Almost TWO years passed….and then an Esperança volunteer surgical team arrived!

Let me take you to La Concordia, Nicaragua

a tiny village settled between lush green mountains of Southwestern Jinotega Department in Nicaragua.


                                                           Despite it’s size…it is RICH in history!

By the early nineteenth century a proud man with his family, many friends and all of their cattle, horses, and fruit trees, left the community of San Rafael del Norte to establish La Concordia. Still today men travel horseback into the colonial town square to conduct their business.  Over the last 100 years, many in this village have dedicated their lives to agriculture and the cultivation of crops like beans, onion and sugar cane. In the cooler mountainous areas of La Concordia, coffee plants grow wild.

Doña Celina who is 81-years-young has called La Concordia home for her entire life; it is where she met her husband and where they have raised their nine children.

Arabica coffee grows in Nicaragua and the harvest season is November through February


Two years ago, when Esperança met Doña Celina she told us she felt vulnerable and weak. She began to have problems with meals. After eating she had a lot of pain. Her stomach would swell and sometimes the pain was so severe she was unable to work.

Her family became very worried and suffered next to her watching her try to work through the pain. They worried about being able to pay for the treatment that their mother needed. And they were even worried that at her age she wouldn’t be able to receive treatment at all.

Earning more money by gathering more coffee to sell at the market seemed like the only way they could help their mother. Her children decided to take her to have an ultrasound which showed that Doña Celina was suffering with stones in her gallbladder.

Doctors explained that to relieve Doña Celina, she would need a cholecystectomy; an operation to remove her gallbladder.

Getting answers provided hope. However her children still had a lot of fear.

They were afraid that their mother would never be operated on because of age-related risks, and their fears were coming true. At the regional hospital Celina had surgery scheduled and, rescheduled.

Almost TWO years passed….. and Doña Celina never received surgery – her stomach pain continued….

Another surgery was scheduled, her children never gave up, finally Monday-operation day- came. Doña Celina traveled 50 kilometers with her daughters to San Rafael del Norte to the hospital for her operation but her surgery would not be performed. Again, the doctors said her age put her at too great a risk.


At the hospital that day was a nurse from Nazareth Clinic – where our Esperança volunteer surgeons from the U.S. were operating that very week.

It was a surgical mission led by Esperança Volunteer General Surgeon Fred Schneider – made possible by capacity building partnerships, skilled volunteers and generous giving from Esperança’s compassionate friends.

Eagerly, Doña Celina went to the clinic. There were a lot of patients when they arrived, over 40 patients were treated during this mission. The visiting doctors and nurses welcomed Doña Celina for an evaluation.


After Doña Celina was evaluated, the doctors wanted a risk assessment for her age. Doña Celina and her daughters were first discouraged because this assessment is expensive and they did not have the money to pay for it. But the doctors told them not to worry, they happily worked for free [little did she know that they even paid their travel expenses to get there]. Doña Celina was evaluated for the risks associated with her procedure and age… with HOPE and JOY, she was scheduled for surgery on Wednesday.

                                                     Doña Celina’s operation was successful!

She had an open cholecystectomy and recovered without complications. Before returning home to her beloved family in La Concordia, Doña Celina shared a message of gratitude with the volunteer surgeons who took away her pain and the worry from her family’s hearts.

She tells us that she is very grateful to Esperança’s volunteer surgical team, for the way they do things.

“Thank GOD you operated on this old woman, since no one wanted to operate on her. I wish you a good journey and many blessings, and that you continue to help more people who need you so much.”

Arabica coffee grows in Nicaragua and it's harvest season is from November to February

Doña Celina left the clinic after recovering, feeling hopeful and strong.


A Mother’s Strength Helps Her Daughter Stand

Cinthya is a beautiful 13-year-old girl from the community of Ccochua, Apurimac, Peru. Despite the fact that she cannot walk or talk, she is a happy child whose family loves her dearly.

Cinthya’s hometown of Ccochua sits at approximately 10,600 feet in the Andes mountains. Ccochua is rich in fertile soil for growing crops, but poor in access to services, such as hospitals and clinics. Because of the difficulty reaching any medical care, Cinthya’s mother, Evagelina, gave birth to all four of her children at home. Complications in Cinthya’s delivery caused her to be born with cerebral palsy. Cinthya has never been able to walk due to the rigidity of the muscles in her legs. To this day, at the age of 13, Cinthya’s mother carries her on her back everywhere they go, including school, with the aid of only a shawl. Since their rural community is only accessible by dirt roads, Cinthya’s wheel chair can only go so far. Therefore, it is faster and more efficient for Evagelina to carry Cinthya.

