, and want the same things: happiness, love, health. It is fairly easy to imagine yourself in their shoes. What luck is it for me to be born into my life? It is a razor’s edge of destiny separating my life from theirs.

Our leader Marina was born not too far from here, and she told me that each time she sees a little girl come through the clinic line she thinks, this could have so easily been me.

Feeling this reality helps keep you open, full of solidarity as a human, and full of empathy. You can’t help but feel and act with kindness. Despite the fact I have a heat rash on my wrists and back, and a bumpy fungal infection brewing on my fingers :)  That sense of solidarity, and community is so evident here in the Philippines. We have noticed a significant amount of rebuilding and recovery all around since our last trip to this region, and I believe that one of the most important aspects in the recovery is the importance of family and community.

And I don’t exclusively mean family in terms of what you are born into, but rather a sense of family that is created. Related or created. It is not the physical form of family, but the support, companionship, security and understanding of the people closest to us. It gives a sense of belonging which is so vital especially in such challenging times. Not only do the people here typically have large extended families, but they live in neighborhood groups called barangays.

A barangay would be like a neighborhood (like Kits, or Yaletown, or Gastown) and everyone in the barangais acts as a group and watches out for one another. A created family. After the typhoon people banded together in their barangay to make sure they were safe, fed, and looked after.

The universal sense of family is also evident in how people refer to each other. For example if you want to catch the attention of a woman in line my interpreter Lynn may say “ate (said ah-tay) come here”.  It means “big sister” even though she may not know them directly, it is a sign of respect and also, to me at least, a sign that we are all part of one family.

In a similar way an older woman is called “Lola” (grandmother), and an older man called “Lolo” (grandfather). Lynn assures me that not only is it appropriate for me to call people by these terms, but is is a sign of respect. All day I also called one of our older lady volunteers “Maam Edna”, and she smiled at me everytime I did. I feel a heavy sense of gratitude for the circle of friends and family that I have back at home, and recognize it as one of the most essential parts of my life. Thank you to all of you.

On a clinical front we continue to experience amazing moments peppered throughout each day: A woman who has never had glasses, who is a +8.00 at distance and a +10.00 at near. For at least the last two decades she has not seen her hands clearly (not to mention the food she is eating, or anything within a a meter or two from her face!).

A 59 year old woman who is -9.00 (unlike the last lady, she can see her hands a few inches from her face but cannot recognize how many fingers you hold up more than 3 feet from her face)- who last had a pair of glasses when she was in high school. Why did she go almost her whole life without replacing them? Honestly, I don’t know: poverty?, prioritizing her children over herself?, adapting to not seeing and forgetting what it was like? Seems in imaginable to me.

Walley, who has a high prescription himself, brought a second pair of glasses with him on this trip, because without them he would feel ineffective and would get brutal headaches. So when he sees people move through the clinic with prescriptions like he has, or worse, he has a significant empathy.

So yesterday he said he wanted to donate his second pair. I explained that he has kind of an unusual prescription with oblique astigmatism and quite a lot of anisometropia (difference between his eyes), that would be hard to match, but of course within a day of him deciding to donate he popped out of his autorefraction station with a smile and said: “I think I have someone for my glasses!”  At the time I thought, probably not, but as karma would have it he had found a great match in a young guy who had never had the chance to have glasses. Not only is h is vision incredibly improved, but his new Oliver Peoples frame with custom clip-on looks totally banging, and would be right at place in the hottest spots in Vancouver!

November 23, 2015:  Gracious, humble and happy

TWECS volunteer Walley Wargolet (the partner of Dr. McDougall), who travelled to Tacloban in November 2015 as well, wrote this post for the TWECS blog: here is his story. 

Eight clinic days into our mission to the Philippines and I am overwhelmed; not by the hard work, the heat, nor the lines waiting for us each morning, but by the gracious, humble and happy people I’ve been blessed to cross paths with.

Each day I’m met with at least 500 smiles as I work with patients, pass people on the street or when a group of adorable kids, like these (that’s Richie in the middle), who as we were closing down today came up and asked me where I was from and introduced himself.

