Optometry Volunteering in Africa and Asia

[uniteforsight]

OPTOMETRY VOLUNTEER OPPORTUNITIES IN AFRICA AND ASIA

What Do Volunteers Do?: Unite For Sight’s volunteers range from undergraduate and medical students, educators, nurses, and public health professionals to optometrists and ophthalmologists. The volunteers serve as interns at eye clinics in Africa and Asia. The eye clinic’s eye doctors and Unite For Sight volunteers jointly participate on community-based screening programs. The clinic’s eye doctors diagnose and treat eye disease in the field, and surgical patients are brought to the eye clinic for surgery. Unite For Sight funds the surgeries for those patients unable to afford eye care.

How Do I Get More Information and Apply? The application as well as complete details about Unite For Sight's international opportunities are available online: http://www.uniteforsight.org/intl_volunteer/

When Are Programs Available? Unite For Sight operates its programs year-round. Volunteers may participate for 10-day periods up to 1-year or more. All program dates and locations are listed online http://www.uniteforsight.org/intl_volunteer/ Unite For Sight is currently accepting applications for December '06 through next Fall '07.

What Do Volunteers Say?: "Working with the eye clinic's team, we were able to treat over 1000 patients and perform sight-restoring cataract surgery on hundreds of patients! I saw more pathology than I will probably ever see as a resident in the U.S. Going to India was one of the best decisions of my life. The satisfaction of giving the gift of sight back to someone who was practically blind is immeasurable. For the first time in over 10 years, a frail and elderly female villager was able to see her reflection in the mirror. She stood up and walked out of the hospital without the help of the nurses, holding a small plastic bag filled with her life belongings, close against her green sari. This memory I will never forget. It was at that point that I realized the significance of why we were there and what we had done. We made a difference." --Walid Mangal, Medical Student, Unite For Sight Volunteer in Chennai, India

"This experience literally changed my life. It was one of the most amazing and rewarding experiences I have ever had. If given the chance, I would do it all over again and for longer (maybe this experience is to be continued……..). I learned so much about Ghana and myself. I learned that I would seriously like to consider optometry, especially so that I could come back to places like Ghana and help develop the eye care system (which lacks enough support). I am actually continuing my work as an officer in the Unite for Sight Chapter on campus. I will never forget this trip! You have no idea how much this memory means to me and what it has inspired me to do and be!"--Hafeezah Omar, University of North Carolina Chapel Hill Student, Unite For Sight Volunteer in Accra, Ghana

"My experience volunteering in Tamale this summer was both inspiring and rewarding. Dr. Wanye and the ophthalmic nurses that I worked with were incredible individuals who were dedicated to helping the people in their region. The other volunteers in my group were great teammates, and together we were able to make a difference in the lives of hundreds of individuals. The Ghanaian people that we worked with in the villages and the clinic were kind and gracious and openly welcomed us into their lives. Personally, it was one of the best experiences of my life, and I am thankful that I was able to do something that really made a difference. Unite for Sight gives you the opportunity to help fund and support dozens of surgeries that restore vision to hundreds of people every year. During the two months that I was in Tamale, I learned the benefits of volunteer work, and I was inspired by the acts of kindness that I witnessed. Now more then ever, I realize the difference that the gift of sight can make in the life of another."--Joseph Bergsten, University of New Mexico Student, Unite For Sight Volunteer in Tamale, Ghana

"When I went to India this past summer, I had a life changing experience with Unite For Sight.

Our days were carefully planned by Uma Eye Clinic. Our hotel was about 10 minutes from the clinic, and we were picked up by the van that was provided by Unite For Sight at about 8:30 am on the morning of the camps. The camps were mostly in villages about 1-3 hours away from the Chennai area, and seemed like an entirely different world from Chennai city. As we drove down the narrow road, we were greeted by a crowd of people at the entrance of each village, eagerly awaiting our arrival. We started our camps at around 10:00 am. On most occasions, there wouldn't be electricity in the villages, so the ophthalmologists were unable to use their advanced equipment, and had to use flashlights to diagnose cataracts and other eye diseases. The volunteers and optometrists worked like an assembly line. First, the patients would register with the Uma Eye Clinic representative, and then receive their medical diagnosis from the optometrists and ophthalmologist. After they were given their prescription, we volunteers were responsible for fitting them with the right prescription glasses. It was an amazing experience to see the reactions of the patients who were able to escape their hazy vision and see with clarity for the first time. Their look of gratitude will forever be etched in my mind. Four days a week, we traveled to villages, orphanages, schools and nursing homes and would screen about 100 people daily and fit them with eyeglasses that we had collected diligently over the last year.

My learning experiences with Unite For Sight and Uma Eye Clinic are priceless. I don't think I would have had the opportunity anywhere else to perform phacoemulsification on a goat's eye, or to work with eye doctors to examine patients for cataracts and refractive complications. I came home with experiences that even medical students dream about. Uma Eye Clinic provided the finest teachers and doctors that enhanced my knowledge about ophthalmology. After each eye camp, about 5 patients would travel back with us in the van for cataract surgery. We the interns were able to participate in every step of the patient's journey-the screening process, patient histories, preparation for the surgery that included a myriad of clinical tests and a thorough analysis of the eyes, the surgery process, and finally watching the patient's reaction as he or she regained their vision.

I feel that I have grown tremendously over this past summer, not only in the knowledge that I acquired from the physicians at Uma Eye Clinic, but my interactions with people in the villages and children in the schools. I am deeply indebted to Unite for Sight for giving me this opportunity to volunteer and learn about international medicine and health care."--Prachi Mayenkar, University of Missouri-Columbia BA/MD Candidate, Unite for Sight Volunteer in Chennai, India

What Do Eye Clinics Say?: "I must say that Unite for Sight volunteers have come to give hope to the people of Tamale and Northern Region, and all of us appreciate the wonderful work these volunteers are doing for these poor and vulnerable people who otherwise would not have access to quality eye care services.

God bless you for your good works, and we hope you would continue to offer your services even more as we struggle with the almost nonexistent resources both human and material in an attempt to give the poor people of Northern Region the Right to Sight. We need you more than ever to be able to achieve the VISION 2020 goal of the Right to Sight for all by the year 2020."--Dr. Seth Wanye, Ophthalmologist, Eye Clinic of Tamale Teaching Hospital, Tamale, Ghana

"So many people tell me to thank you and your family each day for the help you have given by giving sight to the poor. Our desire to serve and poor patients desire to see would not have been possible without the help and support of Unite For Sight." --Dr. Ajit Sinha, Director, A.B. Eye Institute; President, All India Ophthalmological Society

"It is a great pleasure to work with Unite For Sight in Ghana to achieve the goals of Vision2020, the Right to Sight global initiative launched by the World Health Organization (WHO) and the International Agency for the Prevention of Blindness (IAPB). Unite For Sight's high quality programs are very very useful and greatly valued in Ghana. Unite For Sight has touched the lives of so many people in Ghana and reduced the suffering of mankind. The question I have always asked myself is 'what would have happened to all these people who have benefited from Unite For Sight programs had the organization not come to their aid?' It is likely that many would have perished in their agony." --Dr. James Clarke, Ophthalmologist and Medical Director, Crystal Eye Clinic, Ghana

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[premeder]

ive volunteered 2x for unite for sight and am going again in june for 3x. the most awesome experience of my life. you make a huge difference every day youre wth unite for sight. its immediate and obvious that youre needed and wanted by the doctors oversees and the patients. pm me if you have questions.

 

[premeder]

and volunteers can be preoptometry, optometrists or docs premeds med students. and a perk for optometrists and ophthalmologists is you get a free plane ride courtesy of unite for sight.

 

[xmattODx]

How does volunteering for Unite for Sight help countries meet their VISION 2020 goals?

