Getting Out of the Clinic to Give Back: Voluntourism in Optometry

mivision spoke to some of them to find out about the professional and personal rewards that come with volunteering, as well as the logistical challenges.

Leading twenty-one volunteer trips to India, as well as others to Indonesia, South Africa, Zimbabwe and Thailand, is nothing short of extraordinary. Yet it’s something that Paul Clarke, founder of Equal Health and proprietor of Vision West in Perth takes in his stride. Recently recognised with the Medal of the Order of Australia, for service to International Humanitarian Health programs and to the optical profession, he is currently organising the next camp which will take place in February 2018.

“When we first started, my motivation wasn’t purely humanitarian. I’d had a request to bring spectacle relief to underprivileged people in Tamil Nadu, India and so I’d decided to conduct a fact-finding spectacle aid initiative to the area in conjunction with the Australasian Dispensing Opticians Association (ADOA). That was in January 1997 and at that stage, I viewed the opportunity as an adventure, although I did think it would be nice to see the reaction of people who were suddenly able to see when dispensed glasses,” said Mr. Clarke.

The program posed a different kind of challenge to my clinical skills. It taught me to be adaptable while striving to provide consistent quality in my services

On his second visit, he said his motivation shifted. “You realise the need is really high… and it’s rewarding to see you’re making an immediate and significant difference to people’s lives. You know the benefits will continue because the people treated are better equipped to look after themselves and others.”

He said the motivation for volunteering is the same for most people and as a result, he has found one third of the people who volunteer with Equal Health do so again and a very few become “serial volunteers”.

For Mr. Clarke volunteering quickly became part of life. Two years later he partnered with his friend, a dentist, and the opportunities to broaden the aid program expanded. Over 21 years they have taken 1,036 individuals – between 40 – 60 people each year – to camps, among them GPs, optometrists, dispensers, dentists, physiotherapists, and even speech pathologists and occupational therapists.

After so many years, Mr. Clarke said he is no longer phased about many of the sights he sees in India, however he continues to feel deeply emotional about the lack of equality. “We have far more than we need and yet some, by virtue of where they are born, have so little. That might not be so bad until they get sick, because then, with little health care, they are likely to get really sick.”

Mr. Clarke said the generosity of the poorest people in India continues to amaze him. “At one stage, we were working out of an orphanage and we took a bus full of the children to a theme park. It was the greatest day out they could have. These children keep all their possessions – usually just a second set of clothes – in a small suitcase. Some of them had taken their savings – just a few rupee from the odd jobs they’d done around the orphanage – to spend. I watched them give all their money to a group of beggars sitting around a statue. Thinking back to that story, to their incredible generosity, gets me every time.”

Optometrist and academic Khyber Alam joined Paul Clarke and Equal Health in India for the first time in February this year. Having come to Australia as a refugee from Afghanistan, he was particularly keen to help others in disadvantaged situations.

“I remember when I first got there, seeing so clearly the difference between the poor and rich. The poor are not asking for a luxurious life, they simply want the necessities. Seeing children particularly, living like this, is hard to forget. They are so pure and innocent, and they are extremely thankful for the most basic things, like a routine eye check. A person declared blind will have an eye test, receive spectacles and they will be able to see. Someone living in terrible pain receives a basic antibiotic and they heal.”

Optometrist Susan Ang was also motivated to volunteer by her family history. Her parents were Cambodian refugees and she says participating in an organisation that allowed her to return to her mother’s homeland to help the local people and see relatives was a big contributing factor.

Established in 2007, Cambodia Vision travels to small provincial towns each year, focusing on blindness prevention and basic medical health care. The entirely volunteer medical team (comprising surgeons, nurses, general practitioners, pharmacists, optometrists and volunteers) provides free eye screening, spectacles, cataract procedures and medical care to around 3,000 people each visit.

Ms. Ang says volunteering gives her a sense of purpose and is always humbling.

