Leonard Yuen gives a diary account of his tour of the Caribbean and takes a look at the different ophthalmic screening programmes
The Caribbean islands are often seen as a homogeneous tropical destination, but in reality each island has its own distinctive "personality." Their reputation for warm weather, spectacular scenery, and friendliness have made them a target for holiday makers, and now they are becoming increasingly popular as an elective destination for students wanting to escape the winter months.
Common health problems on the islands are diabetes and hypertension. Diabetic eye disease comes in many forms, including diabetic retinopathy and cataracts, which accounts for 50% of blindness (an estimated
17 million people) worldwide. Many complications can be detected early and treated, so screening programmes for diabetic eye disease are essential.
With this in mind and, after a great deal of time and planning, I arranged to island hop to compare differences in health care and culture. Visiting 13 different islands gave me insight into the impact of politics and the importance of funding and education to establish effective screening and a good healthcare system. It was intriguing to see vast differences among the islands in spite of their close proximity.
The journey
My journey started on the cosmopolitan island of Trinidad, the southernmost Caribbean island, just off the Venezuelan coast. Then I moved north through the Windward Islands, which form a barrier between the Atlantic Ocean and the Caribbean Sea, the
Leeward Islands, the Virgin Islandsincluding industry mogul Sir Richard Branson's Necker Islandto Puerto Rico.
The destinations
Trinidad was a fascinating place to start. It has a population of over 1.3 million people of African, East Indian, Chinese, white, and Syrian descent. Only two hospitals have ophthalmology departments. Its lack of training schemes for general practitioners means that only a small number of referrals are made to the departments, and this only happens if there are symptoms or signs on examination.
Cataracts are treated with phakoemulsification (similar to vacuuming the lens out) and diabetic retinopathies with laser treatment to prevent the growth of new vessels. Vitrectomies to remove blood in the vitreous body are rarely done because experienced personnel and equipment are lacking, a common occurrence in the Caribbean.
Next stop was Grenada, the spice island, so called because of the large quantities of clove, mace, and nutmeg that are cultivated there. Its spectacular beaches provided a great place to relax, especially Grand Anse, a 3 km stretch of dazzling white sand. Unlike Trinidad, Grenada boasts weekly specialist diabetic eye clinics that begin to screen patients with diabetes immediately after diagnosis. Their coverage is high, and only a few eye cases go unnoticed.
Banana harvest in the northern village of Mount Young on St Vincent
This contrasted starkly with the picturesque islands of St Vincent and the Grenadines. The islands are poor, with only one screening programme run with the help of Dr Treacy, who flies in from Minnesota every fortnight. Project SCENE was implemented in 1999 with the aim of helping fight visual loss, and doctors from North America offer training seminars to general practitioners and ophthalmologists. Treatment is still limited, but there are talks of introducing new equipment from the United States.
With its splendid beaches and scenery, notably the breathtaking Pitons and impressive waterfalls, St Lucia is not only a popular tourist destination but has provided the backdrop to the films Dr Doolittle, Water, and Superman II. St Lucia has support groups for visually impaired people only if they live on the south of the island. The Blind Welfare Group provides care to patients with visual loss, and Victoria Hospital in Castries, the capital, provides laser treatment and cataract surgery.
Guadeloupe and Martinique are essentially pieces of France transported to the tropics, where language and customs have adapted to the climate. Like France, they provide an excellent heavily funded healthcare system, which results in a high percentage of diabetic eye cases being treated.
I visted Dominica, Antigua, St Kitts, Nevis, and Anguilla (called "the Eel" in Spanish because of its shape) on a weekend, and the project was put on hold. Nevertheless, I got the impression that health care is limited, partly because of poor funding. But I was intrigued to learn that the world's oldest person lives in Dominica. Elizabeth Po Ma-Ma is 126 this year.
Carnival in Trinidad
Sint Maarten or Saint Martin is a peculiar island shared amicably by Holland and France after an agreement made in the 1648 Treaty of Mount Concordia. The split means that the island's health system runs according to its respective ruling countries.
The British Virgin Islands was the most interesting place I visited. A self contained crown colony with a governor appointed by London, it comprises some 60 islands, islets, rocks, and cays, of which only 16 are inhabited. The only hospital, Peebles, provides an operating theatre but no eye department for the 25 000 inhabitants. A private ophthalmologist told me that he is the only ophthalmologist on the islands, and no screening programmes exist. The three general practitioners on the other islands are responsible for follow up after any intervention.
The last destination on my travels was the smallest of the Greater Antilles, Puerto Rico. This sprawling Spanish speaking country is hugely influenced by the United States with its shopping malls, industrial zones, and wide motorways. San Juan is the capital, and the hospital is well funded, providing treatment for cataracts and retinopathies with the most advanced surgeons and technology in the Caribbean.
Overall, I thoroughly enjoyed my trip and would fully recommend it to anyone who wants to experience different cultures and healthcare systems in a hot tropical climate.
Water taxis - the preferred way of getting from beach to beach in St Lucia