 

[premeder]

thats a really great question. unite for sight does everything to achieve those vision 2020 goals. well i think the best answer comes from the doctors that unite for sight works for so ill just put some quotes from the unite for sight website and newsletters. theres a lot more quotes and articles by the doctors around the website.

Dr. Clarke, Ophthalmologist and Medical Director, Crystal Eye Clinic, Ghana says "It is a great pleasure to work with Unite For Sight in Ghana to achieve the goals of Vision2020, the Right to Sight global initiative launched by the World Health Organization (WHO) and the International Agency for the Prevention of Blindness (IAPB). Unite For Sight's high quality programs are very very useful and greatly valued in Ghana. Unite For Sight has touched the lives of so many people in Ghana and reduced the suffering of mankind. The question I have always asked myself is 'what would have happened to all these people who have benefited from Unite For Sight programs had the organization not come to their aid?' It is likely that many would have perished in their agony."

Dr. Seth Wanye, Ophthalmologist, Eye Clinic of Tamale Teaching Hospital, Tamale, Ghana says:"The first volunteers of Unite For Sight (UFS) arrived in Tamale in August 2005. This team of two was made up of one ophthalmologist and a student volunteer. Community and school eye screening which was previously done once in two months was intensified, and these were done twice or more a week. Through that, several patients with cataract, glaucoma, trachoma and refractive error especially amongst school children were identified, among others.

The volunteer ophthalmologist and the host ophthalmologist, Dr. Seth Wanye, operated those who accepted surgery, and Unite For Sight paid for the cost of their surgery. As the number of UFS volunteers increased in 2006, more and more people have been screened. Those who needed surgery have their surgery cost paid by UFS. Those with refractive error of various forms receive free corrective glasses brought by the volunteers. From August 2005 to August 2006, more than 12,000 people have been screened by the UFS volunteers and the eye clinic staff including the ophthalmologist. 712 operable cataract cases were identified, out of which 447 had regained their sight through cataract surgery that was sponsored by UFS. Over 6,000 eyeglasses have been distributed to both adults and schoolchildren who were identified to have refractive error. School eye health educational talks were organized, and UFS volunteers played a very active role in this exercise.

In conclusion, I must say that Unite for Sight volunteers have come to give hope to the people of Tamale and Northern Region, and all of us appreciate the wonderful work these volunteers are doing for these poor and vulnerable people who otherwise would not have access to quality eye care services.

God bless you for your good works, and we hope you would continue to offer your services even more as we struggle with the almost nonexistent resources both human and material in an attempt to give the poor people of Northern Region the Right to Sight. We need you more than ever to be able to achieve the VISION 2020 goal of the Right to Sight for all by the year 2020."

Dr. Ilichie, Lecturer, Department of Optometry, University of Cape Coast, Ghana; Unite For Sight Optometrist in Ghana says: "There are over 20 million people in Ghana today. This will nearly double to 35 million by the year 2020. It has been recognized that the major cause of increasing numbers of visually impaired Ghanaians is the lack of qualified eye care staff in the country. There are only 48 qualified optometrists in Ghana. This includes those with University Post Diploma training from Kwame Nkrumah University, and Ghanaians trained in recognized programs in other countries. Overall, there is 1 optometrist per 396,000 people, whereas worldwide Vision2020 recommends 1 optometrist per 50,000 people. There is no realistic plan to increase the number by the year 2008, when the two training institutions (KNUST and UCC) shall be graduating their first set of Doctors of Optometry.

There are 43 ophthalmologists in Ghana in 2002 (1 ophthalmologist per 442,000 people). Their number has been dropping because greater numbers have left the country than have been trained (brain drain). The question which arises, is that who cares for over 9 million people with visual needs in the over 1,000 Ghanaian communities. The goal of Unite For Sight since its inception in Ghana is to foster and promote volunteer optometric and ophthalmic services free of charge to people in Ghana. So far, we have served over 100,000 people from the various communities.

If you are an optometrist or eye care practitioner touched by this message, Unite For Sight and Ghana invites you to lend your wealth of experience to disenfranchised Ghanaians so that we can all make a significant impact in their lives. Thank you."

Dr. Sinha, President, All India Ophthalmological Society says: "So many people tell me to thank you and your family each day for the help you have given by giving sight to the poor. Our desire to serve and poor patients desire to see would not have been possible without the help and support of Unite For Sight."

 

[xmattODx]

How does using untrained American students promote sustainable, quality care? I am encouraged by the training component of Unite for Sight's programs but would like more literature describing the hows and who's of their programs.

Unite for Sight uses recycled spectacles which is strongly discouraged by the World Health Organization - thoughts?

 

[premeder]

matt i did some searching in your old posts and see that you wrote a 100 page thesis against ngos helping give people eye care. i agree that bandaid programs do nothing to help but not all ngos are bandaid programs. its important not to lump all nonprofits together to make generalizations that they are all bad.

at least this one organization is highly praised and wanted by the local eye doctors and ministries of health and that is because the programs are locally led by the eyecare doctors with support provided by unite for sight. sustainability has got to come from locally led programs that are given 365 days a year in the same locations and with constant and all types of eye care. thats exactly what unite for sight does and its working great. thousands of people are getting eyecare and will continue getting eyecare from the local eye clinics because of unite for sight.

its not american students givng sustainable programs. its the eye clinics working with unite for sight that produces these quality sustainable programs. the students dont do anything but help the local doctors in ways that the doctors need help. the students go with the eye doctors from the clinic to help with screening like patient histories and visual acuity. the local eye doctors are the ones who do the eye examining. when you have 1 or 2 optometrists from the eye clinic and 200 people every day 365 days a year needing to be screened you cant help all those people without staffing. so the student volunteers help the eye clinics optometrists and ophthalmologists so all the people can get care every day. its like an eye doctor office in the u.s. where techs do visual acuity and get patient histories into the charts and then the doctor comes into the room. the students are the techs for the doctors.

its not a bandaid program where you go for a day and leave like with vosh or those other programs that you wrote about in your thesis.

the eye doctors at the eye clinics are the ones who lead everything 365 days a year and the students do what they need to do to help. the eye doctors cant do it and werent able to help these poor patients until unite for sight came to help because they didnt have staff or money.

oh and by the way unite for sight also hires recent graduated local eye nurses to work at the local clinics since the local eye clinics didnt have enough money for that either. that helps lessen brain drain and make sure the recently graduated eye nurses dont leave for england for a job and leave even fewer eye nurses in the country. go read the articles by the eye clinics and quotes by the eye clinics on the website.

so to summarize again the eye clinics in the countries are the ones that lead these programs and have invited the organization to work with them 365 days a year to help give them support with manpower and money.

 

[xmattODx]

Thanks for the info. Know that I am not the only one concerned with the method that Unite for Sight uses. Also know that I am not saying that Unite for Sight is not doing any good.

It is important to remember that VISION 2020 calls for human resource and infrastructure development. I look forward to reading literature from Unite for Sight that specifcally states how they are building this infrastructure. I know of problems that Unite for Sight has encountered in the past - not being invited into an area and producing poor quality research - and hope that they have learned from these past mistakes.

I hope Jennifer will be at the The Inaugural World Congress on Refractive Error
and Service Development hosted by ICEE in South Africa in March to share her successes. She has really built somehing out of nothing very quickly and her enthusiasm and hard work is awe inspiring.

As an optometrist I am struck mostly by the use of recycled spectacles and the lack of developing refractive services around the developing world. (I am not speaking of only Unite for Sight but all refractive care organizations.)

I can speak further on this but I am super tired - looong work day - and I feel I'm probably not making sense.

