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Best Friends Forever

UAB Callahan Eye Hospital and affiliate clinic staff take the gift of vision care to Nicaragua — and get back much more than they give thanks to the Friends of Rudy organization.

Healthy vision is a precious gift. That’s an instantly recognizable fact of life. Less readily recognized, especially in more fortunate societies, is that access to vision care is an equally precious commodity.

However, none of the doctors, technicians, nurses, and support staff who have participated in Friends of Rudy (FOR) Nicaraguan Health will ever take that for granted. By bringing excellent eye care to one of the neediest areas of the world, each of these professionals has gained a global perspective, experiencing firsthand the value and rewards of providing health care for populations in crisis.

FOR Nicaraguan Health, Inc., commonly known as Friends Of Rudy, is a nonprofit organization dedicated to providing medical treatment, resources, and clinic funding to residents of the world’s poorest communities. FOR was initiated on an ad hoc, informal basis during the early 1990s by Jose Rodolfo (Rudy) Vargas, MD, of Birmingham, Ala. A native of Nicaragua, Dr. Vargas came to the United States in 1969 for a residency in internal medicine and a fellowship in the subspecialty of endocrinology and metabolism. He now practices at Brookwood Medical Center.

After Dr. Vargas made many successful mission trips to Granada, Nicaragua, and as various hospitals, churches, and individuals in the Birmingham area continued to grow funding and provide resources, FOR organized mission trips with teams of physicians to a small hospital in Granada. The organization officially incorporated as a nonprofit in 2002 and formalized plans to develop a fulltime clinic in Nicaragua.

Since then, various physicians and staff at CEH and affiliate clinics have participated annually in this remarkable mission, travelling each February to bring treatment, equipment, and other resources to the Nicaraguan communities most in need. Some of those individuals shared their experiences for this annual report.

Michael A. Callahan, MD

I travelled there on my first mission right after a hurricane almost wiped out the city of Granada. The facilities were almost non-existent. The staff was washing sheets on rocks. Everything was tense because the revolution was still going on. One of the volunteers who worked with us was actually smuggled back to the airport in a white coat so that anyone who saw him would think he was a doctor.

Today, most of the work is done at the clinic outside the hospital there. It’s a one-room clinic where we examine patients, and the room functions as both a pre-op and UAB  post-op area. We do about 20 surgeries per day. It’s hot and dry there in February. There may be rodents or insects in the clinic, even birds nesting. We have had water brought in and boiled so we could use it when, for whatever reason, the water supply is cut off. Resources are still limited, even though over the years we have provided plenty of materials and equipment upgrades. FOR has made numerous changes for the better.

We try to get people back to a point where they can at least make a living. Without eyesight, folks in this area face a meager existence; there’s no financial safety net. Worse still, children who have strabismus (crossed eyes) are ostracized in that culture, treated as though they have developmental disabilities, much the way deaf children or kids with disabilities were sometimes regarded in our society many years ago. If they aren’t treated, their vision doesn’t develop properly, which impacts their ability to get an education and greatly compounds the bleak prospects of a meaningful life.

The two main procedures I perform are to remove cataracts and correct strabismus. I call them “Nicaraguan cataracts.” You almost need a hammer and chisel! I think the toughness of the cataract tissue is due to lack of medical care, as well as living an extremely difficult life in a hot, sunny climate that takes a toll on the eyes.

I’ve always had a yearning to go to the places where people needed help. I think many people in my field do. I recall one of our staff coming to me during a recent visit, saying ‘There’s a lady here who has waited all day to see you.’ We continued with some surgeries, then I saw her at the end of the day. This dear woman had been sitting in a chair, outside, in the sun all day. Her sole purpose was to bring me a thank-you note and present it to me in person. The people there are so appreciative. That kind of thing is one of the reasons I got into medicine in the first place.

Katherine Burleson Fuchs, Ophthalmic Technician

My trip to Nicaragua with Dr. John Parker was a crash course, you might say, because I had been working for only a couple of months at that point. I feel like I learned so much because of the sheer number of things we had to do. We screened about 200 patients for cataract surgery and corneal transplant during the first day at the national hospital.

The first year was difficult because we were set up in the courtyard under bright sunlight. The next time we set up in a classroom adjacent to the building. Each day we walked to the hospital we would see children sleeping on top of boxes or digging through trash for food. This is one of the most impoverished areas in the world.

