The non-profit Vision Solidaria Program began in 1999 to provide diagnoses and ophthalmological treatment to low-income persons who would not otherwise have access to specialized medical care, and bring solutions to patients with visual impairments, especially those caused by cataract, which is the leading cause of treatable blindness. The program puts special emphasis on offering high-quality surgical care at all times regardless of the patient’s economic status, but always remembering the goal of self-sustainability.





The Vision Solidaria Program (PVS in Spanish) is backed by the Evangelical Lutheran Church of Argentina and directed by Dr. Jorge Kleisinger, president of the foundation of that name since the end of 2007. The program was begun under the auspices of the World Health Organization and the International Agency for the Prevention of Blindness (IAPB), with support from Christian Blind Mission (CBM), the leading NGO in the world in the field of the prevention of blindness, which is a fundamental pillar of the overall development effort.




The program is carried out in the supposedly ‘impenetrable’ Chaco forest in the north-central area of the Chaco Province of Argentina. Poverty and marginalization are the problem here, whether in regards to escaping malnutrition or blindness.


The “Impenetrable” is a region where the country’s most discouraging social statistics are generated. For example, some 66% of the population does not have access to any public facility for dealing with their health problems; and infant mortality is 26.7 deaths per thousand live births, while the national average is 16.8.


The Vision Solidaria Program has been instituted in the Departments of Guemes and Maipu. The two departments have a combined population of 80,000, but the population is widely scattered, and travel to major population centers is not easy. Guemes, which is the larger of the two departments, and which has a larger population, has a land area of 35,487 square kilometers but possesses only 150 kilometers of paved road. Even in cases where the patient can reach one of the more populous places in the province, a surgical solution for cataract is still hampered by the fact that there is only one public hospital that is prepared to perform ophthalmic surgery: the central hospital located in the provincial capital, at the extreme western end of the province. That means that for most inhabitants of the department who want ophthalmic surgery in a hospital, it is necessary to travel about 500 kilometers, with half that distance being over dirt roads and in places where no public transportation exists. Others in more distant locations must make round trips totaling up to 1,400 kilometers to have their problem diagnosed and receive an appointment for surgery, which will then result in a second or third such journey. In spite of these obstacles, the public hospitals are absolutely overcome by their patient load, and cannot cover the active demand, much less the real demand for care.


Today, as is shown by the Rapid Assessment of Cataract Surgical Services (RACSS) survey, we can say that the primary cause of blindness in Argentina is cataract. Except for that study, done in the Buenos Aires metropolitan area, no published study data exists for the north of the Chaco Province nor Argentina. Data do exist, however, for a nearby and similar geographical area: the Republic of Paraguay, where it has been shown that cataract has a 0.4% prevalence rate, and is responsible for 60% of all blindness.


The World Health Organization's VISION 2020, The Right to Sight, Program recommends that in order to control the growth of the number of persons affected by this disease, it is necessary to reach a cataract surgical rate (CSR) of 3000 surgeries/million inhabitants per year. In Argentina there are few planned and structured long-term programs for this purpose, and our CSR is only 1,700 per million, well below the WHO recommendation, with large variation between provinces.


The PVS has managed to increase the Cataract Surgery Rate (CSR: surgeries/million inhabitants/year) in Castelli itself from zero in 1999 to more than 4,000 in 2007. This achievement is important considering that the province to which this locality belongs, the Chaco Province, has an overall CSR of 600 according to a study by the Nano Foundation published in the Archives of the Argentine Society of Ophthalmology (SAO) in 2006 and also reported in the digital journal of the Pan American Health Organization (PAHO: BIREME).




We are currently finishing a vision census of the city of Juan José Castelli. The census consists of a vision test for persons over 50 years of age using the RACSS methodology, to find baseline data and detect persons with visual impairment to be offered solutions. The objective is to declare the locality of Juan Jose Castelli, Chaco free of blindness due to cataract by the year 2012. If a patient does not come in for two appointments, we check them in their homes.