 

[premeder]

well the optometrists and ophthalmologists who know an organization through personal involvement are the ones qualified to decide the quality of an organizations programs. and there are a whole few pages of quotes already in this thread from optometrists and ophthalmologists praising everything. and as i said there are tons more quotes and published articles on the website from all the optometrists and ophthalmologist in the countries and from the optometrists and ophthalmologists who traveled there to work and help the eye clinics. you said you wanted to read articles theres a bunch of stuff on the site already.

i addressed the human resource part of your question. its all about building infrastructure with the eye clinics. and reducing brain drain and the rest of the problems encountered in the developing world.

to be clear the organization isnt a refractive care organization. its total eye care and mostly surgical care since thats what makes the biggest difference for people. glasses get lost or broken or arent worn or you need new ones in a year. cataract surgery, pterygium surgery and treatment of infections and others lasts a lifetime. well for glasses volunteers have to sign a form saying theyre going to bring mostly reading glasses and only some if any spherical distance glasses and sunglasses. that means no getting glasses from the lions club because they distribute old cr*p cylinders that people cannot wear. i dont know why the lions club are praised for doing that. unite for sight takes a lot of care to bring only useful quality glasses to the partner eye clinics and again the eye doctors at the clinics prescribe those glasses and ask for more. some places where the organization works there is infrastructure in the country to make new glasses locally so thats done too.

in terms of infrastructure as i said the programs are run and led by the eye doctors on the ground so they decide what is to be done in their community. i think thats the best thing about unite for sight that the local eye doctors receive the resources they need to better the eyecare in their own community. that includes surgery equipment that unite for sight gets them too and even major equipment like vision field machines. whatever the clinic needs there is a way to get it for them and thats what unite for sight does. the eye doctors decide what the volunteers will do. in general the optometrist volunteers coming over to help are partners with the eye clinics optometrists and they go together to screen the 200 people in the day. having optometrist volunteers reduces the burden on the local optometrists who work so hard because there is just so little manpower. then the ophthalmologist volunteers work with the local ophthalmologists to give surgeries and train in new techniques as needed. and the nurses and student volunteers support the local optometrists and ophthalmologists in whatever way theyre needed. its a year round 365 day schedule.

i hope the readers of this thread are getting a clear idea of the huge impact unite for sight has and how appreciated volunteers are by the eye doctors the volunteers go to help.

matt youre right that youre tired and really not making sense. the organization does not even produce any research. your post is really weird since you asked me all these questions about the organization and havent worked with them or been involved with the organizaition.

well matt pm me if you have any more questions. this thread is getting ridiculously long.

you should definitely read the website. all the information i posted about the organization is on the website so you can find everything i wrote and more by doing a little reading there. www.uniteforsight.org

ciao

 

[prettygreeneyes]

Unite for Sight uses recycled spectacles which is strongly discouraged by the World Health Organization - thoughts?

Hey Matt,

Because this is your area of expertise, would you mind discussing why the WHO discourages the use of recycled spectacles? I'm asking the question out of genuine curiousity rather than any preformed opinion one way or the other.

Thanks!

 

[premeder]

hey prettygreeneyes

well its because most organizations give out old big glasses that dont match for pupillary distance, dont fit the person right, or are the wrong prescription. in general if you make new glasses for someone theyre going to be the right prescription since theyre custom made. so a lot of organizations bring old beatup glasses from the lions club and give them out. if the person even wears them they probably dont help much if the pupillary distance is off or prescription is not right. also the lions club gives cylinders. if you need to give someone a -3 spherical only but you have a -3 +.25 x180 a lot of organizations would give the glasses with cylinder even if the person doesnt have astigmatism. thats not good. another problem is bifocals. organizations give out bifocals if the distance prescription matches what they need but maybe the person isnt far sighted and doesnt need the near prescription. so to make sure organizations dont do these things its recommended that new glasses be given, but you cant always give new glasses if there isnt infrastructure in the country to produce them.

unite for sight avoids those problems since the organization makes sure that mostly only reading glasses and sunglasses go to the eye clinics. and any distance glasses can only be spherical. no cylinders or bifocals allowed. if someone is -3 they get a -3. if theyre a +2 they get a +2. the eye doctors at the clinic treat the "used" glasses the same way they would treat new glasses. the "used" ones are just premade.

unite for sight also gets a lot of new reading glasses and sunglasses from manufacturers so a majority of the glasses that volunbeers bring are new and never worn or used.

there was a guy who tried to make a 3d printer to produce new glasses in developing countries but i think its been like 6 years since he got an award and nothing ever came of it. theres another guy who makes preadjustable glasses with mineral oil where the person makes their own prescription strength but the glasses are hideous to look at so people dont want to wear them. theyd rather not see clearly than be so unfashionable.

 

[KHE]

hey prettygreeneyes

well its because most organizations give out old big glasses that dont match for pupillary distance, dont fit the person right, or are the wrong prescription. in general if you make new glasses for someone theyre going to be the right prescription since theyre custom made. so a lot of organizations bring old beatup glasses from the lions club and give them out. if the person even wears them they probably dont help much if the pupillary distance is off or prescription is not right. also the lions club gives cylinders. if you need to give someone a -3 spherical only but you have a -3 +.25 x180 a lot of organizations would give the glasses with cylinder even if the person doesnt have astigmatism. thats not good. another problem is bifocals. organizations give out bifocals if the distance prescription matches what they need but maybe the person isnt far sighted and doesnt need the near prescription. so to make sure organizations dont do these things its recommended that new glasses be given, but you cant always give new glasses if there isnt infrastructure in the country to produce them.

unite for sight avoids those problems since the organization makes sure that mostly only reading glasses and sunglasses go to the eye clinics. and any distance glasses can only be spherical. no cylinders or bifocals allowed. if someone is -3 they get a -3. if theyre a +2 they get a +2. the eye doctors at the clinic treat the "used" glasses the same way they would treat new glasses. the "used" ones are just premade.

unite for sight also gets a lot of new reading glasses and sunglasses from manufacturers so a majority of the glasses that volunbeers bring are new and never worn or used.

I really don't understand your posting here at all.

On one hand, you claim that its a "bad thing" if a group gives someone who is a 3 diopter myope in a developing nation an Rx of -2.75-0.25 X 90 but on the other you advocate for a group giving out only spherical corrections....

What if you have someone who is a -3.00-1.00 X 180. Its ok to give someone -3.00 in that case?

Can you please explain where you are coming from?

I also don't get your concern over pupillary distance... the vast majority of humans have PDs between 59 and 65. Unless you start getting into Rxs over 7 diopters, the amount of induced prism you will induce is negligible.

Somehow, I don't think mild asthenopia from induced prism is a huge concern to the 6 diopter uncorrected myope living in a bombed out village in the mountains of Guatamala.

 

[xmattODx]

I thought I'd address your points on the open thread rather than through PM because I think its valuable for others to be able to read this discussion and consider both sides.

unite for sight does everything to achieve those vision 2020 goals ... the summary answer is that unite for sight volunteers support the eye clinics so poor patients can be screened and get eye care.

As you know VISION 2020 is the guiding document for the prevention of visual impairment in the developing world. Its goals are simple:
1. To raise awareness of the causes of avoidable blindness and their treatment among key audiences,
2. To identify what resources are needed to increase prevention and treatment programs available, and
3. To facilitate the planning by National Programmes of the three core strategies. (WHOb)

The three core strategies are:
1. Disease Control: to facilitate the implementation of specific programmes to control major causes of blindness,
2. Human Resource development: support the training of eye care personnel,
3. Infrastructure and technology development: improve infrastructure and technology, thereby allowing eye care to be more accessible.(WHO, 1997; WHOb)

I can see that Unite for Sight raises awareness - especially through its annual conference - it is also active in disease control but I fail to see how it develops human resources or infrastructure. Having volunteers act as support staff for clinics is useful but temporarily so. Training of locals to do the screenings is more useful than sending students over to do whatever it is that they do.

... Those with refractive error of various forms receive free corrective glasses brought by the volunteers ...

