Commentary

Humanitarian optometry missions should build capacity, not dependency

Consider partnering with local groups or nearby facilities.

We often read about U.S. optometrists who donate their services to travel around the world and deliver primary eye care to people in great need. While these humanitarian trips seem praiseworthy, short-term visits provide no lasting impact on an impoverished population of people who desperately need permanent eye services.

I have personally taken 18 eye mission trips through Volunteer Optometric Service to Humanity (VOSH) over the past 20 years. I now lead a nonprofit organization, Vision for the Poor, which co-builds self-supporting eye hospitals in Latin America and Haiti. I know firsthand the excitement of participating in mission trips, the camaraderie of the team approach, the personal satisfaction of helping many people and the multilayered adventure of experiencing the natural beauty and alluring culture of developing countries.

I first began to doubt the value of traditional optometry mission trips while on my second VOSH trip in 1994 when I encountered many blind patients with cataracts. Typical of most optometry mission teams, we were equipped only to provide eyeglasses and acute medical treatments. Having no resources to help these blind patients, most of whom were subsistence farmers living in abject poverty in rural Guatemala, I felt like I was leaving wounded soldiers on the battlefield to die.

Douglas J. Villella OD

Douglas J. Villella

Eye hospital built in Guatemala

Serendipitously, on that same 1994 trip to Guatemala our team met a missionary who invited us to build a badly needed eye hospital in the northern rainforest region. While this was an endeavor totally beyond our comfort zone, our VOSH group in Pennsylvania responded generously to the request. Within a short time, and with much guidance, we learned to fundraise, grant-write and establish relationships with three skillful and compassionate Guatemalan ophthalmologists, as well as with organizations that had vast experience with international eye hospital development, most notably the International Eye Foundation (IEF).

Our first eye hospital was built in 1997.

By 2006, along with the IEF, our VOSH group had co-built three self-supporting social service (patients pay for services based on income, with the very poor and children receiving free care) eye hospitals in Guatemala. They were staffed full-time by six Guatemalan ophthalmologists, three optometrists (with full funding for the education for four more optometry students) and a staff of more than 100 people while concurrently maintaining a robust mission trip schedule with an advanced twist: all mission trips were exclusively made to Guatemala. Each trip brought grant funds from Rotary and Lions Clubs International Foundations, which helped build the new facilities; all patients in need of advanced care were referred to the new eye hospitals; and the surgical and optical care for each referred patient was funded by our group.

Mission trips to Guatemala no longer needed

By now, each eye hospital had developed its own outreach team to screen the rural populations, and because they did it for a fraction of the cost of a mission team from the U.S., the need for our VOSH mission trips to Guatemala became obsolete. In 2008 we split into two organizations: one that solely performs mission trips to Haiti, called VOSH/PA, and one that exclusively focuses on replicating the successful model developed in Guatemala by building eye hospitals throughout Latin America and Haiti, called Vision for the Poor.

In 2013, five self-supporting Vision for the Poor social service eye hospitals in Guatemala, Haiti and Nicaragua treated 93,000 patients.

Along the way I have learned a few things, marking a shift in my understanding of what genuinely constitutes the best and most enduring kinds of humanitarian efforts.

Hundreds of traditional optometry mission trips launch from the U.S. every year – more than 100 by VOSH chapters alone – and continue to provide short-term, episodic treatments that provide acute care for a chronic problem. However, glasses break, recycled eyeglasses do not work 80% of the time for nonpresbyopic patients, glaucoma medications need to be refilled, and eye trauma happens 52 weeks a year – not just during the week the team is present. Above all, blindness due to cataract is cured with an 8-minute procedure that the team does not provide.

The operating room at Visualiza, the Vision for the Poor flagship eye hospital in Guatemala. Visualiza is the designated teacher of the Aravind model for sustainable social service eye care for Latin America and the Caribbean.

The operating room at Visualiza, the Vision for the Poor flagship eye hospital in Guatemala. Visualiza is the designated teacher of the Aravind model for sustainable social service eye care
for Latin America and the Caribbean.

Image: Villella DJ

However, the most important, yet overlooked, issue is that the well-intentioned efforts of mission teams to provide free care creates a culture of dependency and undermines the prospect of sustainable, permanent and high-quality eye care that may be available at a nearby facility. What if the team partnered with a nearby facility? What if the team helped transport patients to that facility or assisted with funding their patients’ surgery and optical needs?