“On my first mission, a nine-year-old boy guided his grandmother in for screening. Rather than going to school he looked after her at home while his parents worked in the rice fields. He looked so sad compared to the nine-year old boys I see in my practices in New South Wales.”

The grandmother had dense brunescent cataracts that had left her with only light perception in both eyes.

“I was there when her bandages were removed after surgery on one of her eyes. It was the first time she had seen her grandson and she put her hands on his cheek then gave him a little slap on the head. She said, “how did you get that scar so big?”

“She had all of us, including her grandson, laughing tears. I realised that helping the grandmother to see gave her freedom and meant the little boy had his freedom returned as well.

“I reflect on experiences like that when I’ve had a tough day and quickly remind myself that my suffering is not as severe as theirs. That can often spin my mood from a victim ‘why me?’ mentality, to one of relief and gratitude.”

Professional Development

Specsavers optometrists Tuong Nghiem and An Vu were also motivated by family history to join an outreach program. In their case it was The Fred Hollows Foundation’s Vietnam Child Eye Care Project in the province of Ti?n Giang. Specsavers supports The Fred Hollows Foundation outreach programs in Australia, the Pacific and Vietnam through its Community Program. A portion of the proceeds from every pair of spectacles sold at Specsavers stores in Australia and New Zealand is donated to the Foundation or a local charity (of the practice’s choice).

As an Australian-born Vietnamese person and a second-year member of the Specsavers Graduate Program, Ms. Nghiem said she felt very fortunate to be selected to participate in the outreach to Vietnam, which she said, was confronting.

“Healthcare in Vietnam is severely underdeveloped, especially in regional/ rural communities. The province of Ti?n Giang needs a lot of attention and support when it comes to eye health. Even the smallest changes would go a long way to alter the outlook for many people living in these remote locations. We are very blessed to live in a country where eye care is affordable and easily accessible. The same cannot be said for much of Vietnam where optometry is a relatively new concept – the country’s first cohort of optometrists graduated in 2014.”

An Vu grew up in Vietnam with myopia, and went undiagnosed despite being raised in one of the country’s largest and most developed cities.

“The significant impact spectacles have had on my quality of life is one of the primary reasons I pursued a career in optometry, and it’s also the reason I decided to apply for the outreach trip,” said Mr. Vu.

He said one of the biggest surprises was discovering the vast segregation between refractive care and ocular health care. “Many of the professionals in Vietnam who provide the community with spectacles do not simultaneously check for binocular vision or ocular health issues, meaning many diseases can go undiagnosed, even if the patient has gone through a routine eye test.

“A patient in Vietnam has to go through numerous appointments and various professionals before they can have comprehensive eye care. This is costly in both time and finance, severely limiting access to healthcare for patients with a low socio-economic background.”

He said the outreach program provided opportunities for professional development.

“The program posed a different kind of challenge to my clinical skills. It taught me to be adaptable while striving to provide consistent quality in my services. Skill-sharing sessions with Vietnamese health professionals allowed me to develop skills in public presentation, as well as in compiling academic resources to suit specific audiences. The experience also showed me Vietnam in a whole new light, one completely removed from my former viewpoints as a child, as a resident, and as a tourist. I have never felt more engaged, challenged, or fulfilled by my birth country.”

Similarly, Mr. Alam said his trip to India with Equal Health added his professional development. “You see so many eye conditions and with that, you develop your time management skills, your diagnostic skills, your ability to test, diagnose and manage ocular disease. You also develop a network of amazing professional contacts who become friends – the people I volunteered with in India – doctors, dentists and optometrists – were all there because they shared the same kindness. I keep in touch with every single one of them.

Volunteering in Australia

Back on Australian soil, groups like The Essilor Vision Foundation and OneSight, established by Luxottica, are making a very real difference to the lives of local disadvantaged children, Indigenous people, migrants, refugees, and people with mental health issues.