Evagalina carries Cynthia on her back everywhere they go

When Cinthya and her parents came to be evaluated by Esperança’s orthopedic surgical mission team to see if she could benefit from surgery, her parents wanted one thing: for Cinthya to be able to walk.

The three surgeons on the mission all took part in Cinthya’s evaluation. Once they had discussed her case and agreed upon surgery, through an interpreter they made sure Cinthya’s parents understood that this surgery would only be one of several that she would need in order to be able to walk. However, they thought that with this first surgery, which consisted of elongating two tendons in each of her legs, Cinthya would be able to stand for the first time on her own. Her parents were ecstatic and asked the team to proceed.

When children have cerebral palsy, they often have difficulty swallowing and clearing their secretions from their throat. Because of this, Cinthya stayed longer in the recovery room than other patients, receiving high quality care and additional supervision from the Esperança doctors and nurses. Cinthya’s surgery was successful in that the doctors set out to do what they wanted to do – make it possible for Cinthya to stand and prepare her for additional surgeries. Cinthya stayed in the hospital for a few more days before being discharged with a pair of crutches. It will take time and more surgeries for Cinthya to be able to walk, but Cinthya and her parents have a new-found hope they haven’t had for 13 years.

In the next weeks, Cinthya will learn to stand and take her very first steps on her crutches. Our team is looking forward to seeing the whole family next year!

The surgical program is one of the easiest ways to see Esperança’s immediate impact in the developing world. And when you consider the expense of a surgical procedure in the U.S. and know that on average for $8,500 we perform 30-40 surgeries you see the impact. CLICK HERE to make a donation today to support the surgical program!


Hamilton’s Help

8-year-old Hamilton Ariel, the twelfth of fifteen children. He lives with his family in the rural community of San Miguel de Atapal, about 300 kilometers (186 miles) from Jinotega in Nicaragua. About a year ago his mother, Doña Sonia Salguera, found several small cyst-like balls growing underneath his jaw. Greatly concerned, she took him to the nearest health center, which is a 40 minute walk from their home. Clinic personnel prescribed antibiotics and set up an appointment for the following month.

However, Hamilton and his mother were unable to return for the appointment. Two months later they made the trip again, and Hamilton’s growths were markedly worse. One cyst had grown to the size of a golf ball. Clinic personnel transferred Hamilton to the larger health clinic in Ayapal where doctors diagnosed the growth as a tumor. They informed Hamilton’s worried parents that they could remove the tumor for 3000 pesos (approximately $120 US) but that if he still wasn’t cured they would need 10,000 pesos ($400) to complete the treatment. The amount seems modest to us, but, like most others in the region, Hamilton’s family lives on less than $2 per day. Since the family was unable to afford the surgery, he was released without it. His father decided to resort to natural medicine, which did not help.

In March 2013 Doña Sonia noticed Hamilton had 4 or 5 new cysts in the same area. She was greatly alarmed by their rapid growth and decided to take Hamilton to the health center. Once again, the staff recommended that Hamilton be transferred to a hospital because he required surgery they were not equipped to provide. She explained to the doctor that she didn’t have the necessary money, so he told her to go home, somehow scrape together the money and return in two weeks.  Hamilton was hospitalized on April 22nd. His tests provided no definite diagnosis, and, unable to afford the surgery for the necessary biopsy, the staff decided to treat him for lymph node TB.

Two months later, Dr. Custer and his team arrived at the hospital. They performed the biopsy which Hamilton had needed for more than a year and sent it to pathology for further study. He was subsequently transferred to the hemato-oncology wing of the children’s hospital in Jinotega. Esperança made Hamilton’s treatment possible by covering the costs of his transfer as well as lab tests.

Esperanca helped the family with follow-up lab exams and a consultation with a specialist. He was evaluated by an oncologist in the country’s capital, Managua, Nicaragua. For more than 30 days, Hamilton was in the Managua hospital for testing. They diagnosed him with stage 3 Hodgkin’s Lymphoma and recommended chemotherapy as once. He has been through one chemo treatment and is headed to Managua today, August 12th, for his second chemo treatment. Obviously the parents are very distraught with this diagnosis but the doctor said that he is progressing well and they are all having faith in God.


Stu and Mary’s volunteer experience in Bolivia

Mary Menacker and Stu Brackney are Esperanca donors who traveled with one of our surgical mission teams in July. This blog post brings you the story of their volunteer experience in Bolivia.

