El Salvador Cataract Mission

29 Nov El Salvador Cataract Mission

The Need

Cataracts are the leading cause of curable blindness in the world.  No one should be blind from a cataract–No one. And yet, almost 20 million people are blind from curable cataracts worldwide. One study found that in El Salvador, 4.3 percent of illiterate women over the age of 50 are visually impaired just because they need glasses and about 2% of unemployed men over 50 are blind from cataracts.¹

Basic cataract care in El Salvador is generously provided at national hospitals.  All the patients have to do is wait long enough (currently one year) for their turn to come up and then purchase their IOL, suture, and surgical knife at a store across the street from the hospital to present to their surgeon.  The problem is these items cost them about $80 dollars which many just don’t have, so their vision slowly fades to blind.  In addition, the cataract surgery provided is done with a method largely abandoned by developed countries 25 years ago.  Those with enough money can fly to Miami or seek out one of the few private ophthalmologists in country that provide modern cataract surgery like the Jose Lopez, MD or Gabriel Quesada, MD who are both involved in helping our clinic.  Our goal is to end cataract blindness in El Salvador and bring self-sustaining, local ophthalmologist delivered, high level cataract care to all socioeconomic classes in the country.

History of the Love

My first introduction to the amazing El Salvadorian people was in 1981 when I began spending significant time with newly arriving refugees while working as a missionary in the Spanish speaking neighborhoods of San Jose, California. There I heard first hand of the profound difficulties and dangers they faced in their country and developed close friendships.

I have grown to love El Salvador and the amazing Salvadorians.  First of all, the entire month of September every year they celebrate with half price doughnuts, nationwide!  The lines inside Mister Donut are social events in and of themselves.  All around town you see motor cycles driving around with four or five large dozen size boxes of doughnuts tied to the back.  Here’s a photo of the line I waited in to get my dozen. 

Conveniently, they use the U.S. dollar as their only currency, so I, like everyone else, bought my doughnuts with dollars (half price).  Don’t even get me started about the trees that make chocolate and hibiscus plants growing naturally all over the place.  It is lush and beautiful.  Their national bird is one of the most amazing creatures I have ever seen.

Much more impressive, they named their country after the Savior.  How can you help but love a country that would take His name upon them like that.  The county’s landmark they are most proud of is a giant statue of the Cristus called “El Salvador Del Mundo” (The Savior of the World) at the center of a massive roundabout in the center of San Salvador. 

The History of the Need

For decades El Salvador along with the rest of Central America and its governments were decimated by the banana companies that ruled with a cruel, non-local-friendly fist.  Perhaps fortunately, the advent of the banana fungus largely destroyed the banana industry in the region so the companies moved on.  The coffee industry also brought wealth to some in the country, but even though they are known to grow some of the best coffee in the world, much of that has moved off to other countries like Brazil that can produce it for less. 

It has been devastating to lose the largest sources of their economy, but it has given them back some independence.  With all of this upheaval, they became embroiled in civil war from 1980 to 1992.  The rebels (some Marxist and some just antigovernment) were fighting for more opportunity and their ideals, while the government was fighting for theirs.  This war was fought in the jungles, in the cities, and in the neighborhoods.  Probably worst of all, every night government forces and or government sympathizers would “disappear” anyone suspected of having any ties to the rebels and rebel forces would “disappear” anyone believed to sympathize with the government.

The standard protocol was kick down their door at night and then torture those kidnapped until they gave the name of someone that may be involved with the opposite side.  Many of the names given had nothing to do with either side, but giving a name signaled the end of torture and the life of kidnapped would then be found on the side of the road the next morning.  The next night the cycle of violence would continue with the new names both sides had “collected” the night before.  Every morning there were new victims strewn along the roadside and every night all that remained would go to sleep wondering if that was the night they would “disappear.”  This was just 28 years ago, so many of those affected are still alive.

