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Third-world countries need all levels of eye care services
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To the Editor:
I read with interest the recent commentary by Douglas J. Villella, OD, regarding humanitarian optometry missions (“Humanitarian optometry missions should build capacity, not dependency,” August 2014). I applaud his success in Guatemala and forming a coalition with local ophthalmology to provide surgical care.
I do, however, take exception to the premise that optometric humanitarian missions, specifically Volunteer Optometric Service to Humanity (VOSH) missions, not only are not helpful to the communities they serve, but are somehow detrimental to the health and welfare of those same communities and the patients and citizens within them.
I currently serve as the president of VOSH-Connecticut and have led a mission to the town of San Juan del Sur, Nicaragua, for the past 13 years. I also visited the same community for 3 years prior to founding VOSH-Connecticut as a member of VOSH-New England Council of Optometry. Our missions have provided free eye care services to those in need throughout Nicaragua, having served approximately 35,000 men, women and children over the past 16 years. In all that time, I have not met a single ophthalmologist, either local or visiting, who has been willing to provide eye care services to this population. There are ophthalmologic services available to those who have the money to afford it in Managua or to limited amount in the nearby city of Revas. The problem really lies in the depth of the poverty of many people in this area.
In a country such as Nicaragua, a true dictatorship in every sense of the word, there is no prospect of ever providing an impoverished population permanent or even temporary eye care services. Here is a society strictly of haves and have-nots. The haves have everything, including access to adequate health care services, either locally or abroad. The have-nots are left to fend for themselves, young and old, one generation to the next. In theory it sounds nice to lift up, get ahead, providing health care services to those in need regardless of their ability to pay. In reality, especially in a place like Nicaragua, only money talks, and without it patients have nothing.
Our group hires buses to provide free transport to our clinic from outlying barrios throughout Southern Nicaragua. We do not provide surgical services, but optometric services such as routine exams, eyeglasses and treatment of glaucoma and external eye diseases are provided. Through the generosity of several drug companies, we are able to provide needed eye drops and other types of eye medicine to those in need.
During our yearly 4-day mission, we see approximately 600 to 800 patients a day, many of whom travel and wait patiently for hours to be seen. The same group of Connecticut optometrists return with us year after year, and many patients now request and “schedule” their yearly eye exam with the same doctor. Many doctors have also brought along their spouses and children who give so much and ask for nothing in return. In addition, approximately 50 local volunteers return year after year to help out at the clinic, and many have gone on to community involvement as a result of their initial work with VOSH-CT. VOSH-CT also provides a great yearly boost to the local economy where the daily wage is $5.00 at best.
Over the past 16 years, our missions have also provided an invaluable learning experience for several hundred optometry students from the University of California Berkeley School of Optometry and others. At the start of each mission their young men and women arrive as students and leave as doctors. No one on our missions is there to make themselves “feel good.” On the contrary, year in and year out, we all fundamentally address and improve the condition of those in need.
Dr. Villella’s article speaks about providing surgical services such as cataract surgery. My contention is while that is important, optometric services such as simple refractive care provide an invaluable service to the patients we serve. The United Nations coined the term “functional blindness” to describe the visual circumstance patients with significant refractive errors face when they have no access to refractive care and eyeglasses. My experience has been that the ratio of patients in Nicaragua needing simple refractive services to cataract surgery is at least 100:1. Therefore, a mission delivering optometric services can have a very positive impact on the communities it serves. Patients are also very pleased with the glasses they receive from us through the generosity of Virginia Lions Eyeglass Center, and in no way do they fail 80% of the time.
I think the true reality is that the third world needs all of the above, the development of in-country health care resources, assistance from external agencies such as Dr. Villella’s Vision for the Poor and VOSH missions to try to help those in need now while the future health care systems are being developed. I welcome the day our local sponsor in Nicaragua says we are not needed there anymore, but I will wait until those on the ground living and serving their own country tell me it is time to find another place that needs our help. Based on our many years of service and experience, that will be a long time coming, if ever.
Founder and president of VOSH-Connecticut
Chairman of the Connecticut State Board of Optometry
Private practitioner
Torrington, Conn.