|Year : 2020 | Volume
| Issue : 1 | Page : 33
Methods and findings on an ophthalmic mission trip to colombia
Ethan Waisberg1, John Harvey2
1 UCD School of Medicine, University College Dublin, Belfield, Dublin 4, Ireland
2 Division of Ophthalmology, Department of Surgery, Faculty of Health Sciences, McMaster University, Hamilton, Ont, Canada
|Date of Submission||14-Jul-2020|
|Date of Acceptance||18-Sep-2020|
|Date of Web Publication||10-Dec-2020|
Dr. John Harvey
Division of Ophthalmology, McMaster University, 2757 King St E, Hamilton, ON L8G 5E4
Source of Support: None, Conflict of Interest: None
Background: Medical ministry international (MMI) is a Canadian charitable organization that coordinates healthcare missions to underserved people in developing countries.
Objective: We report on the baseline clinical findings of a mission trip to Ciénaga de Oro, Colombia, present the methods used in the mission and the efforts to establish a local eye care service with long-term sustainability.
Methods: Data were collected on patients seen during a 2-week mission trip from January 13 to 24, 2020. Data included eye health and the services given.
Results: Altogether 5529 patients were seen by the team. Nearly 247 surgeries were performed by ophthalmologists. The most common diagnosis performed was a refractive error, for which 4066 patients (74%) received eyeglasses. Another 835 (15%) had a consultation by an ophthalmologist, of which 260 (5%) received surgery, mostly manual small incision cataract surgery and intraocular lens insertion.
Conclusions and Importance: MMI is helping to reduce the prevalence of preventable blindness in the Ciénaga de Oro population; however, further training to increase the capacity of local ophthalmic services is required to improve long-term eye care to the community.
Keywords: Cataracts, developing country, medical mission trip, preventable blindness, strabismus, vision impairment
|How to cite this article:|
Waisberg E, Harvey J. Methods and findings on an ophthalmic mission trip to colombia. Pan Am J Ophthalmol 2020;2:33
| Introduction|| |
The World Health Organization (WHO) estimates for 2019 were over 2.2 billion people having some level of visual impairment or blindness, at least 1 billion of which were preventable or yet to be addressed. About 90% of blindness in the world is found in developing countries, where typically no ophthalmic services are provided, and cataract surgery is unavailable. Colombia was classified by the united nations human development report as ranking 79th of 186 countries on the human development index in 2019. The Córdoba region was ranked near the bottom of this index, at 27 out of the 33 regions in Colombia. The region has high levels of systemic poverty and is known primarily for cattle ranching.
Refractive error now accounts for approximately 25% of world blindness and 50% of low vision. This seems astonishing from the perspective of living in a developed country, where optometry services and prescription eyeglasses can easily correct these errors. Routine vision testing for those at risk for vision loss should be established as a preventative measure in Colombia, and referral should occur if vision is worse than 6/12. Visual acuity scoring <6/12 has been shown to significantly decrease quality and length of life, with a doubling of mortality and social isolation.
Medical Ministry International (MMI) facilitates health care workers to serve on 1-or 2-week projects in a developing country. A key goal is to support local health workers in developing country in providing high quality and affordable health care to make a lasting change. MMI also serves to support residency training programs to improve the accessibility of physicians in these countries. During this mission trip, basic eye care services were provided at a local school and surgical procedures at a nearby hospital. The most common cause of vision impairment seen during this mission was a refractive error, which was followed by cataracts. During the 2 weeks, 4066 pairs of eyeglasses were dispensed and 260 surgical procedures were performed.
| Methods|| |
Prior to the arrival of the MMI team, the residents of the nearby towns were informed about the team coming to provide eye care. Several Colombian people from other more developed towns who were proficient in English were employed to act as interpreters. Most Ciénaga de Oro residents heard about the clinic through word of the mouth. A total of 5529 people presented to be examined during the 2-week long clinic from January 13 to 24, 2020. The volunteer team consisted of nine ophthalmologists, eight registered nurses, one optometrist, one ophthalmology resident, two opticians, four interpreters, one anesthesiologist, 26 general helpers, two ophthalmic technicians, one family doctor, and one medical student. The clinic was divided into seven parts:
- Patient registration to collect information about demographic data and medical history;
- Assessment of distance and near visual acuity;
- Basic ophthalmic screening using ophthalmoscope;
- Full slit-lamp examination for referred patients;
- Surgical preoperative preparation was performed by volunteer nurses;
- Surgical procedures occurred at a nearby hospital and were performed by the visiting ophthalmologists;
- Postoperative examinations occurred the morning after the surgery.
