You are in: eMedicine Specialties > Ophthalmology > OPHTHALMOLOGY FOR THE GENERAL PRACTITIONER Volunteer Eye CareArticle Last Updated: Feb 29, 2008AUTHOR AND EDITOR INFORMATIONSection 1 of 12
  Author: Mark Ventocilla, OD, FAAO, Clinical Professor, Michigan College of Optometry; Editor, American Optometric Association Contact Lens and Cornea Section Newsletter; Chief Executive Officer, Elder Eye Care Group, PLC; President, Lakeshore Professional Eyecare, PC Mark Ventocilla is a member of the following medical societies: American Academy of Optometry and American Optometric Association Coauthor(s): Jeffrey Schrauben, Michigan State University; Jerome Finkelstein, MD, Clinical Assistant Professor, Department of Ophthalmology and Visual Sciences, University of Michigan Editors: Richard W Allinson, MD, Associate Professor, Department of Ophthalmology, Texas A&M University Health Science Center, Scott and White Clinic; Simon K Law, MD, PharmD, Assistant Professor of Ophthalmology, Jules Stein Eye Institute; Chief of Section of Ophthalmology Surgical Services, Department of Veterans Affairs Healthcare Center, West Los Angeles; J James Rowsey, MD, Former Director of Corneal Services, St Luke's Cataract and Laser Institute, Florida; Lance L Brown, OD, MD, Ophthalmologist, Affiliated With Freeman Hospital and St John's Hospital, Regional Eye Center, Joplin, Missouri; Hampton Roy Sr, MD, Associate Clinical Professor, Department of Ophthalmology, University of Arkansas for Medical Sciences Author and Editor Disclosure Synonyms and related keywords: vision service, volunteer eye project, missionary eye care, volunteer ophthalmologic service, volunteer optometric service, eye care in developing countries, eye care in disaster areas, world blindness, volunteer organizations, volunteer health professionals, volunteer work, missionary work BENEFITS AND COSTS OF ORGANIZING AN EYE PROJECTSection 2 of 12
  The foremost reason people organize an eye project is for the joy of helping others see again (see Media file 1). However, other benefits may include the following:
Possible costs include the following:
Firsthand accounts of volunteer eye care experiences often provide the best descriptions of what one can expect on a project. The authors of this article offer 2 such accounts, one from an experienced practitioner and the other from a nonprofessional volunteer. A firsthand account by Dr. Mark Cook on providing vision care in In January 2005, in response to the tsunami disaster in the Indian Ocean, President Bush ordered the hospital ship, USNS Mercy, to Project HOPE had the foresight to invite and integrate ophthalmologists and optometrists to participate in this mission, which was also a historical first for them. My expectation as a DPA/TPA certified optometrist was that I would provide full-scope vision care. I did not anticipate the overwhelming demand for refractive eye care. Prior to the tsunami, sophisticated health care was available in The eye team that went ashore each day consisted of 1 optometrist, 2 ophthalmologists, and 1 US Navy Corpsman, acting as an optician. We were transported by helicopter to the land clinic at 8 am and worked until 2 pm when the US Navy ordered us back to the landing zone for transport back to the ship. Security was a concern, and the US Navy wanted everyone back on the ship and accounted for by 5 pm. As a result, clinic days were short and initially got off to a slow start. Within 5 days, we were averaging 200 examinations per day, with the crowds growing larger and more difficult to control each day. Eventually, 8 US Navy security personnel were needed to control the crowds outside of the eye clinic sites. Our goal and challenge was to leave no one unseen by the time we had to leave each day. By the end of the 8-week mission, 4900 examinations and surgeries had been performed, and 4747 glasses had been dispensed. The workload grew from 3 patients on the first day to hundreds daily. On our 10th day at the clinic site, 403 patients were waiting to be seen when we arrived in the morning. It quickly became obvious that the vision care needs of these people could only be met if the ophthalmologist, optometrist, and optician worked together, maximizing on each person's individual skills and doing what each person does best. The optometrist refracted, prescribed, and referred; the ophthalmologist performed cataract surgery; and the US Navy opticians made and dispensed the glasses that were provided. Looking back on the experiences in A firsthand account on the impact volunteering can have on one's life is provided below by Peru Eye Project volunteer Jeffrey Schrauben. On arrival in Besides the amazing scenery though, I learned an incredible amount while I was in The trip was also eye opening for me because I was surrounded by people who really loved their jobs. The doctors who went on the trip were inspiring to me in the sense that it was obvious they must really care about what they were doing to give up their money and countless hours of their time, just to leave their normal jobs for awhile and go and work some more. I had done some job shadowing previous to this experience, but it had always seemed to be more or less another day at work. It was from observing and working with these doctors in a charitable context that I was able to make the decision that I wanted to be an optometrist. I feel that during my stay in CHOOSING A LOCATIONSection 3 of 12
