In our strategic plan for Bolivia for 2016 I set out the need for a closer alignment between AMM and Bolivia from a

political stance. With this in mind I traveled to Bolivia in January to get things started and to assess the realism of our

plans.

Firstly, start the process of registration of AMM as a Bolivian Foundation. This will give us tax advantages, protect and

enhance our credibility as a medical organization and open new avenues for funding and communication from within

Latin America.

Secondly, achieve formal involvement in Bolivian Ophthalmology training from the University of San Simon in

Cochabamba. Discuss the opportunity to write some course content and work with individual ophthalmology trainees

during our surgical trips each year.

Thirdly, develop our relationship with the Bolivian Ophthalmology Society which having started well had begun to wain

as our intention for permanence in this country is now clear. There is a lot of support for our work amongst many

Bolivian ophthalmologists. However there are those who perhaps see AMM as a threat to the status quo and have a

closed agenda to growth of eye care services and surgical knowledge in Bolivia.

To identify new towns and villages where we can work this year and beyond. El Beni has 19 municipalities of which we

have worked in just 7 so far. Reaching new and larger towns as well as providing services in our existing towns is crucial,

Its amazing just how many villages there are and making their selection and researching them properly will help with

planning the correct number of days required and best team fit. I was able to identify Exaltacion, San Ignacio and San

Borja as new towns for AMM as well as agreeing to return to Santa Ana and San Ramon where we could access

Magdalena and our existing patients from Itenez.

And finally I wanted to explore the opportunity to help a Bolivian Ophthalmologist I had heard about working in San

Borja in El Beni (but with no equipment). I met with him and we discussed working together in June. Between January

and May, Dr. Fernandez agreed to identify patients for surgery which we would operate on in May together with

patients for second opinion and advice from our medical team.

In the main most of these aims were achieved and I returned to the UK with much to do before we were ready for this

year’s medical trip which was scheduled for 28th May until the 6th July.

AMM Newsletter - 2016 update

Before I describe this year’s trip, I would like just to spend a moment to explain where we are after 5 years working in

Bolivia and the need that remains.

Map showing northern Bolivia and the towns that AMM have worked in together with the location of current Bolivian

eye care services.

If we assume that 80% of blindness is treatable then it is estimated that there are 9000 operations needed to bring

blindness down to 1 % in El Beni alone. (More than 100,000 are needed for Bolivia as a whole). Additionally there are

patients who are not blind yet but will become so. Therefore services need to run at a level that reduces the current

blindness and copes with the volume of newly blind patients that present, as well.

In El Beni the capacity of the Bolivian eye services runs at about 200 operations a year all done in Trinidad. AMM

performs another 200 operations per year on top of this. At these levels, the number of blind is not decreasing quickly

enough, despite all of our best efforts.

Therefore this year’s priorities were to establish and equip the ophthalmologist in San Borja to add to the number of

patients that can be treated by Bolivian services throughout the year and for AMM to access new and larger towns to

treat a greater volume of patients during our visit. We want to do this without forgetting the many people who are

relying on us from the villages and towns that we normally attend.

The Trip

I traveled out ahead of the main group of doctors and nurses and had the pleasure of the company and help of my son

Matthew and Elisa his lovely girlfriend. This made traveling much easier and it was wonderful to show them around

Bolivia where I was born and where AMM now work.

We used our first few days to sort through the essentials for the trip, collect the medicines and consumables ready for

delivery to SAM air who would again fly us into El Beni. After lots of unpacking and counting out and repacking, I felt that

we had the right quantities for each group. For some unexplained political reason there was a blockade on in Santa Cruz

at this time and all roads were closed in and out of the city. This meant that all the usual domestic flights were booked

up and it was looking bad for a while. As it happened we did manage still to get our equipment to Sam Air and to get to

Trinidad as there was a momentary lift of the blockade just at the right time for us.

We took local transport to San Ignacio where we met with the town official Gomercinda Meneses who is an amazing

organizer in her town and a lovely person to work with. She genuinely cares about her population and couldn’t do

enough for AMM to see that we were looked after and that we had all we needed. We were provided with a disused

convent (below) to stay in which proved to be ideal. We had to wait a while due to poor flying conditions but eventually

met up with Greg from Sam Air who delivered all our equipment safely. We separated out what would be needed for

San Borja and took the remainder to the Hospital ready for the arrival of the teams. San Ignacio has a picturesque lagoon

as shown below.

