Project MARC

Phase III

• Special Community Needs Assistance
• Education & Hygiene Training
• Rural Blindness Prevention
• Towards Community Selfsuffciency

Rural Blindness Prevention

 

Vision Rural Vanuatu (VRV) Program

~ Background ~

 

Until the establishment of the Australian Fred Hollows Foundation clinic in Luganville a few years ago there was no resident ophthalmologist in all of Vanuatu and only the one-third of the population living near the urban centers had access to surgical eye care when international eye teams would visit once or twice per year for a 1-week period. Through the FHF outreach program, directed by ophthalmologist Dr. John Szetu, specially trained ni-Vanuatu nurse practitioners now also reach some of the rural population that lives close enough to an airstrip to travel there by truck, canoe or on foot.

During the 2002 season the Vision Rural Vanuatu (VRV) program made it possible - for the first time ever - to extend eye care to the hardest-to-reach 30-40% of the population with little or no access to regular boat or aircraft service. We decided to focus on sending our eye screening teams to remote island communities in order to identify those patients who were being threatened with functional or total blindness. Subsequently, patients in urgent need of eyeglasses would be helped in our newly built small clinics whereas patients needing cataract surgery or other types of specialist eye care would be transported to Port Vila in August by our sailing vessels in order to be treated by the SEE international eye surgery team reinforced with a Project MARC eye surgeon & nurse team (Dr. Roger and Beverly Harrie).

As described in our 2002 VRV report, more than 20 remote communities were successfully screened and hundreds of eye patients with refractory problems were helped in our local clinics. Moreover, more than 50 patients in need of eye surgery and wanting to go to Port Vila were identified. To our disappointment, however, only 10 of the final 50 eye surgery candidates came to the agreed beach landing areas when our 75 ft sailing vessels S/V "Siome" and "Ranui" appeared to take them on board. Moreover, upon being returned to their villages 4 or 5 days after the surgery several patients developed noticeable post-operative complications, thought to be caused by substandard hygienic conditions and poor compliance with postoperative home care instructions.

Learning from these first year experiences, our VRV 2003 operational plan called for more intensive pre-operative as well as post-operative patient education and instruction by specially trained village health workers as well as Project MARC teams in order to try and increase overall patient participation while reducing post-operative complications.

Sailing Rural Patients to Regional Eye Surgery Clinics

 

Of the many thousands of eye patients in the Vanuatu archipelago threatened with blindness through cataract or other forms of eye disease, 40-50 % live in remote rural areas where they are out of reach for visiting international eye surgery teams as well as for Vanuatu's only eye clinic in Luganville. Eye surgeons currently have to restrict their base of operations to the few regional hospitals that meet minimum standards of electric power, operating room facilities and hygiene. Moreover, besides facing the severe logistic problems of all remote archipelagos, Vanuatu is one of the poorest countries in the world, with family incomes of less than a dollar per day on many outer islands. Therefore, even where local access to airstrips or boat landings exist the cost of transportation by sea or air is prohibitive to all but the most prosperous families.

VRV Program funding received by Projected MARC has enabled eye screening in over 50 remote villages on the large outer islands of Ambrym and Malekula as well as in the Maskelyne island group. Specially trained and equipped Project MARC eye teams identified nearly 100 cataract and other eye patients threatened with blindness. Sixty of these patients (10 in 2002 and 50 in 2003) were transported to regional hospitals by Project MARC sailing vessels "Siome" and "Ranui" where they were operated in close collaboration with other international programs such as the Fred Hollows Foundation (FHF) and Surgical Eye Expeditions (SEE), as well as with local health authorities. After a 3-5 day hospital stay supported by VRV funding, all patients were successfully repatriated to their island villages where they received final postoperative care from Project MARC teams especially trained for this purpose.

 

Project MARC volunteers also constructed new village clinics equipped with eye examination rooms, while refurbishing several older ones. Thousands of pairs of prescription and reading glasses were measured and fitted for eye patients of all ages, many of whom would be "functionally blind" without these glasses. Moreover, more than 1000 protective sunglasses were distributed. In addition, nearly 3000 prescription and reading glasses were donated to the FHF eye clinic in Luganville for distribution during the "wet" season when Project MARC teams are unable to operate in the outer islands of Vanuatu.

Education and training efforts were intensified at all levels. A dozen or so Project MARC volunteers were trained by Utah ophthalmologist Roger Harrie, using a special Eye Screening instruction manual developed by RN Beverly Harrie based on her own field experience in August 2002, when this remarkable, highly experienced husband-and-wife eye surgery team performed cataract operations in Port Vila Central Hospital. In turn, our volunteer teams in Vanuatu were able to train many local village health workers who accompanied them on all remote village screening expeditions and greatly helped intensify the education and instruction of patients with regard to their potential eye surgery options.

 

 

Project MARC's "Mobi-Doc" Jungle Clinic

~ A New Approach to Rural Eye Surgery ~

Nonetheless, in view of the inherent risks and costs of ocean passages with eye surgery patients, many of whom are elderly and/or ailing, we have developed a low-cost, ultra-light mobile clinic that can be compacted into two container pallets and delivered to remote island locations by sailing vessels or local copra boats. In 2004/2005 A proto-type "Mobi-Doc" was designed and constructed by University of Utah Mechanical Engineering students.

August 2005, one of our volunteer teams successfully installed a prototype Mobi-Doc clinic high up in the Sauriki River canyon in West Santo, near some 8 - 10 mountain villages. September 2005 our first medical team started working in "Jungle Mountain Clinic", as baptized by the villagers (see the Phase II video report a few pages back).

October 2005, Jungle Mountain Clinic was visited by a special Ministry of Health medical team consisting of provincial health manager Joseph Mape, eye surgeon Dr. Kasso, and eye nurse Colwin. They declared JMC fit for perform small eye surgery procedures. The first eye surgery team to perform cataract operations and other surgical interventions in this remote island location, thus far inaccessible to specialist medical care, is expected to reach JMC aboard "SV Alvei" in October 2006.

If successfully deployed and tested in Vanuatu, the low-cost Mobi-Doc concept should be applicable to many other remote archipelagos as well as to a broad range of jungle, mountain and desert environments across the globe.