Project location can dramatically affect how you prepare for the project. Whenever possible, choosing a desirable location (eg, beach, tourist area) will make enlisting volunteers easier. Both rural settings and urban settings have their advantages and disadvantages, but rural settings often provide the greatest challenge. Rural settings dictate that you account for the following:
Urban settings often pose more of a security risk for personnel in their travel to and from the clinic. To minimize this risk, volunteers may consider the following:
PROJECT GOALSSection 4 of 12
The greatest reward for any project is the feeling that you have provided care to people who would otherwise not be served. However, project success can be maximized if you set realistic goals at the start of the project. Moreover, the goals you set will determine the composition of the team you take with you. Some goals to consider are outlined below. Number of patients to be examined The number of patients examined per day will vary depending on the expertise and experience of the group. In general, most optometrists will see between 50-100 patients per day. Local staff can help prepare the project by pre-enrolling patients. Handing out numbered and color-coded (different color for each day) enrollment forms to patients and having them complete a brief history will reduce crowds and help keep the examination time problem focused. Keep in mind that the working conditions will be less than ideal; schedule accordingly. The environment may be hot and sticky (eg, Pitfalls are tolerated more easily if the schedule is not overly aggressive (see Media file 4). Regardless, establishing patient volume allows the hosts to preregister patients and to set the number of support staff needed to assist those patients. Education to be provided "Tis better to learn to fish than to be given a fish." Including local professionals in the project enables them to further their skills as well as to contribute to the project. This, in turn, increases their commitment to the project and ensures success. Providing didactic education to local eye care professionals during nonclinic hours enhances their skill level, making them better able to serve the people. Demonstrating the eMedicine Web site to local professionals can provide them with a resource to search for answers to medical questions. Supplies to be donated Much needed donations of glasses and surgical supplies provide the tangible evidence of the project's efforts. (See Suggested Supply List for a more complete listing.) PROJECT PERSONNELSection 5 of 12
Dividing the project into teams improves the patient flow and increases both the quality of the examination and the number of patients seen. Traffic flow/security team Expect that more patients ask to be seen each day than what is planned. To direct patients to the correct area, it is best if one person is assigned to each area to move people along. For example, directing a cataract referral to the surgeon or directing a remake on the glasses to the refraction team. Also, occasionally, especially late in the day, the crowd can get restless, and it helps to have local staff that can help maintain order (see Media file 5). Intake team This team verifies that the patient has an examination card with a completed history for the correct day. Usually, this team requires no more than 2 people. Initial examination team Duties of the initial examination team include the following: recording the chief complaint, checking near and distance acuity, verifying present lenses, and checking motility, confrontation visual field, and pupils. Having a doctor present to perform direct ophthalmoscopy allows the screening out patients with no obvious pathology who require only reading glasses. Refraction team The number of doctors willing to donate their time is the limiting factor in terms of how many patients can be seen. Also, the amount of experience each doctor has on similar projects will affect the planning. Dispensing team Ideally, the number of volunteers in the dispensing area should be at least double the number of doctors performing refraction. See Media file 6. Surgical team It is best if each surgeon is able to take a surgically trained assistant that he or she has worked with previously. However, nonophthalmologic assistants can be trained on-site if they are familiar with surgical technique. In addition, an anesthesiologist would be helpful; however, locally trained staff may be sufficient. PREPARATION CHECKLISTSection 6 of 12
Establish roster/determine project goals Often, people will volunteer only to withdraw at a later date. It helps to have planning sessions early on to establish commitment and to determine the project goals and philosophy. For example, do volunteers want to screen the greatest number of people possible or provide the highest level of care possible? Poor planning can result in a disorganized trip and volunteer fatigue. Contact hosts Establish how your hosts wish to support the project.
