A vision restored.

Byline: Tim Christie The Register-Guard

EDITOR'S NOTE: The Eugene-based Cascade Medical Team nears the end of an intense six days of tending to the highland villagers in western Guatemala. The team packed up and left Barillas on Saturday, April 5.

BARILLAS, Guatemala - Nurse Verna Stallsworth spots the boy sitting on the floor of the town gym on this Thursday afternoon, a little guy with a round face, rocking back and forth, lost in his own world.

She approaches the boy and offers him a dinosaur Band-Aid, but he doesn't respond. You can give him the Band-Aid, his aunt tells the nurse, but he can't see it.

Dr. Bill Cox, a Eugene ophthalmologist, examines the boy. His milky eyes tell the story: Congenital cataracts have robbed him of his vision.

But Cox isn't sure he can help the boy. He hasn't done pediatric surgery for a long time. And the boy would never sit still for surgery - he would have to be anesthetized. The anesthesiologists and their equipment are up the hill at the hospital. The big microscope Cox uses for cataract surgery is here at the gym, and it would be difficult to move it to the hospital.

Eye nurse Carol Hernandez will have none of it. We have to help him, she tells Cox. She cries. She begs. Then one of the MacGyvers on the team, the men whose job it is to make things work, tells Cox that they can move the microscope. No problem.

And so it is that Marvin Enrique, age 3, sees for the first time.

Civil unrest changes plans

So far, members of the Eugene-based Cascade Medical Team have encountered unseasonably cold weather, missing luggage, cold showers, power outages, gastro-intestinal distress and other inconveniences.

At Thursday night's team meeting, John Sigler, co-staff director of Helps International, tells those gathered that Barillas has posed the most logistical challenges of any site that the parent organization has set up.

"You guys have rose to the occasion," he says. "Now we have another road bump. We know you guys are going to rise to the challenge."

There have been questions and rumors during the week about the team's travel plans to Antigua, where members will relax at the end of the trip. Now the team learns that political unrest is forcing a change in the team's travel plans.

Demonstrators are blocking key roads around the country, demanding that the government pay them for fighting in Guatemala's 36-year civil war, which ended in 1996. They're blocking roads in at least two locations between Barillas and Antigua.

Sigler explains that the government has reneged on a promise to pay the demonstrators, who were members of civil defense patrols during the war. So the civil patrollers have decided to make life difficult for the people of Guatemala by blocking roads, he says.

Sigler doesn't tell the team that the demonstrators have blocked an airport or that they used machetes and clubs to sabotage an oil pipeline. He doesn't say that last summer, the civil patrollers, many of them armed, blocked all major roads in the province of Peten, forcibly detaining some tourists.

The team had planned to leave for Antigua on Sunday morning. But now, the buses will leave at 5 p.m. Saturday, traveling overnight to avoid the demonstrators who are blocking roads during only daylight hours.

Helps International officials have consulted with Guatemalan military officials in Barillas and U.S. Embassy officials in Guatemala City to come up with the alternative travel plan, he says.

Team members sit quietly in the darkened courtyard of Hotel El Quetzal, listening to Sigler. They have questions.

What about the members who are sick with diarrhea? IVs and medicine are available, says team leader Dennis Schuelke.

Are these demonstrators armed? The military says the patrollers won't be confrontational, Sigler says.

Dr. Bill Knight, a jaw and facial surgeon from Eugene, stands up and suggests an option of flying out of Barillas in small airplanes at a cost of about $80 a head.

Schuelke says if people are sick and can't travel by bus, they may have to be flown out. But the whole team won't, he says.

"We're in this boat together. We ought to stick together," he says.

Marvin's surgery

The next morning, Cox stands outside San Vicente de Paul Hospital, getting ready for surgery. He doesn't have great hopes for Marvin, the boy with congenital cataracts.

Marvin, who also is deaf, should have had cataract surgery when he was 6 months old. It may be too late for the boy to have clear vision because the visual pathways between his eyes and his brain may not develop, Cox says.

"I hope we can give him traveling vision, so he can walk around without bumping into things," he says.

Marvin's grandfather and aunt, Inez and Basielia Herrera, bring Marvin to the hospital Friday morning. Just before 10 a.m., Dr. Michael Pilla holds Marvin as another anesthesiologist from Eugene, Dr. Stephanie Heindel, slides a mask over the boy's mouth and puts him under.

Cox, 56, has done literally thousands of cataract surgeries in his 27-year career, but only a handful on children as young as Marvin.

Cox inspects Marvin's eyes, looking for one that may have had some vision in his formative years. He picks the left eye, and nurses place surgical drapes over the boy's face. Cox puts an eyelid spreader on the eye and peers through a microscope at the cloudy cataract in the lens behind the iris.

"This is going to come out as potato soup," Cox says, describing what the cataract will look like when he removes it.

Cox pokes a 3-millimeter-wide hole near the edge of Marvin's iris, using a tiny tool to open the front capsule of the internal lens of Marvin's eye. He inserts an irrigator/aspirator, something like a miniature turkey baster, and carefully sucks the cataract out of the eye. When he's done, he stitches up the eye using suture that's one-tenth the diameter of a human hair.

He puts some antibiotics and steroids in the eye to help it heal and some drops to keep it dilated. At 11 a.m., he finishes up and bandages the eye.

Later, as Marvin lies snoring on a bed in the recovery room, Cox talks to his grandfather and aunt.

"The surgery went better than expected," Cox says. But it's too soon to tell how well the boy will see.

The family has traveled for three hours by foot, then another 3 1/2 hours by car to see the American doctors. To a visitor, Inez Herrera says he's grateful for the care given his grandson.

"We have faith in God," he says in Spanish, "and faith in the specialists and people like you. We need you to be here."

