As Together We See (TWS) grew, our team conducted international vision screenings. In these programs, we’d begin by remotely training volunteers in that region to conduct visual acuity examinations using OcularCheck. In an ordinary year, our team would have conducted these ourselves, but we couldn’t travel due to pandemic restrictions. A few virtual meetings later, our volunteers would be ready to conduct vision screening for their community. After the screening process identified people with an impairment, TWS provided financial support and transportation for hospital visits. The process of organizing a vision screening program—from writing easy-to-understand instructions for volunteers to encouraging community members to get screened—taught me the value of cross-cultural communication in international health initiatives to maximize the number of people who receive help.
In this post, I’ll discuss my thoughts on the social determinants of health in regards to TWS’s international program development. I pieced together connections about public health factors through interviews and whenever possible, validated them through a survey tool administered through the SurveyAnyplace platform.
Our team had little trouble asking the parents of elementary schoolchildren to enroll their kids in TWS’s vision screening program. Every parent, except one, agreed.
I believe TWS’s success may be partially attributed to the program’s location in a school. Indian culture places a high value on education; 84% of participants selected that their child’s education was either “important” or “very important.” This makes sense; due to the high rates of poverty and increasing income inequality in Palanpur, parents may feel that their children’s education can empower them to break the cycle of destitution. As a result of the cultural emphasis on education, a visual impairment can be particularly debilitating, as kids will learn slower than their peers. Hence, due to the connection between visual health and education, parents were happy to have their kids screened.
Yet, there was a different story when it came to adults and more particularly, elderly women, who—although they were happy to send their kids—were reluctant to come themselves. While the causes behind this are multifaceted, I believe gender roles may in part be responsible for this disparity. Some of the women I interviewed were reluctant about coming because they felt leaving their family at home in the evening would be unfair.
Saarya : My husband and kids need me to make dinner for them in the evening, we’re making pav bhaji. It would be selfish of me to leave them hungry and come here [to the vision screening center] for myself…
Indian culture is deeply family-oriented, and women are enculturated in households that encourage them to place the familial needs above their own. As a result, some mothers felt guilty about addressing their own health needs first.
Saarya: Sometimes, things look blurry to me, like the schedule at the bus stop, like 10–15 meters away… I can’t see that far, but I think that’s just normal at my age. Besides, I don’t go out very often, so I think I will be okay.
To add to this, some women felt that due to their position as a homemaker, they didn’t need treatment. Hence, in rural regions where traditional gender roles are magnified, such roles may serve as barriers to health.
Together We See trained volunteers in the Losimingori village in the state of Arusha to screen tribal community members for visual impairments.
Due to the lack of access to post-secondary education and the lack of nearby hospitals, there was limited medical knowledge of visual impairment in Losimingori (on average, people lived three hours away from the nearest hospital, and only one person from the village had access to a college education). When limited information is available to people about visual impairment, impairments aren’t recognized at their onset but rather after they’ve too become severe to cope with. This was reflected in the greater rates of uncorrected moderate and severe visual impairment our team observed.
Losimingori is a sedentary village of the Maasai peoples of Africa, but other groups in the Engaresero region have continued their longstanding tradition of nomadic pastoralism. As pastoralists rely on cattle herds for nearly every aspect of sustenance, pastoral groups’ diet is heavily dependent on milk, cattle blood, and raw meat—in fact, warrior men exclusively consume these three foods for several decades of their life. While this diet reduces the risk of cardiovascular and dental conditions, it lacks nutrients that are key to visual health—for example, vitamins C and E are known to prevent age-related eyesight problems (e.g., macular degeneration) but they are lacking in red meat and milk. Hence, if TWS conducts vision screening programs for pastoral groups, we find greater occurrence of age-related visual impairment.
At the time of writing, TWS just finished conducting a vision screening program in Sai Yok, Thailand and is beginning one in Roatán, Honduras. I look forward to analyzing the interconnectedness of culture and health in these parts of the world.
Campbell, T. (2015, July 17). Masai and Inuit High-Protein Diets: A Closer Look. Center for Nutrition Studies. nutritionstudies.org/masai-and-inuit-high-protein-diets-a-closer-look/
Lipton, M. (2020). How Lives Change: Palanpur, India, and Development Economics. The Journal of Development Studies, 56(1), 221–222. doi.org/10.1080/00220388.2019.1666460
Meixner, M. (2018, July 25). The 9 Most Important Vitamins for Eye Health. Healthline. healthline.com/nutrition/eye-vitamins
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