Fund nondonated items Working with your local civic club (eg, Lions, Rotary) may provide built-in support both at home and at your destination. Grants from organizations, such as the Lions Club International Foundation, can provide financial support to purchase equipment and supplies. Most organizations will not fund airfare or accommodations. Secure airfare/baggage Few airlines offer a significant reduction in airfare to volunteer projects. Most airlines provide group discount rates. The best fares often are with national airlines of the destination country. International passengers are limited to 2 pieces of checked baggage (70 lb and 62 linear inches maximum) and 1 carry-on bag (40 lb and 45 linear inches maximum). National airlines may provide a waiver for excess baggage. Lost luggage can cripple a project. Carrying on sensitive surgical instruments is best, and, if asked, preboarding is often allowed to ensure adequate overhead space for instruments. Tagging group luggage with brightly colored stickers and taking a luggage count at check-in helps limit lost luggage. Immunization Begin the immunization process at least 6 months in advance because some immunizations need to be completed in series. University hospitals often have international clinics and can offer advice on what is needed. Another resource for advice is the Centers for Disease Control in Atlanta. Customs Clearing customs is the most unpredictable portion of the project. Obtaining a letter of invitation from the host nation's Minister of Health can keep the medicine from being impounded. Obtaining a declaration from the Consulate Office stating that the supplies are donations can minimize any taxes that would otherwise be applied. However, the best resource will be having someone of high local authority meet the plane and escort the group through customs. Pack Pack your supplies at least 2 weeks early, so any adjustment in packing can be made (eg, what is needed, what is not needed, how much space is needed). Publicity Publicizing the eye project via radio, television, or print media will help the sponsors and hosts justify the present and future projects. Also, recognition for project accomplishments provides tangible proof to volunteers of the value of their efforts. See Media file 7. SUGGESTED SUPPLY LISTSection 7 of 12
Optometric equipment Wherever possible, use local equipment to reduce the amount of baggage that is transported. See Media file 8.
Surgical equipment Contact your sales representative for donations of intraocular lenses (IOLs)/medications and save unused disposable supplies. Seek out funding for used surgical instruments. Nonstandard operating rooms are the norm overseas. See Media files 9-10. Possible surgical supplies include the following:
Toys Children often accompany their parents to the examination even though the parents may not feel the children need to be examined. Giving toys to the children wins their trust and helps speed the examination. Used tennis balls from tennis clubs are a good choice of toy because they are inexpensive, durable, age appropriate, and easy to transport. Soccer balls for schools also are often a welcome gift. LOCAL CUSTOMSSection 8 of 12
Dress can vary dramatically between countries. Short sleeves, short pants, and sandals may be appropriate in some countries and not in others. Ask the host ahead of time so no one will be offended. Also, it is wise to take at least one formal outfit, as hosts often have formal dinners at the conclusion of the project. Above all, pack comfortable, loose-fitting clothing with shoes that offer good support. Dress in layers, so as you warm up you can take off a layer of clothing. Food and hygiene can sometimes be a problem. Only eat fruits that can be peeled as other fruits may have been washed with unclean water. Make sure any meat is well cooked before eating it since refrigeration is often inadequate. Bottled water is safest, but check to make sure the cap has an unbroken seal before drinking it. If additional travel is planned after the project, consider bringing earplugs, because videos and music are often played loudly on bus rides between cities. Physical touch (eg, handshake, hug, kiss on cheek) can be inappropriate in some countries but expected in others. Try to adapt your style to the local customs. Bring something representative of your city, state, or country that you can give away as gifts to your hosts or to the people that you meet. Giving away such things as postcards, candy, playing cards, and souvenirs shows appreciation for their help. VOLUNTEER ORGANIZATIONSSection 9 of 12
