The life and times of an optometrist: December 2018

So at the end of part 1 we had the clinic set up and we thought we were all set up and ready to go for the week, as a newbie how wrong were we?!

As refraction is the main part of what we do on a daily basis Heather and I started on team refraction with the aim of working out the best prescription we could for patients with the target of 20/40 (equivalent to 6/12 in UK which is the UK driving standards).

The patient journey started with crowd control and getting people into a queue then entering the church to be booked in and those at risk due to age or family history were seen at the nurses station for blood pressure and blood sugar check. Everyone then moved onto the vision station where their unaided vision, or vision with current glasses if applicable was tested using logMAR letters, numbers or tumbling Es depending on literacy and communication. After this they moved onto pre-testing where they had their interocular pressure measured, were dilated, and had auto-refraction to give us an idea of their prescription. The big station was triage where the patient had their eye health checked, retinoscopy to see if auto-refraction was right and a decision was made whether the patient needed refraction and prescription glasses, to see the doctors for a pathology check or if they just needed glasses for reading and sunglasses. (Everyone was given sunglasses to protect their eyes from the harmful UV of the Caribbean sun). The refraction station was next where a patient's prescription was checked and if needed we could also refer to pathology for a health check. The doctors in pathology were able to prescribe medication for glaucoma, refer for cataracts but also to send over to our laser team who were performing laser operations for glaucoma and diabetic retinopathy. After all this patients who needed prescription glasses were sent to the dispensary where the best glasses for the patient were found or made if needed.

For the first half of the week we also had a team who went out into local schools to screen children and refer to the main clinic later in the week. This team was made up of a couple of optometrists and a couple of students and at the end of the week we saw a few of the screened children coming through and helped them out.

Each day started with an early start with breakfast around 7:30 then meeting up with everyone at the buses at 8:00 for quick brief, making sure we had all equipment and drinks for the day then loading up onto the mini-buses for the 30 minute commute. Every morning we arrived at the clinic to find a queue of people which only seemed to increase as the day went on. Upon arrival we would organise drinks, move any tables and equipment needed, and in my case re-stick the tarpaulin covering the windows back up as it fell down every single day!

The doors opened at 9 and the queue would slowly start to filter through the stations which meant that it took about 30 minutes before I saw a patient but once they started they kept coming for pretty much the whole day. The patients varied between fairly normal hyperopic prescriptions on patients who could communicate well to patients with high prescriptions, often astigmatism, who struggled to understand the test and my accent. Astigmatism and hyperopia were definitely the trends of the week, rather than the myopes we tend to see in the UK. Lunch was cooked by a team of cooks from the other side of Jamaica who had been brought over specially for the week and you just tried to take a break in a slight lull when others from your section weren't at lunch. It was typical Jamaica fare of rice and beans, chicken and vegetables.

And then it was back to the grindstone of doing our best to help out as many patients as we could for the day and week. We closed the doors at around half 3 to 4 to allow the last patients to work their way through the system and be dispensed before we finished the day and had everything packed up for around 5 o'clock. And then it was back to the resort for around half five to six for a much needed cocktail and to enjoy the sunset.

The one exception was on Tuesday evening when we held a clinic for Sandals staff and we saw 65 staff within the 2 hours we had for the clinic, which was a great evening and a thank you to them for putting up with us all week.

In total our team of 49 volunteers served 2,682 patients in 5 days, performed 1944 vision exams in the clinic (not all had refraction) and 702 exams in local schools, 110 SLT laser surgeries (for glaucoma), 33 diabetic retinopathy PROP surgeries and distributed 739 pairs of prescription glasses (98 made in clinic) with 34 custom orders from the US. We distributed 1205 pairs of reading glasses and 2119 pairs of sunglasses. PHEW!

It was an amazing week and the two days of relaxation at the end were much needed before flying back to the UK and back to the routine day job. Seeing all the patients out there handicapped by simple visual problems that could be easily treated here in UK really showed how much we take our sight for granted and that there will almost always be a solution to any ocular problem we have via the NHS or private optometrists, and why it is so petty when people complain about the price of eye drops or a sight test (rant over).

Thank you to Great Shape Inc for organising the trip, Sandals for hosting us, everyone who donated to help us go and all our supporters. One love and bless up!

At the end of October I flew out to Jamaica with a friend and colleague (Heather) as part of the iCare initiative run by Great Shape Inc., an American charity that provides a variety of services to the people of the Caribbean including dentistry, teaching the teachers and eye care. The iCare initiative has been running for 9 years, this year was the 10th year. This year it ran two projects in Jamaica, and one in Turks and Caicos. I went to the second week in Jamaica which was based in the west of Jamaica in Negril.

After getting up very early, about 5:40, to get a 9:45 flight we were on our way to Miami for a few hours of wandering around shops and trying to buy stamps for postcards. For reference you can't buy stamps in American airports for some stupid reason! A few hours later we were on last short flight down to Montego Bay, and then another 90 minutes of transfer to the resort. By the time we got to the resort it was about 22:00 local time but felt like 4 in the morning to us! So it was quick check in, finding rooms, saying brief hello to room-mates for the week before passing out with exhaustion.

Bob Marley statue in Time Square

Our first day in Jamaica was spent acclimatising to the weather, in Heather's case the gym, in my case getting a sneaky scuba dive in and trying to recover from the jet-lag. We then went for a walk down towards the town of Negril to do some souvenir shopping, pick up some post cards and get a feel for the area. The locals were really friendly although a little confused that we actually wanted to walk the couple of miles down to town rather than get a taxi. We caught a taxi back after a successful trip round Time Square, yes the mall (collection of 20 shops) is called Time Square, so we could watch the sunset. The sunset in Negril is truly stunning.

Sunset with a photobombing pelican

Sunday morning started with a brisk walk down the beach to enjoy the weather before fighting off the birds at breakfast, they really are persistent, before heading across the road to start the induction for the week, meet everyone and be told how it was all going to work for the week. We also donated some toys which are currently being donated to kids around Jamaica as part of the Sandals Foundation toy drive. In total there were 49 of us ranging from optometrists, student optometrists, ophthalmologists, dispensing opticians, student dispensers, lab technicians. nurses and retired engineers. Most were from various parts of the United States with a few Canadians and Heather and I as the sole British representatives. A lot of people were returners with some having done as many as 7 previous trips with iCare and a few had already done the mission to Ochi 2 weeks before.

The iCare Negril team

In the afternoon we headed down to Little London, where our clinic would be based for the week. Little London is a pleasant 30 minute drive from the resort, if you can cope with the randomness of Jamaican drivers. We were based in the Fellowship Church of God and it's neighbouring church hall. We spent the afternoon rearranging the church so there was a nice flow through all the different sections of booking in, nurses, visions, pre-tests, triage, refraction, pathology, laser, sunglasses and dispensing/lab in the church hall. As you can imagine doing all this lifting and moving in 28 degree heat was a little hot and sweaty so we were all grateful when we had finished and were able to go back to the resort to get changed and relax for the evening before bracing ourselves for the week to come.