Visual Health is Not a Luxury 

Reflections on the 2012 ASAPROSAR Campaign

By Liz Umlas 

The patient sat before me in a clean white shirt, neatly pressed pants and old but polished dress shoes. His eyes were red, and his long, thin face had a weary expression that made him seem tired and old. At the same time, the dark, curly hair framing his face made him look younger than his 49 years. His chart revealed that he was a jornalero, a day laborer. This was the first eye exam he had ever had.

I asked the patient what had brought him to the clinic that day. He said he had noticed problems with his vision since he had started studying. "What are you studying?" I asked him. "I am in first grade," he replied. "I never finished primary school and I’ve returned to get my degree."

The ophthalmologist performed the eye exam, and then delivered the diagnosis to me. It was not good. The patient had early-stage glaucoma in both eyes, and must remain on medication for the rest of his life, or risk blindness. We could give him six months of glaucoma drops to control the pressure, but after that, he would have to get himself checked regularly, and eventually buy the drops on his own. Unfortunately, six months of drops were all we could provide: there were not enough resources to do more than that for everyone who needed it.

As I explained this to the man in Spanish, he absorbed the news as if it were a slow-motion blow, his face falling as he nodded slowly and repeated the word, "blindness." It was painful to watch him process the information, his shoulders drooping under the weight of the diagnosis. But after a few seconds’ reflection, he replied that everything was God’s will: a refrain we heard from many other patients that week. He said he had hesitated about whether to come to the clinic that day, but he eventually decided that God had intended for him to go, so he did, and that he was thankful for the treatment we were providing.

I was part of a group of volunteers – doctors, nurses, technicians, translators – who participated last month in an annual visual health campaign in El Salvador. We worked through a local NGO called ASAPROSAR (Asociación Salvadoreña Pro-Salud Rural, or Salvadoran Association for Rural Health), the country’s main provider of eye care – exams, glasses, surgery – to low-income people.

Setting up shop in two of ASAPROSAR’s eye clinics, the volunteers, organized by Massachusetts-based Friends of ASAPROSAR, carry out a week-long campaign every winter in the cities of Santa Ana and San Miguel. The aim is to provide surgery and glasses free of charge for Salvadorans who most need these services. In addition to its work throughout the year, ASAPROSAR promotes the annual campaign, prescreens patients from all over the country, provides the facilities and administrative staff to make the campaign possible, feeds the volunteers and handles all follow-up procedures with the patients. After over 20 years of practice,

the campaign is a well-oiled machine. In 2012, just over 2,000 people were seen – including 144 surgeries and 1,691 pairs of glasses given out in the space of less than a week.

Visual health is not a luxury. In wealthy countries we take it for granted, but it is a vital part of our well-being, and, by extension, that of the people we live with and support. Although during the campaign we met a few blind people who had been fortunate enough to receive specialized training in lines of work for which they did not need to be sighted, they were the exception. More often, we met people for whom visual impairment meant that their already precarious financial situation could only get worse. In a nation such as El Salvador, where almost 40% of the population lives below the poverty level, blindness can easily mean the loss of a livelihood, not only decimating family income but also often pulling another wage earner out of the system to care for the person who has lost her sight.

During my time in Santa Ana, and since coming home, my thoughts have returned repeatedly to the day laborer, more than to anyone else I met. Many of the patients were facing truly dire situations. But there was something especially heart-breaking about this middle-aged man who just gone back to elementary school to better his life and his prospects, receiving a diagnosis of an illness that – in a wealthier country, with universal health care – could be controlled through surgery and medication. What was to become of him now?