Seeing the World in a New Way

Conveying the shape and feel of an I Care clinic is difficult because the process is experienced by lots of people.  There are so many points of view. 

Not everyone who contributes makes the trip.   We have student volunteers from Morris, Illinois and Paso Robles, California high schools that wash and clean random bulk glasses received from members and friends of I Care and the Lions Club, and then assess each one using a piece of equipment known as a lensometer.  Once the exact prescription is determined for each eye it is written on a label on a plastic bag into which the glasses are placed. 

Some of those high school volunteers are “Dreamers,” and others are first generation immigrants from Central America.  They have a purpose in helping I Care that goes beyond filling volunteer hours required by their school. 

Both those who donate glasses and those who assess them trust their efforts will be rewarded when the glasses they processed are taken out of a bag by an I Care volunteer at a clinic in Central America and given to a person who lacks the means to obtain their own.  We conduct these annual clinics to preserve that trust. 

Volunteers take bagged glasses, bifocal and single vision, minus prescriptions for the near sighted, plus for the far sighted, corrected for astigmatism, the whole range of corrective needs, and create a catalog of glasses that will be used at the clinic site.  Over the years, optometrists have determined the type and range of prescriptions that will likely be needed.   Glasses are sorted by type and then a wide assortment of prescriptions are placed in cardboard sleeves in ascending order from the weakest  to strongest prescriptions.  This becomes the stock from which the prescriptive needs of individuals are matched to available used glasses.

Up to 6,000 used glasses may make the trip in black canvas bags to a clinic site, carried by I Care volunteers who pay for their own travel, lodging, and meals while performing the tasks needed to conduct a clinic.  Those volunteers are the people our patients see, but they represent others who may never travel to a clinic yet are indispensable to its success.

The single biggest cause of poor vision in the world is caused not by glaucoma, or cataracts, or retinal disease, or other maladies of the eye.  The biggest cause of poor vision is the lack of corrective lenses.  That’s what we strive to provide, improved vision to those whose eye problems can be improved with glasses.

I Care certainly doesn’t create and plan these clinics from the United States in a vacuum.  Before anything happens, we need to make sure people in the community we intend to serve extend a formal invitation, provide local contacts, security, recruit local volunteers, and do the hard work of site selection and logistics. When we arrive in county we need help getting our equipment through customs, transportation, meals, and more details than any one of us fully understands.  We found the cooperation we needed and more in hard working members of a Rotary Club in San Miguel.  Without them the clinic would have never happened.  We can’t thank them enough. 

Twenty-seven volunteers from the USA, one from La Penita Mexico, and two from Mexico City traveled to El Salvador to join with our Salvadoran hosts in staging this four-day clinic.  They worked at six clinic stations.  Here they are briefly.

Registration-Our most fluent Spanish speakers converse with each patient to determine basic demographic and personal information and gather a self-report of visual difficulties.  They record that on an intake sheet that travels with the patient throughout the clinic. 

Nurses-Because high blood pressure and diabetes are so closely correlated with vision problems, and vital information for our optometrists, we refer likely candidates to a station where nurses take blood pressures and determine blood sugar levels.

Acuity-Volunteers stand by eye charts on a wall pointing at smaller and smaller descending lines of symbols.  Ten feet away volunteers with clipboards listen to their responses and record the extent of their success; 20-20, 20-40, sees fingers at three feet, whatever the outcome, for each eye.  They do this hour after hour, day after day, for each and every person entering the clinic.

Auto Refractors-Two volunteers operate the most expensive machines on the trip, portable auto refractors which measures the way each eye bends and receives light.  It gives eye doctors a powerful indicator of the type of prescription likely needed best improve their vision. 

Docs-We had six optometrists on our trip, plus two last year optometry students from University of Missouri St. Louis.  That’s an abundance of professional volunteer help.  For the first time in the organization’s history, we believe, all of our optometrists and students were women.  By working well together they made the clinic’s operation very smooth despite a high volume of patients.  Docs evaluate the health of each patient’s eyes, diagnose eye disease if present and provide consultation and referral if possible, and determine the prescription needed for glasses if any.  Not everyone needs glasses, but everybody deserves a good eye exam.  Many get the first of both in our clinics.

