Continuing a volunteer legacy
Rockwood ophthalmologist’s team provides cataract surgeries in HondurasMay 11th, 2017
Early last month, Spokane-based ophthalmologist Dr. Jonathan Haymore returned from his second annual surgical expedition to Honduras, where he and a team of volunteers work to perform cataract and other eye surgeries on those who can’t otherwise afford or access such procedures.
According to data from the Eradicating Cataracts Honduras Outreach Foundation (ECHO), a nonprofit based in Acworth, Ga., 20 million people worldwide are blind from cataracts, a medical condition in which the inside lens of the eye becomes progressively clouded, resulting in blurred vision.
The foundation says 160,000 of those 20 million live in Honduras, a country which has the lowest cataract surgery rate in Latin America, and less than 90 surgically active ophthalmologists.
“It’s a very poor country,” says Haymore. “Ophthalmologists there are overwhelmed with the volume of patients who can’t pay. We’re able to come in and volunteer our services free of charge.”
Haymore is a practicing ophthalmologist at Rockwood Inland Eye Center, at 842 S. Cowley, and serves as the medical director for the Rockwood Eye Surgery Center.
He specializes in medical and surgical eye problems, treating conditions such as cataracts, macular degeneration, glaucoma, and diabetic eye disease.
“I see probably 40 patients during the week, and do about 10 surgeries one day each week,” he says. “Most of the surgeries I do involve either cataracts or glaucoma-related issues.”
Although this was only his second such trip to Honduras, Haymore says he plans to turn the trip into a lasting tradition.
“It’s only 10 days, and it’s a lot of work to put together, but it really changes lives,” he says. “In the U.S., we’re lucky enough to have a great medical system, but it’s trips like this that allow you to see what some people live with.”
This year, Haymore says, four volunteer teams performed a total of 113 surgeries, almost 20 more than last year.
“It’s nice knowing 113 people can see again, and that we’ve helped them to get back to living their lives,” he says.
Originally from Twin Falls, Idaho, Haymore earned his undergraduate degree from Brigham Young University, in Provo, Utah, and went on to attend medical school at the University of Rochester School of Medicine and Dentistry, in Rochester, N.Y., completing his residency at SUNY Upstate Medical University, in Syracuse, N.Y.
Haymore moved to the Spokane area in 2010, joining Dr. Michael Cunningham’s practice at what was then called the Inland Eye Center. Haymore eventually took over the practice there, following Cunningham’s retirement in 2014.
He says he first heard about the need for eye care in Honduras through two of his former professors, Drs. Robert Weisenthal and Thomas Bersani, both of whom practice in Syracuse and are faculty members at the SUNY Upstate Medical University.
“They’ve gone down to Honduras for nearly 30 years,” he says. “They helped provide us an introduction to the area, and we do all of our work from their clinic space in La Cieba.”
Haymore says La Cieba is a port city on Honduras’ northern coast where members of the volunteer team stay during their 10-day trip, which generally is scheduled for the first week in April.
Haymore says his friend and former co-resident at SUNY Upstate, Dr. Robert Hill, also participates in the volunteer trips, in his role as an eye plastic surgeon.
“We’ve stayed close friends and hope to continue the legacy of Drs. Weisenthal and Bersani,” he says.
Haymore says each of the four doctors choses their own team to bring on the trip, including a scrub nurse, a circulator, and a translator.
Loretta Higgins, a nurse who works within the Rockwood Eye Surgery Center, serves as scrub nurse for Haymore’s team, while his wife, Veronica serves as the team’s circulator.
“A circulator is a nonsterile member of the surgical team,” he says. “She holds patient’s hands, sterilizes instruments, preps supplies for surgery, and helps us with record keeping.”
Haymore says the role of translator generally is filled by bilingual college students who’re experienced in international travel.
Upon arrival in La Cieba, teams begin preparing the clinic for operations in order to be ready for patients.
“Patients start lining up at 6 a.m.,” Haymore says. “We arrive by 7, and work until about 6 p.m. I’d say we take care of about 10 or 12 cataracts each day, and any patients we don’t get to are seen first the next day.”
He says the team used to allow patients to stop by on a drop-in basis, but soon found that method was taking business from local doctors.
“When the surgery is offered for free, and performed by an American doctor, they wait until that day to stop in,” he says. “To cut down on that, we try to have a list of patients beforehand. That list also gives us a better idea of needed supplies.”
Haymore says most of his patients in Honduras are between 40 and 50 years old, and blind in both eyes due to cataracts.
“Cataracts are typically caused by sun exposure, poor nutrition, and limited access to medical care,” he says. “Here, we don’t usually see advanced cataracts, as we’re able to correct them before that stage.”
Haymore says some patients have lost jobs due to lack of sight, while others can’t attend school.
Haymore says the most common treatment for cataracts is a procedure called phacoemulsification, which involves cutting into the eye, removing the blurred lens, and replacing it with a clear implant.
“We make a small incision through to the lens, just beyond the iris or colored portion of the eye,” he says. “Next, we insert an ultrasound probe which is used to break the cataract into pieces that we then vacuum out.”
After the cataract material is gone, doctors then fold a new lens implant into the empty space. Because new lens implants have to be fitted to the shape of a patient’s eye, Haymore says the doctors are often limited to the selection of lenses they’re chosen to bring with.
“We do a pretty good job matching everyone to the closest (lens) power possible,” he says.
For most patients, the team fixes one eye, sometimes arranging to do the other during the next year’s visit.
While cataract surgery typically lasts 10 to 15 minutes here in the U.S., Haymore says in Honduras it could last up to 45 minutes depending on the technique used.
“Sometimes, the cataract is so hard that the probe can’t break it up,” he says. “In those cases, a larger incision is needed to remove the whole lens as one piece. That takes longer, and the patient usually needs several stiches after.”
Haymore says another complication to cataract surgery in Honduras is the lack of anesthesia available.
“Here in the U.S., we use intravenous medication to help sedate the patient, but it’s not general anesthesia. Patients are sedated and monitored by an anesthesia professional,” he says. “In Honduras, we don’t have anesthesia personnel, nor a way to monitor a patient’s reaction to anesthesia, so our alternative is to use what’s called a nerve block.”
A nerve block involves injecting medication directly into the patient’s eye socket, which effectively numbs the whole area.
Haymore says doctors here don’t usually use nerve block for cataract surgery, as it’s uncomfortable for the patient, and there’s some risk of complications.
Haymore’s trips to Honduras are funded in part through the Rockwood Medical Foundation, a local nonprofit that funds philanthropic activities, including donations to Eastern Washington University, patient education programs such as Diabetes Day, and scholarships for staff to further their education.
“The foundation seeded us an initial donation,” he says. “That’s developed into the eye surgery fund, which accepts donations year-round.”
Haymore says his team’s first trip cost about $13,000, which included a special surgical microscope and other needed equipment and supplies.
“Our largest expenses are surgical instruments and larger equipment,” he says. “This year’s trip cost closer to $8,000, which I expect will be about average for most trips from now on.”
Although the teams have mostly modern equipment and adequate supplies, Haymore says the work environment is still a bit more difficult than operating in the U.S.
“Down there, there’s a lot less paperwork, with no consent or insurance forms to fill out,” he says. “However, it’s sometimes a longer process anyway, working as a team to organize patients and instruct them on aftercare.”
Haymore says follow-up care also is somewhat harder to track.
“We are usually able to check progress the next day,” he says. “And there’s nothing like the moment of taking off a patient’s patch and watching their face as they see again for the first time.”