Free corrective glasses undermine the development of sustainable distribution networks of quality, new spectacles. The WHO opposes this form of care calling it well-intentioned but not a cost-effective strategy. They raise quality control concerns, as well as concerns with patients not receiving spectacles that are correct for their refractive error. Importantly, the WHO refractive error work group points out that the use of recycled spectacles is not helpful in the development of a sustainable refractive error eye care system as it creates a dependence on outside sources(WHO, 2000).

The goal of Unite For Sight since its inception in Ghana is to foster and promote volunteer optometric and ophthalmic services free of charge to people in Ghana. So far, we have served over 100,000 people from the various communities.

This is in contradiction to VISION 2020 which is to develop local human resources and infrastructure NOT volunteer teams.

If you are an optometrist or eye care practitioner touched by this message, Unite For Sight and Ghana invites you to lend your wealth of experience to disenfranchised

I agree but do so via work with the local optometrists/opticians/ophthalmologists in conjunction with their government's VISION 2020 goals.


It would be useful for Unite for Sight to publish some of their work so that outsiders can see their projects and programs.

WHO. (1997). Global Initiative for the Elimination of Avoidable Blindness. WHO/PBL/97.61.
WHO. (2000). Elimination of avoidable visual disability due to refractive errors: World Health Organization. WHO/PBL/00.79, 1-54.
WHOb. World Health Organization: What is VISION 2020? Retrieved February 13, 2006, from http://www.who.int/pbd/blindness/vision_2020/en/

 

[xmattODx]

well the optometrists and ophthalmologists who know an organization through personal involvement are the ones qualified to decide the quality of an organizations programs. and there are a whole few pages of quotes already in this thread from optometrists and ophthalmologists praising everything. and as i said there are tons more quotes and published articles on the website from all the optometrists and ophthalmologist in the countries and from the optometrists and ophthalmologists who traveled there to work and help the eye clinics. you said you wanted to read articles theres a bunch of stuff on the site already.

I don't think quotes extolling the virtues of a program replace quality research as to the effects of the programs and projects. On top of that every organization active in the control/treatment of visual impairment must use the national VISION 2020 document as its guide. If a nation does not have a national plan the organizations are to help in its development. I have not been able to find any information on lasting change created by Unite for Sight. If it is out there I'd love to read it. All I read are descriptive summaries of different peoples experiences - which are touching but are not research.

i addressed the human resource part of your question. its all about building infrastructure with the eye clinics. and reducing brain drain and the rest of the problems encountered in the developing world.

reducing brain drain but how does the use of foreign volunteers lead to local, sustainable human resource development? (I'm speaking here not of OMDs training surgeons in new techniques or ODs working alongside local optometrists but of using untrained undergrad students.) Are they training locals to help? Is Unite for Sight investigating cost recovery mechanisms for the surgeries they pay for? Are they involved in the development of mid-level eye care practitioners? I have a lot of questions but find few answers on the website (and they didn't respond to my survey)

to be clear the organization isnt a refractive care organization. its total eye care and mostly surgical care since thats what makes the biggest difference for people. glasses get lost or broken or arent worn or you need new ones in a year. cataract surgery, pterygium surgery and treatment of infections and others lasts a lifetime.

You've just insulted all of our well intentioned optometrists. As you know refractive error blindness is the second leading cause of preventable blindness in the world. Refractive care does have a place in the developing world. A large place.

well for glasses volunteers have to sign a form saying theyre going to bring mostly reading glasses and only some if any spherical distance glasses and sunglasses. that means no getting glasses from the lions club because they distribute old cr*p cylinders that people cannot wear. i dont know why the lions club are praised for doing that. unite for sight takes a lot of care to bring only useful quality glasses to the partner eye clinics and again the eye doctors at the clinics prescribe those glasses and ask for more.

Countries ask for the Lions to continue to bring their "cr*p glasses" as well. Your point is lost on me.

matt youre right that youre tired and really not making sense. the organization does not even produce any research.
you should definitely read the website. all the information i posted about the organization is on the website so you can find everything i wrote and more by doing a little reading there. www.uniteforsight.org

My point exactly. Any public health organization NEEDS to produce research. If it isn't evaluating its programs and projects how does it know if it is being successful? I have done a lot of reading about Unite for Sight. I have talked about Unite for Sight with a lot of people. I am unable to support its current efforts.

 

[xmattODx]

Hey Matt,

Because this is your area of expertise, would you mind discussing why the WHO discourages the use of recycled spectacles? I'm asking the question out of genuine curiousity rather than any preformed opinion one way or the other.

Thanks!

Free corrective glasses undermine the development of sustainable distribution networks of quality, new spectacles. The WHO organization opposes this form of care calling it well-intentioned but not a cost-effective strategy. They raise quality control concerns, as well as concerns with patients not receiving spectacles that are correct for their refractive error. Importantly, the WHO refractive error work group points out that the use of recycled spectacles is not helpful in the development of a sustainable refractive error eye care system as it creates a dependence on outside sources(WHO, 2000).

I bolded the biggest problem I see with the use of recycled spectacles.

Thanks for asking.

 

[premeder]

hmmm all of the quotes you quoted from "me" are from the quotes that the local optometrists and ophthalmologists wrote. the local optometrists and ophthalmologists wrote everything that you quoted and that you dont like.

i think the optometrists and ophthalmologists from the countries who have lived there and worked there for 50+ years can better determine what is needed in their own community than outsiders looking in. thats why i answered your questions with the doctors own quotes because theyre the ones who are and should be determining what is done in their own community not me or you or any organization.

unite for sight and the eye clinics trains and works with locals too. theyre involved with every program and every day.

ive volunteered for the organization and trying to answer your questions but it doesnt appear appropriate for anyone to make judgments about an organization without any knowledge or involvement and just from snipets that im writing on a message board.

its also not right to speak against what the local optometrists and ophthalmologists believe is needed in their own community. no one from the u.s. knows better than the local eye doctors about what is needed and what works best in their own community.

if there was only one way to meet the goals of vision 2020 there wouldnt be 35 million people with preventable blindness in this world. 35 million people need eyecare but dont have a way of getting it. the doctors in the developing world are the ones who need to decide what to do to eliminate blindness in their own country. the role of me and you is to support them with what they decide they need to meet the goals of vision 2020.

ciao

 

[xmattODx]

there was a guy who tried to make a 3d printer to produce new glasses in developing countries but i think its been like 6 years since he got an award and nothing ever came of it. theres another guy who makes preadjustable glasses with mineral oil where the person makes their own prescription strength but the glasses are hideous to look at so people dont want to wear them. theyd rather not see clearly than be so unfashionable.

These are not the solutions that are going to work in developing countries. What will work is the use of ready-mades, and the development of local production facilities. This is ongoing research and hopefully more will be learned in the coming year.

 

[prettygreeneyes]

Free corrective glasses undermine the development of sustainable distribution networks of quality, new spectacles. The WHO organization opposes this form of care calling it well-intentioned but not a cost-effective strategy. They raise quality control concerns, as well as concerns with patients not receiving spectacles that are correct for their refractive error. Importantly, the WHO refractive error work group points out that the use of recycled spectacles is not helpful in the development of a sustainable refractive error eye care system as it creates a dependence on outside sources(WHO, 2000).

I bolded the biggest problem I see with the use of recycled spectacles.

Thanks for asking.

So to clarify, the prescription being not exactly correct for each patient is definitely a concern, but the more important concern to you is that it doesn't really do anything to address a region's long term vision needs.

premeder's response made it seem like you are a bad human being if you even think of giving someone recycled glasses...