Dispensing-Two types of volunteers work in dispensing, pickers and fitters.  Pickers comb through the stock of glasses and select the closest match to the prescription the eye doctor has written.  Once located they pass the glasses on to fitters who put them on the patient, determine if the glasses work well for them, and then adjust them for a comfortable fit.  Not every script works every time.  The fitters are the end of the line.  They ensure the process works for those counting on it for improved vision.    

Together we served 1,707 patients in four days, an average of 427 a day.   That’s a lot.  But all my observations so far are from the perspective of the clinic volunteers.  What’s missing is the perspective of the Salvadorans we served.       

I can’t speak for them of course, but I work as a fitter with limited Spanish and was able to talk to a good many of those who received glasses.  I want to tell you the stories of two of them, in hopes of conveying the essence of I Care’s El Transito clinic.

On a hot afternoon in a noisy crowded clinic I introduced myself to Alma, a 9 year-old girl from a village near El Transito.  She came to the clinic on the first day, Sunday, all dressed up.  She was accompanied by her mother, who explained that Alma’s teacher suggested she see an eye doctor.  Alma was really shy.  Her mother explained she was not sure she wanted to come, and even more unsure about wearing glasses. 

I looked at the prescription the doctor had written, and the glasses the picker had chosen.  Alma required single vision minus glasses.  Those are designed for patients with myopia, which we know as near sightedness.  Her prescription was a -2.50 sphere.  Alma’s near vision was likely OK she but would struggle to see things far away.  Her teacher may have noticed that when she was trying to see chalk marks on a blackboard. 

That’s a moderate version of the kind of vision I have.  I got my first glasses at her age, also reluctantly.  But after realizing how well I could see with them I didn’t want to take them off. 

The pickers had found a nice pair of small glasses, plastic frames brown on the outside with pink on the inside.

“Alma, have you worn glasses before?”

I said that in Spanish knowing the answer but wanting to strike up a conversation.

“No.  Nunca.”

Nunca means never.  It’s the most frequent answer to that question every time, every year I make the trip.

“Well these glasses should help you see things much better at a distance.  I bet you can read well, is that right?  You see words in a book clearly?”

Alma just nodded.  Her mother answered for her, proudly. 

“Alma is a good reader.  She reads a lot.  Not a problem.”

“OK. Tell me what happens when you look through these.”

I unfolded the glasses and put them over her ears.  They settled down over her nose nicely.

“Ahora, mira aya.”  (Now look away.)

I pointed across the room.

Alma looked over the crowd at the people doing acuity.  I saw her gaze shift up to the pigeons sitting on a ledge above them.  I watched her closely.  A little smile broke out on her face as she gazed across the room.  

“Como es?  Claro?” (How is it?  Clear?)

I knew the answer from her smile, but I wanted her to tell me.

“Si.  Muy Claro.”  (Yes.  Very Clear.)

She turned to her Mom and gave her a bigger smile.  Her Mom looked relieved.

I went into a little rap I have memorized in Spanish about wearing the glasses every day, putting them on the first thing when you get up and taking them off only when you go to sleep.  I advised that she may not need them to read and if it was more comfortable to take them off while reading.

I cautioned both her and Mom that the lenses were plastic and easily scratched.  They should be cleaned with soap and water and wiped only with a soft cloth.   I gave her one of the donated microfiber lens cleaning cloths some nice donor furnished for us to distribute.  Her Mom put it in her purse.

Before they left, I asked her Mom if it was OK to give Alma a small gift.  I went to the table where we kept our adjusting tools and selected something for Alma from a box.

I held a Pez dispenser in front of her.  At its top was the head of a white rabbit.

“Mira Alma.  Es un conejo.” (Look Alma it’s a rabbit.)