Established by Luxottica 28 years ago, OneSight is now an independent global organisation that relies on the broader eye health community to be sustainable.

Anthea Muir, OPSM President, pointed out that “OneSight is critical, there are 1.1 billion people in this world who don’t have access to eye care and although we have an amazing ability to provide it, we can’t do it on our own”.

Ms. Muir, who grew up and qualified as an optometrist in New Zealand, has worked in OneSight clinics overseas and in Australia. “By working with OneSight I have been able to work in communities around the country and that has made me feel part of Australia. Working in clinics with schools is so much fun and working in the Gulf region is very interesting from the indigenous perspective but from my experience, the most interesting work I’ve done was in Sydney, on a screening program with the Wayside Chapel. That’s because it made me realise that despite living in a very rich city, there is a huge demand and need for services and for some people it can be so difficult to access them,” said Ms. Muir.

The Essilor Vision Foundation was established in Australia in May 2016 and just over one year on, has screened over 6,500 people across the country. The foundation, comprising a board headed by Richard Grills and two staff, (former Optometry Qld/NT employees) Greg Johnson and Marika MacKenzie, relies on volunteer optometrists, optometry students, orthoptists, dispensers and low vision professionals to implement its programs.

“We’ve been overwhelmed by support from universities who provide us with fourth and final year students to deliver the screening programs under the supervision of volunteer optometrists,” said Greg, CEO of the Essilor Vision Foundation.

“Deakin University, in particular has embraced the program and have made primary school screening part of their curriculum. Every Monday we run an eye screening program in a lower socio economic primary. Six optometry students work with two clinicians to screen a total of 48 students who come through in groups, each for 45 minutes.”

“The results from our national screening program are already shining through. We did a repeat screening at a school in Queensland and the principal told me she had abandoned a remedial reading program. Having received free spectacles via the Essilor Vision Foundation, the children had improved their reading by 10 levels and were able to work in the mainstream.”

Logistics and Fund Raising

Unfortunately, whether you’re running an outreach program in a lower socio economic area of Victoria or facilitating clinics in India, the financial commitment is hefty and there are only so many government organisations and corporates you can turn to.

While many would assume the Essilor Vision Foundation is fully funded by its founding company, like OneSight, the aim is for the organisation to be self-sustaining, which means its future is dependent on donations from government, corporates and individuals. Mr. Johnson is actively seeking support. “We firmly believe government, councils and enterprise should be funding our program because the difference we can make, by helping people to see, will make a difference to their lives and their ability to learn, earn and look after themselves,” he said.

Smaller independent organisations like Equal Health have always had to be self-sustaining and after 21 years, Mr. Clarke says his organisation has the benefit of loyal financial backers in Australia and partners in India who assist with purchasing supplies and administering the clinics. It’s a hefty financial proposition. Mr. Clarke has calculated that each camp costs around AU$250,000. “As well as taking up eye screening equipment, we take up 5,000 readymade spectacles in a range of powers, portable dental equipment, medical equipment for checking blood pressures and blood sugars, and antibiotics.

“Fortunately, over the years we have developed strong relationships with organisations who provide the funding or product, although of course, it’s never guaranteed. All the spectacles we take are brand new frames donated by wholesale and retail members of the Australian optical profession and we buy the lenses in. They’re made up in a Perth prison.”

At the other end of the spectrum, fledgling volunteer groups like Cambodia Vision and Eyes4Everest run fundraisers and door knock to build support.

Eyes4Everest, which was established by Shaun Chang in 2014 to provide eye health to Sherpas and their families in the most remote villages of the Everest National Park, Nepal, has attracted CR Surfacing and Opticare as sponsors. They provide funding and basic equipment, and now that his organisation is becoming better known, he says equipment like portable slit lamps are almost within reach.

Along with finding funding, Mr. Chang said one of the greatest challenges for Eyes4Everest is managing the logistics of travelling and transporting equipment to such a remote area.