Stu causing smiles and laughs with a Bolivian family


Mary interviewing a boy waiting for surgery

You may have wondered, as we did – how exactly does a volunteer surgical team provide their hands of hope to families and children?  How do they change people’s lives?  The generous hearts and hands of Dr. Nick Retson’s surgical team performed 24 plastic surgeries (working 10 to 12 hours each day) in 5 days. He changed the lives of children and adults with serious burn injuries in the small picturesque town of Tarija, Bolivia.  As a result of having the honor of accompanying the surgical team in July 2012, we will try to capture the inspirational experience for you and answer these two questions.

It started with two days of travel (four different airplane flights) in order to arrive in Tarija, Bolivia.  The surgical team brought with them 22 large duffle bags filled with medical supplies, equipment and medications unavailable in the destination community.  This in itself is no easy task, especially, as you can imagine, maneuvering all of this equipment through customs.

Upon arrival the surgical team interviewed and assessed the patients’ needs.  Some parents from rural areas walked with their children 5 or more hours to receive a life-changing surgery.  These surgical services are unavailable anywhere else for the families because of their limited resources.  No one who could benefit from the surgical team’s expertise was turned away.

Dr. Retson evaluating one of his young patients

What happened when the electricity went out in the middle of a surgery?   An electricity blackout occurred on two different occasions while we were at the clinic.  The efficient, well-prepared surgical team calmly pulled out small flash lights so that surgery continued without skipping a beat. The surgical team anesthesiologist, Dr. Raja Ravella, manually kept vital air flowing into the sleeping patients’ lungs.

There are so many life-transforming stories that happened during this mission.  Many are like Gabriel, age six, who sustained serious burns on his legs and knees as a toddler. 

Gabriel waiting for surgery

The family did not have immediate access to medical care, resulting in thick scar tissue developing around his knees and legs that prevented him from walking normally. Gabriel’s parents were reluctant to travel to Tarija because they did not have any money.  Bolivian doctor Marcelo Duran convinced them to accept the surgery for their son by telling the parents of his first- hand experience as a volunteer doctor for Esperança.      

Dr. Duran was a general surgeon volunteering for Esperança when he met Dr. Retson three years ago. He was so inspired by Dr. Retson’s plastic surgery techniques with burn victims and children with cleft palates that he decided that he wanted to become a plastic surgeon himself.  He is now a volunteer surgeon for Esperança when Dr. Retson’s surgical team comes to Tarija, Bolivia.

Dr. Retson and Dr. Duran in the Bolivian OR

How does the work of this surgical team change people’s lives?  Dr. Retson tells the story of a little girl who was crying after cleft palate surgery.  He asked her if she was in pain and needed pain medication. “No”, she replied she was not in pain. She said she was crying because she was happy.  She would now be able to go to school and play with other children.

How do Esperança’s surgical teams change people’s lives?  One surgery at a time!!!

Thank you Mary and Stu for sharing your surgical mission experience, and for your continuous support! 


Despite travel obstacles, ophthalmologist performs 36 surgeries!

Dr. Georges Birenbaum, an ophthalmologic surgeon from Oregon, traveled on his third surgical mission with Esperança. His travel conditions were not ideal. The week he flew in, city-wide strikes in Tarija, Bolivia closed down all land and air transportation. He was stuck for several days in the larger city of Santa Cruz, waiting for the first available flight into Tarija in order to be able to perform surgeries. Fortunately for many patients, he didn’t give up. Once he arrived to Tarija, he would walk or talk a motorcycle every day to get to the hospital and bypass all the roadblocks that were set up. As a result, he was able to examine 83 patients and complete 36 surgeries.

Dr. Birenbaum checks out a patient for possible surgery

Rural families, dealing with the roadblocks, also had difficulty getting to the hospital. Some walked for hours to get there. Local clinics provided some patients a ride in the ambulance. Some families weren’t able to make it due to limited transportation and rainy weather. Those who did were able to be treated for cataracts and other eye problems, and many regained their sight!

Dr. Birenbaum examines a patient

Thank you Dr. Birenbaum for your patience and flexibility despite the many barriers that you confronted during your mission! Those patients are forever grateful!


“Valley Doctor Helps the Poor in Nicaragua”

“Valley Doctor Helps the Poor in Nicaragua”

by Russ Wiles – Feb. 17, 2012 03:20 PM
The Republic |

Dr. James Foltz, a gynecologist at Paradise Valley Hospital, recently put his medical practice on hold for a week and paid his own way to Nicaragua so that he could perform surgeries on indigent women.

A relaxing vacation? Maybe not, but Foltz has participated in five surgical missions, and he’s ready to do it again.

