Volunteer Optometric Services to Humanity (VOSH) is a humanitarian eyecare organization most known for their short-term international eye clinics. But these days, VOSH is so much more.
There are international, state, local, and student chapters that focus on bringing clear vision to people all over the world who are most in need. They know that those who cannot see clearly cannot perform well at school or work and this has detrimental effects on the personal and economic conditions of a society.
Many of you may have participated with S-VOSH as a student. But there are many ways to get involved post-graduation. Check out your state chapter to join a local US based clinic, international clinic (Covid-19 permitting). There are also longer term international commitments like VOSH-Corps where you can teach internationally at a growing optometry school; VOSH Ambassador’s Program where you can teach more short term internationally or SVOSH Mentorship to assist a student VOSH chapter on their international clinic.
In this article, I’ll interview two of my own VOSH heroes, Greg Pearl, OD, and Bina Patel, OD, as well as provide my own input on the discussion.
Dr. Pearl, co-chair of the VOSH Corps Committee and past president, took his first VOSH mission to Venezuela in 1989 and was so inspired by the experience that he chartered the VOSH/California chapter later that year with several colleagues. Since then, he has led or participated in 54 weeklong VOSH/CA missions to Venezuela, Costa Rica, El Salvador, and mainland Mexico. He helped to establish the first optometry school in Nicaragua in 2011 and currently leads efforts to develop several sustainable clinics there.
Dr. Patel is professor of biomedical science and disease and director of the Center of the International Advancement of Optometry at the New England College of Optometry (NECO) as well as the director of international programs. Dr. Patel has local and international teaching experience in primary care optometry with an emphasis in ocular disease. She has been involved with numerous SVOSH missions at NECO.
I’ve learned so much from their wisdom and generous spirits, and I hope you also enjoy hearing of our experiences.
What has been your experience with VOSH?
Dr. Pearl: I took my first VOSH trip to Venezuela in 1988 and learned that most people in developing countries have no affordable access to optometric care. We set up our clinic in an civic auditorium and our team examined hundreds of patients every day.
Half of the patients just needed simple OTC reading glasses for their presbyopia. We dispensed used prescription glasses for another 35% of the patients hoping to provide some functionality. Another 15% of the patients needed surgical referrals, but we simply put them on a list hoping that our local host group would find help for them.
These patients had advanced pathologies such as cataracts, pterygiums and diabetic retinopathy which would've been treated already if their public health system had been adequate.
Fortunately, since then VOSH has established student VOSH chapters at every optometry in the US and Canada, and now I enjoy leading optometry students on campaigns to Mexico and Central America. VOSH also supports the establishment of optometry colleges in developing countries where their students have also started VOSH chapters to collaborate with us on campaigns.
We still dispense a lot of reading glasses, but custom eyeglasses are fabricated for the 35% that need them and the 15% needing referrals are properly sent to non-profit surgical centers or public hospitals with the capacity to provide surgery. We dilate more patients and the students learn to provide more thorough eye exams.
It's a great learning experience for them all.
Dr. Patel: I was first asked to participate by the students at the New England College of Optometry on a humanitarian trip to Chetumal Mexico in 1997. Chetumal is close to the border of Belize. The trip was arranged in conjunction with DIF in Mexico.
We set up the clinic in a building and patients were lined up to be seen. We were 2 doctors and a group of approximately 20-25 students. All the patients were refracted and they were given prescription glasses if needed. We triaged the patients that had pathologies.
I can recall an interesting case when a student came to me and said they thought a young mother with a small baby may have a hemorrhage in the vitreous and her vision was very poor. I had a direct ophthalmoscope and was trying to get a view and noticed that adding approximately 16 D of minus I was getting some view of the fundus. The student was guided to correct the refractive error.
On trial frame refraction, the patient was amazed and could see her baby with more clarity. We creatively used the trial frame lenses and placed them in a frame for the patient to take home with her.
Since then, I have participated on humanitarian trips in Mexico, Colombia, Nicaragua, and the Dominican Republic. Taking students on trips has been very fulfilling. We take more hand held equipment with us (BIO, ICARE, Perkins, slit lamp etc.), and we dispense reading glasses and also custom make Rx’s for patients who need them.
The learning experience cannot be understated.
As for me, during my undergrad experience, I had been involved with international volunteer work and decided I wanted a career that would allow me to travel anywhere in the world and bring a skill with me—hauling gravel, I learned, was not my skill.
I became interested in optometry when I learned of organizations such as VOSH that could allow optometry to be just that skill.
When I interviewed at NECO, I learned that only the president of S-VOSH (during 3rd year) could also attend the trip as a second-year student. Otherwise, the trip was exclusively for third-year students. So I made it my goal to become president of the student VOSH chapter at NECO to have more opportunities to provide international eyecare.
