(solemn music) (birds chirping) - My colleagues from the city probably think that I'm crazy for coming all the way from the city to get here.

The amount of patients or the amount of surgeries that we perform every day, it's a lot.

- You really need to give a lot of time, a lot of effort.

Sometimes we have really, really long days.

And some people find that the work there is really heavy workload, and the money that they're getting back is maybe not worth it.

So you really need to have a passion for helping people to be able to be part of these community.

(solemn music) (birds chirping) - [Narrator] There is an eye hospital in Nuevo Progresso, Guatemala, a place most people have never heard of.

On a good day, it's about a six-hour drive from the capital, Guatemala City.

It's also nowhere near the volcanoes, Mayan ruins, and other destinations most tourists visit.

While most developing nations have eye hospitals, few are like Hospital de la Familia.

(Claudia speaking a foreign language) - So a regular day at the clinic, it begins with seeing the post-op patients from the day before.

And we remove the patches on the patient, and we check the visual acuity, we check the patient's pressure, and we check the first day of the eye result.

After that, we get into the OR, and we perform around five to 12 surgeries a day.

(Claudia speaking in foreign language) - You feel like you are not good enough to be doing this.

I mean, like, you are in charge of saving somebody's eyes.

That's, I think, a big responsibility.

So, I think that's the biggest challenge.

- [Narrator] Claudia Terraza Lopez, a Guatemala-trained ophthalmologist, is head of eye center surgery at Hospital de la Familia.

In addition to supervising surgeries, she helps train other Guatemalan and Central American doctors in the precise skills required for eye surgery.

- We don't have, like, a robotic eye here to try the surgery there.

We have real eyes here, so they have to be really perfect.

They have to improve like really fast because it's an eye person that they are having on their hands.

(solemn music plays) - [Narrator] Hospital de la Familia serves a large geographical area in Western Guatemala.

(Zoemy speaking a foreign language) - [Narrator] Zoemy Reyes Garcia has already had surgery on one eye.

Now she's having surgery on her other eye.

(Sindy speaking in foreign language) - [Narrator] Sindy Ventura, a social worker from the hospital, is checking in with her before bringing her back to the hospital.

Since Zoemy has other medical issues that may complicate her surgery, Sindy explains what the hospital planned to do.

(Sindy speaks in a foreign language) - [Narrator] Before her first eye surgery, Zoemy experienced many problems related to her inability to see.

(Zoemy speaks in a foreign language) Though Zoemy had been nervous before her first eye surgery, she fought through her fears.

(Zoemy speaks in a foreign language) Hospital de la Familia's eye center has only recently been staffed by Guatemalan and a few other Central American doctors.

Just a few years ago, eye surgeries at the hospital were performed almost entirely by teams of American doctors who would visit for a week or so and then leave.

During their visits, they would also provide training to a small number of visiting Guatemalan doctors.

Though the presence of the American teams was beneficial, depending on Guatemalan doctors proved far more efficient and had other rewards as well.

- The roots of the La Familia Eye Center go back several decades.

In the mid 1970s, the Hospital de la Familia was founded and opened, and eye care for this region was provided pretty much only by visiting international eye teams.

These teams would come and provide care and then leave.

And throughout those early decades of the hospital, the region was served by perhaps maybe 400, 500, 600 cases per year.

(doctor speaks in a foreign language) - [Narrator] Andy Sorenson, an American ophthalmologist who has contributed his surgical skills to the Hospital de la Familia Eye Center for more than 20 years and still provides training as part of his visits, is a driving force in making the eye center more self-sufficient.

The results have been dramatic.

- 2016, there was a pivot made, and the pivot was hiring a Guatemalan ophthalmologist.

And by hiring this Guatemalan ophthalmologist, we were able to, instead of having international teams provide the care, we're able to train, and equip, and empower a local ophthalmologist to do the care.

(doctor and patient speaking in foreign language) In his first year, the eye center pivoted from providing care for maybe 500 or 600 surgical cases, first 800, then a thousand, then 2,000.

And this last year, 2023, the center was able to provide care for nearly 4,000 individuals.

- [Narrator] The COVID pandemic highlighted the need to bring local doctors to the hospital.

- I started working for this hospital in 2019, and one of the biggest challenges that I faced was the pandemic that hit us around the first quarter of 2020, COVID.

That make it impossible for the American doctors to travel to Guatemala due to the traveling restrictions.

And we realized that was a window of opportunity to understand that it was really necessary to do not rely only on American doctors, but create a more sustainable program to rely in local doctors.

And that's how we understood that it was really necessary to put more efforts in the local capacity.

- [Narrator] One way of attracting these doctors was the far greater surgical experience working at Hospital de la Familia provided.