At 8 a.m. Saturday, the Herreras return to the town gymnasium with Marvin to see Cox and to have the bandage removed.

Cox talks with the family and poses for photos. Marvin rocks back and forth on his aunt's lap. In an exam room, Cox takes off the patch and Marvin cries. Cox uses his fingers to open the eye to light. Marvin cries and pulls away, keeping his eyes closed.

Cox shines a flashlight in Marvin's eyes. He blinks and looks at Cox. The doctor waves a red pack of wipes in front of him. Marvin reaches out and grabs the pack.

Nurses and other team members who have come to watch start crying. They take the boy out into the gym and set him on piece of black plastic. Marvin is holding the pack of wipes, rolling his eyes, rocking back and forth.

"I wish we had another week to do his other eye," Cox says.

Marvin is flashing little smiles. People are gathered around, taking pictures, handing him small objects and crying and hugging. Cox is stunned.

"He clearly can see things he couldn't see before," he says. "I'm amazed he can see as much as he can. ... He uses his vision better than I would have expected.

"He has better than traveling vision. I didn't expect him to see small objects."

Cox says he's not an emotional person, "but this is one of the most special things I've been involved in."

Inez Herrera, tears falling down his weathered cheeks, says, "Gracias a dios." Thanks to God.

Nighttime trip

At 4:30 p.m. after a daylong effort to pack up equipment and materials, the team climbs into six buses and rolls out of Barillas. The buses are trailed by six cargo trucks, two pickup trucks and a troop transport truck. Each bus carries a Guatemalan soldier armed with a machine gun.

The 16-hour trip to Antigua is long, but uneventful. Some of the buses get stuck on a steep ascent outside Barillas and need a push. People read, play cards and listen to music, but mostly snooze.

At 2:15 a.m., the buses pull into a Texaco Starmart in Huehuetenango, and team members invade the convenience store, heading for the bathrooms and loading up on junk food.

Just after 7 a.m., about 30 minutes out of Antigua, one of the buses gets a flat tire on a busy commercial strip in Chimaltenango. Half an hour later, the tire is fixed and the buses roll again. The team pulls into Antigua about 8:15 a.m. Sunday.

The business end of the trip is over. And now the reward: three days in Antigua, the ancient capital city of Guatemala.

Antigua is a vibrant place with cobblestone streets and rich Spanish colonial architecture. The conical, 12,352-foot volcano Agua towers over the city.

The team arrives just in time to witness one of Antigua's famous Easter season, or Semana Santa, processions. The streets are decorated with alfom- bras, beautiful carpets made from colored sawdust, flower petals and pine needles, depicting religious scenes and figures. At 11 a.m., congregants of a local Catholic church, wearing purple robes and hoods begin marching through the streets.

A massive float, 40 or 50 feet long with carved religious statues, sways back and forth as it's carried by nearly 100 of the purple-robed churchgoers, who strain and sweat under the mid-day sun and march right over the colorful carpets. They move the float a block at a time, then hand it off to the next group of congregants, as a band follows behind playing a mournful dirge.

Team members relax around the pool at the Hotel Antigua, walk around town, visit the artisan markets, rent motorcycles and go on city tours.

At a banquet Tuesday night, the team members learn that Marta Esteban, the 17-year-old woman who suffered a burst appendix, is doing well. After surgery in Barillas, she was flown to Guatemala City, where she had a second operation to make sure the infection was cleaned out. She's already out of the hospital.

Team leader Dr. Dennis Schuelke of Eugene recites the numbers: The team treated more than 2,000 people during its time in Barillas. Surgeons did 64 operations. Doctors saw 831 people in the general medicine clinic, 153 people in the eye clinic and 163 people in the dental clinic. At the daily out clinics in surrounding villages, doctors and dentists treated 820 people.

"You won't remember the numbers when you get home," Schuelke says. "You'll remember the faces of the people you cared for.

"We promised you an adventure. I think we've given you one."

Reporter Tim Christie can be contacted at 338-2572 or [e-mail]. Photographer Thomas Boyd can be contacted at 338-2411 or [e-mail].

FOR MORE INFORMATION

Cascade Medical Team: 2557 Willona Drive, Eugene, OR 97480-7325. Phone: [phone]. Web: www.cmt-oregon.org. E-mail: [e-mail].

Helps International: 15301 Dallas Parkway, Suite 200, Addison, TX 75001. Phone: [phone]. Web: www.helpsintl.org. E-mail: [e-mail].

CAPTION(S):

Using a microscope, Dr. Bill Cox works on the left eye of Marvin Enrique, 3, a Guatemalan toddler who has suffered from congenital cataracts that left the boy blind. The Associated Press Thomas Boyd / The Register-Guard Anesthesiologist Dr. Stephanie Heindel wakes 3-year-old Marvin Enrique who just had a congenital cataract in his left eye surgically removed. The Guatemalan boy was deaf and blind when he arrived at the Cascade Medical Team clinic in Barillas. Thomas Boyd / The Register-Guard Eye team nurses Verna Stallsworth (left) and Carol Hernandez hug each other after realizing that 3-year-old Marvin can see well enough to grab items in front of him. Dr. Bill Cox talks to Inez and Basielia Herrera as Marvin Enrique recovers from eye surgery. Cox shines a light in Marvin's eye to see if he shows any sign of being able to see. Marvin seems pleased with his newfound ability to see as he looks around the hospital room. Thomas Boyd / The Register-Guard Family members look at a Polaroid photo that a nurse took of them while they waited for a relative at the hospital in Barillas. Members of a volunteer medical team who treated the people there were told they will remember their patients' faces. MISSION TO GUATEMALA Please turn to VISION, Page A7 Vision: Team treated more than 2,000 people during their stay Continued from Page A6 Vision: Medical team treated more than 2,000 people Continued from Page A6