My first VOSH clinic was in 2011. I participated in three clinics in the Dominican Republic with VOSH: one as a second year student, one as a third year and one as a supervisor attending optometrist during my residency.
On those campaigns, we set up a clinic in a central building in the town. We performed dilated exams, retinoscopy, and refraction on all patients. Patients were given pre-made reading glasses, donated prescription glasses if we had something close to their prescription. For those with very high prescriptions where we didn’t have anything close, we would have the glasses made in the US after the trip and send them back to the patients afterwards.
I remember thinking during my first clinic that the experience was like optometry boot camp. If you didn’t feel comfortable with some of your clinical skills beforehand, you were going to get comfortable very quickly as we saw hundreds of patients per day.
Having the help of attending optometrists (usually 5 ODs for 20-25 students) was invaluable. Dr. Patel and Dr. Pearl have been crucial to my own interest and growth with VOSH as a student and beyond.
Since then, I have been on multiple other VOSH trips, primarily to Nicaragua. One clinic was just my husband (also an optometrist) and I with a suitcase full of hand-held equipment, such as diagnostic kits/BIO, and OTC readers.
How have your experiences with VOSH outreach enhanced your day to day patient care?
Dr. Pearl: I always come home with a greater appreciation for our capacity to address optometric needs in the US. Clear vision is an essential ingredient to our national productivity. Lack of access to optometry obviously limits people's human potential in developing countries and directly limits their economies.
Dr. Patel: It is a humbling experience. Patients cannot access and afford treatment needed for conditions, such as pterygium and cataract removal. The resources are limited; it makes me appreciate all we have here.
Learning skills to communicate with patients who cannot speak English. Learning their language—in this case Spanish.
I learned, firsthand, when you’re on a VOSH trip, you have to be flexible. The power might go out. There might be a torrential downpour when you’re in a packed room in a building with a tin roof making it so that you have to shout over the rain and the people while trying to perform a trial frame refraction.
There is always a line of people waiting. They are likely standing in the hot sun while they wait hours to have their eyes checked. They may have traveled quite a distance to get to you that day. They might be tired of waiting or just tired. It really puts things into perspective for you when you are also tired, thirsty, and hungry.
It also puts things into perspective for the things we might get frustrated about in day-to-day practice back home, like the EHR not running smoothly, or a patient showing up late for an appointment. I feel like having a broader context for what people endure in life can help you be more empathetic and better handle what may come in during your daily clinical practice and in life in general.
What are some of the most common sentiments first timers experience on VOSH trips?
Dr. Pearl: I think it is exciting to travel abroad as a team of volunteer optometrists. The work is challenging with so many patients in need and long work days. However, the patients are so gracious and thankful for our efforts that we are paid several times a day with hugs and handshakes.
Dr. Patel: The warm, satisfying feeling of helping someone to see better or help them with ocular issues. The days are long and tiring and despite the high volume, we give our best to all the patients. The children are so well behaved and barely cry when you put drops in their eyes. It also allows us to gain a greater sensitivity to inequities of healthcare.
First timers are most often humbled by the experience of a VOSH trip. From seeing the way others live, to the gratitude expressed when someone’s sight is restored with glasses for the first time, it is truly an awe-inspiring experience. While the days are exhausting, they are also energizing, as your team works together to bring eyecare to a community previously lacking.
What would you say to encourage other optometrists to participate in VOSH?
Dr. Pearl: Freely giving your optometric skills is a rewarding experience and I would recommend that every optometrist try it once. If you participated in a VOSH campaign as a student, it is time to get back out there and enjoy it again. Volunteering on a VOSH campaign feeds my soul like no other experience I've found.
Dr. Patel: Once you go on a humanitarian trip, you will want to go again and again. You have an opportunity to work with others in a team. Patients are so grateful. It will be one of the most fulfilling experiences of your career.
Personally, participating in a VOSH trip has the potential to change your perspective on your entire life. When you come back from seeing the way so many people in the world live, it will really make you reevaluate what we all take for granted on a daily basis, such as running water, electricity, and sturdy homes.
The people you examine, despite their difficulties, also have a joy for life, which is apparent in getting to know them. If you have never been on a VOSH trip, I would strongly suggest you contact your state chapter to get involved.
Conclusion
VOSH/International offers the gift of vision and eye health to those in need, providing a global impact to support sustainable clinics and optometry schools worldwide. This volunteer-based organization supplies eyecare to so many around the world in a multitude of settings—student-based clinics, short-term domestic and international clinics as well as providing international teaching opportunities.
Whether or not you participated in a VOSH campaign as a student, your life will be impacted if you decide to participate at whatever stage of your career you’re in. As an optometrist, your life will be changed if you have an opportunity to participate in a VOSH clinic.
