The Eye Health Institute Volunteer Trip - Jamaica
Dr. Wicker at a vision screening
Donna Wicker, OD, chief of the optometry division at Kellogg, and Matthew Manry, MD, third year ophthalmology resident at Kellogg, traveled to Jamaica for one week in April 2016 to examine patients and perform eye surgery.
Supported by the Kellogg Eye Center for International Ophthalmology, they were part of a delegation of health providers under the auspices of The Eye Health Institute (EHI), founded in 2000 to render eye care to underserved citizens in Jamaica. EHI consists of ophthalmologists, optometrists, opticians, nurses, technicians, and optometry students from the United States and Canada who collaborate with health care workers in Jamaica.
EHI’s link to the University of Michigan came through one of EHI’s founders, Joseph Myers, OD, assistant director of optometry at the University Health Services, which provides care for U-M students. Based on an innovative multidisciplinary approach to eye care, Dr. Myers received a grant from U-M through the Third Century Initiative, which funds projects with high global impact.
Container being assembled
EHI’s main innovative feature was a “container” that could be shipped and assembled in country to provide a space for eye examination, opticianry, and other basic preventive health functions, such as vaccination and health care information. Designed by architects at the U-M School of Architecture, the container is being assembled in a United States Agency for International Development compound near Montego Bay. Fueled by solar panels, the container uniquely will have air conditioning and dehumidification, critical to protect against malfunction of precision equipment.
Because the container had not been yet been assembled at the time of their visit, Dr. Wicker and Dr. Manry worked at other sites. Dr. Wicker screened patients, refracted, and prepared glasses for patients in a church and at a nearby health clinic and elementary school. She was assisted by optometry students from the State University of New York. Dr. Manry operated at a local hospital.
Here is how Dr. Wicker described her typical day:
“It was dripping hot--all the time. Fans circulated the moist hot air. Elderly patients sometimes sat on a bench for up to 6 hours for the chance to have an eye exam. In assessing visual acuity, we often faced patients who did not know letters or numbers. A patient with glaucoma had run out of eye drops months ago, which can cost thousands of Jamaican dollars per year. EHI provided her with the eyedrops free of charge. I was able to instruct some patients in how to use stand magnifiers when high add readers were not sufficient. One of my patients with dense cataracts was put on a waiting list to be evaluated for cataract surgery when EHI was to return in 6 months. In the interval, she had to make due with high add readers, which allowed her to read large print. She was very happy, but I cannot imagine this scenario in the United States.”
With the help of a low vision grant from the Ratner foundation, Dr. Wicker was able to bring low vision aids like magnifiers and telescopes to Jamaica. Making them available to patients allowed them the pleasure of reading their bibles.
Dr. Wicker also conducted visual screening of school children—sometimes 70 in a day. “When the kids needed glasses, we made them in a nearby hotel and delivered them two days later. On our last day, the school principal came by to thank us.”
Matthew Manry, MD and patient at cataract screening examination
Dr. Manry operated in the maternity ward of a local hospital. In a new initiative, he was able to perform Kelman phacoemulsification, the type of advanced cataract surgery practiced in the developed world, with instruments uncrated when he arrived. Dr. Manry and his team did their own set-up of all surgical instruments, intraocular lenses, an autoclave sterilization machine, and an A-scan ultrasound machine to determine the proper intraocular lens to insert.
Dr. Manry reported that dense cataracts were common, but so were pterygia. “One patient had such a large pterygium that I had to perform an amniotic membrane graft to help heal the area of resection. Another patient had a very large seborrheic keratosis that required a rotational flap for closure. These are more advanced cases than I had encountered in my training at Kellogg. They were a real challenge, but I believe we got good results.”
In one week, 202 eye examinations were performed, 197 school children eye screenings, and 5 low vision exams; she dispensed 52 eyeglasses and 95 readers. Dr. Manry performed 11 surgical procedures and screened dozens more patients for future surgery.
But as Dr. Wicker observed, “the value of this trip went way beyond patient care. It gave us a chance to evaluate how we provide eye care, and to re-evaluate our clinical judgments. We provided an unparalleled educational experience to the 3 optometry students assigned to us. We learned how to come together as a team when resources were limited and how to adapt to different patient needs and expectations. We are so much better doctors for this experience and we think our patients’ vision is better too!”
Kellogg’s next presence in Jamaica will be in April 2017, when Joseph Grubbs, MD, MPH, second year resident in ophthalmology, travels there with Dr. Wicker. Dr. Grubbs is collaborating with Dr. Myers on a survey aimed a gauging how Jamaicans are accepting the EHI initiative. And when he arrives there, the container will be in full swing!
Matthew Manry, MD and operating room nurses