Consider the possibility that the team might develop a long-term partnership with the facility or assist with the purchase of new and better equipment, a retina service or an optical service to provide low-cost eyeglasses made while patients wait. If no nearby facility exists the team might actually construct one. For the cost of a half dozen mission trips, an entire permanent eye hospital can be built. By utilizing their resources more thoughtfully and with a mind toward long-term sustained benefit, mission teams have the possibility to make a profound and long-lasting change for the better in their patients’ lives.

As an eye doctor participating in eye missions, it is incumbent to be educated in the international standard of delivery of eye care to developing countries. One extraordinary resource to help with such understanding is Pavithra Mehta’s and Suchitra Shenoy’s book, Infinite Vision, the story of the development of the Aravind Eye Hospital system in India. Mehta and Shenoy masterfully detail the critical importance of developing sustainable, high-volume and consummately high-quality indigenous eye care.

Vincent, Pearce, Leasher, Mladenovish and Patel also write about their “Rationale for shifting from a voluntary clinical approach to a public health approach in addressing refractive errors” in Clinical and Experimental Optometry.

Richard Stearns, president of World Vision, is a person with formidable experience in development work aimed at reducing human suffering in developing countries. He states: “Frankly, giving things to the poor does much more to make the giver feel good than it does to fundamentally address and improve the condition of those in need” in The Hole in Our Gospel.

I am afraid this has been the plight of much of humanitarian optometry. However, with keen insight about the limitations of traditional mission programs along with awareness of the best kinds of development programs, we can collaborate with local and international partners to create the most impactful and enduring eye care in the history of humanitarian optometry. Consider supporting Optometry Giving Sight and its rapidly growing role in representing sustainable refractive needs of poor populations globally.

References:
Mehta PK, et al. Infinite Vision. San Francisco, CA: Berrett-Koehler Publishers; 2011.
Stearns R. The Hole in Our Gospel. Nashville, TN; W Publishing; 2009.
Vincent JE, et al. Clin Exp Optom. 2007;90(6):429-433.
For more information:
Douglas J. Villella OD, is executive director of Vision for the Poor. He can be reached at doug@visionforthepoor.org; (814) 823-4486.
Disclosure: Villella has no relevant financial disclosures.

We often read about U.S. optometrists who donate their services to travel around the world and deliver primary eye care to people in great need. While these humanitarian trips seem praiseworthy, short-term visits provide no lasting impact on an impoverished population of people who desperately need permanent eye services.

I have personally taken 18 eye mission trips through Volunteer Optometric Service to Humanity (VOSH) over the past 20 years. I now lead a nonprofit organization, Vision for the Poor, which co-builds self-supporting eye hospitals in Latin America and Haiti. I know firsthand the excitement of participating in mission trips, the camaraderie of the team approach, the personal satisfaction of helping many people and the multilayered adventure of experiencing the natural beauty and alluring culture of developing countries.

I first began to doubt the value of traditional optometry mission trips while on my second VOSH trip in 1994 when I encountered many blind patients with cataracts. Typical of most optometry mission teams, we were equipped only to provide eyeglasses and acute medical treatments. Having no resources to help these blind patients, most of whom were subsistence farmers living in abject poverty in rural Guatemala, I felt like I was leaving wounded soldiers on the battlefield to die.

Douglas J. Villella OD

Douglas J. Villella

Eye hospital built in Guatemala

Serendipitously, on that same 1994 trip to Guatemala our team met a missionary who invited us to build a badly needed eye hospital in the northern rainforest region. While this was an endeavor totally beyond our comfort zone, our VOSH group in Pennsylvania responded generously to the request. Within a short time, and with much guidance, we learned to fundraise, grant-write and establish relationships with three skillful and compassionate Guatemalan ophthalmologists, as well as with organizations that had vast experience with international eye hospital development, most notably the International Eye Foundation (IEF).

Our first eye hospital was built in 1997.

By 2006, along with the IEF, our VOSH group had co-built three self-supporting social service (patients pay for services based on income, with the very poor and children receiving free care) eye hospitals in Guatemala. They were staffed full-time by six Guatemalan ophthalmologists, three optometrists (with full funding for the education for four more optometry students) and a staff of more than 100 people while concurrently maintaining a robust mission trip schedule with an advanced twist: all mission trips were exclusively made to Guatemala. Each trip brought grant funds from Rotary and Lions Clubs International Foundations, which helped build the new facilities; all patients in need of advanced care were referred to the new eye hospitals; and the surgical and optical care for each referred patient was funded by our group.