Main Objectives:



1) Return the right to sight to all persons who are unnecessarily blind due to cataract.

2) Achieve self-sustainability. We consider an absolute lack of financial dependence to be an indispensable prerequisite for continuing the program in the long term:

- We do not promote either the expectation of handouts or full-scale welfarism.

- The patient is the provider of his own solution to the extent that that is fairly within his means.

- Other actors in society are also to be involved: Agreements for co-financing and cooperation with city governments, support from businesses and individuals, cooperation with other NGOs, commitment of the Lutheran Church.

3) Declare the city of Juan Jose Castelli “Free of Blindness Due to Cataract” by the year 2012.

3) Reduce blidness prevalence and maintain the CSR in the region, remembering that 80% of blindness is curable (preventable or treatable).






Results:

Our principle parameter is the CSR. The table which follows shows the clear increase in the CSR from 1999 to 2007.





Juan José Castelli Free of Blindness Due to Cataract:



The campaign to free Castelli of blindness due to cataract by the year 2012 is an ambitious project launched in 2005 which will require a joint effort by the community, the Vision Solidaria Program, and government authorities. It will require carrying out a vision census and maintaining an adequate CSR for 5 years.

o Vision census of the entire city

o Monitoring and assistance for cases of low vision. Attention at the base clinic or in patient homes.

o Access to high-quality surgery regardless of the socio-economic status of the patient.



Strategy:



Based on charity for the needy and love for one’s neighbor.

We believe that charity is not synonymous with handouts, and that “Justice lies not in treating all people equally, but in treating them according to a just appreciation of their possibilities”.

o Bring eye care to the inhabitants of the region by overcoming the classic barriers that block people from reaching adequate treatment. These barriers are geographical, cultural, economic, and due to lack of information about the disease.

o Charges for surgery that are adapted to the real ability of each patient to pay, remaining faithful to the principle that the low-income patient should still be the protagonist of his or her own solution to the degree possible.

o Medical consultation at low cost that is accessible to low-income patients, with revenues used to fund the system.

o House-by-house vision census to detect cases of low vision.

o Reduction of surgical costs.

o Annual campaign for to check intraocular pressure (IOP), by taking the IOP on the roadside or in churches.

o Work in association with other institutions. ACAPS (the Argentine Christian health professionals association), city governments, churches.

o Stimulating commercial enterprises to form part of the solution for blindness among the indigent by inviting them to co-finance surgery.

o Co-financing agreements with municipal governments, NGOs, and businesses. That means that financing of surgery would be done between the patient and the co-financier(s).

o Rural eye-health monitoring campaigns in the “Impenetrable” region of the Chaco.


Education for eye-health:

o Promote prevention of blindness, healthcare in general, and eye health in particular for the whole community.

o Spreading the word about visual health:

- Short weekly radio broadcasts on eye health on Saturdays at 7:30 AM (listen online at www.visionsolidaria.org.ar ).

- Talks given in primary and secondary schools.

- The Vision Marathon: held to mark World Sight Day, the second Thursday of October every year. The marathon has significant impact and regional reach. People of all ages participate, but it is especially directed at children and young people from 5 to 25 years of age.

o Annual events to mark World Sight Day (second Thursday of October of each year).




Recognition and Awards


The paper, "The Vision Solidarity Program, the First Five Years: Problems and Solutions in the Organization of a Blindness Prevention Program”, was named the best work on prevention of blindness in Argentina for the year 2005, and was chosen to represent the country at the 2006 World Ophthalmology Congress in Sao Paulo, Brazil.


Declared to be of provincial, social, and legislative interest by the Honorable chamber of Deputies of the Chaco Province on June 7, 2005 in resolution no. 541, proposed by Deputy Juan Jose Bergia.


Declared to be of institutional and social interest by the physician’s circle of the Chaco on June 16, 2005.