On the Saturday Manuel Saldana joined us in San Ignacio and we had a great evening together before having to leave

him and travel to San Borja. Throughout Monday the 6th June the teams were transported in by SAM air to each town

and by the afternoon we were screening patients and setting up theatres.

Both towns had good hospitals and were well prepared to receive us. It is always a bit hectic at first until the systems

start to take shape and everyone gets into rhythm.

Photo on the left shows the team in San Borja operating theatre. Photo on the middle shows Dr. Fernandez the Bolivian

Ophthalmologist and Blanca from AMM. Photo on the right shows Pieter from AMM in the San Ignacio theatre.

Both San Ignacio and san Borja are big towns and we had a great response to our campaign with lots of patients and lots

of surgery. Both groups had different priorities. In San Borja many patients had been screened by Dr. Fernandez before

we arrived and therefore the focus was on training and equipping this hospital. This worked really well and at the end of

the trip AMM donated to a working microscope to the unit and some instruments for surgery. Dr. Fernandez turned out

to be a patient focused and caring doctor with some good basic skills and a good responder to training. We finished here

confident that he could continue to treat many of the pterygium in the San Borja area.

We had a few equipment issues as often happens in Bolivia and ended up running our microscope from a car battery as

the mains unit had melted from a power surge. You have to be able to adapt in this environment.

In san Ignacio things were different. This was a poor town and had not had an ophthalmologist visit since 2004 when

two Spanish doctors passed through for about a week. We attended to high volumes here screening over 800 patients

and operating on 100 blind or nearly blind in just ten days. We also ran a skin tumor service here where Manuel our skin

specialist on this trip removed many carcinomas from around patient’s faces and necks. This was the first time we had

done purely a skin cancer programme and it was a great success and something that we can repeat each year. Our

training here this year comprised A&E training for doctors and nurses and we also ran a specific lecture on identifying

vision problems in school children for all the school teachers in the town.

Left - photo showing patients waiting to be seen in San Ignacio. Middle - shows a lovely Spanish theatre nurse working in

San Ignacio who was most helpful in preparing the patients for surgery as shown on the right.

On the Sunday the 12th June the teams had the day off to visit the surrounding area which is very beautiful and

interesting. We explored the villages alongside the rivers and ventured into the Chimani communities.

The first two weeks passed quickly and on the 16th the teams had to return to Santa Cruz for their flights home. The

towns laid on grand thank you dinners with lots of speeches’ and some lovely gifts and certificates of thanks. They

clearly valued our work and dedication to the people of this region. Few other specialists ever come here.

This left us with just four people, Bruce, Matt Elisa and I.

We had until Monday to prepare for the next two teams. Firstly we needed a backup microscope and I had one stored in

Magdalena. I also wanted to see Shalet again. She is a long established patient of AMMs who suffers very poor vision

due to a syndrome she has called Marfan’s. We are preparing to take her to Paraguay for surgery as this cannot be done

safely in Bolivia. I needed to discuss many things with her and her family such as passports and travel arrangements as

well as seeing if her condition had worsened.

As is customary we called on SAM air who moved us to Magdalena and retrieved the microscope whilst Bruce and I saw

to Shalet. This is a very difficult case as she does see some of the time and is very fearful of surgery. However at other

times she sees almost nothing at all. It was good to see her and she is continuing to try hard at school so that she does

not fall too far behind. We changed her glasses again which helped her and discussed the best way forward for her

condition.

Left - Bruce examines Shalet. Middle – Magdalena by air Right Matt and Elisa with CP2156 SAM air’s trusty 1977 Cessna.

We said Goodbye to Bruce at this juncture who was traveling to the Village of Bella Vista for a few days and set off for

Santa Ana to prepare for the next two teams who were arriving on the 19th. We needed to stock take again and

redistribute medicines and consumables. The next two towns had very different population numbers. Exaltacion is

remote and a small village whilst Santa Ana is much larger and we were expecting higher volumes here.

The teams arrived and after a hearty lunch we split into those that would work in Santa Ana and those traveling with me

to Exaltacion which was only a an hour away by relatively good road. Again the team at the ministry of health for Santa

Ana were amazing in organizing everything and providing the transportation to Exaltacion who were their less well-off

neighbors.