Mission trips to Guatemala no longer needed

By now, each eye hospital had developed its own outreach team to screen the rural populations, and because they did it for a fraction of the cost of a mission team from the U.S., the need for our VOSH mission trips to Guatemala became obsolete. In 2008 we split into two organizations: one that solely performs mission trips to Haiti, called VOSH/PA, and one that exclusively focuses on replicating the successful model developed in Guatemala by building eye hospitals throughout Latin America and Haiti, called Vision for the Poor.

In 2013, five self-supporting Vision for the Poor social service eye hospitals in Guatemala, Haiti and Nicaragua treated 93,000 patients.

Along the way I have learned a few things, marking a shift in my understanding of what genuinely constitutes the best and most enduring kinds of humanitarian efforts.

Hundreds of traditional optometry mission trips launch from the U.S. every year – more than 100 by VOSH chapters alone – and continue to provide short-term, episodic treatments that provide acute care for a chronic problem. However, glasses break, recycled eyeglasses do not work 80% of the time for nonpresbyopic patients, glaucoma medications need to be refilled, and eye trauma happens 52 weeks a year – not just during the week the team is present. Above all, blindness due to cataract is cured with an 8-minute procedure that the team does not provide.

The operating room at Visualiza, the Vision for the Poor flagship eye hospital in Guatemala. Visualiza is the designated teacher of the Aravind model for sustainable social service eye care for Latin America and the Caribbean.

The operating room at Visualiza, the Vision for the Poor flagship eye hospital in Guatemala. Visualiza is the designated teacher of the Aravind model for sustainable social service eye care
for Latin America and the Caribbean.

Image: Villella DJ

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However, the most important, yet overlooked, issue is that the well-intentioned efforts of mission teams to provide free care creates a culture of dependency and undermines the prospect of sustainable, permanent and high-quality eye care that may be available at a nearby facility. What if the team partnered with a nearby facility? What if the team helped transport patients to that facility or assisted with funding their patients’ surgery and optical needs?

Consider the possibility that the team might develop a long-term partnership with the facility or assist with the purchase of new and better equipment, a retina service or an optical service to provide low-cost eyeglasses made while patients wait. If no nearby facility exists the team might actually construct one. For the cost of a half dozen mission trips, an entire permanent eye hospital can be built. By utilizing their resources more thoughtfully and with a mind toward long-term sustained benefit, mission teams have the possibility to make a profound and long-lasting change for the better in their patients’ lives.

As an eye doctor participating in eye missions, it is incumbent to be educated in the international standard of delivery of eye care to developing countries. One extraordinary resource to help with such understanding is Pavithra Mehta’s and Suchitra Shenoy’s book, Infinite Vision, the story of the development of the Aravind Eye Hospital system in India. Mehta and Shenoy masterfully detail the critical importance of developing sustainable, high-volume and consummately high-quality indigenous eye care.

Vincent, Pearce, Leasher, Mladenovish and Patel also write about their “Rationale for shifting from a voluntary clinical approach to a public health approach in addressing refractive errors” in Clinical and Experimental Optometry.

Richard Stearns, president of World Vision, is a person with formidable experience in development work aimed at reducing human suffering in developing countries. He states: “Frankly, giving things to the poor does much more to make the giver feel good than it does to fundamentally address and improve the condition of those in need” in The Hole in Our Gospel.

I am afraid this has been the plight of much of humanitarian optometry. However, with keen insight about the limitations of traditional mission programs along with awareness of the best kinds of development programs, we can collaborate with local and international partners to create the most impactful and enduring eye care in the history of humanitarian optometry. Consider supporting Optometry Giving Sight and its rapidly growing role in representing sustainable refractive needs of poor populations globally.

References:
Mehta PK, et al. Infinite Vision. San Francisco, CA: Berrett-Koehler Publishers; 2011.
Stearns R. The Hole in Our Gospel. Nashville, TN; W Publishing; 2009.
Vincent JE, et al. Clin Exp Optom. 2007;90(6):429-433.
For more information:
Douglas J. Villella OD, is executive director of Vision for the Poor. He can be reached at doug@visionforthepoor.org; (814) 823-4486.
Disclosure: Villella has no relevant financial disclosures.