(Maria speaking in foreign language) - Just one week, I was able to learn two new techniques and different approach with the patients and how to do it efficiently.

Here in my four years of residency, I did 80 surgeries.

And in three months at Novo Progresso, I was able to do, like, 260 surgeries just in three months.

And, I mean, the impact, it was huge.

(Maria speaking in foreign language) (machine beeping) - I started visiting Hospital de la Familia when I was a second year resident in my main hospital in Guatemala City.

I went there when there was a medical mission that would lasted for a week.

I got in love with the hospital from that first visit.

So, I said to myself and told my fellow co-residents back in Guatemala City, "We all have to go and train in Hospital de la Familia because we have to learn this modern techniques to do cataract surgery."

We were trained with a cataract surgery technique that lasted an hour and a half to do one cataract surgery.

Back in Hospital de la Familia, were getting trained to do cataract surgery, which can take 30 minutes, 20 minutes, or if you get better, less than 10 minutes surgery.

So your impact with patients is a lot more, your surgery results is a lot better.

- [Narrator] Hospital de la Familia has also been able to attract Guatemalan and other Central American doctors by offering them experience with the latest surgical equipment made possible by donations from leading medical manufacturers in the United States.

One of the most prominent is New World Medical, which provides glaucoma treatment devices in addition to part of the 10% of its profits given annually to medical centers around the world.

- Hospital de la Familia's model is really unique in that they're able to attract surgeons from the urban areas like Guatemala City to come to the areas where the need is greatest, like Western Guatemala.

And they're able to do that partly by providing them access to the cutting edge technology from organizations like ourselves.

You know, we're one of the leading glaucoma surgical organizations in the world.

- What's the criteria that we're going to (indistinct).

- We're looking through... We're looking for a couple things.

Mostly the diameter.

So, like, the three hole and where we have the barbs.

- Yeah.

- So we want to make sure that they're both evenly spaced and concentric.

- [Narrator] However, it's not enough to just provide the latest technology without the training needed to be able to use it.

- One of the benefits for us, and one of the issues even if we want to be able to be impactful in areas like that, is there's...

Your products are only as efficacious as the utilization by the surgeon.

And if they're not properly trained, then they're not going to be used in a way that actually is impactful, and actually they could potentially be harmful.

And that's where Hospital de la Familia is a unique model of not only providing access to the training, but ensuring that the mentorship and education is there for these surgeons to fully incorporate these technologies into their treatment algorithm.

(upbeat foreign music) - [Narrator] The eye center has been able to attract Guatemalan and other Central American doctors through the wide range of experiences that working there provides, as well as through a unique culture that has also taken shape.

- In an unanticipated outcome, we have employed now over a dozen doctors, and they're all women.

It's not by design, but it just has turned out to be a very safe place for women to receive training, to be supported, and to be in environment with other women ophthalmologists from Central America who are able to provide a circumstance that is just apparently unique and difficult to find in other places.

- If you're talking about sustainability and if that's your goal, it can't be led externally, because those folks just aren't as grounded in the community and they're not going to be there on a day-to-day basis and perpetuating it, and they won't have the support from the local community.

If you're really going to impact the healthcare system, you have to have indigenous leadership that not only is based there and is part of the community, but then can propagate that and continue to enhance the healthcare system overall because they are fully grounded in that organization versus the fly-in fly-out model where a lot of times, actually, it's distorting the health economic reality on the ground, and sometimes it's actually doing more harm than good because they're not allowing for a sustainable ecosystem to develop that supports the community in a perpetuating way.

(bright music) - [Narrator] Telesforo Miranda worked in agriculture buying and selling bananas.

(Telesforo speaking in foreign language) Not only was his work impacted by his inability to see, but it also had an impact on his relationships.

(Araceli speaking in foreign language) Now getting ready to have his other eye operated on, he recalls how nervous he was before his first surgery.

(Telesforo speaking in foreign language) Telesforo, after having his second eye examined, hears the doctor say that it has become a more complicated problem, which she discusses with his son.

(doctor speaking in foreign language) (Sindy speaking in foreign language) Sindy Ventura, Hospital de la Familia's social worker, makes home visits to evaluate the social conditions patients face before and after their surgeries.

She finds that trying to address underlying social conditions, which patients often face, places greater demands than she is able to meet.

(Sindy speaking in foreign language) Often in wealthier places such as the United States and Europe, having eye surgery is typically seen as an individual problem.

You experience some difficulty with your vision and you get a cataract operation.

In places such as rural Guatemala, eye problems become social problems, potentially impacting a wide range of people.

- When someone goes visually impaired, he won't be able to work, that he will be needing help from somebody else, so that somebody else who could be studying or helping or working won't be able to do it.

And that will affect the whole family dynamics, and that will, of course, affect the community, and that will impact in our country.