I tipped the rabbits head back and a little Pez candy pushed forward.

“Y es un dulce tambien.”  (And it’s a candy too.)

She smiled bigger than before.

I’m pretty sure the I Care clinic worked well for Alma.  She was able to get her vision corrected early in her life, which will make a real difference in how she sees the world growing up.  With any luck she and her Mom will realize their importance and will find a way to get more glasses as she grows.  Myopia is not a condition that goes away.  But it is easily corrected.  Someone donated those glasses to I Care.  Others did the work needed to provide a good eye exam and make those glasses available to benefit Alma.  I was just lucky enough to see that benefit unfold firsthand.



We worry sometimes that our hosts do not take seriously the task of promoting a clinic in their community.  In this case the Rotary Club of San Miguel teamed up with the city of El Transito and simply broadcast over public media the dates and times of the clinic.  That approach has not always worked in the past.  This time it did.  It was our first time working with this Rotary club, our first time in El Salvador.  We should have trusted them to know their community.

The clinic was a madhouse.  Each day before we arrived, in order to keep waiting patients out of the sun, our hosts packed the place with waiting people.  It was very difficult to walk through the crowd.  We asked out hosts to create aisles through the rows of chairs so we, and patients crossing to the next station in the clinic, could make our way across the room.  The clinic was the biggest thing in town.  It attracted vendors.  They balanced their wares on their heads.

Inside the all concrete structure the steady hubbub of the crowd coupled with an amped up public address system and a woman with a microphone speaking into it with a shrill voice and it was damned hard to hear.  We leaned in closely to catch the responses of our patients.
  
I often asked the people who were receiving glasses from me how long they had waited.  Some reported being there over four hours.  You would never have known that.  They were calm.  Families brought their children and accompanied the elderly.

The locals managing the crowd were careful to give priority to the handicapped, the frail, and those in wheelchairs.  I was impressed with the patience and kindness they showed each other, and us.  I wanted to return it.  I think each I Care volunteer shared the desire to both reciprocate the welcome shown us by our hosts and reflect the kindness we felt from the people we served.

  
When the fitters were backed up dispensing glasses, when too many people crowded our waiting area, the pickers jumped in to help us.  My wife is a picker but doesn’t know as much Spanish as she would like.  One of the good young Salvadoran volunteers, Carolina Navarro, served as her translator.

She called out a woman’s name and an elderly woman was helped to the front by her grand daughter. She walked with a cane.  Colleen looked closer at her intake sheet and saw that she was 97.  Her name was Victoria.

“I would never have guessed her to be that old,” Colleen said later.  “She was so engaging.  And anxious to get those glasses.”

 “Have you ever worn glasses Victoria?”  Carolina translated Colleen’s words into Spanish.

“Nunca.”

“She never has,” Carolina explained.

“Well here you go.”

Colleen unfolded the temples of the bifocals and tried to put the glass on the old woman’s face, but she reached out quickly and put them on herself.

We make assumptions about the elderly.   Colleen assumed she needed and wanted the strong bifocals primarily for reading.

“Carolina, ask her how the letters look in this newspaper.”

Colleen handed the 97-year old Victoria a page of newsprint.  She brushed it aside and responded, cheerfully

“No sabe leer.”

“What did she say Carolina?”

“She says she can’t read.”

The old woman straightened up in the chair and looked slowly all around the clinic.  Smiling she looked back at Carolina and my wife.

“Ask her what she sees Carolina.”

“Que ves Victoria?”

“Te veo, y eres hermosa.”

“What did she say?”

“She said she sees you, and you’re beautiful.”

When my wife heard Victoria’s words through Carolina, big tears came to her eyes.  If you don’t catch the emotion wrapped up in bringing improved vision to those who have never experienced it, you miss the impact I Care has on people outside our borders.  Like Alma, the nine year-old girl we were able to help, Victoria had just received her first pair of glasses, and with them a new view of the world around her.
  
And in many ways, we Americans who made the trip to El Salvador opened our eyes to a new world too.