“The week flew by, and we were sad to leave,” said Foltz, who was accompanied by anesthesiologist Dr. Carlos Rodriguez and nurse Sandy Sargent. “As a physician, it allows you to go back to doing medicine as you thought you’d be doing it.”

Valley gynecologist Dr. James Foltz (left) sits with anesthesiologist Dr. Carlos Rodriguez and nurse Sandy Sargent.

Courtesy of Dr. James Foltz

Valley gynecologist Dr. James Foltz (left) sits with anesthesiologist Dr. Carlos Rodriguez and nurse Sandy Sargent.

In other words, with a focus solely on helping patients and not worrying about the business aspects.

Foltz, who’s also an obstetrician, gives a lot of the credit to Esperanca, a Phoenix-based non-profit that funds surgical missions in Latin America, builds water-treatment and sanitation systems in the region and provides health-education programs to low-income groups on both sides of the border.

Esperanca coordinated Foltz’s mission, located a hospital and had pre-screened patients waiting when the Arizona surgical team arrived. It also provided interpreters and other support staff and followed up with patients after the Americans returned home.

“I’ve never seen an organization make better use of its resources than this one,” he said.

The organization was founded 42 years ago by James Tupper, a doctor and Catholic priest later known as Father Luke who was providing medical care in Brazil’s Amazon region, said Tom Egan, Esperanca’s chief executive officer.The group’s name means “hope” in Portuguese. Esperanca was founded in Phoenix because that’s where Tupper’s brother Jerry, an attorney who incorporated the non-profit, was living.

Since then, the group has focused on Bolivia and Nicaragua. “They’re the second- and third-poorest countries in the Western Hemisphere,” Egan said. But compared with the poorest nation, Haiti, those two countries don’t receive nearly as much U.S. aid.

“Nicaragua and Bolivia also are safe and stable enough that you can send volunteers,” he said.

Esperanca, which counts eight paid employees in Phoenix and hundreds of volunteers, is a medium-size non-profit, generating $2.7 million in revenues over its most recent fiscal year. The group spent about 83 percent of expenses on program services, with most of the rest on salaries and benefits, according to its Form 990 filed with the Internal Revenue Service.

Program costs include hiring staff in the recipient nations who coordinate the medical missions. Esperanca plans to coordinate 15 missions this year. Its surgical teams, from across the U.S., address deformities, burns, gynecological problems, eye issues such as cataracts and more.

Foltz said he and his team brought their own surgical instruments, and the mission was aided by donations of materials and pharmaceuticals from Paradise Valley Hospital. He and his team did 42 consultations and performed 32 surgeries during the week they were in Jinotega, a mountain town.

The surgeries were mostly done to treat urinary incontinence or remove tumors, with one procedure to remove an early stage cervical-cancer growth. They removed a 5-pound tumor from one patient.

Esperanca conducted 15 surgical missions during its most recent fiscal year, which ended Sept. 30. That encompassed 832 surgeries valued at $2.43 million in donated medical services, plus $1.39 million in donated equipment and supplies. Egan calls Esperanca one of the most efficient charities of its type and points out the group received a top four-star rating from watchdog Charity Navigator, plus a Seal of Excellence from Independent Charities of America.

Ironically, the group’s surgical reach is constrained less by the willingness of medical specialists to volunteer than by the cost of hiring staff to coordinate the details in the recipient nations. In fact, Egan said Esperanca has to turn away some doctors and other medical professionals.

“None of these people went into the medical field to deal with managed care and insurance paperwork — rather, they want to help people,” Egan said.


What: Phoenix-based non-profit dedicated to improving health in low-income nations.

Financial highlights: Generated $2.7 million of revenue, entirely from private sources, over its fiscal year ending Sept. 30. Spent roughly 83 percent of total expenses on program services, with the rest on salaries and benefits.

Contact: 602-252-7772,

Original article:


Surgical Mission Success: Seberina’s story

Dr. Diane Sklar is a gynecological surgeon based in San Francisco. She has dedicated her life to medical missions, and Esperança is only one of the organizations that she volunteers with on a regular basis. For many years, Dr. Sklar has travelled with a team to the Esperança medical mission sites, and she currently goes to Bolivia and Nicaragua once a year. The local staff and the patients love her and her team, not only for the important operations that they provide but for their warmth and compassion for the local people.

Dr. Diane Sklar with a patient post-surgery

In November of 2011, Dr. Sklar and her team of four returned from another successful gynecological mission. They operated on 33 women, performing multiple complex procedures on each one.

