Celebrities such as Bono and Madonna grab headlines when they take on a cause to help raise awareness and funds for international aid and development projects, but what of those everyday heroes, who spend their working lives devoted to implementing sustainable public health solutions in developing nations? People such as the unassuming Dr. May Ho who has been responsible for setting up eye care programs in Cambodia and Vietnam.
A child in glasses walking to school over drought ravaged land or a smiling woman in traditional dress wearing new spectacles; without doubt these images of public health conjure emotions to captivate an audience.
Yet go behind the scenes of in-country professional education and you will see lives committed, long term, to transforming the human landscape by building local health care capacity and sustainability.
Dr. May Ho, Program Manager for Cambodia and Vietnam for the International Centre for Eyecare Education (ICEE) is dedicated to building eye care services in these neighbouring south-east Asian countries, both still recovering from brutal wars.
While there has been significant improvement across a range of health indicators in Cambodia in the past decade… many challenges remain to ensure universal access to quality health care
“It’s the raw potential of a region which has always attracted me, the great need for building new systems, education and training,” said Dr. Ho.
On graduation from the University of Melbourne, she worked at the Australian College of Optometry (formerly the Victorian College of Optometry) and first volunteered for in-country work for the International Centre for Eyecare Education (ICEE) in 2003. Her fluent Indonesian helped her establish a training program for the local nurses in Timor Leste (East Timor), offering new skills in refraction and eye care.
Following a trip to post-tsunami Sri Lanka for ICEE to conduct a situational analysis, Dr. Ho was formally employed by ICEE and began working across service delivery and training projects, including in the Pacific Island countries of Vanuatu and Tuvalu.
Grass roots Thinking
Dr. Ho’s passion for building capacity and developing sustainable refractive error services is evident in her work. Her modus operandi is grass roots thinking in action – building integrated education systems which will eventually stand alone and be self perpetuating, operating in a symbiotic way, specific and beneficial to the province and country.
In developing countries, where eye care providers are most needed, there is often insufficient education and training. In some cases there are no programs at all. The development and implementation of locally relevant and culturally appropriate education resources lies at the heart of all ICEE projects. Over the past 12 years, ICEE has used this system to train eye care personnel in more than 40 countries across four continents.
In 2005, ICEE was engaged to run a ‘Training of Trainers’ refraction workshop at the Ho Chi Minh City Eye Hospital, Vietnam, a country Dr. Ho had been watching for some time.
“I could see one of the biggest barriers was the lack of trained human resources,” she said. “There seemed to be quite a number of optical shops but the need for education and training of eye care professionals was an obvious and limiting factor. There seemed to be a reliance on auto refractors in many locations largely due, I would say, to a lack of skilled refractionists.”
Dr. Ho began analysing the situation in Vietnam and by 2008 was running, for the first time, a three month Refraction Training Course in Hanoi at the Vietnam National Institute of Ophthalmology (VNIO). Progress since then has seen the Refraction Training Course established in Hanoi at the VNIO as a respected, ongoing refraction training facility.
“When we first started the training program in Hanoi, it was a whole new thing at the Institute. They hadn’t been exposed to optometry training practices before. The Head of the Training and Research Department, Dr. Tai, sat in on my lectures for the first week, which I admit made me nervous, but I was confident and determined he would see the value of our work for the community, which of course he did, ” said Dr. Ho.
Vietnam has experienced some welcome changes in optometry and vision care over the past few years.
In 2010, ICEE started an initiative to conduct refraction courses for local and provincial medical staff in collaboration with the Danang Technical College of Medicine No 2 and the Ho Chi Minh City Eye Hospital (HCMCEH). Chief Refractionist at the HCMCEH, Mr. Tran Hoai Long, has set a new precedent for eye care. He is the first person in Vietnam with a Masters of Optometry degree, which he gained through the University of New South Wales.
Mr. Long is delighted by the ICEE initiative.
“I am so pleased with what we have achieved at the refraction department,” he said. “We have worked closely with ICEE to conduct the refraction and spectacle technician courses. They have been well received locally and we are planning more.”
