reflections THE HUMAN SIDE OF OPTOMETRY
Poco a Poco
Little by little, eyecare flourishes in a remote community.
SCOTT E. PIKE, O.D.

How many of your patients would shower you with thanks if you gave them a well-used pair of glasses that were off by one-half of a diopter? In 1996, I visited the village of Santa Maria in the remote Ixcan region of Guatemala. Santa Maria has about 2,000 residents; the Ixcan region has 70,000. The nearest eye doctor is a day's journey away. By the time a person goes, receives treatment and returns, at least three days have elapsed. Most can't afford the trip, the treatment or the time away from their farms. I wanted to create a permanent source of eye care for these people.  

Finding the right partner

Pedro, a villager, has been instrumental in helping me meet my goal of bringing eye care to Santa Maria. A Mayan descendent of about 50 years of age, he attended school through maybe the third grade. He has five children, including a daughter who, since getting glasses from me last year, wants to be an eye doctor.

Like all the homes in Santa Maria, Pedro's has no electricity or running water. The people there don't have cars. His farm is about a 30-minute walk from the village. As a village health promoter (a volunteer with training in basic health care), Pedro dispenses medications to diabetics, administers vaccinations and first aid, advises on the care of latrines and treats malaria and any other diseases that people present with. He even understands my Spanish!

PHOTO COURTESY OF SCOTT E. PIKE, O.D.

Another piece falls into place

InFOCUS (Interprofessional Fostering of Ophthalmic Care for Underserved Sectors) was another crucial component in realizing my goal. The organization's mission is to build a local capacity for primary eye care and to link the communities to medical resources. It provided advice, training materials and a portable refractometer for the project. I taught Pedro how to use InFOCUS's Focometer, a device similar to a handheld monocular, which the patient focuses on a target. When the target is clear, Pedro reads the power needed to correct the acuity in the eye off the instrument's barrel. He then selects the prescription from an inventory of used glasses I compiled from donations, as well as new reading glasses purchased with financial gifts from friends. The prescription may not be perfect, but the residents of Santa Maria appreciate them.

Next year I hope to raise enough money to bring the villagers Instant Eyeglasses, which InFOCUS offers at a low cost through a partnership with Eye Deal Eyewear Inc. Pedro can assemble them to a specific prescription in the field.

Achieving the goal

I put my project, Enfoque Ixcan, into motion in 1997. I return once a year to replenish Pedro's inventory and to teach him more about ocular health. Each time, I'm more impressed with his commitment to his village. I see just a handful of patients during my visits -- only the cases Pedro can't figure out. This is a year-round service, and I don't want people to wait for me to have their eyes checked.

I've enlisted the help of Guatemalan M.D.s for Pedro to refer to when he encounters someone who needs surgery or emergency treatment, and a lab that will provide low-cost glasses when his inventory can't help. Enfoque Ixcan is now also working with the region's school system, making it a win-win project for all of Ixcan. We tested more than 1,000 primary school students in March.

DO YOU HAVE A MEMORABLE EXPERIENCE YOU'D LIKE TO SHARE? DISCUSS YOUR STORY WITH RENÉ LUTHE, SENIOR ASSOCIATE EDITOR OF OPTOMETRIC MANAGEMENT, AT (215) 643-8132 OR LUTHER@BOUCHER1.COM.