Due to unforeseeable circumstances, my contact in St Lucia (who had recently returned to the island from Dunedin NZ (where I met him) after submitted his PhD doctorate investigating strategies for reducing poverty using a ‘bottom up’ (or ‘grassroots’) approaches) was not able to give the organisation that I hoped to some work with enough advanced notice for work to be organised for me to participate in.
The organisation that I had hoped to be utilised by was the Saint Lucia Blind Welfare Association (BWA). I met with the Executive Director, Mr Anthony Avril (pictured sitting beside me in photographs below), who helped me to understand the major role this organisation has in providing eye care to the residents of St Lucia (which has a population of approximately 165 000). Those who have irreversible vision loss have access to the only vision rehabilitation officer for the island. She makes house visits and provides advice on and equipment for daily living tasks. The BWA also employs a refractionist, and has just hired an optometrist - both locals who trained abroad - who are able to examine and provide patients with spectacles that are sold at variable subsidised rates. (The final cost is mean tested in ways unique to a small population where social networks make it possible to cross check the validity of the claims people make concerning their finances.) The BWA also employs an ophthalmologist for a day and a half each week, who anyone can book in and be examined by, again at a reduced rate. Finally, roughly twice a month, a team is sent to a school or an outlying village in order to screen for eye disease.
The BWA is also involved in public health; I joined the team that was staffing an information stall at a health fair, which was an initiative of the Ministry of Health and the local Methodist Church (which hosted the fair). Lectures on Glaucoma and Diabetes were given, as both conditions are present in a large portion of the general public here. In fact, a recently published an article makes claim (based on questionable research methodology) that Saint Lucia has the highest incidence of diabetes per capita in the world.
The bulk of eye care on the island is provided by a team of Cubans who work out of the local hospital where they can be seen for free. In an undisclosed arrangement between the two governments it was arranged for a team of Cubans to be based in St Lucia; Each team member stays for a period of two years. Nobody knows how long this arrangement is set to last. The team includes four ophthalmologists, two medical doctors, four nurses, one refractionist, one accountant, and a statistician.
The Cubans run a daily screening program that sees two doctors travelling to all corners of the island, and each suburb of the larger cities, with a slit lamp & a direct ophthalmoscope to quickly examine all comers. On the day that I spent with the team they saw about 75 patients (despite the slit lamp light giving up half way through the day). The emphasis on the examination is on finding pterygia (which they call ‘flesh’) and cataracts, which are both referred to their colleagues in the hospital for further investigations and treatment.
I spent a day observing the Cuban team in the hospital. They have been performing pterygium surgery on the island now for over a year and have seriously reduced its incidence. They are now happy to operate on any pterygia that has crossed the limbus (even if only present in one eye). Patients who require cataract surgery are still being flown to Cuba for their treatment. Equipment should be arriving this month to enable the team to do cataract surgery in the local hospital. (They also need a laser for treating diabetic retinopathy (as the clinic only has a YAG laser).)
There is only one private ophthalmologist on the Island, Dr Suresh, an Indian who has been practicing in St Lucia for about five years now. He is a very busy man, responsible for all the ocular surgeries and conditions that the Cubans are not set up to handle. In addition to running his own private practice, he works in another part of the local hospital a couple of days each week, and he is the ophthalmologist that the Blind Welfare Association employs. He was also the one who delivered the public lecture on glaucoma at the health fair. (Interestingly, I learned in that presentation that there has only been one instance of closed angle glaucoma on the island in the all the years he has practiced there, and that particular eye belonged to an English tourist.)
There are about four optometrists on the island, who all run private practices in the two biggest towns. I did not get the opportunity to interact with any of them.
As the Vision 2020 director at the BWA explained to me, St Lucia is well serviced by eye specialist, and residents have many different eye care options to choose from, each catering to those of differing means. The only concern I have for eye care on the island is that if the Cubans were to up and leave, there would be only one ophthalmologist left on the island, who is also not native to the country.
Next stop: The new Vision 2020 School of Optometry in Guyana.