 

[premeder]

So to clarify, the prescription being not exactly correct for each patient is definitely a concern, but the more important concern to you is that it doesn't really do anything to address a region's long term vision needs.

premeder's response made it seem like you are a bad human being if you even think of giving someone recycled glasses...

no no. i was just writing what is documented as the problems with recycled glasses. people using recycled glasses have got to avoid those problems like giving people wrong prescriptions or giving people big glasses that people will take with a smile and never wear because theyre unfashionable.

the world health organization funds and promotes those mineral oil glasses but theyre ugly and word is that most people who have them dont wear them. just like you or i wouldnt want to wear big huge glasses that look ugly. people care about fashion in the developing world too. the mineral glasses are probably helping some people tho so thats a good thing. its just not widespread

 

[xmattODx]

So to clarify, the prescription being not exactly correct for each patient is definitely a concern, but the more important concern to you is that it doesn't really do anything to address a region's long term vision needs.

premeder's response made it seem like you are a bad human being if you even think of giving someone recycled glasses...

You can do some good with recycled spectacles but it is true that they are never on prescription. Does that matter for a near Rx for presbyopia? A little, but something is better than nothing. This is where the difficulty comes in.
Those that distribute recycled specs would say that they improve the vision of those that they help even though the Rx is off so what they do is fine. Its hard to argue against that point when there is no research on either side indicating the utility of used glasses. From my experience the Rx is off enough that if we were to distribute them to a patient here they would have issues with "visual comfort". To distribute them in developing countries, to me, is, therefore, unjust and harmful. When correct Rx's become available will those who received used specs from a foreign teams forgo getting the correct Rx because "my last pair didn't help"?

I wouldn't say you're a bad human being for giving out recycled spectacles but I would argue that you're misguided and are not aware of the larger implications. (As you eloquently put it "it doesn't really do anything to address a region's long term vision needs".) Even if you give an individual the perfect Rx if it is recycled it probably won't last long - where does the patient go for replacement/repair?

The WHO has a five step program for refractive error control which I think makes good sense:
1. Screening of individuals to determine who will benefit from refractive error correction;
2. Refraction to determine an appropriate prescription;
3. Manufacturing of low cost spectacles;
4. Dispensing of appropriate spectacles to those who require them;
5. Follow-Up to take care of needed spectacle repairs or re-dispensing(WHO, 1997).

Please remember that I have been on four vision camps. I have dispensed my fair share of recycled spectacles. I don't think I'm a bad guy. I think, though, that I was misled by the leaders of the trip. Upon questioning people who do this type of work the majority will say: "I know I am doing good because the patients I see smile when I give them glasses." This is not adequate proof of the usefulness of using recycled specs.

WHO. (1997). Global Initiative for the Elimination of Avoidable Blindness. WHO/PBL/97.61.

 

[POJO]

Dear Forum,

Already used spectacles vs new spectacles?

While I'm aware of the benefit of used spectacles, the amount of "back end processing" must be significant to catalog, store, and distribute the relevant spectacle lens.

Which is easier to do do, "make new spectacles"? or use "old spectacles"?

I think also the we should avoid our normal prejudices regarding third world eye care. There are ample opportunities for all concerned to contribute in the way they want to. I could easily say that each organization could hardly put a dent in the many, many who need this basic level of care. I would congratulate those who already have participated and to those who plan on it.

 

[premeder]

Dear Forum,

I think also the we should avoid our normal prejudices regarding third world eye care. There are ample opportunities for all concerned to contribute in the way they want to. I could easily say that each organization could hardly put a dent in the many, many who need this basic level of care. I would congratulate those who already have participated and to those who plan on it.

beautifully articulated POJO

 

[xmattODx]

I think also the we should avoid our normal prejudices regarding third world eye care. There are ample opportunities for all concerned to contribute in the way they want to. I could easily say that each organization could hardly put a dent in the many, many who need this basic level of care. I would congratulate those who already have participated and to those who plan on it.

I feel like I'm being misunderstood. I have always expressed gratitude to those willing to sacrifice their time and money to go to developing countries to work on preventable blindness projects and programs.

I also realize that there is no single solution to developing eye health care. I believe, however, that the use of recycled spectacles is not an adequate solution in any circumstance and that the communities should decide what the solution to their visual care needs should be not the donor organizations.

I trust that if given the choice folks would prefer to see a well trained, competent local with an in-country distribution network of spectacles, and ocular medications rather than vision camps that come sporadically.

Unite for Sight has a lot of good ideas (supporting local professionals) but like every other organization in the world it can use improvement. I hope that they continue to evolve but monitor and evaluate every step they take.

 

[POJO]

I feel like I'm being misunderstood. I have always expressed gratitude to those willing to sacrifice their time and money to go to developing countries to work on preventable blindness projects and programs.

I also realize that there is no single solution to developing eye health care. I believe, however, that the use of recycled spectacles is not an adequate solution in any circumstance and that the communities should decide what the solution to their visual care needs should be not the donor organizations.

I trust that if given the choice folks would prefer to see a well trained, competent local with an in-country distribution network of spectacles, and ocular medications rather than vision camps that come sporadically.

Unite for Sight has a lot of good ideas (supporting local professionals) but like every other organization in the world it can use improvement. I hope that they continue to evolve but monitor and evaluate every step they take.

I understand well. I just said that unless you join Unite for Sight and become a governing member, i really don't care what they do. There is so much "need" in the third world that anybody can do anything they want so long the client organization or country are agreeable.

 

[premeder]

I feel like I'm being misunderstood. I have always expressed gratitude to those willing to sacrifice their time and money to go to developing countries to work on preventable blindness projects and programs.

I also realize that there is no single solution to developing eye health care. I believe, however, that the use of recycled spectacles is not an adequate solution in any circumstance and that the communities should decide what the solution to their visual care needs should be not the donor organizations.

I trust that if given the choice folks would prefer to see a well trained, competent local with an in-country distribution network of spectacles, and ocular medications rather than vision camps that come sporadically.

for anyone coming to read this thread without reading all the other messages above i think i should remind anyone reading that unite for sight does exactly what matt suggests in that the solution to the vision care needs are made by the local eye clinics that unite for sight supports and there are no sporadic vision camps. as i wrote above and as you see from the quotes by the doctors - the eye care is coordinated entirely by the local ophthalmologists 365 days a year and unite for sight supports their endeavors in all ways requested by the ophthalmologists.

we need more people to take action and help the 35 million blind people who dont need to be blind. we need more people to help these eye doctors in the developng world who are trying to help get them all treated.

ok! the thread is finally done. hope some of you are going to take action in some way or another to help cut down on preventable blindness.

 

[xmattODx]

ok! the thread is finally done. hope some of you are going to take action in some way or another to help cut down on preventable blindness.

Why are you so desperate to be done with this discussion? I think its been a fair discussion which has been worthwhile.

I feel my point has been missed. I'll ask my question explicitly now.

How does sending un-trained undergrad students help develop eye health care in developing countries? I understand the concept of providing clinics with support workers, however, I fail to see how this develops a sustainable eye health care system.

I would think that it would be more beneficial to train a local person to do the support work and thereby provide them with a job and the clinic with someone who is always there. This will also decrease language issues - no need for translation and allow for an increased level of comfort for the patients.

I have more questions but this thread started with a call for anyone from undergrads to professionals to volunteer their time so this is an appropriate question.

Please know that I am always open to changing my opinion. This isn't an attack simply a question.

 

[premeder]

As I said earlier, local people are trained and involved with the eye clinics too.

Until you are an ophthalmologist living for 50 years in a developing country, I don't think you should question what the eye doctors say, want, or think works best in their community. It undermines their dedication to Vision 2020 and all of their struggles while we in the US sit on expensive computers and analyze what they are doing. And until I am an ophthalmologist living for 50 years in a developing country, I do not have a right to speak for them. The only thing I can do is relay their message to other people and hope that more people want to "unite for sight" and help them meet their country's goals for Vision 2020. By helping the eye doctors in the developing countries meet the goals of their community and country, we are helping the world's goal of eliminating blindness for 35 million people who do not need to be blind.