- This is one of the poorest regions in the Western hemisphere.

It's actually the most malnourished region in the Western hemisphere, second only to Haiti.

70% of the children here in this region of Western Guatemala suffer from malnutrition.

And when you fast forward that over several decades, you now have a population that has a history of malnutrition, has severe poverty, has delayed or no access to healthcare.

We're also in a very harsh environment in terms of exposure to ultraviolet light.

And then we assume there must be some genetic components to the population in this region that lend to very profound vision loss from cataracts, glaucoma, corneal scarring and trauma to the eye, whether it be laborers who are in agriculture, someone working in a butcher shop with a splintered bone that might hit the eye.

There's so many examples of vision loss in this region and then, sadly, the inability to get care.

And you can do a limbal relaxing incision if you needed to.

- At 180 or... - At 180.

On the steep axis.

- The lack of education is something very important because people sometimes start using herbs or alternative treatments without medical supervision.

They only seek a doctor or an eye doctor only when their vision is very bad or their condition is too painful.

That makes treatments a lot more complicated.

- [Narrator] Because many patients need to delay surgery, often when done, it becomes far more difficult to address.

- People always get to the hospital when they're almost blind, so cataracts are hard rock cataracts.

So you have very small eyes since the height of our population is low.

So eyes are smaller, cataracts are bigger.

So bring out a cataract in our patients, in our population, is a lot more complicated than what even people in first world countries are used to.

- Most of the patients that comes here, they are over 60 years old.

They don't know how to write or read.

They depend on family member to understand in a easy way to follow the treatment after the surgery.

With people that we have here in Guatemala, more than many other languages besides the Spanish language.

So we have to be very careful that we try to understand as much as they can the importance to follow the adequate treatment.

(solemn music) - [Narrator] While Hospital de la Familia is partially supported by the Hospital de la Familia Foundation in California, being able to pay for eye surgery is another complicating factor for many patients.

(Zoemy speaking in foreign language) - The minimum salary of a person here in the country declared by the government, it's around $15 per day.

That's the minimum that the labor can make.

So, we cannot charge too much to a patient because we know that even 10 days of work could be okay for a surgery, that's a lot for them.

So we want to be conscious about the reality of the country, but we also want to make them understand that if they invest in their health, they will kind of take better care of their health and they also provide some support for us.

So, for example, the minimum that we could charge for a surgery, like, a cataract surgery, for example, it could be like $100.

We know that that's still a lot for somebody who is poor.

That's why we run a social study or we visit their houses.

We try to understand how they live so that we can even give the whole services for free.

(health worker speaking in foreign language) - [Narrator] While underlying social conditions such as poverty are beyond the hospital's capacity to address, the hospital does focus on preventive care.

(health worker speaking in foreign language) Despite the many challenges Hospital de la Familia faces, the rewards outweigh the obstacles.

(Zoemy speaking in foreign language) (Maria speaking in foreign language) - Eye care is unique in the realm of health problems because someone who comes in with a cataract and is blind, or comes in with high nearsightedness and can't see because they don't have glasses, or comes in with a scar, these have treatments that can be provided in a single sitting and can reverse the blindness.

And so that's a unique area of healthcare that is worth thinking about.

Because if you can provide the resources for the region, you can actually solve the problem of preventable and reversible blindness.

(health worker speaking in foreign language) - [Narrator] While eye problems often have many underlying nutritional, economic and environmental causes, once reversed, the transformation has a dramatic social impact.

- When someone's blind and it's treated and they go back home and now they can see, data from around the world show that that individual is now able to free up two or three people from their family or circle of friends who were previously caring for them, but now no longer need to walk them around or take them to eat or take them to gatherings that they might need.

Someone who has their blindness secured, studies around the world show that the economic impact of that is very powerful.

For every dollar invested into reversing preventable and reversible blindness, there might be a payback of $20, $30 or $40 on the other end of that.

- So this is a 70-year-old who's had a cataract surgery already in the right eye with a glaucoma implant and a cataract in the left eye.

- [Narrator] While Guatemalan ophthalmologist now provide the bulk of the surgeries and care for patients, visiting American medical teams still play a significant role.

- They come here to teach us some techniques that maybe we haven't had the chance to learn in our residence programs.

And that's something that we appreciate a lot.

If we are in need to reach them, if we have some case that we don't know what to do, we do need them for support and for mentorship.

- My dream and the reason for what I'm training here in Hospital de la Familia is because I am from Honduras, and Honduras is going through a similar situation that in Guatemala with lack of eye surgeons and lots of people, millions of people with no eye care providers.

By training in Hospital de la Familia, I would be able to go back to Honduras and serve my people and my population as well.

(bright music) (bright music continues) (bright violin music) (lively music)