After the first day’s screening, we stay overnight in the home of our second VHW, Dr. Liang. In the morning, the six of us as well as Dr. Liang’s daughter trek out toward the village committee office, where there is more space for screening.
Unlike the previous village, this one is a lot larger, and Dr. Liang has done an impressive job of advertising beforehand. Plus they have the added advantage of a little technology: an epic loudspeaker that can be heard all around the village, which we use to make an announcement.
Soon villagers are streaming in, and we set up separate vision screening areas and a third for blood pressure testing. With so many villagers, we soon find an overwhelming assortment of eye conditions other than cataracts, and it’s at this point that I suddenly understand the crucial importance of technical support.
One villager complains of gradual vision loss for two years, with central vision deteriorating the fastest, and a “bending” of straight lines. I suspect age-related macular degeneration—but what do I know, I’m just an undergraduate student and it’ll be years before I’m qualified to “suspect” anything. I give Dr. Wang a call.
Another patient shows up with a growth on the inner edge of the eye lid and asks whether it’s serious. I snap a picture for Dr. Wang and take down the villager’s phone number.
We had recognized the limitations of doing screening without professional doctors from the onset, and thus designed this program with very simple referral standards in mind: visual acuity ≤ 0.1, or intense pain and pus. But when you’re down in the field, you can’t possibly stick to those mechanical guidelines and knowingly turn away patients who might have a serious, preventable condition. It’s true, sometimes we felt like we were in over our heads—amateurs trying to play doctor:
But when you realize that many of these villagers had never had an eye exam in their life, and may never will, a 4th year undergraduate armed with a phone and a doctor on the other end doesn’t seem that bad.
By the end of the day, we’ve screened over 20 patients and referred a good handful. More importantly, the vast majority of the screenings and referrals were done by Dr. Liang herself, who was constantly up and ready, speaking directly with patients and asking us for guidance only when needed.
“The hospital has done outreach screening in our village before,” Dr. Liang had confided to us two days ago during the training, “but they leave too fast, villagers often can’t leave their homes or their work during that time, and by the time villagers show up they’re gone.” You can work to address a problem only after you recognize there is one, and I think it was that realization that drove Dr. Liang to learn so diligently. This time around, the VHWs were randomly selected to give a representative sample. But in the future, the success of a VHW training program will depend upon selecting eager and able VHWs from step one.