The Australian Government’s
Avoidable Blindness Initiative (ABI) funds projects like these through Vision 2020 Australia’s Global Consortium – a partnership of nine Australian eye health and vision care organisations working to eliminate avoidable blindness and vision loss in the Asia Pacific region. ICEE is working with in-country partners in Hanoi, Ho Chi Minh City and Danang, including local scholarships for trainee optometrists.
“In the time since we began training refractionists and spectacle technicians in Vietnam we have produced encouraging numbers of qualified professionals. The figures show more than 160 people have been trained over the last three years,” said Dr. Ho.
ICEE’s future vision for building capacity and sustainability in Vietnam is centred on two strategies. In the short term, the approach is to further establish ICEE collaborations, run courses on refraction and spectacle making, and in the long term to establish optometry schools. Further down the road, Dr. Ho would like to see the development of a higher-level national optometry faculty, possibly at tertiary level.
ICEE first became involved in Cambodia in 2004 when it was engaged by the international Christian development agency CBM and the Disability Action Council of Cambodia to conduct a situational analysis of refractive error services. Together with the Cambodian Optometrists Association (COA) and the National Program for Eye Health, ICEE helped develop a three-month refraction training curriculum, approved by the Ministry of Health, and conducted a ‘Train the Trainers’ program for refraction trainers at COA.
Dr. Ho’s focus switched to include Cambodia in 2007, following an invitation to ICEE from the Fred Hollows Foundation to collaborate on developing a National Refraction Training Centre in the country’s capital, Phnom Penh.
Located in the Preah Ang Duong Hospital, the training centre is today run entirely by local professionals and currently offers three-month intensive refraction courses to local trainees – the National Refraction Training Course.
“Our training models have always been focused on developing sustainable systems that are culturally appropriate and will last beyond ICEE involvement in each country,” said Dr. Ho. “The support and involvement of local governments has always been critical to the success of the education systems and the Cambodian Government has been an important partner.
“Additionally, the work is also being helped through ABI funding from the Vision 2020 Australia Global Consortium.”
In this year’s federal budget, the Australian Government reaffirmed its commitment to eliminating avoidable blindness in the Asia Pacific with the announcement of AUD$21.3 million dedicated to the next phase of the ABI.
This will enable further expansion of programs to tackle avoidable blindness and improve the public health system in Cambodia.
While there has been significant improvement across a range of health indicators in Cambodia in the past decade and a substantial increase in the national health budget, many challenges remain to ensure universal access to quality health care.
In the Vision 2020 Australia Global Consortium’s first Annual Report, Cambodia was noted for its progress over the past year, offering evidence that the lives of thousands had been transformed. The report highlighted significant progress with human resource training – 661 Cambodian health professionals participated in eye health training
From an ICEE perspective, Dr. Ho looks forward to the sizeable growth in the number of Vision Centres operating in Cambodia in 2011. In August, Vision Centres, funded by ABI, opened in Banteay Meanchey, Kampot, Kampong Cham, Pursat and two in Battambang. ICEE worked with local partners and NGOs including International Resources for Improvement of Sight (IRIS), SEVA Foundation and Battambang Ophthalmic Care.
Dr. Ho was present at the launch of the ICEE Phnom Penh Vision Centre in June 2009. Since then, figures show there has been 10,125 eye examinations, 5,062 pairs of spectacles dispensed and 506 patients referred for further eye treatment.
“These Vision Centres offer affordable eye care, referral and refractive error services to the local communities. Collaborations with local NGOs ensure that the population now has access to eye examinations and low cost glasses,”
said Dr. Ho.
“I am excited by the prospect of the increase we will see this year. The ongoing training of local eye care workers is slowly but surely increasing the accessibility of eye care for the people of Phnom Penh and now the reach is also spreading across more rural locations in Cambodia,” she said.
Selina Madeleine (BA Comm) is the Communications Manager at the International Centre for Eyecare Education (ICEE).
ICEE acknowledges the support of Optometry Giving Sight through the funding of the ICEE Vision Centre in the District 7 Hospital, developed in partnership with the Ho Chi Minh City Eye Hospital.
1. World Health Organization, Country Cooperation Strategy at a Glance: Cambodia. Accessed online on 26/07/2011 at: www.who.int/countryfocus/cooperation_strategy/ccsbrief_khm_en.pdf