The thing that always amazes and touches me is the warmth and gratitude of that community. After patients undergo a successful surgery, they are so expressive of their gratitude. It’s so humbling. Their families have so little, but they would come back to the hospital to bring us gifts and food. Dr. Parker has invited me to go to Nicaragua every year since then. It’s an opportunity I recommend to anyone who gets the chance.

Cindy Ratliff, Office Manager

My first visit to Nicaragua to participate in the Friends of Rudy project was a gift from Dr. Callahan for 30 years of service at the hospital. Once I was there, my job was to get patients on a gurney before surgery. I was proud of the work our teams were doing in this country, of course, and thrilled that I could be a part of giving something of tremendous value to the people there. But I’m just as impressed with what those wonderful people gave back, or I should say, what they taught us in return.

We learned so many lessons from those who don’t have the blessings we have. For example, instant generosity; I don’t recall walking past a single home where we were not invited to share a meal. And the children; I would love to have brought them all home with me! One of my tasks was to distribute donated toys, and quickly it became apparent that I would barely have enough Beanie Babies, or coloring books and crayons, or other toys on some days.

I became concerned about having an age-appropriate toy for each child, and even though by some miracle we always had just the right number of crayons and coloring books, I worried about it. I was always thinking in terms of “having enough.”

Then one morning I noticed a little girl was tearing out, one by one, all the pages of the coloring book she was given. When I had a moment free I went in the room to see what she was up to. This precious girl was giving one page and a few crayons to other children in the room so that all of them could enjoy the coloring book. I was so touched by her immediate understanding of sharing.

I told my great-granddaughter about that little girl when I returned. Later, just before my next trip to Nicaragua, she came to me to ask if she could share her crayons and coloring books with the children there. I also told both my grandsons, who play baseball, that I saw kids in the villages so poor that they were playing with sticks and rocks to make a game for the group, yet it was their parents who had offered us meals. Both my grandsons wrote stories about that for classroom assignments.

That’s why I feel like I brought as many gifts back with me as I took. So many beautiful lessons that I will never forget, and that continue to touch my family. When I first asked Dr. Callahan what in the world I could offer if I travelled with the FOR group, he said, ‘Just your smile.’ That was a nice thing for him to say, but let me tell you, I returned from Nicaragua with a much bigger smile.

Richard M. Feist, MD

I think most of us here have some innate instinct to help others, and I think we get more from the experience than the people we go down there to help. I’ve made 15 or 16 visits. For the first few years, the national eye hospital was closed, and the roads were still in terrible shape from the wars with the Contras and Sandinistas. It was difficult to transport equipment to the hospital, but as things improved we were able to get more resources shipped there and put in place, so now we are able to take cases we could never have treated in the early days. The success of Friends of Rudy has been tremendous. In the time I have been participating, we have gone from not treating retina cases at all to performing retinal surgery.

Teaching is a big part of what we do there. The residents are engaged in every aspect, from examining patients and screening for surgical candidates to performing procedures and surgeries. We work side by side on all the cases we treat.

Nothing makes you more confident as a surgeon than performing procedures in an unfamiliar place, with less equipment, fewer resources, and more difficult cases. It’s how we learn to be comfortable with whatever circumstances fate throws at us. Because we’re blessed with so many resources here at Callahan Eye Hospital, and with so many colleagues who can participate and support us in treating patients, it’s only in places like Nicaragua we can learn to do a lot with a little, under trying circumstances.

We also might discover an area where we excel or gain a new interest. We have at least two residents at UAB who have decided to become retina specialists based on their experience with Friends of Rudy. All around, the experience with FOR makes us better physicians after we get back home.

Karen Burleson, AVP Human Resources

Our first trip was to Ecuador in 2011. I’m not a medical staff member. I help patients get to where they need to go, help them get undressed or dressed for surgery, and I assist with the surgery schedule and locate whatever materials the doctors need. I’m just really an extra pair of hands, whether that’s with patient care or organizational tasks.

Of the entire wonderful experience, I think I was most taken with how much gets done under less-than-ideal circumstances. I’m accustomed to a modern health care environment with almost unlimited resources, and there are regulatory issues with every treatment, every patient visit, or every procedure. Down there you just roll with it and do what needs to be done.

It’s impressive, not just how our doctors respond so well to that setting, but that they get excellent outcomes for so many patients. You can gain a real appreciation for what we otherwise might take for granted at Callahan, where patients have access to all kinds of support if they are vision-impaired. A serious condition means a lifestyle change, of course, but for our patients in Nicaragua, low vision can be a matter of life or death. If they can’t see to work, they have nothing to fall back on.