The Problem:
Most of us living in the developed world do not consider how lucky we are to have easy access to eyeglasses, cataract surgery, and even eye-drops.  It is easy for our mothers to buy a cheap pair of $2 reading glasses at the drug store when they can no longer read the menu in a restaurant or for the young man mowing the lawn to put a few drops in his dry eyes.  When Grandpa’s eyes become a little filmy from cataracts, insurance will invariably pay for removal surgery, leaving him with 20/20 vision.  But for those living in developing countries, many barriers exist that prohibit people from obtaining these necessities.  First, families often survive on less than $1 per day.  There is no extra money to buy eye-care items.  Second, many live in rural settings far away from optometrists and ophthalmologists.  There is often no transportation to take a person who needs a glasses prescription to the nearest doctor’s office.  Finally, when people start losing their vision, they do not know that they need to visit a doctor’s office or go to a pharmacy for help.  Sheer lack of information is a barrier to eye care.

The Result:
What happens when a person loses their vision?  Partial or complete blindness has far-reaching affects.  Older people who are farsighted can no longer perform their daily obligations around the household.  Women cannot sew or cook.  They cannot see the faces of their family members or read their Bibles.  Those with cataracts have more severe difficulties.  Depending on the maturity of the cataract, the person may or may not be able to walk unassisted.  And as these people can perform fewer and fewer tasks, other relatives must help.  Perhaps a child can no longer go to school because he must stay home to guide the blind.  Without an education, the child’s future earning power is significantly curbed making it harder for his family to climb out of the hole of poverty.  If an adult must spend more time at home, that adult is making less money for the household, again, entrenching that family in poverty.

And the most frustrating thing about such eye problems is that many conditions are TREATABLE and/or COMPLETELY PREVENTABLE!!

The mission of Unite for Sight:
Unite for Sight (UFS) is an organization that seeks to provide eye-care worldwide with international clinics in Honduras, Ghana, and India.  To end preventable blindness, UFS aims to educate as many people as possible living in underserved areas, to decrease barriers to eye-care, and to fund eye surgeries.

My trip to Tegucigalpa, Honduras:
Unite for Sight provides the opportunity for volunteers to work in its international clinics.  On June 1st, I arrived in Tegucigalpa to work at COVA (Centro Oftalmologico Vida Abundante), a clinic partially funded by Unite for Sight.

The clinic:
COVA provides discounted ophthalmology/optometry exams and surgeries to Hondurans who cannot afford care otherwise.  From 7:00 AM to 3:00 PM, the clinic is crowded with patients waiting to be seen.  The clinic functions like an assembly line, seeking to examine as many patients as possible each day.

Brigadas (Outreach trips):
Each week, Unite for Sight sponsors a brigada to an underserved, rural area of Honduras.  The outreach ‘team’ consists of Victor, an optometrist, and Rolando, an optic technician.  My main role as a Unite for Sight volunteer was to travel with Victor and Rolando on the brigadas in order to increase the efficiency of the clinics.  For 3-4 days each week, we would set out in a large truck, piled high with optometry equipment and free eyeglasses, ready to work hard.  At each sight, dozens of patients would be lined up waiting for care.  One goal of the brigadas is to identify which patients have mature cataracts and need surgery.  Before beginning examinations, Victor would explain to the patients our mission, why we were there, and what would happen to patients who were diagnosed with cataracts.  During exams, Victor would write down the contact information of those with operable cataracts.  He would get in touch with these people in the next couple weeks to schedule their surgery.  Then, during the last week of the month, Victor would return to the village, sometimes driving up to 8 hours each way, collect the surgical patients, and take them to the COVA clinic in Tegucigalpa where they would receive free surgery funded by Unite for Sight.

The brigadas have 4 stations.  After patients are registered, they proceed to the visual acuity station where a ballpark number is obtained for their refraction.

Next, patients are examined with an autorefractor, which estimates the patient’s glasses prescription.

Finally, the patients are examined by Victor, who provides exact glasses prescriptions, diagnoses cataracts and other eye conditions, and dispenses general eye-hygiene instructions.

After seeing Victor, patients can order reduced-price prescription glasses and/or receive free reading glasses from Rolando.

Limitations:
Victor is not given any medication or free eye-drops to distribute to patients.  If a patient presents with an infection, for example, Victor is only able to tell that patient to obtain medication and treatment at the nearest hospital.  Those who suffer from allergies or dry eyes are told to buy drops at a pharmacy.  But there is no way for Victor or the volunteers to tell whether or not patients follow their instructions.

Anecdote:
At a clinic near San Lorenzo, Honduras, an elderly man wandered into our clinic wearing sunglasses.  He first approached the visual acuity station where I asked him to remove his sunglasses.  Open seeing his eyes I was alarmed.  There was thick white mucus flowing freely down his lower eyelids and onto his upper cheeks.  Not knowing what to do, I politely asked him to approach the optometrist station where he would be further examined.  Victor tried to examine his eyes, but was unable to come to any conclusions.  He only knew that the many was suffering from a serious infection.  When asked when the infection began, the man replied that it had begun four years ago!  Whey then did he not seek medical care sooner?  Well, he either did not know where to seek help, he had no money to seek help, he had no way to get to the place where he could receive help, or he simply did not think that his condition required medical attention.  All that could be done was to tell the man to wash his eyes out with clean water every day and to go to a hospital immediately.  Because we had no medication and no way to diagnose conclusively the condition, we could do nothing more to help.  Hopefully the man sought the proper medical treatment, but chances are he went on living the way he had been living the past four years.  The situation was very frustrating for the entire outreach team and goes to show how many more resources are needed by the mobile clinics.

Note: My interest in public health has been spurred by the guidance of the head-optometrist who travels on the outreach trips, Victor Montoya.  Victor’s dedication to helping his fellow Hondurans, his kindness, and his motivation have been inspirational to me.  Knowing Victor has ignited my interest in international medicine and in COVA’s mission.  To know him and to help his cause has been such a rewarding experience.

More examples of severe eye conditions seen on brigadas:

**If you are interested in learning more about how to help COVA and/or Unite for Sight, please contact me at RBauman1@swarthmore.edu or visit www.uniteforsight.com.

This post was written by rachel.baumann

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