By David Liscio / The Daily Item

SALEM — In a small house surrounded by barbed wire and protected by armed guards, a team of North Shore Medical Center doctors and nurses attended to more than 1,500 patients over 10 days during a March trip to impoverished El Salvador.

Many of the patients walked barefoot for miles to reach the “gringo” clinic in Santa Ana, the Central American country’s second-largest city, said Dr. Riad Riskalla, an anesthesiologist and president of the NSMC medical staff. Others arrived by bus from San Miguel, sensing the clinic could be a one-time chance to receive much-needed surgeries.

“This is really an eye campaign,” said Riskalla. “The majority of surgeries involve cataract removal and replacement with a lens transplant. In the United States, we take our eyesight for granted. If we need glasses or simple eye surgery, it’s something we can take care of easily. But it doesn’t work that way in El Salvador.”

The NSMC team also performed corneal transplants. “We brought down cadaver corneas with us and whoever had a corneal disease, we would do a corneal transplant on, which is about a three-hour procedure,” the doctor said. “We saw a lot of kids for corrective surgery. Many of them have lazy eyes, divergent or convergent. The eyes are not centrally located, so it’s really a form of excessive lazy eye. It looks like they are squinting.”

Riskalla, who lives in Topsfield and has attended the El Salvador clinic six times in seven years, noted the medical problems are widespread. “What is really endemic is Ptyregium, which is due to excessive pollution or exposure to the sun,” he said. “The cornea, or the colored part of the eye, gets covered with a membrane. It’s as if somebody pulled down the blinds on your eyes so that you can’t see. I’ve never seen so many cases in my life.”

The doctors and nurses performed more than 140 eye surgeries during the most recent visit. “It’s extremely rewarding work and really puts life in perspective,” said registered nurse Patti Gatti, who has made three such trips to El Salvador.

Riskalla became involved in the so-called Eye Campaign in 1998 when another doctor from the South Shore asked him to help open an operating suite in Santa Ana.

Yet another physician, Dr. Vicky Goodman, had already established the program in El Salvador, its mission to care for the poor and needy. She contacted medical colleagues in the U.S. and asked for their assistance.

“Once the doctors here became involved, it grew very quickly,” said Riskalla, noting that NSMC has been sending a team to the annual eye clinic ever since.

In addition to Riskalla and Gatti, this year’s team included Dr. Ray Smith of Marblehead, registered nurses Mary McCarthy, Jane Walker, Jeanne Nevins, Cindy Kent, Barbara Corning-Davis, Catalina Lewis and Robin Gallant.

NSMC subsidized the trip to El Salvador for all staff members involved and helped secure critical medical supplies and equipment that made the clinic possible. Some patients were provided with eyeglasses at no cost. According to Riskalla, nearly all patients received free medical services.

The Eye Campaign, run by the Asociación Salvadoreña Pro-Salúd Rural Salvadoran Association for Rural Health (ASAPROSAR), has become El Salvador’s primary resource for eye care for low-income people. The program’s goal is to prevent and cure blindness, and relies on volunteers and donations to operate.

ASAPROSAR was founded in 1970 with a mission to empower the poor in El Salvador and currently serves more than 90,000 people. The organization also offers educational programs in health, nutrition, family planning, child development, the environment and sustainable agriculture.

“This is the second year we have extended services to San Miguel,” said Riskalla, referring to a smaller village in the region. “But there is no surgery at that clinic. Those patients must get on the bus in San Miguel and come to Santa Ana. We all feel sorry for them. Some travel huge distances on foot. They arrive exhausted and dehydrated. But they do arrive after hearing that the gringo clinic is coming to Santa Ana again. If we didn’t go down there, these people wouldn’t be seen, and vision for them is everything. If you lose your sight, you can’t find a job, and that means your whole family is going to suffer.”

The NSMC doctors and nurses stay in Santa Ana, in a modest house with divided sleeping quarters, which doubles as an outpatient clinic and operating suite.

“It’s very confined. The house is heavily guarded by private security, armed guards who protect this compound,” Riskalla said. “There’s barbed wire all around because there are still some security troubles with gangs and crimes in El Salvador.”

This volcanic land of six million people, smallest of all Central American countries, abides by an uneasy truce between the government and leftist guerillas forged in 1992. It is not high on the list of vacation destinations, and has no shoreline on the Caribbean Sea, yet the doctors and nurses return year after year. Supplies and medical equipment for the clinics are donated by various U.S. hospitals, including NSMC and the Lahey Clinic.

“A while back, a hospital closed in Stoneham and we were able to get lots of supplies from them,” Riskalla said. “That was great.”