I don't think we should be worried about changing your opinion about what eye doctors think works best in their community. It is not about you or me. The opinions that matter are the eye doctors themselves who are struggling to help all of the blind people, and the thousands of blind patients who are now having their sight restored by the eye clinics. These eye doctors are the highest qualified with training in some of the best programs in the world. They are brilliant, kind and compassionate, and dedicate their soul and being to helping their country. They could have been wealthy, rich, and sitting at expensive computers in the US and practicing in comfortable offices here, but they chose to be honorable humanitarians and return to their country to make a difference for their people. These eye doctors should be respected and never questioned by anyone who does not know their community.

If there were more eye doctors like these people in the developing world, and if there were more people in the US who took direct action to help the eye clinics in the developing world, we would not have 35 million people struggling with preventable blindness.

You asked why i wrote "ok! this thread is finally done". It's because I have more productive things to do than to spend my weekend on a message board.

I wrote my message with proper grammar and capitalization because I think this message is important.

 

[xmattODx]

These eye doctors should be respected and never questioned by anyone who does not know their community.

If there were more eye doctors like these people in the developing world, and if there were more people in the US who took direct action to help the eye clinics in the developing world, we would not have 35 million people struggling with preventable blindness.

I appreciate your passion but disagree with your conclusions. I don't appreciate the implication that I sit around on expensive computers practicing in a comfortable office and therefore contribute nothing to eye health care in developing countries. You know better than that.

I've enjoyed this discussion but will end my participation here as the tone of the conversation seems to have taken a negative turn. I apologize if that switch in tone was my fault.

 

[eyedoc1991]

Dear Forum,

Already used spectacles vs new spectacles?

While I'm aware of the benefit of used spectacles, the amount of "back end processing" must be significant to catalog, store, and distribute the relevant spectacle lens.

Which is easier to do do, "make new spectacles"? or use "old spectacles"?

I think also the we should avoid our normal prejudices regarding third world eye care. There are ample opportunities for all concerned to contribute in the way they want to. I could easily say that each organization could hardly put a dent in the many, many who need this basic level of care. I would congratulate those who already have participated and to those who plan on it.

I am not sure why we even have a discussion regarding the use of OLD or New spectacles. We live in a non-perfect society where sometime you have to do something rather than nothing. I applauded those who attend missions to help the less fortunates. I always believe "some vision" is better than no vision. Unless there are proofs that used glasses does more harm than uncorrective errors, I am in full support of ANY glasses. I worked for Lenscrafters where we have our Gift of Sight (GOS) mission. We collected use glasses and we give out new glasses where it is feasable to do. I think private doctors have their own program call, Optometry Giving Sight (OGS). The decision to use or not use the old glasses should be up to the people who received them. I met a patient at one of these mission in Los Angeles who is wearing a -8.00 diopter glasses. Her Rx was -6.50 - 2.00 cyl. I was stun to find out she bought this old glasses from a recycling place. I was sad that we still can not take care of the needy in this country but I applaud her for using any mean she can to see better. This world is far from perfect and I hope we all do what we can to change that.

 

[xmattODx]

I think private doctors have their own program call, Optometry Giving Sight (OGS).

Once again my point has been missed. Think nationally not at the individual level. Does the distribution of recycled spectacles help an individual? For a short period of time - perhaps. Does the use of recycled spectacles harm the development of local eye health care? Yes. Which is more important? The public health community believes that developing local eye health care is more important than one time distribution of recycled glasses with no availability of repair or re-dispensing.

OGS does not distribute recycled spectacles.

Dang it. I said I wouldn't write here anymore.

 

[jefguth]

Once again my point has been missed. Think nationally not at the individual level. Does the distribution of recycled spectacles help an individual? For a short period of time - perhaps. Does the use of recycled spectacles harm the development of local eye health care? Yes. Which is more important? The public health community believes that developing local eye health care is more important than one time distribution of recycled glasses with no availability of repair or re-dispensing.

OGS does not distribute recycled spectacles.

Dang it. I said I wouldn't write here anymore.

I understand your fustration with this thread and I agree that the NGO's participating in eye care services in the developing world could be doing more to develop sustainable LOCAL solutions.

Part of this is not only working to improve the state of eye care, but also improving the local economy overall. While free eyeglasses sound great, would it not be even better if we could establish networks of professionals serving their own communities for modest reimbursement that supports their families and trickles down throughout the rest of the community?

A good example of this in action is the Scojo Foundation. They train local people to provide low cost reading glasses (newly manufactured) to presbyopes in their communities. While not a model of comprehensive eyecare, it's a step in the direction of building sustainable solutions that contribute to the health of patients, and the development of the economy.

A number of years ago I read an article about how Beta Shoes had built a large production facility in Kenya to produce shoes for the domestic market. In exchange for building the factory and employing local labour, the Kenyan gov't had promised to enforce import duties against used foreign shoes so that the factory would be competitve with imports from developed countries. While the imported shoes may have been cheaper at the outset, supporting local industry helped to improve the economic situation of the entire community.

The next step is provide more than bandaid solutions and begin supporting the educational institutions that will train the future eye-care providers of these high demand and needy regions.

 

[premeder]

while many of us can decide theoretically what would be a perfect solution to eye care, hunger, or aids, it's another thing to find a real solution that works in ground realities.

and any solution cannot be made from the u.s. solutions come from ground realities from the doctors who know the solutions better than any of us in the u.s.

supporting the educational institutions is a nice idea and many of them receive lots of support. but when students graduate from these supported educational institutions, they leave the country for Europe or the US. it is the rare well trained eye care provider who will go to a high demand and needy region. only those committed to those high demand and needy regions will stay in the country. its a very small number who will. thats why there are high demand and needy regions.

this is why the doctors already in the high demand and needy regions need to be helped. the doctors are already there and already committed, and they need and want help. the help goes right to the people and has direct results.

at a conference last year i heard scojo talk. they were asked by someone else on the panel what about people who have refractive error and other problems like cataract? or people without refractive error and other problems like cataract? scojo didnt really have an answer because theyre so focused on eyeglasses. eyeglasses are good but like you said jefguth, its not comprehensive eye care. eyeglass programs shouldnt exist by themselves just like glaucoma programs shouldnt exist by themselves. eye care should be comprehensive because there are a lot of eye afflictions. if someone comes for eyeglasses and has a cataract but no refractive error, the refraction program is going to send them home without eyeglasses and without cataract surgery. the person is probably never going to go to an eye doctor again. they will think there is nothing that can be done for them since that first eye doctor sent them back home. if scojo fit itself within a comprehensive program i think it would really be a leader. i dont think it would be hard for them to do this either. i really wonder why they havent already moved beyond eyeglasses unless its a conscious effort on their part and want to specialize so closely in just reading glasses. as i said though i think there are risks to being too focused like that.

even countries that produce eyeglasses cant provide their people with affordable glasses. who are the major producers of eyeglasses? united states, india, china to name a few. the statistics are sobering when you hear how many people need glasses in those countries that have abundant new eyeglasses a few miles away.

 

[xmattODx]

Part of this is not only working to improve the state of eye care, but also improving the local economy overall. While free eyeglasses sound great, would it not be even better if we could establish networks of professionals serving their own communities for modest reimbursement that supports their families and trickles down throughout the rest of the community?

Thank you! Cost recovery is an important component of sustainability. It helps the professional and allows the outside donor/agency to leave a program behind that can support itself

A good example of this in action is the Scojo Foundation. They train local people to provide low cost reading glasses (newly manufactured) to presbyopes in their communities. While not a model of comprehensive eyecare, it's a step in the direction of building sustainable solutions that contribute to the health of patients, and the development of the economy.