Dr. Sklar and her surgical team

One woman, 46 year old Seberina, was able to reap the incredible benefits that Dr. Sklar and her team offered during this mission. Seberina is a mother of 6 children. Never able to attend school, she is unable to read or write and only speaks the indigenous language of Quechua. Seberina and her husband are very poor farmers who make an average of $70 a month. More than four years ago, she began to have gynecological issues that affected her everyday well-being. She was no longer able to tend to the crops, and was in constant pain. Two weeks before the volunteer surgeons arrived, she heard a radio announcement about their arrival. Her heart skipped a beat when she realized that this may be her opportunity to have surgery and be healed. The local doctors told her that the volunteer doctors would decide on which patients would receive the operations. She prayed fervently every day that she would be selected. On the day the team arrived, Seberina arrived at 4am to be the first one in line with all her lab and diagnostic tests already completed. When she was selected, she gave praise to God although she admitted she was a little afraid as well. Dr. Sklar and her team operated for 3 hours on Seberina, and performed 5 different procedures. It was a long surgery but the outcome was very positive and Seberina will fully heal.

Seberina with Dr. Sklar and Dr. Kayser

Returning from her last mission, Dr. Sklar expressed how every year she looks forward to the Bolivian volunteer experience. “It is a unique environment to teach, provide services and interact with the local community. I love the staff, patients and Bolivian support. Thank you for allowing my team to participate.”


Bolivian women given a better chance to fight off cancer

Dr. Sung Ho Lee and his team of four from New York returned from another successful gynecological mission with Esperança on December 9th.

Dr. Sung Ho Lee and his team

Despite issues with customs at the Bolivian airport upon their arrival, they were able to operate on 16 women in just a few days who suffered from health issues such as cysts, tumors and prolapsed uterus. Many of these women had endured their illness for many years and traveled for days to receive the operation.

One of Dr. Lee’s team members, Dr. Iris Wertheim, is a gynecological surgeon who specializes in oncology. She operated on several women with more complex cancer-related health issues, and gave these women a better chance at fighting off the cancer.

The team also squeezed in some time to provide education and training with local medical professionals, which Esperança encourages of all our medical volunteers!

Teaching session with local medical professionals

Dr. Lee has been on several surgical missions to Bolivia with Esperança and we are so appreciative of his team’s time and dedication to serving the poor.


152 given the gift of sight in just 5 days

Ohio ophthamological surgeons, Dr. John Pajka and Dr. Brian Stahl, and their team of 7 returned to Tarija, Bolivia on November 12-19th, 2011 for their 4th surgical mission with Esperança.

Team posing for a group photo

There were hundreds of potential patients waiting on the first day. You could feel a sense of urgency and desperation as each individual hoped that they would be selected for surgery. Every day, more would arrive after days of traveling from rural villages to see if there was a chance to receive this life-changing operation.

Line of people waiting to be selected for surgery

In just 5 days, Dr. Pajka and Dr. Stahl operated on 152 individuals – about 30 patients each day, and provided more than 450 consultations. With each surgery costing the average Bolivian $2,000-$3,000 dollars, an amount that many don’t see in a lifetime, it was considered a miracle to be given the gift of sight.

Dr. Pajka examining a patient

The most transformational moment came the day after surgery, when their bandages were removed from their eyes, and they were able to see clearly. Tears of joy and celebration were abundant during the week of this surgical mission! Thank you Dr. Pajka, Dr. Stahl, and their amazing team for traveling so far to change the lives of so many.

Patients waiting to have their bandages removed


2nd Dental Mission to Nicaragua

In conjunction with the Kartchner surgical mission to Nicaragua, dentist Dr. Lewis Leavitt, traveled from Tucson, Arizona to provide dental services for poor families in Nicaragua. This was his second mission with Esperança, and he came well-stocked with supplies and materials to attend to as many patients as he could. Hundreds traveled from far away villages in hopes that Dr. Leavitt would be able to attend to their oral health issues.

Dr. Lewis Leavitt attending to a young patient

Dental services are considered a luxury in the developing world. Oral health comes last on the priority list when compared to accessing clean water and food. Extractions are the most common dental procedure, and long-term pain and suffering from dental infections and cavities is considered the norm. For children, the pain can be debilitating, having long-term effects on their health and education.

Young dental patient and her extracted tooth

In just a week’s time, Dr. Leavitt attended to 175 patients, many of them children. He provided fillings and dental repair on the teeth that could be saved, and provided antibiotics to cure infection. On some patients, he worked on 4 to 5 teeth at a time.
Esperança is grateful for Dr. Leavitt’s time and skills and we look forward to having him return in the future!

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