Guatemala At A Glance
Guatemala, the most populous country in Central America, is a land of rain forests, mountains, grasslands, and Mayan ruins. But, with over 60% of the country’s population living in poverty (1), it is also among the poorest thanks to a civil war that began in 1966 and lasted more than 30 years (2). Today, access to health care is still limited, especially in rural areas.
Most of Guatemala’s population is clustered in the south and the majority of the country’s healthcare is located there (2,4). The northern grasslands and rain forests are rural areas where healthcare is very limited. Many of the people living here belong to indigenous tribes of Mayan descent. For them, cultural beliefs about sickness can sometimes be an additional barrier to receiving appropriate care (4).
Eye Care in Guatemala
As is the case with most countries outside the United States, the definition of an optometrist in Guatemala is different from ours. For example, The Universidad Galileo in Guatemala City offers a two-year technical degree in optometry, but the courses focus mostly on refraction and little is taught about diagnosis and treatment of eye diseases. This is because it is the ophthalmologists in Guatemala that provide most of the country’s eye care. Many optometrists work with ophthalmologists, but the optometrist handles refraction while the ophthalmologist checks ocular health and performs surgeries.
Visualiza is a non-profit organization in Guatemala City. It also operates several social service clinics in the Peten, Guatemala’s most northern department. Its optometrists and ophthalmologists serve the population of Peten as well as some of the neighboring departments. Patients pay a low cost for prescription glasses, cataract surgery, and other procedures (5).
Enfoque Ixcan is another non-profit clinic located near Guatemala’s northwestern border of Mexico. Local eye health promoters have been trained to refract, select appropriate eyeglasses, and screen for eye diseases.
Dr. Scott Pike of Pacific University College of Optometry founded Enfoque Ixcan in 2002 and continues to be heavily involved. He answered some questions about optometry in Guatemala:
Q & A with Dr. Scott Pike, Pacific University College Of Optometry
Q) What are the most common eye diseases in northern rural Guatemala?
A) Cataracts are the most common. When I started working in the Ixcan 20 years ago, many people didn’t know about cataracts. This is still true in many areas. People know that when they get old, they will become blind. They don’t know that there is a surgery that helps you see again. At first (in Ixcan) there was a lot of fear. People were afraid to make the trip and afraid of the surgery. One man told me he heard that the doctor would take your eyeball out of your head, work on it, and then put it back in! Finally, a few brave people consented to have the surgery and that helped calm fears. Now, we take them 20 at a time for the surgery.
Q) Are over-the-counter (OTC) eye drops available at pharmacies in rural areas? What about prescription drops?
A) The rural areas have pharmacies, but they carry only OTC drops and ointments. The only place to get prescription eye drops is at an eye clinic, which is a big problem for patients with a disease like glaucoma. If the doctor prescribes a beta blocker, the only place the patient can get it is at the clinic, which is likely several hours from home. Even if patients have access to the medication, they likely are unable to afford the drops. This is why first-line therapy for glaucoma here is surgery.
Q) What can Optometry students in the United States and Canada do to prepare for international optometric service during their careers?
A) If you have an interest, act on it! Get involved in SVOSH or other service trips. Go on a trip and see what it’s like. Go to conferences that focus on service, public health, etc. Meet international health people.
You can also develop an interest. That’s what happened to me. I had no training or mentorship when I got involved in Guatemala. The idea found me. I went to Guatemala to visit a friend who was working in human rights during the 1990’s. I spoke no Spanish, but I went anyway and met Pedro. One year later, I went back and asked Pedro if he wanted to help with an eye care project. I had no idea what I was missing out on before I got involved.
“You must give up the life you planned in order to have the life that is waiting for you.”
– Joseph Campbell