I hope that Scojo can evaluate its programs. They haven't (which, as an aside is partially my fault - I was to work with them for my summer experience during my MPH degree but due to a family emergency was unable to). Some people think that by providing refractive care - even simple presbyopic care - it gets the community thinking about eye health care and encourages people to seek out secondary and tertiary care if it is required. It would be interesting to see if the scojo program is doing this and how much simple presbyopic correction is helping the people.

The next step is provide more than bandaid solutions and begin supporting the educational institutions that will train the future eye-care providers of these high demand and needy regions.

If anyone is interested in helping in this way consider contacting the World Council of Optometry. They have a fellowship program where they will put you in touch with an institution that needs help. It can be short, medium or long term. I've not participated but I know people who have.

See: http://www.worldoptometry.org/fellowship.htm

 

[xmattODx]

while many of us can decide theoretically what would be a perfect solution to eye care, hunger, or aids, it's another thing to find a real solution that works in ground realities.

and any solution cannot be made from the u.s. solutions come from ground realities from the doctors who know the solutions better than any of us in the u.s.

Let me use some active listening here. I am going to repeat what you've said but in the way that I hear it. This is what I hear you saying throughout this thread: "Doctors in developing countries are dieing for un-trained, undergraduate students to come and help them. Their presence is what is missing in global eye health care." That is what I hear. I understand the importance of sharing knowledge amongst colleagues (new surgical techniques etc) so I haven't been talking about that part of Unite for Sight. I've been talking about the use of undergraduate students.

supporting the educational institutions is a nice idea and many of them receive lots of support. but when students graduate from these supported educational institutions, they leave the country for Europe or the US. it is the rare well trained eye care provider who will go to a high demand and needy region. only those committed to those high demand and needy regions will stay in the country. its a very small number who will. thats why there are high demand and needy regions.

You are exactly right. There needs to be a lot of discussion about brain drain both externally and internally. Even if the professionals stay within their country of birth they often migrate to the cities due to a better quality of life. That's no reason not to support education. I would argue that it is far better to train the locals and institute some type of necessary "payback" for the students who are supported. That is for your education you must pay back 4 years in an under-served area. Of course this will be a national decision.

this is why the doctors already in the high demand and needy regions need to be helped. the doctors are already there and already committed, and they need and want help. the help goes right to the people and has direct results.

How long do they need help for? What is your exit strategy if you haven't supported training programs and investigated (along with your national counter-part) anti-brain drain programs.

at a conference last year i heard scojo talk. they were asked by someone else on the panel what about people who have refractive error and other problems like cataract? or people without refractive error and other problems like cataract? scojo didnt really have an answer because theyre so focused on eyeglasses. eyeglasses are good but like you said jefguth, its not comprehensive eye care. eyeglass programs shouldnt exist by themselves just like glaucoma programs shouldnt exist by themselves. eye care should be comprehensive because there are a lot of eye afflictions. if someone comes for eyeglasses and has a cataract but no refractive error, the refraction program is going to send them home without eyeglasses and without cataract surgery. the person is probably never going to go to an eye doctor again. they will think there is nothing that can be done for them since that first eye doctor sent them back home.

I just want to state that the people who visit a Scojo Vision Entrepreneur know that they are not seeing a doctor. If the patient does not reach a certain VA or has a visible issue (pterygium, Cat, etc) they are referred up the chain. I agree that an ideal situation would be to have eye care as part of primary care. There is good work like this in Thailand in the refugee camps.

The International Rescue Committee is training community health workers in refraction. They had already been trained in basic eye issues but had refraction added in. These are not doctors but skilled health workers. The eye clinic is part of the primary care clinic and sounds promising. Look for literature later in the year.

 

[premeder]

I hope that Scojo can evaluate its programs. They haven't (which, as an aside is partially my fault - I was to work with them for my summer experience during my MPH degree but due to a family emergency was unable to). Some people think that by providing refractive care - even simple presbyopic care - it gets the community thinking about eye health care and encourages people to seek out secondary and tertiary care if it is required. It would be interesting to see if the scojo program is doing this and how much simple presbyopic correction is helping the people.

providing refractive care is not going to get people thinking about eye health care and encouraging them to seek out secondary and tertiary care if required. thats a nice theory but if someone is blind and has not sought out secondary or tertiary care, hearing about an organization giving out glasses is not going to be more encouraging to someone to seek out a place that might be 20 hours away for an eye doctor. they wouldnt even know where to go. even people who live 5 minutes away from an eye doctor dont go to an eye doctor if they are blind. this applies in the us and in the developing world. there are all types of barriers and handing out reading glasses does not miraculously get rid of any of those barriers.

i did not know that this was the theory that scojo was using - that giving eyeglasses is going to encourage someone to go find more eye care on their own. comprehensive eye care needs to be brought to the people. most of the 35 million blind are living on less than 1 dollar a day. are they going to travel 20 hours to find an eye doctor when they dont even know where to go? or are they going to try to eat? how do they know that an eye doctor 20 hours away is going to do anything more than the scojo women in the village who are prescribing reading glasses? traditional healers are called "doctors". "quacks" without medical degrees call themselves and are called "doctors". the people in the villages are going to think that the scojo women are doctors even if they say they are not and will not understand that a real eye doctor hours away can give back the person's sight even though the glasses can't help.

after hearing this theory of refractive care that reading glasses will motivate people to seek out comprehensive eye care i think it's "politically correct" to hop on the bandwagon of some bandaid groups if they have the word "sustainability" in their mission statement. sustainable reading glasses in a vacuum is not going to do anything to meet the goals of vision 2020.

scojo should be encouraged because they are at least helping people. thats good. but i think a really tiny amount of effort to do comprehensive eye care would do a lot.

 

[premeder]

You are exactly right. There needs to be a lot of discussion about brain drain both externally and internally. Even if the professionals stay within their country of birth they often migrate to the cities due to a better quality of life. That's no reason not to support education. I would argue that it is far better to train the locals and institute some type of necessary "payback" for the students who are supported. That is for your education you must pay back 4 years in an under-served area. Of course this will be a national decision.

i did not say that education should not be supported. quite to the contrary. i said that education is not going to eliminate or even help the problem of brain drain.

these things need to be thought through. if you force a new medical doctor to stay in the country for 4 years in an underserved area, this will not work. first of all if they do not want to be in this underserved area, they are not going to work or put effort into helping. second of all, what happens 4 years later when that first doctor leaves? a new young doctor fresh out of medical school comes in, and then leaves. this is not sustainable. new young doctors still need training. you dont pop out of medical school and know everything there is to know. that is why young doctors still keep learning from their elder peers. isolating a young doctor in a rural place for 4 years without access to knowing any new research or access to doctors who can teach old techniques, that is putting that young doctor at a disservice. and that young doctor will know it and not want to opt for this 4 year plan.

look how few people in the us do the national program where you get a totally free medical education if you stay for 2 years in the rural midwest. the rural midwest still has nice medical offices, actual schools, electricity and water, comforts. and still, hardly anyone does this program for a free education. it's equivalent to a $200,000 grant.

now turn to the developing world. no medical equipment, a tiny medical office if there is even any, no good education, no electricity, no water, no comforts, probably not even any patients if the patients cant afford $1 for medical care.

if there REALLY was a sustainable solution to brain drain, vision 2020, aids, doctorless regions, the problem would be solved or at least improving. the problems are getting worse despite all these groups in all these public health areas who are promoting their programs with the catch word "sustainable" in their mission statement.

what about the nobel prize winning Doctors Without Borders? They are nobel prize winners, their work is highly commendable, no one should speak badly of them ever. but they send *gasp* foreign people to doctor the villages. they usually dont give training to local doctors because there are no local doctors where they go. they work with practically no equipment. but how many people are they helping? scores, endless numbers.

when these realities are discussed, we need to remember the perspective of the patient and the doctors and the REAL ground realities. sitting in meetings or on a message board, we do not know the ground realities and cannot pretend to know the ground realities. we can all do things to help and everyone really does have an obligation to get involved. but we can HELP doctors and countries with what they say they need help with. we cannot decide what should be done or should not be done based on our preconceived notions of sustainability or ground realities.

since you posted your degree i guess i should post mine. i have an MPH and an MSc so you should not be speaking down to me as if i do not know about public health.

