GUIDELINES FOR VISITING VOSH OPTOMETRIC TEAMS TO DEVELOPING WORLD COUNTRIES

VOSH/INTERNATIONAL GUIDELINES FOR VISITING VOSH OPTOMETRIC TEAMS TO DEVELOPING WORLD COUNTRIES

The primary mission of VOSH/International is to facilitate the provision and the sustainability of vision care worldwide for people who can neither afford nor obtain such care.

PREMISE: Visiting humanitarian VOSH teams wish to provide the best quality care to all patients at their temporary clinic sites. Teams will provide a standard of care commensurate with field work to include at least:

  • Basic refractive care
  • Dilation of all diabetics
  • IOP’s on all adults
  • Medications for acute care needs or solicit local sources
  • Referral to local Eye Clinics those patients who cannot be cared for (such as chronic conditions, atypical refractive error that needs new eye glasses that VOSH is not able to supply on site, and need for surgical care).
  • Entering and exit visual acuities to determine if visual chief complaints have been addressed.

PLANNING PHASE: Prior to a trip, permanent social service eye Clinics should be identified in the developing country to be visited by VOSH teams. Please contact a member of the VOSH board if you need help finding contacts in the country of interest. The clinics should be staffed by the ophthalmologists and or optometrists in the region along with the VOSH team. The goals of these clinics should be to be self-sustaining and to eliminate avoidable blindness from disease and refractive error, by supporting the local infrastructure. Ideally patients in these clinics are charged fees on a sliding scale based on their ability to pay. The very poor receive free care.

Clinics should wish to partner with visiting eye teams by providing for the eye care needs of those patients who require care beyond the scope of the visiting team. Visiting teams significantly help Clinics achieve the regional goal of elimination of avoidable blindness. To provide care for those patients referred to a Clinic, Clinics may need the financial support of the visiting team to cover the cost of care for each patient. In this way, the visiting team will be making a more comprehensive humanitarian contribution to the people of the country.

Logistics:

  1. Visiting teams will work closely with the Host Clinic administrator and/or outreach coordinator in trip planning. Scheduling should be carefully planned based on the calendar schedules of Clinics. The Trip confirmation should be completed at least 2 months prior to the visit to enable Host Clinics to get the needed permits as well as plan for the logistics necessary.
  2. Visiting teams to cover all their own costs for travel, lodging, food, transport, translators and any other requirements they may have in country not provided by Host clinic.
  3. Teams will bring their own examination forms.
  4. All surgical patients should be supported with cost of surgery being paid to the Clinic ($price to be determined/- per cataract surgery and $ for a new glasses if not able to be provided by the VOSH team). This includes patient evaluation cost. Another option could be that they pay the Clinic $ for a cataract surgery but also supply the IOL, Viscoelastic and sutures for surgery. These supplies are often available from organizations such as SEE (Surgical eye expeditions).
  5. Visiting team to budget for these costs in advance of the trip and provide payment at the end of the visiting teams work.
  6. Communicate with the Clinic hosts the number of patients the team can treat each day.

CLINIC HOST SUPPORT TO THE VISITING VOSH TEAM: Hosts will provide the following support to the visiting VOSH team:

  1. Meeting visiting team at airport
  2. Pre-arrange for lodging, food and ground transport for the visiting team
  3. Pre-arrange location for the visiting team to work based on regional needs and outreach history
  4. Make arrangements with local authorities for teams clinic facility
  5. Arrange for patient volume each day of clinic operation based on teams’ capacity.
  6. Provide one ophthalmologist or optometrist at the clinic site each day if available.
  7. Provide translators
  8. Arrange transport of surgical patients to main clinic for surgery day
  9. Other needs the team may have can be discussed with Host Clinic outreach director.
  10. Whenever possible a host representative should be appointed to follow up with selected patients, including those with high refractive error who received glasses, those with ocular pathologies that were treated with topical or oral medications for acute or chronic conditions, to assess outcomes. There should also be a source for this designee to report to if outcomes are not as projected and to replace lost or damaged eyeglasses.

Date: January 2, 2014

Please note: VOSH-International posts the above guidelines for the use of visiting optometric teams. Use of these guidelines, or any part of them, as recommendations for team organization and possible standards of care, is purely optional and creates no legal obligations of any type whatsoever.

Updated COVID-19 and VOSH Humanitarian Clinics Advice

VOSH/International recently consulted its US and International Chapters about the feasibility and timing to restart our humanitarian clinics. While the vaccination process continues with different levels of success depending on availability and acceptance, it is evident that vaccine inequity and the availability and reliability of data in several countries are issues we need to consider.

Even if already vaccinated, our chapters are still concerned about the wellbeing of our volunteers and patients.  Some chapters, are organizing clinics locally where they are better able to comply with the existing safety requirements and respective state/country regulations.

The COVID-19 pandemic is being experienced quite differently depending on state, region, country, vaccine availability, vaccine acceptance, and the spread of SARS-COV-2 variants. Most VOSH chapters are not holding clinics or traveling internationally in 2021.

Thus, VOSH/International is slightly moderating its overall guidance against clinics and travel issued in late March 2020 and renewed in January 2021. This will be reviewed and communicated on a quarterly basis.

If a VOSH Chapter choses to hold a clinic or travel internationally, we highly recommend that the chapter performs due diligence to comply fully with the requirements established by the visited country, ensures all VOSH volunteers are aware of and follow strict safety guidelines and all existing protocols and regulations of the country, and keeps the principle of “do no harm” embedded in all its decision making. As always, the wellbeing and safety for VOSH volunteers and our patients is of utmost importance and central to any decision-making process. We have published our updated clinic guidelines with best practices to be observed in this new context. VOSH chapters in specific countries are using protocols that need to be considered as well. You can download VOSH/International clinic guidelines here.

*VOSH/International is formed by autonomous US and international chapters that are fully and only responsible for their activities, fundraising and decision-making.  VOSH/International can only provide recommendations based on our best knowledge and information at the time.

Also please keep checking the following sites with official and most recent updates:

World Health Organisation: https://www.who.int/emergencies/diseases/novel-coronavirus-2019

US CDC: https://www.cdc.gov/coronavirus/2019-ncov/travelers/when-to-delay-travel.html

US Government Travel Advise: https://travel.state.gov/content/travel/en/traveladvisories/COVID-19-Country-Specific-Information.html

Thank you for your hard work and dedication to improving vision and eye health throughout the world.

John Daniel Twelker, OD, PhD, FAAO, FVI

President, VOSH/International

July 2021