When the war ended, most of the soldiers just integrated back into society with members of both sides now living in the same ancestral neighborhoods.  Is it any wonder that they brought home with them a culture of violence?  With freedom and freedom from war, the country experienced a renaissance and made amazing progress, but the propensity for violence and the drugs passing through the country on their way to the U.S. made El Salvador fertile ground for gangs.  Out of this background sprang the MS-13 gang, widely considered the most dangerous gang in the world.  With all this, it is not surprising that El Salvador still has the highest murder rate in the world for 2020. 

Given all these challenges, the resilience and the rapid progress the El Salvadorians have made since their civil war ended is nothing short of a miracle from their Namesake. 

Now they face a new challenge in the pandemic.  El Salvador has about the same population as Colorado.  Their Covid numbers appear lower than Colorado’s, but the effect on the economy and food security may end up being devastating. 

I started by admiring the fact that the El Salvadorians named themselves after the Savior.  Even with all their miraculous progress as a country, perhaps they will need Him now more than ever. 

Why a Clinic in Santa Ana?

Several years ago while doing some cataract surgery in San Salvador with my friend, Kevin Waltz, MD, we discussed a significant unmet need for cataract services he had discovered in Santa Ana, El Salvador.  Kevin and I had done a number of mission trips together over the years to San Pedro Sula, Honduras.  In the past we had always done our mission work collaborating with a strong local surgeon as a home base.  This provided us with needed local infrastructure that we could build upon and lift.  The problem we had noted is that working that way lifted and trained one local surgeon, but none of other eye surgeons in the community.  This made our efforts helpful, but non self-sustaining.  The goal was to find a neutral location and build it up, de novo, so all the local eye surgeons in a region could use the enhanced facility and be trained in modern cataract surgery.  Santa Ana seemed like the ideal place to try this. 

La Universidad Católica De El Salvador

The Catholic University of El Salvador (UNECAES) seemed to be the best location for this new clinic and surgical center in Santa Ana.  The university had tall, barb-wired walls all the way around it with a gated, guarded entrance so it would be safe.  Second, the university already had a medical school.  Third, the university is filled with 5,000 of the most hope filled student faces I have ever seen.  They just shine. Fourth, they have long term aspirations to build a hospital on campus if they can work through the politics (story for another day) and they viewed the construction of our potential clinic as a helpful stepping stone to their eventual hospital. 

The Plan

We met with the Monsignor and university officials and agreed that they would build the building and we would provide all the equipment, supplies, and staff salaries for the clinic/OR.  I spearheaded the project from that point along with local surgeons Drs Aguilar, Rivas, and Portillo.  Thereafter began a long saga of lessons in politics and the difficulty of starting a “neutral clinic” with no nascent infrastructure in a foreign country that is still trying to decide if anything U.S is good for or with them.  This mistrust has been earned as the U.S. has been very involved in the misfortune El Salvador faced in the banana wars and in their civil war.

After a series of OR builds (literally we built it twice), border difficulties, Covid 19 delays, pleadings with the ministry of health, personal trips to Santa Ana or last minute canceled trips to Santa Ana every other month over the past three years, La Clinic De Ofthalomogia UNICAES with its magnificent operating room was officially approved by the ministry of Health on October 8, 2020. 

In a separate post I will outline the details of the history of the building, its approval and the hope “La Clinica De Oftalomogia UNICAES” creates for the future of the Eastern half of El Salvador. Patients have been finding our clinic even though we haven’t publicized it. To this point we have been taking them to San Salvador for cataract surgery. Now our doors and arms are wide open to help them where they live and we can make known the opportunity for vision in the churches and Unidades (local heath care clinics.). We probably need to do about 30,000 cataracts to catch up in this part of the country which is about the population of Windsor, Colorado. Here is the thing about that number of surgeries:

• Happens to be a bit less than the number of cataracts I have done in my career–that makes the task conceivable.
• Help from my partners and colleagues around the U.S. and El Salvador–that makes the task achievable
• Hope founded in El Salvador Del Mundo–That makes the task and ultimate victory inevitable

Gary Foster, MD, is a cataract and refractive surgeon in Colorado and Wyoming.

1. Rius, A. Prevalence of visual impairment in El Salvador: inequalities in educational level and occupational status. Rev Panam Salud Publica. 2014 Nov;36(5):290-9.