A week in Fiji sounds very appealing in mid-winter, but a VOSO trip is no picnic in the sun, although there was a bit of that as well. The Labasa Lions Club hosted us and provided local food at every village for lunch and restaurant dinners every night back in Labasa. Each day was well organised with transport, distribution of bottled water and a plan of where we were to go.
Each day teams of two optometrists, one nurse and a driver would drive for about two hours, a lot of it over rough dirt roads to reach outlying villages. On arrival, there would already be a large group of locals sitting waiting. Some had walked for three hours to reach the school or heath centre. They were seen first so they could start their long walk home again. The nurse would do other health checks such as blood pressure or child health checks or would do visual acuity for the optometrists.
For the last three days, one team stayed at Labasa hospital and I was able to see 19 low vision patients with an age range of 5 – 90 years old, while teaching Noa, the Community Rehabilitation Liaison Officer and Nari, an experienced and equally devoted ophthalmic nurse, as much as I could about assessing and helping patients with low vision. Both are very passionate about the work they do, and it was a real joy to work with them. I hope to keep in contact and continue to support them as much as I can.
A real light bulb moment occurred when Noa and I realised that he is working with many children who have been operated for congenital cataracts and have no reading glasses to help them with their school work. He also has several girls with Albinism on his books and I was able to give him some small sunglasses for them, as they do not have any at present.
The majority of the work we did as a team was providing reading glasses, though we were surprised at the large number of hypermetropes who needed distance glasses as well. On the first day we had no high plus glasses amongst the spectacles collected by Lions Clubs from New Zealand. One just had to improvise and give one pair for distance and a second pair to wear one on top of the other for reading. Not unexpectedly, we found a lot of pterygia and were also able to provide sunglasses for protection. Sadly, the word has gotten around that the VOSO teams from New Zealand have previously given out sunglasses, and many people who could well afford to buy glasses from the local optometrist (Indian trained) or pharmacy were approaching us, sometimes in the street, for their free sunglasses. Apparently, sunglasses and spectacles for distance is something of a status symbol. The traditional culture of the village is that one does not wear a hat or any glasses including sunglasses in the village, as it is considered an offense to the village chief that you are trying to place yourself above him.
The VOSO team agreed that the emphasis on future visits to Labasa should be on the outreach to the villages providing screening, spectacles and sunglasses to the population that need it most. On the other hand, the low vision part worked well from out of Labasa hospital. In total, the four optometrists Jill Mottram (team leader) Olga Hammond, John Mellsop and I, saw 950 patients of which 40 were referred to the hospital mainly for cataracts and pterygia, as well as 19 low vision patients.
It was a truly rewarding experience particularly helping people who have never had any eye health checks, have no access to spectacles or have never seen a magnifier before, and a privilege to work with such dedicated people; my colleagues, the Labasa hospital team and the small but very active Labasa Lions Club.
VOSO would like to acknowledge with thanks the assistance and donations of low vision aids and equipment from:
Jennie Vowles – Lions Club Karori Neil Pugh – Lions Club Ferrymead
Milburne & Neill Optometrists Mike Sladen Optical
Pacific Vision Eyeline Optical
Greenlane Low Vision Clinic Blind Foundation and members
Jenny Carpenter Viv Gapes
Sr Isabelle – Kaikohe Shirley McMurray
Nancye Carter’s family Mrs Sally Fraser
Essilor NZ Ltd
Auckland Eye specialist Dr David Pendergrast has recently returned from a voluntary trip helping with the Taveuni Eye Project in Fiji. This is an annual Eye Surgery Programme providing removal of Cataracts and Pterygia for Fijians in remote villages and islands who could otherwise not afford the travel and accommodation costs.
The Rotary Club of Taveuni (RCTI) organises the transport from their village, which is often incredibly long and arduous. From the most remote villages it may mean travelling on a bus to the ferry, then a ferry trip of up to 12 hours, and finally a Rotary van from the wharf on Taveuni up to the local accommodation provided in the hospital or church or school.
The patients all sleep on mattresses in the hospital and on the post op day the patients with eye patches on are sitting in rows on chairs watched by others who have either already had their surgery or are awaiting surgery the next day. The local Rotary team also provides food for the patients including hundreds of kilos of taro, sacks of rice, and lots of sugar for their tea.
The Taveuni Project has been going for 11 years now and the team includes a great mix of locals and New Zealanders. Ineke Van Laar from Tauranga has been the very efficient organiser for the nursing and theatre side, and the transport, logistics and food is organised by Michael Prasad who is a tireless and enthusiastic local businessman. He sits at the hub of the clinic area and makes sure we all have enough to do. We have learned to never believe Michael when he says “only another 4 more cases and we are finished for the day". Somehow he always manages to fill the day up to the brim.
The leader of the surgical team is Dr Jeff Rutgard, an American surgeon from San Diego, who has been operating in Taveuni since the project started. He will often bring a junior surgeon (either a fellow or new consultant level).
In addition, many instrument and surgical supply companies have also assisted, this year we had the benefit of two beautiful operating microscopes supplied by Zeiss, one at minimal cost, one donated. They were very much appreciated.
Anyone who has gone on a trip like this , which is generally organised through the Volunteer Ophthalmic Services Overseas (VOSO), will understand the satisfaction of helping people who are often severely visually impaired, and otherwise would not have access to treatment. The faces of the patients on the post op day, their thanks and the beautiful singing that always seems to follow, especially on the final day, makes all the hard work more than worthwhile.