Volunteers who could speak Spanish fluently conducted a basic interview to collect relevant medical history information about each new presenting patient and demographic information such as age and occupation.
The best visual acuity of patients was determined using a E-optotype Snellen chart. The choice of this chart was due to the high rate of illiteracy seen in the local population. If a patient was unable to read the top letter on this chart, visual acuity was further tested and could be: counting fingers at 0.5 m, 1 m, 2 m, hand movements, no light perception, or light perception. Intraocular pressure (IOP) was measured using iCare Handheld tonometry. Examinations of the anterior and posterior segments were performed using a slit lamp (Carl Zeiss Meditech, Dublin, USA). Criteria for examination by an ophthalmologist included: pterygium affecting vision, abnormally high IOP (above 20 mmHg), and dense axial cataracts (visual acuity of 6/36 or worse). Patients with complex conditions requiring special follow-up care were referred to an ophthalmologist in Bogotá.
| Results|| |
In total 5529 patients were seen by the team [Figure 1]. About 611 out of 5529 were children (11.1%). Most the patients were from the town of Ciénaga de Oro, where the clinic was located. Many people with more severe conditions traveled several hours to attend the clinic. About 835 out of 5529 (15.1%) were examined by an ophthalmologist. Of these patients, 260 surgeries were performed at a nearby hospital. Nearly 4066 pairs of eyeglasses and 542 pairs of sunglasses were dispensed.
The most common eye condition seen at the clinic was an uncorrected refractive error, seen in 4066 out of 5529 patients (73.5%). Of the 260 surgeries performed, 174 of which were cataract extractions with intraocular lens insertions (66.9%), 9 adult strabismus (3.5%), 15 pediatric strabismus with general anesthesia (5.8%), and 51 pterygia with a graft (19.6%). A more detailed summary shown in [Table 1].
|Table 1: Types of surgeries performed during the Medical Ministry International mission, January 13-24, 2020|
Click here to view
| Discussion|| |
We present the clinical findings and methodology of the MMI mission on January 13–24, 2020. Uncorrected refractive errors, followed by cataracts, were the leading causes of vision impairments within the 5529 patient cohorts. All patients that underwent surgery gained significantly improved vision.
It can be inferred from the cases seen at the MMI January 2020 clinic, and through the lack of eye care specialists in the Ciénaga de Oro region, that eye disease remains largely untreated. Many people in this region continue to live with severe visual impairments that are preventable. Drawing conclusions from clinical data from this project should be made with caution, as data from eye clinics have an inherent statistical bias in the over-selection of participants having preexisting vision problems. Population data likely cannot be extrapolated from our data. A future survey of the population in Ciénaga de Oro could potentially fill this gap of information. This population data would likely show an extremely high prevalence of eye disease and uncorrected refractive error, which could potentially be used to advocate for more eye care services to be delivered in the region.
The mission's help model used on this trip was highly efficient, resulting in a total of 17,473 eye care services provided in a brief time span of 2 weeks. All mission team members were volunteers who donated their time and expertise and paid for their own flights, meals, transportation, and accommodation. Eye care services were provided for free; patients undergoing surgery were charged 50,000 Colombian pesos (approximately CAD $19.50). Patients who could not afford this nominal fee were not charged. MMI estimates that for every $1 donated, $8.33 of services is provided to patients.
| Conclusions|| |
These findings demonstrate how global missions such as this one are valuable in reducing avoidable blindness where there is a shortage of ophthalmologists and eye care professionals, as in Colombia. Mission trips like this one can help greatly to reduce the prevalence of preventable blindness in developing countries; however, further training and increasing the capacity of local ophthalmic services are required to provide improved long-term eye care to the community. In addition, a population survey should be conducted in the region to determine the prevalence of uncorrected refractive error and eye disease.
MMI has taken steps toward establishing full-time ophthalmic services in the region. The organization has forged relationships with local government officials and eye care partners in towns nearby. These connections were vital to earn the trust of the local community. Due to the lack of resources in Ciénaga de Oro and throughout rural Colombia, establishing a permanent ophthalmic service is unlikely in the coming years. However, a regional eye care team helped work alongside the volunteer ophthalmologists and optometrists and further developed their skills. This regional team will continue to deliver eye care using a similar outreach clinic model. Recruitment of more ophthalmic workers is needed to achieve wider coverage and increase the capacity of the local service.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Taylor HR, Keeffe JE. World blindness: A 21st
century perspective. Br J Ophthalmol 2001;85:261-6.
Medical Ministry International. Medical Ministry International. Available from: https://www.mmi.org/
. [Last accessed on 2020 Jun 10].