I’m also overwhelmed by how lucky I am to have been blessed with the ability to have had eye care since age three. While it broke my dad’s heart his son had to wear “Coke bottle” glasses at a young age, that gift of sight allowed me to have the life I have. Each day as I auto-refract patients (technology that provides the eye doctors a starting RX) we come across at least a handful of people aged 9 to over 60, whose RX either matches or supersedes mine and they have never owned a pair of glasses. I can’t even imagine my life without my corrected vision.

As a related note and one of my favourite moments of the trip thus far, was being able to give an old pair of my glasses to a young man, who had an almost exact RX as mine, yet never owned a pair of glasses. He was both shocked (seeing life clearly for the first time) and very thankful for his “new” pair of glasses.

Shameless plug: please donate your old glasses, you may change someone’s life.

As we get ready for our last couple of days here, the other thing that sticks out to me is the happy people I see each day lost so much two years ago during typhoon Yolanda, but that has not stopped them from rebuilding and moving on with their lives. While I came here to help, I’m leaving with a life lesson taught to me by the men, women and children of the Philippinian island of Leyte, no matter what comes in your path you find the strength to forge on, and you do it with a smile.

November 26, 2015:  Community Hall

It wouldn’t be right to not post at least one picture like this, because we see several people with an eye like this each and every day of the clinic. And after seeing so many, you can help but see this as an analogy for the difficulty of life here; traumas, scars, loss.

Gross eye picture alert!

As my partner Walley wrote about this resiliency we witnessed: “Something bad happens, it probably hurts pretty bad for awhile, but you forge ahead with life anyway, and don’t really let it define your life.

In this case, this is a 74-year-old rice farmer who got something in his eye 15 years ago. It never resolved itself, and he never sought care for it. At this point he has the worst case of symblepharon I have ever seen (the eyelids are scarred onto the cornea, so they are unable to blink). He assured me that it does not hurt at all, and he seemed surprised that I was interested. As I was looking at it, he told my interpreter Lynn: “That one doesn’t work.” Yes, right.

He just wanted a pair of glasses to be able to see up close, so he could fix his tools and knives. We gave him a couple pairs, and also a pair of protective goggles, which he will hopefully use: because of course he is still working every single day at his rice farm with no plans of stopping.

It seems like near the end of each trip there is a very special moment which acts like an insurance policy that convinces you to do another mission in the future. Even while you are dripping with sweat and grime, still not done with the trip at hand.  I saw a young 14-year-old girl, in a school uniform, come through the triage line up. She was born completely blind in one eye, and the other eye had very limited vision and a bad nystagmus (involuntary eye movement). But some how she had made it through high school and was in her first year of college, which starts very young there. What amazing persistence and intelligence she must have to get so far with such barriers. She had no measurable distance vision, but she could see 20/200 at near by holding the chart about two inches from her eye and pushing her eye-focusing muscle hard. The amount of effort she would have to put in to get through a day of work is pretty extreme.

At my practice in Vancouver, I have a particular interest in Low Vision, which is creating magnifying systems for people with legal blindness. It is complicated, expensive and not always successful, even with a full set of resources at my disposal. So after talking with this little girl for a few moments I went to our small supply of donated low-vision devices, and within a couple minutes I had found a perfect match for her. It is just like the perfect solution spontaneously emerged. There was a spectacle-mounted surgical microscope 5X, aligned on her only seeing eye, in a frame that fit her little head perfectly.

Like any normal telescope or microscope you would use, if the alignment is off-center with your eye even a millimeter or two it renders the optics useless. This was absolutely perfect for this little girl. Within just a couple of minutes of instruction through my interpreter she was able to find the focal point perfectly and see her picture and info on her school badge for the first time ever.

There are many things that amazed me about this, but the ease and speed of it all coming together was hard to believe. At home this might take several visits, thousands of dollars, and still might not work. Here in the middle of a community hall in Tunanan it came together in minutes. It is not really anything I did per se, except be at the right place at the right time.  A God moment, no matter who your God is.