“We spend a lot of money flying equipment into the region on a small twin otter plane. It’s usually transported up to the main Sherpa settlements in expedition duffel bags carried by jorks (a hybrid of a yak and buffalo) and in the case of shorter distances, (less than three hours) we use porters,” he explained.

People Management

Aside from managing logistics, there is the huge task of managing people to ensure their safety, well-being and hopefully, their repeat participation in future outreach programs.

Ensuring volunteers are prepared for the physical and mental challenge of high altitude trekking in Nepal is a major consideration. “You can work on your legs, shoulders and core in the gym but the best training is always outdoors on difficult steep terrain whether it be sand, snow, or uneven rock. This helps you work on technique, breathing, route finding and pacing.”

Jenny Hsieh has completed two trips to Nepal with Eyes4Everest. “Before my first trip I trained by running an hour a day and hiking on weekends. I would look for steep up and down hill hikes or long hikes with uneven terrain. Walking with a weighted backpack makes it more challenging for training purposes,” she added.

Mr. Chang said managing altitude is particularly difficult. “Unfortunately, there is no solution for altitude training in Australia – we live in a very flat nation. There are gyms that simulate a low oxygen environment but it is low pressure that causes altitude sickness. While in Nepal, we manage altitude by ascending no more than 300-500m a day and spending a day eye testing to help with acclimatisation. Managing your diamox intake (a drug used to prevent and reduce the symptoms of altitude sickness) is also key.”

Mr. Clarke said he learnt the hard way that putting systems and processes into place well in advance of camps was essential. “In the first year we were flying by the seat of our pants a bit. I took a group of like-minded people up in 1998, thinking that we’d all just get on with our jobs, but it wasn’t that easy, because everyone has their own ideas of how things will work.

“I started to follow the processes recommended by AusAid. That introduced a ridiculous amount of paperwork, but as with any business, the bigger you get, the more important it is to dot the i’s and cross the t’s. As a result of taking this very serious approach we earned credibility. This helped gain support of donors and volunteers, and negotiate arrangements with the charitable service organisations we partner with in India.”

Managing the health, safety and well-being of volunteers while at camp, and fostering a team ethic is particularly important, said Mr. Clarke.

“We are not associated with any political group or religion; our volunteers are expected to understand the local culture and participate in the celebrations and rituals of our host partners, there is no alcohol at camp and everyone signs an contract to acknowledge they agree with the program.

“To prevent burn out we work two days then have a day off. In the early days people would take off in different directions, but now we realise the many advantages of organising team outings.”

Mr. Clarke said briefing sessions prior to going to India are important, particularly for first timers who need to be prepared for the extremes of poverty and poor health. Daily de-briefings are also essential.

“After dinner, we have an army style debriefing that acts as a neutraliser to the very raw emotions that can arise. Everyone has to say something – whether it’s something they saw that made them feel sad or excited or a problem that needs to be discussed. We have a final debrief, which is usually quite emotional and then, when we get back to the main city – Chennai or Calcutta – we have a celebration.”

As head of optometry with Cambodia Vision, Susan Ang also recognises the importance of team building and mentoring. “Working as a volunteer really is about removing the I and thinking of the ‘we’ or ‘us’ and that can be challenging for optometrists who usually work solo.

“This is further complicated by the physical conditions. Screening 500 people every day can be exhausting, especially in hot, humid weather and without all the modern comforts we’re used to. We work with a language barrier further complicated by regional dialects and with equipment that isn’t necessarily up to the standard we’re used to. At night we share rooms with other volunteers, so there’s very little personal space.

“Tempers can fray and it can be a challenge to remain hyper-focussed and compassionate towards patients under these stressful circumstances. In my role, it’s important to juggle team spirit amid the chaos. I encourage my team to reflect on the people we are seeing and their extremely difficult circumstances. Remaining calm, compassionate and grateful for the lives we lead is essential.”