Guyana, one of South America’s most diverse and unique republics, is turning the corner on several of its biggest healthcare concerns. According to the World Health Foundation, the country has made significant improvements in the nation’s life expectancy, maternal and child mortality and immunization rates in the past eight years.
Chronic disease is now a major public health focus in Guyana, particularly diabetes that is currently at a significantly higher rate than the global average. The World Diabetes Foundation, in partnership with the University of Toronto, Orbis International and Guyana’s Health Ministry, launched the five-year Guyana Diabetes and Foot Care Project to address this problem. EyePACS has been part of this project for two years, supporting their diabetic retinopathy screening program. (See our article of August 8, 2016.)
“As EyePACS expands to more diverse settings,” said Dr. Jorge Cuadros, OD, PhD, Director of EyePACS, “we continue to learn from our collaborators how to refine our system to accommodate global needs and conditions. Completing our third visit to Guyana has helped us to adapt EyePACS to locations with limited internet connectivity. Together with the Guyanese project team, we have been able to customize the software to automate user functions and create a workable solution for clinics with low bandwidth.”
EyePACS works with its partners to keep patients on track in their DR screening by providing equipment, training, and maintenance for an effective diabetic retinopathy screening program. This year we worked with optometrists Lani Lord and Fionna Todd; Fionna established the program in 2016.
Dr. Brian Ostrow, MD, FRCSC, on the faculty at the University of Toronto Department of Surgery, is the project leader and also directs related research. Another leading force has been Dr. Shailendra Sugrim, M.D., Consulting Ophthalmologist at Georgetown Public Hospital, and, of course, Dr. Michelle Ming O.D., also of Georgetown Public Hospital, has been one of the “guardian angels” of the project from its inception.
Our ongoing work with the Guyana team fosters EyePACS to explore new models of global telemedicine, because each international program has its own local cultural, regulatory, and geographic realities that must be addressed. In Guyana, unlike in most U.S. eye care scenarios, the screening and diagnosis are generally accomplished in the same visit to a public eye clinic. The EyePACS software and store-and-forward system then provides the foundation for categorizing and tracking patients. Guyanese optometrists are trained to evaluate the EyePACS images on site, and if they need further support, they can consult the EyePACS web site and network of eye care professionals to weigh in on questionable cases.
On this latest visit, we fine-tuned the workflow to successfully identify, screen and refer patients for treatment. Dr. Cuadros shared with Guyanese eye care professionals the importance of establishing a reliable system for early detection and triage. Local optometrists and nurses were taught how to provide digital retinal screening with the Canon CR-2 AF camera. Eye care specialists were trained in the grading of DR levels based on those digital retinal photos, and they were all securely connected to the EyePACS cloud-based archive system.
Dr. Cuadros summarized this latest visit: “While we generally focus on technology as a key to chronic disease management, we always emphasize that the human aspect of healthcare remains paramount. In Guyana we saw superb communication between professionals and patients, with a priority placed on a clear understanding of the disease and its impact on vision. We saw healthcare professionals asking the right questions, accurately gauging patient comprehension, and providing appropriate lifestyle recommendations.”