Regional Hospital Dr. Luis "Chicho" Fabrega, Santiago de Veraguas, Panama  –   Every endeavor extends beyond mere moments, offering opportunities to forge connections, sharpen skills, and enhance operational readiness. In July 2023, a team of dedicated surgeons embarked on a mission to address a diverse spectrum of chronic eye conditions, instilling resilience and adaptability for unpredictable scenarios.

At the heart of this mission was U.S. Army Lt. Col. Erin Seefeldt, a seasoned ophthalmologist assigned to the 1888th Head and Neck Surgical Detachment at Joint Base Lewis- McChord, Washington. The three week long, intensive mission unfolded at Regional Hospital Dr. Luis "Chicho" Fabrega, Santiago de Veraguas, Panama. It was here that Seefeldt served as one of four subject matter experts and was responsible for mentoring junior surgeons in manual small incision cataract surgery (MSICS) and pterygium excisions.

"These missions exposes junior attendings and residents to diverse medical cases, cultural contexts, and challenging scenarios," she explained. "Working in resource-limited settings sharpens their clinical skills while nurturing problem-solving, adaptability, and flexibility, which are crucial as the equipment, methods, and setting often differ from the usual, requiring surgeons to adapt."

In the ever-evolving field of medicine, missions like these go beyond conventional patient care, embodying skill refinement and technique adaptation, reinforcing the idea that surgical practice is an ongoing journey of mastery.

"Surgical expertise is a skill continually honed, regardless of experience. We view it as a practice, a technique always being refined," she said. "For the benefit of all, having a larger pool of proficient individuals performing procedures is highly advantageous."

The team's primary focus remained on restoring sight, tackling the challenges of cataracts, which occur when the eye's lens clouds, causing vision impairment. Treatment involves removing the cloudy lens and replacing it with a clear one, often using phacoemulsification, a method involving ultrasound to break the lens for removal through a small corneal incision. 

"While I've performed similar procedures in the U.S., working here presents greater challenges due to various factors," said U.S. Army Maj. Matthew Cardinale, an ophthalmologist at the 53rd Head and Neck Team of the 147th Field Hospital, Joint Base Lewis- McChord, Washington. "The saying goes, a skilled surgeon with basic tools can outperform a less competent surgeon with the most advanced tools."
    
Although phacoemulsification, small-incision cataract surgery is more commonly used to remove cataracts, in resource-limited areas, MSICS holds advantages – shorter surgery duration, reduced technology reliance, and lower costs.

"I've learned so much from my surgical experiences, along with others' surgical experiences and complications during this trip that have only enhanced our skills and makes us all better surgeons," Cardinale reflected. "This opportunity restored sight, improved quality of life, and enhanced functionality for those suffering from blindness, and the impact we leave behind is profound."

In these cross-cultural interactions, the languages of medicine and compassion converged, bridging the gap between medical expertise and human connection.

"The shared achievements, camaraderie, and optimism have been truly inspiring," Cardinale emphasized. "Witnessing what a diverse group can achieve through dedication and a shared mission is astounding."

The shift of Panamax Alpha from a U.S. Army mission to a TriService effort involving the U.S. Army, U.S. Navy, and U.S. Air Force demonstrates unity of purpose and aligns with the Defense Health Agency's mission to support the medical readiness of the armed forces.

"I've observed the evolution of these missions for over a decade, and as professionals, we recognize that we're all performing the same surgeries and providing superior patient care for the same cause," Seefeldt explained. "I believe the vision is that we should collaborate just as effectively stateside as we do here. Witnessing a strong TriService presence on this mission has been truly gratifying."

This collective effort, driven by the pursuit of excellence, leaves more than restored sight; it etches a narrative of solidarity transcending borders, fostering hope for a brighter future.

"Participating in these missions is among the highlights of my military career, so it's bittersweet knowing it’s my last mission," reflected Lt. Col. Seefeldt. Her words resonated with a sense of fulfillment and purpose, knowing that her expertise was fostering a lasting impact. "This team comprises exceptional surgeons, future educators, and subject matter experts. I'm confident in their abilities to handle future missions with the same compassion, care, and expertise demonstrated here."