Social Determinants of Health

Why I’m passionate about medical anthropology and public health: Sharing my story of vision care (pt. 1)

In 3rd grade, my math class was playing Around the World—a game where whoever solves a multiplication problem the fastest can go “around” the classroom—to help us memorize our times tables. Every time it was my turn, I stood up, but I was never able to answer. 

What numbers is everyone looking at? Why can’t I see them? I thought.

In reality, the multiplication cards were being shown at the front of the classroom. But, what I saw as “blank space” was actually filled with numbers I wasn’t able to read. This was when I realized that I suffered from a visual impairment: myopia. In third grade, I already had developed a prescription of -3.0 diopters, which prevented me from seeing faraway objects.

As I grew older, experiencing the difficulties of myopia firsthand gave me a better perspective of the challenges of living with visual impairments in day-to-day life. This fostered in me great gratitude that corrections, like glasses, were accessible to me and my family. Furthermore, I became fascinated by the anatomy of the eye and how visual impairments could affect one’s perception of the world. 

My curiosity sparked me to learn more about these disorders. One October Saturday, I drove from Austin to San Antonio to visit an eye clinic (the Lions Sight Research Foundation’s Mobile Eye Clinic) to learn more. I was amazed to see that the clinic was actually a repurposed truck which fit an assortment of optometry equipment, children’s toys, and sitting areas inside.

Inside the mobile eye clinic was optometry equipment, children’s toys, and sitting areas.

Mr. Lloyd, the leading ophthalmologist, greeted me on my arrival and showed me around the room. As I learned, this clinic was entirely volunteer-run and founded to provide free eye care to low-income areas in San Antonio. He introduced me to his team of volunteers and taught me how to use each piece of equipment. Under his guidance, I became familiar with each machine that was specialized for a specific test: the visual acuity examination, the IOP (intraocular pressure) measurement, and the visual field test. 

Although the screening machines were fascinating, my most enjoyable memories happened as I interacted with patients. After the clinic opened and patients began coming in, I had the opportunity to talk with them and hear each of their stories. Some had come to the clinic because they felt their vision had been deteriorating. Others came because health services they ordinarily couldn’t afford were now being offered for free. Many had last seen an optometrist more than 5 years ago, and some had never seen one in their entire lives. Each person I talked with had a unique background, and one woman shared a story that touched my heart (for personal privacy, I have changed her name to Garcia).

Garcia was a Hispanic grandmother whose daughter had brought her to the clinic as she was concerned about her recent falls at home—perhaps she couldn’t see objects properly? As neither of them could speak fluent English, I used my limited Spanish vocabulary to try to better understand their situation. She explained they were from an extremely low-income background, and they feared the cost of diagnosis and treatment would put them in even greater financial trouble, which led them to search for free clinics like this one.

After diagnosing her glaucoma and cataracts, Mr. Lloyd told her the importance of visiting an ophthalmologist to treat her disorder. However, her family was initially unwilling to go because of the financial burden—I felt deeply sorry for them. As more patients arrived, I learned that many others suffered from similar situations. Through these shared experiences, I began to realize how factors beyond one’s control often affected their health and quality of life. 

Initially, I’d come to volunteer to learn how visual impairments were corrected from a scientific, medical perspective. However, while this curiosity remained, I gradually realized that the problem of visual impairments was much greater than something that could just be solved by eye doctors and technology.

As I saw firsthand at the clinic, socioeconomic, educational, and societal factors had tremendous influence over one’s quality of life. For example, the language barrier could deter communication between minority patients and well-intentioned doctors who couldn’t communicate well with them — this could be detrimental to diagnosing and treating their visual impairment. This problem wasn’t only unique to San Antonio, with a 64% Hispanic population, but throughout America in cities with large minority populations. In addition, other factors — such as socioeconomic status and education level — could place entire levels of health care out of someone’s reach.

I discussed my concerns with a university student there, and she introduced me to the fields of public health and anthropology, explaining how public health disparities were beyond the scope of traditional medicine, but they still had to be addressed. This led public health activists and anthropology researchers to come together to mitigate  health inequality. A new field was born, medical anthropology, that sought to understand the factors resulting in unequal access to healthcare: the social determinants of health (to learn more about these factors, read my previous post on the social determinants of health). 

Today, medical anthropology creates the perfect bridge between anthropology and public health. This field has given our society deeper perspective into the causes of health inequalities, allowing us to prevent infections by reducing underlying risk factors in vulnerable communities. I’m continually inspired by the work they do, as it’s currently not the focus of our healthcare system. I hope that I’ll be able to contribute to this growing movement and help bring awareness to this issue.

Photograph of the truck used for the vision screening.
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