 

[xmattODx]

they wouldnt even know where to go. even people who live 5 minutes away from an eye doctor dont go to an eye doctor if they are blind. this applies in the us and in the developing world. there are all types of barriers and handing out reading glasses does not miraculously get rid of any of those barriers.

i did not know that this was the theory that scojo was using - that giving eyeglasses is going to encourage someone to go find more eye care on their own.

Wow. Go to the Scojo website. Read a little. Its called a referral.

I know all about the barriers to eye care. Would you like me to discuss them? Scojo does not claim to destroy these barriers. They are focused on presbyopic care - with training to refer as appropriate. They do not claim that their program will work everywhere.

I don't know how to respond to your last post. Community health workers - lay people - are used for a lot of things in a lot of places. Why not eye care?

 

[premeder]

Wow. Go to the Scojo website. Read a little. Its called a referral.

I know all about the barriers to eye care. Would you like me to discuss them? Scojo does not claim to destroy these barriers. They are focused on presbyopic care - with training to refer as appropriate. They do not claim that their program will work everywhere.

I don't know how to respond to your last post. Community health workers - lay people - are used for a lot of things in a lot of places. Why not eye care?

referrals are nice but do not work in most situations. this applies to the us or to the developing world. how many people even go to the eye doctor in the us when they have money, a nice car for transportation, an eye doctor on every corner. in the developing world you cannot just tell someone to go to an eye doctor when they have no way of getting there, no money to get there, no money to pay a doctor, no knowledge that this other doctor 20 hours away will have more to give than the eyeglasses the women are giving out in the villages. you need to do more than just refer people if you actually want them to be seen by an eye doctor.

as i said i have worked with community health workers on comprehensive care and its great. what i am saying is that refractive care should not be done in a vacuum because the people do not know that the eye doctor 20 hours away does anything more than give out more glasses. the concept in the developing world is that glasses will fix whatever their eye problem is. simply telling someone this is not going to change those preconceived ideas until they see the doctor and are given that comprehensive eye care. they are not going to get that comprehensive eye care until the barriers are gone.

 

[xmattODx]

since you posted your degree i guess i should post mine. i have an MPH and an MSc so you should not be speaking down to me as if i do not know about public health.

Remember I'm not talking about doctors going to other countries to help. This thread began as an invitation to undergrads and partially trained OD students to go to help these doctors. That is where I have an issue. If an OD wants to go and help train new doctors/offer assistance I think that's great. I don't believe that these physicians are looking for untrained help.

I apologize if you felt I was talking down to you. If it appeared that way it was unintentional.

I agree with everything you said about brain drain. A very complex situation with no easy solutions. I don't envy those who need to address the issue.

 

[xmattODx]

as i said i have worked with community health workers on comprehensive care and its great. what i am saying is that refractive care should not be done in a vacuum because the people do not know that the eye doctor 20 hours away does anything more than give out more glasses. the concept in the developing world is that glasses will fix whatever their eye problem is. simply telling someone this is not going to change those preconceived ideas until they see the doctor and are given that comprehensive eye care. they are not going to get that comprehensive eye care until the barriers are gone.

I agree. I'm not all for Scojo but you have to realize that the refractive care organizations are so far behind the rest of the public health world it's sad. They are a step in the right direction?

 

[FutureClinPsyc]

I would love do these volunteer things. I have one question though. How do you afford it? How can you afford to go there, and stay if you don't have any money? Do they offer financial aid programs just to furnish the money to volunteer, or what?

 

[premeder]

this is what im trying to get across. doctors want support, they ask for students to help them because they find the students helpful in their work. they work with local people too. but they need and want the students to help them in their work, just as much as they want and need ODs and MDs. no one should be arguing with what these doctors say they want. it is simply not our role to decide what the doctors in the developing world want or need.

as i said scojo might be a step in the right direction if they did more than just reading glasses. as it currently stands, i came to the realization today when thinking about this, that there could be a substantial percentage (maybe even close to 100%) of people thinking that nothing can help them if those reading glasses don't help their vision. no matter how many times a village worker says they are not a doctor, they will be called and thought of as a doctor. people who have never been to any doctor before are not going to know the difference between an eyeglass distributor "doctor" and an ophthalmologist.

due to this i think eye care organizations need to make sure that when they enter any village, a local eye doctor needs to be there. local health workers are good but only if they transport free of charge anyone who needs any form of eye care and only if the transportation is provided right then and there. a service of local health workers telling people that they need to be seen by an eye doctor is not going to help. the local people will think that the local health worker is the doctor, they were already examined, nothing was done, so there is no hope and no need to travel and spend money to go see an eye doctor.

 

[xmattODx]

this is what im trying to get across. doctors want support, they ask for students to help them because they find the students helpful in their work. they work with local people too. but they need and want the students to help them in their work, just as much as they want and need ODs and MDs. no one should be arguing with what these doctors say they want. it is simply not our role to decide what the doctors in the developing world want or need.

as i said scojo might be a step in the right direction if they did more than just reading glasses. as it currently stands, i came to the realization today when thinking about this, that there could be a substantial percentage (maybe even close to 100%) of people thinking that nothing can help them if those reading glasses don't help their vision. no matter how many times a village worker says they are not a doctor, they will be called and thought of as a doctor. people who have never been to any doctor before are not going to know the difference between an eyeglass distributor "doctor" and an ophthalmologist.

due to this i think eye care organizations need to make sure that when they enter any village, a local eye doctor needs to be there. local health workers are good but only if they transport free of charge anyone who needs any form of eye care and only if the transportation is provided right then and there. a service of local health workers telling people that they need to be seen by an eye doctor is not going to help. the local people will think that the local health worker is the doctor, they were already examined, nothing was done, so there is no hope and no need to travel and spend money to go see an eye doctor.

Thank you for this post. I am sure you've said all of what you said already but I'm dense.

Let's step back from vision care and into the realm of public health. In your MPH I'm sure you talked a lot about the use of low level health workers. Do you have the same concerns with trained birth attendants as you do Scojo entrepreneurs? Other lay health workers?

 

[xmattODx]

I would love do these volunteer things. I have one question though. How do you afford it? How can you afford to go there, and stay if you don't have any money? Do they offer financial aid programs just to furnish the money to volunteer, or what?

Friends and family, churches, social service organizations are often very willing to donate funds. It isn't actually all that hard to gain support that will cover your expenses. I once raised enough money to pay for my ticket, my wife's (then girlfriend), and pay for all in country expenses for the whole team and leave money behind for our sponsor organization. Just get good at writing letters and public speaking.

 

[premeder]

Thank you for this post. I am sure you've said all of what you said already but I'm dense.

Let's step back from vision care and into the realm of public health. In your MPH I'm sure you talked a lot about the use of low level health workers. Do you have the same concerns with trained birth attendants as you do Scojo entrepreneurs? Other lay health workers?

i don't have enough personal knowledge of the situation with birth attendants to draw conclusions. i dont like pretending to know anything about ground realities of situations when i do not have any involvement in a particular area.

i can speak to other models though with a little basis since ive seen hiv work on the ground. i like the model of paul farmer because the doctor diagnoses, and the local health workers dispense the meds and make sure people are keeping on schedule. but hiv is different since the care is ongoing and constant. reading glasses dont need to be given every month, and cataract surgery is one shot deal.

another model i think is at the forefront is OneWorldHealth but there are no pills to cure blindness.

what models in international health do you think are at the forefront? this of course with the caveat that neither of us really know a lot about these other fields so we are just looking with a bird's eye view.