We jump out of the van and into the screening site to find…seven, maybe eight villagers waiting for us. The goal had been to find 15-20 villagers eligible for cataract surgery (about 20-30% of the participants at a screening).
“How did this happen?” I ask the hospital director traveling with us. “Poor outreach and advertising,” she responds nonchalantly. “The village cadres must not have been enthusiastic about the screening and didn’t give clear directions to village leaders, or maybe the village leaders themselves didn’t bother to do much outreach.”
The ability to make a screening event well known among the local population perhaps the most important step of any capacity building program—if you can’t find patients, everything else doesn’t amount to much. The way that outreach normally works is that 5-6 days before a screening, the “village council” (村委) contacts each village leader (村长) of the 4-5 villages governed by that council, who then through various methods (door-to-door, phone call) contacts the villagers in his/her village, especially those he knows to have vision problems. The village council can also contact the village doctor.
To reach the next level of outreach, more needs to be done in terms of creating a continuous advertisement, one that reaches beyond a one-time contact by the village leader. For example, simple, brightly-colored posters with self-explanatory pictures hung up all around the village is bound to grab villagers’ attention. If there are sufficient funds, a radio or TV advertisement can continuoually broadcast details of the event. Perhaps the distribution of simple products such as hats, T-shirts, or umbrellas with a date and location can be effective, especially if a regular, annual screening is set up at one site (currently such a system exists in India but not in China).
As we leave, I watch the hospital director walk up to one of the cadres. I expect her to reprimand him for making such poor preparations, and warn him that if this continues then they won’t come back and waste their time. Instead, I watch as she takes out a wad of folded bills and slips them in his pocket. The logic seems a little backwards, I think in amazement—we’re coming to provide free screening and services for their residents, and they expect extra payment? “Not everyone in China thinks that way,” the hospital director tells me. She tells me that the village council is elected, which makes me think that the incentives should be there for them to avoid losing the next re-election—this, after all, is the pinnacle of democracy, isn’t it? But very few people actually care to be on the council, she tells me, and moreover it’s become an expectation that any kind of service requires a price.