All of last week, I had the opportunity to travel to three county-level hospitals to participate in their cataract screening programs and help facilitate the GUSTO project, which asks the screening team to provide counseling for patients eligible for cataract surgery.
The three hospitals differed greatly in their screening locations, personnel attitude, equipment, and screening experience, but throughout the week I encountered several crucial themes:
1) A lot of things in China happen last minute, and planning/preparing for screenings is no exception. This was compounded by the fact that these screenings involved two new but separate projects—the first being GUSTO, and the second being a capacity building project that came with its own set of new equipment and forms. It would have been fantastic to sit down with each hospital’s team beforehand and walk through, even practice, the screening flow. Which brings me to my second point…
2) As an outsider undergraduate student, I found myself constantly treading a fine line, with the need to do a heavily practiced, proper job on one side, and the fear of breaking cultural rules and ruining a lot of 关系 (“relationship”). As someone in my position, it’s rather difficult to try to demand anything, even if its simply extra preparation.
3) There is a need for comprehensive screening services, beyond simply cataract screening. We were turning away patients with cataract or refractive error, or sometimes accepting patients who wouldn’t necessarily benefit from surgery because of a secondary condition. The need for refractive services seemed especially tantamount, yet one hospital could not even carry out proper pinhole vision testing.
Finally, a few more miscellaneous bits of knowledge. One of the three hospitals had once participated in a program to train local doctors how to recognize specific diseases, and subsequently transfer those patients to facilities that have treatment capability. I think this is a really promising model—it would take too long to train local doctors to treat more specialized diseases, and equipment will be a huge issue, but teaching them to diagnose and transfer allows them to “screen” patients for you and direct them to where they can be treated.
We already came across one patient who had decided not to get surgery because she thought she was too old for it to be worth it. The medical personnel believed this kind of attitude was a result of a lack of support from their children, who often pay a part of the surgical fee. This stresses the importance of providing counseling not only for the patients but for their children as well.