Left loading the ambulance for Exaltacion – Middle - our accommodation. Right -our eating place for the next week.

Exaltacion was a new municipality for us. The total province has a population of 3000 people and so we were expecting

about 30 + operations here. As it happened the geography here is huge and there are very little roads connecting the 15

small villages. Therefore many of these people could not access us easily and we will need to rethink how we work here.

We have committed to returning in 2017 and with SAM air’s help we could cover this area more effectively. We still had

140 patients to attend and had some of the best results here of the whole trip. One patient who really stands out was a

blind lady called Nancy. She arrived from a village upriver and lived under a tarpaulin for her stay in Exaltacion as there is

no hotel here. We operated on her for cataract and the results were brilliant totally changing her life.

When we eventually told her she was free to return to her village, she broke down in tears and I’m afraid we all did

likewise. It was a lovely moment and one we will never forget.

Pictured left - Nancy’s tarpaulin house. Right the Exaltacion hospital team watching eye surgery for the first time. Right -

Nancy with Prasad Palimar two days after successful surgery.

The hospital in Exaltacion had never had surgery performed here and the team of doctors and nurses here really

immersed themselves in our visit. Observing in theatre and clinics and helping in every way they could. We did our usual

teaching here and at the then of the trip it was nice that Dr. Mara who was a doctor in training announced that she was

choosing ophthalmology as her chosen specialty inspired by our visit. I hope she is successful.

After 4 days we had exhausted the potential here and took an eight hour river trip to Puerto Siles where we transferred

by ambulance to San Ramon where we had worked three years previously. Unfortunately we clashed here with a major

sporting event and very little preparation or effort had been made for our visit. Although we were well looked after for

food and accommodation, the advertising for the trip had not been carried out very well.

The main method of communicating to the public is by radio and the radio station here had been out of order for three

months and so only the town’s people knew we were coming. Most of these didn’t need to see a specialist and it was

frustrating to know that blind people were out there but unaware of our trip. Exasperated by the situation I traveled to

San Joaquin and here with the aid of a working radio managed to find 50 or so patients who needed help. Some were

not operable and had old infections or painful irreparable blind eyes. In some cases we were able to treat for pain but

not vision. Notwithstanding I did find 14 cataract blind or pterygium patients and were able to operate on these by

transporting them to San Ramon where we were short of numbers. For all the frustrations it was great to see some of

AMM’s previous patients doing well and we were able to repair second eyes in a couple of cases.

Left – Loading the riverboat with our equipment. Middle - the 8 hour river journey. Right- Umberto one of our patients

from 2013. Even though his surgery had gone well, he lost much of his vision following a fungal infection and his vision

with one eye was poor. We were able to help him by removing the cataract in his other eye.

Meanwhile in Santa Ana our other team was very busy. Our team here was Luke John and Patricia who are surgeons and

Sam our theatre nurse. It was John and Patricia’s first time in Bolivia. John had worked many years in Africa and we were

keen to learn from him both surgically and in terms of our own organization. Patricia was our Spanish speaker and was

kept very busy with clinics and theatre as well as managing the relations with the local hospital staff and town council.

For their weekend activity the team was treated to a river trip with a camping stopover in a remote village a few hours

away. It was a great experience and was enjoyed by all even if a little apprehensive of sleeping in tents in the jungle.

At the end of two weeks the town put on an evening of food and speeches which went on late into the night. Again it

was sad to leave but pleasing that we had built on our work of last year and had given many people back their vision.

Left - John and Patricia meeting the town officials in Santa Ana. Right, certificates and speeches on the last evening.

The final few days of the trip were spent by Matt Elisa and me in Santa Cruz getting the equipment ready for storage,

planning repairs and counting stock of medicines before we too had to return to the UK.

Over the whole trip we as a team screened 2000 patients, operated on 220 blind or nearly blind patients and carried out

lots of teaching and set up one ophthalmology centre in San Borja serving 49,000 people. Not bad at all.

Plans for 2017 are already underway.

If you would like to make a regular donation to support our work or to discuss working with us, please contact Dave

Goldsmith for more information.

Email dave@andeanmedicalmission.co.uk

Mobile 07807432035