On Monday we went to the youth cultural and recreational centre to see patients.
Four of us doctors in front of the poster.
It was a large auditorium, and the bleachers were already packed with people who wanted eye exams.
Full on the other side, too. There were already too many people for us to get through today, so they gave some of the people tickets to come back tomorrow so they wouldn't wait around all day and not get seen.
We were originally going to set up in the auditorium, but we moved to this smaller side room because it was a bit darker, so we could see in the back of the eyes better, and because it also had air conditioning, which made us much more comfortable.
The volunteers set up in lines out in the auditorium.
Checking people in and getting their history.
Checking visual acuity.
Pinhole occluders are helpful so you can see what the patient's vision would be with glasses. If it's good, then their eyes should be pretty healthy. If it's bad, then you know to look for diseases more.
Checking intraocular pressure.
Then onto autorefraction.
Some people there wasn't much we could do. This patient was already blind in the right eye from severe glaucoma. Normal IOP is 10 to 20; this person's is 35 to 55 in the right and 24 to 25 in the left.
Another problem is we only have spherical glasses, so we can't correct astigmatism. So with this patient, who has a lot of astigmatism in their left eye, we have to do a spherical equivalent for the glasses prescription. It won't be too clear, but it will still be better than nothing.
For the glaucoma, we sent 600 bottles of timolol, and we'd give out a year's supply to glaucoma patients. While we can't do anything for the right eye any more, we can hopefully stop the left eye from going blind.
Another patient with very high intraocular pressure, in the 30s in the right eye and around 60 in the left. Drops probably won't be enough for this patient; they probably need surgery. There is a local hospital we refer them to, and also some independent ophthalmologists on the island.
Checking refractive error.
Checking pupil responses.
Checking vision with trial lenses.
Looking in the back of the eye with a direct ophthalmoscope. While the DO gives you a decent view of the optic disc and macula, you can't really see farther out in the retina. And sometimes even the central view is a bit hard to get.
In which case, we dilated the patients and used a binocular indirect ophthalmoscope (BIO). We didn't need to do this for most patients, but if they had poor vision we couldn't find a reason for or were at risk for peripheral retina diseases, we did. We actually saw a bunch of kids with sickle cell anemia, which can cause retinal damage. You never see actual retinopathy in the US, but in Grenada, a few of the kids had some early forms, although thankfully nothing severe.
Dispensing glasses to patients. We brought a bunch of different spherical powers.
The patients also got a little bag.
With a lens cloth, a glasses strap, and a granola bar.
I had also brought a box of erasers to give to kids. Especially if they didn't need glasses, it was nice to give them a little present so they didn't wait for hours for nothing for them.
Still long lines, although there are fewer people in the bleachers now.
If any area got backed up, some of the doctors would go help them catch up, since we're faster at everything than the volunteers as we've been doing these for years and they just started today. They did very well for having no experience.
I saw 64 patients, and we saw 259 in total.
People playing soccer in a nearby field.
I stopped by Antonio's for dinner.
That's a lot of food; I'll have plenty of leftovers.
It was a short walk back to the apartments we were staying at, and the area was very safe.
Lit up red and green.
This lizard was also up and ready to go on Tuesday morning.
The bleachers aren't quite as packed this morning; the tickets we gave out yesterday helped.
We adapted some things due to issues yesterday. The lines were rather long and messy in the auditorium, so we moved the volunteer testing into this room so it would be more organized.
We also modified what we asked on history a bit. Mostly to focus on a single issue the patients are here for.
Two stations for checking visual acuity worked pretty well.
The portable autorefractor can get rather heavy after hours of use, so instead of sitting and holding it up, it was easier to stand and have the patient look up.
We also moved where the patients waited in the doctor room to get to them a bit faster.
For smaller kids, it's helpful if the parents hold them.
It can be a little tough if they look around, but all of the kids were well-behaved, so that made it easier.
Max brought a few mobility canes to give to people who were completely blind, although there were only a few patients with vision this bad.
Trial framing lenses is a little slower than the flippers, but if the patients have a large difference in refractive error between the two eyes, this will give a more accurate corrected visual acuity.
Having the patient look way up to see the superior retina.
Checking reading prescription.
I saw 96 patients today, and we saw 354 total. Many more than yesterday, so our changes improved our efficiency.
I wanted to try this street grill food, it smells really good, but I still have my leftovers from yesterday.
Back on Wednesday. They had some fruit and vegetables at a table out front.
Every morning we had a huddle with all of the volunteers to discuss what went well yesterday and what we could improve on. Patients had been getting a bit backed up at the visual acuity station, so we covered up letters on the visual acuity chart. It made this station move much faster because the patients only read three letters per line instead of five or six.
Me determining refractive error with retinoscopy rack bars. These are much faster than individual lenses because you can just slide it lens to lens rather than changing lenses one by one.
Then checking vision with flippers.
Sometimes the line would build up a bit, but we were pretty good about controlling it.
You can see a charger plugged in on the wall. I had two handles, so I'd use one while charging the other.
Checking in the back of the eye.
And far off in the periphery.
We had some portable slit lamps to check the anterior parts of the eye, too.
I saw 88 patients today and we saw 357 total. About the same number as yesterday but still much more efficient because we got done at 4:30pm today, whereas the last two days we were done around 6:30pm.
We had to get done earlier today because we were going to Dodgy Dock.
For Street Food Wednesday.
Where they had a ton of food vendors.
Each had different items.
Which you purchase with tickets you had bought.
Some live music.
More food on the other side.
This looks spicy.
Grilling.
A bar.
Nice view.
I got some chicken.
With stuff inside.
Someone else got fish.
Our group.
More live music where we were sitting.
A singer.
And another one.
A video of the music.
Neat lights.
Thursday, our fourth and last day of clinic.
This patient was on five different glaucoma drops.
This patient needs a corneal transplant.
I saw 81 patients today, and we saw 315 total. We also got done a bit earlier today, at 3:30pm.
Over the four days, I saw 329 patients, and we saw 1285 total. We also gave over 100 patients a year's supply of timolol for glaucoma and referred others to the hospital for glaucoma, cataracts, pterygium, and other ocular diseases. We dispensed a lot of artificial tears and allergy drops, as well as sun glasses, too.
These were the various powers of glasses we gave out. Mostly reading glasses, but some myopic prescriptions, including a few quite high powers. We ran out of the low myopic powers, from -1.00 to -4.00. We were basing the numbers off of Jamaica, which has very few myopes, but there were more here. We wrote down the name and phone numbers of the people who needed glasses we ran out of so we could send them some.
Time for a snack. They don't have Snickers.
But they did have a few varieties of Kit Kat I haven't seen before, so I can take those back home for Ogii.
That night we had dinner at Dr. Marryshow's.
Dickon Mitchell, the prime minister of Grenada, even showed up to thank us.
A group pictures.
Just the doctors.
The organizers from Alliance of Jamaican and American Humanitarians (AOJAH) for this trip.
The other volunteers.
A certificate I received. Overall, it was a very successful trip. We dispensed a lot of glasses and glaucoma drops, educated many patients they needed to go to the local hospital for further treatment, and reassured many other people that they eyes were healthy and they had great vision.