However, there is always the frustration of those difficult cases as well, which show the limitations of treatment options and ongoing access to medication in Fiji. There are no vitreo-retinal services in Taveuni and even simple things like intra ocular inflammation or glaucoma may not get adequate or indeed any treatment once the team leaves.
Dr Jeff however, was impressed that in New Zealand there is such a strong tradition of voluntary surgery, with significant numbers of surgeons regularly participating in VOSO or similar trips as well as those who work with Pacific Eye Institute or other organisations. Jeff said only a handful of US surgeons are interested in voluntary surgery.
The team at Auckland Eye is committed to providing ophthalmic support to our neighbouring developing countries. To read more about the volunteer work our doctors undertake take a look at our Philanthropy page.
Aside from the television advertisements showcasing tranquil island getaways, I knew very little about Samoa when I decided to take the opportunity to accompany John Tarbutt on VOSO’s annual optometric outreach to Samoa in August this year.
We spent a week on the beautiful island of Savai’i; working at Safotu and Tuasivi hospitals; refracting, examining and giving out new and pre-loved spectacles we had brought with us from NZ. We were fortunate to be able to work with Samoa’s only resident optometrist, Fuiavailili Erna Takazawa, who is based in the capital Apia, as well as several well-trained eye nurses at the local hospitals. For most of the year, these nurses offer the only optometric and ophthalmic care to the island’s residents.
We were also able to identify many cases of pathology which were referred for ophthalmic care when the next surgical team arrived on the island. With the lack of adequate eye care, many simple pathological cases, such as cataract, pterygia and diabetic retinopathy, were in their most advanced states; to a level which we would never see in NZ. While acutely aware of how much more I would be able to offer these patients if they were in my home practice in the Waikato, their gratitude for our services provided the driving force to make this appeal a success.
My week in Samoa was an eye-opening experience which enabled me to appreciate the true value of the care we offer as optometrists. It was a privilege to be able to help the lovely people of Savai’i, and I encourage any interested optometrists to volunteer their time for future outreaches should the opportunity arise.
Malo e Lelei! This year was my first VOSO trip and my first visit to the beautiful Kingdom of Tonga. The team spent the week solely on the main island of Tongatapu this year. Hywel Bowen and I provided optometric services in the team along with the support of the nurses of the Vaiola Hospital who were extremely helpful as assistants as well as interpreters. Mele Vuki, an optically trained nurse, was able to screen many of the straightforward presbyopes while we tackled some of the tougher cases. We examined plenty of diabetics, some with severe proliferative retinopathy. We also saw a few more “interesting” cases, such as the man who has not taken his prosthetic eye out to clean in 20 years!
One young boy of 11 years old had his second juvenile cataract operated on this year by the doctors of our team, Dr Andrew Riley and Dr John-Paul Blanc. They had a fantastic result with him achieving 6/9 vision each eye unaided. I refracted him and I was able to find him a pair of small progressive spectacles that he could use for school. He left clutching his spectacle case with a big smile on his face. With no local optometric specialists or facilities, either private or public, based in Tonga, we knew we’d made a real difference to this boy, who will not get a chance to see another clinician for 12 months.
My first VOSO trip was certainly very busy but it was also incredibly rewarding. I was very appreciative of all the work and planning that was put into our one week. I left Tonga with a new perspective on the islands and on eye care in general, and I know I will be back!
Although Samoa attracts many tourists to its paradise beaches, it remains on the United Nations list of least developed nations. Samoa has strong links with NZ and has been visited by VOSO at least once a year. This was my first opportunity to volunteer with VOSO, and hopefully not my last.
Geographically Samoa is comprised of two large volcanic islands, Upolo and Savai’i, and a few smaller islands. The situation for eye care is poor outside the capital of Apia, especially on Savai’i where there is only one resident GP for a population of 60,000 and no optometrist or ophthalmologist. Over the years the VOSO team led by John Tarbutt has been trying to shift the focus from cursory eye screenings to a more thorough eye examination.
For two weeks, John and I were ably assisted by the national hospital optometrist Erna Takazawa, and two local nurses. Most days we had two optometrists refracting while the third was on slit-lamp. The clinics were packed full of pathology. There were injuries aplenty from cricket balls, tree branches, nails and fishing hooks. The pain tolerance of the Samoans was immeasurable!
We identified those with advanced cataract, pterygia, and other pathology requiring surgery for the Pacific Eye Institute surgical team who were to follow a week behind us. I was staggered to hear that the Pacific Eye Institute (PEI) team reached a record-breaking outreach with 186 operations in 5 days!
I was impressed with the quality of the new and pre-loved spectacles we were able to prescribe. Even more impressed with John who somehow managed to fit a new slit lamp into his luggage! This slit-lamp was generously donated by Optimed to replace the broken one at the hospital. The fluorescein donated by John, was also most welcomed, as there was a fishhook emergency while we were at hospital and the only fluorescein they could find was a strip that expired in 2005.
It was certainly a different type of optometry than what we are used to in NZ – one can’t be too idealistic and one needs to be adaptable and prepared to compromise.
We achieved most objectives with regard to referrals to the PEI surgical team, diabetic screenings, refractions and spectacle dispensing. Where possible we provided mentoring to Erna and the eye nurses, including two trainees, importantly maintaining good VOSO and Samoa National Health Services relationships whilst also helping them towards self-sufficiency.
I could not have asked for a more prepared, hardworking, and enjoyable team to work with. Volunteering in Samoa was the perfect opportunity to put my newly acquired therapeutic knowledge to use. It allowed me the opportunity to experience a new culture beyond my normal travels. Ultimately though it was great to regain some perspective and to give something back. Faafetai lava (thank you very much).