The following organizations may be of assistance in coordinating, equipping, or funding your eye project. If you are unable to contact an organization listed below, please email the author. More detailed information regarding each group may also be obtained by contacting the American Optometric Association. VOSH (Volunteer Optometric Service to Humanity) Web site: http://www.vosh.org. Telephone: 407-330-5261 FAX: 407-302-6046. Major activity is: Primarily devoted to eye care. Flying Samaritans Telephone: 800-775-9018 FAX: N/A. Major activity is: Devoted to health care, which may include eye care. Christian Eye Ministry, Inc. Telephone: 616-846-7490 FAX: N/A. Major activity is: Primarily devoted to eye care. Lithuanian RC Charities. Major activity is: A support/resource organization, does not provide direct care, education of health care professionals. Liga International Telephone: 714-852-8611 FAX: 714-852-8739. Major activity is: Devoted to health care, which may include eye care. Project World Eye Foundation World Eye Foundation Telephone: 501-227-6980 FAX: 501-227-8144 Telephone: 510-357-3952 FAX: 510-357-1582. Major activity is: Primarily devoted to eye care, education of health care professionals. Northwest Medical Teams Intl., Inc. Telephone: 503-624-1000 FAX: 503-624-1001. Major activity is: Devoted to health care, which may include eye care. Focus Inc. Telephone: 312-996-7445 FAX: 708-216-3557. Major activity is: Primarily devoted to eye care, education of health care professionals. Vision Health International Telephone: 707-224-5956 FAX: 707-224-9420. Major activity is: Primarily devoted to eye care. Adventist International Eye Society Telephone: 909-824-4633 FAX: 909-824-4638. Major activity is: Primarily devoted to eye care. US Committee for Scientific Cooperation Telephone: 608-263-4150 FAX: 608-262-2327. Major activity is: Devoted to health care, which may include eye care, education of health care professionals. Mercy Ships Telephone: 903-939-7000 FAX: 903-882-0343. Major activity is: Devoted to health care, which may include eye care. Medical Ministry International Telephone: 972-437-1995 FAX: 972-437-1114. Major activity is: Primarily devoted to eye care. Combat Blindness Foundation Telephone: 608-238-7777 FAX: N/A. Major activity is: Primarily devoted to eye care. Healing the Children Midlantic, Inc. Telephone: 973-838-7114 FAX: 973-492-8299. Major activity is: Devoted to health care, which may include eye care. National Program to Control Blindness Telephone: 301-8510 FAX: 301-4594. Major activity is: A support/resource organization, does not provide direct care. Remote Area Medical Telephone: 865-579-1530 FAX: 865-609-1876. Major activity is: Devoted to health care, which may include eye care. Bureau for the Prevention of Blindness Telephone: 012-346-1171 FAX: 012-346-1606. Major activity is: Primarily devoted to eye care. Jeff Blevins Memorial Children's Fund Telephone: 407-933-2590 FAX: 407-933-6896. Major activity is: Primarily devoted to eye care, devoted to health care, which may include eye care, education of health care professionals. Doctors of the World Telephone: 303-758-5405 FAX: 303-758-4124. Major activity is: Devoted to health care, which may include eye care, education to health care professionals. Mercy International Health Services. Major activity is: Devoted to health care, which may include eye care. F.A.M.E. Telephone: 812-379-4351 FAX: 812-379-1105. Major activity is: Devoted to health care, which may include eye care. Andean Rural Health Care Telephone: 704-452-3544 FAX: 704-452-7790. Major activity is: Devoted to health care, which may include eye care. Oprece Eye Clinic Catholic Medical World Cataract Lens Project Telephone: 901-753-9130 FAX: 910-767-1747. Major activity is: Primarily devoted to eye care, education of health care professionals. The Beeve Foundation Telephone: 818-790-8101 FAX: 818-79-7757. Major activity is: Primarily devoted to eye care. Lighthouse for Clinica De Oftalmologia Fundacion De Los Sentidos Telephone: 593-428-2882 FAX: 593-444-5929. Major activity is: Primarily devoted to eye care, devoted to health care, which may include eye care. UMTATA General Hospital Telephone: 471-24174 FAX: 471-24174. Major activity is: Devoted to health care, which may include eye care. International Relief Teams Telephone: 619-284-7979 FAX: 619-284-7938. Major activity is: Devoted to health care, which may include eye care. Glazmed International, Inc. Telephone: 615-377-1255 FAX: N/A. Major activity is: Primarily devoted to eye care, devoted to health care, which may include eye care, education of health care professionals. Mexican Medical Friends of the Children of Lascuhobas Telephone: 914-633-9084 FAX: 212 316-3713. Major activity is: St. Catherine's of Siena/Dame Marie Telephone: 973-263-8999 FAX: 973-263-8601. Major activity is: Devoted to health care, which may include eye care. Aloha Medical Global Eyecare Incorporated Telephone: 718-733-5730 FAX: 718-733-5744. Major activity is: Primarily devoted to eye care, education of health care professionals. World Eye Vision International Eye Missions Telephone: 707-546-6088 FAX: 707-823-1521. Major activity is: Primarily devoted to eye care. I.R.I.S. Telephone: 604-733-0452 FAX: 604-733-0447. Major activity is: Primarily devoted to eye care. International Executive Service Corps Telephone: 203-967-6000 FAX: 203-324-2531. Major activity is: A support/resource organization, does not provide direct care. Share Nepal, Inc. Telephone: 303-620-9307 FAX: 303-690-8788. Major activity is: Devoted to health care, which may include eye care. Rainforest Health Project Telephone: 218-246-9555 FAX: 218-246-9674. Major activity is: Devoted to health care, which may include eye care. ACKNOWLEDGMENTSSection 10 of 12
The authors and editors of eMedicine gratefully acknowledge the contributions of previous coauthor, Mark J Cook, MD, to the development and writing of this article. MULTIMEDIASection 11 of 12
REFERENCESSection 12 of 12
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