Learning About Diversity Through Community Health Eye Care

I feel very lucky to have worked in community health programs. Each community health center has its own character due to the unique community it serves. Each has a similar mission to provide exceptional care for its patients and families, to understand the cultures of thinking within that community, and to serve its individual needs. I have worked at the Dorchester House Multi-service Center in the past serving Vietnamese, Haitian, Hispanic/Latino, and old neighborhood Italian/ Irish families. I’ve been able to provide eye care to generations within families, but also to offer them primary care resources. I now work in a family practice that serves a diverse population that includes Albanian, Greek, and Lebanese patients. Different demographics are at risk for different systemic conditions and eye conditions. Each family or family member has a different story. They may have grown up in the community seeing the same doctor for years. They may have emigrated here and are adapting to a new culture and are experiencing the challenges of finding new health resources.

Today, the students that I work with had a discussion about different types of patients and the advantage of working in a family practice because exposure can vary from infants to elderly, English speaking to multi-lingual, teenagers to working moms, mechanics to attorneys. Every day brings a new perspective and challenge. This exposure is what drives my own passion daily. Often students are apprehensive about facing the challenges of this diversity and about being able to adapt to various situations that may present themselves. They agree, though, that this is one of the things that makes the profession fulfilling.

The students also discussed their concerns about their next clinic site experience, wondering if they are prepared to work at a veteran’s hospital, pediatric practice, or low vision clinic. They are almost finished working with me at this site. It really felt good for me to be able to encourage them that they are ready to move on and to tell them they have been successful. They have a good foundation to build upon in other clinical sites. More importantly, they needed to hear that part of their success in a clinical environment is due to being proactive in learning and being as best prepared as possible for the type of patient they may see.

I also see these students as more prepared to work with any patient, more comfortable having transformed didactic knowledge to clinical care. They aren’t just doing tests, but they are understanding why they do a test. They understand better that their actions help patients. They are eager to see the same patient for follow-up. Their patients are eager to see them. Some patients bring treats or simply their thanks for caring. Recently, one teenager of a patient wanted to look through the teaching tube to see what we were seeing on her mom. She is now interested in becoming an optometrist. Another young patient wanted pamphlets about diabetes for her younger brother. An elderly patient who grew up in the community wanted to bring in a friend to have his eyes examined and to get glasses.

Community health encompasses many special experiences. It is normal for interns to feel a bit anxious at the end of their year. Are they ready to move on to the next experience? I think experience in community health helps them to be ready with a variety of tools to have for a variety of best outcomes.

“If You Hold It This Way, It’s Much Clearer. See?”

“If you hold it this way, it’s much clearer. See?” I smile when I see the look on my student’s face as she pulls the lens into focus correctly. It’s what all teachers live for, the “Ah-ha!” moment when the clinical skill and the classroom knowledge finally blend together. She straightens in her chair, feeling more confident now in her diagnosis for her elderly male patient. Together, we discuss with him our findings and concerns, and I listen as she instructs him on our plan for his future care.

It wasn’t long ago that I was the student, excitedly trying instruments and practicing my newly learned skills. I remember holding a lens and seeing the optic nerve in three dimensions for the first time. It was amazing! I could see the contour of the surface, the blood vessels, the changes in coloration of the structures inside the eye. I remember my first full eye exam on a patient, a sweet woman who was enthralled by the thoroughness of my exam (my instructor was not as enthralled with the time it took me to perform such an exam!). I remember classes and tests and board exams. But my favorite memories are those times when the knowledge finally clicked, when I had my own “Ah-ha!” moments and I was able to really see and understand what was happening in my patient’s eyes. It’s an incredible experience, because it is then that you realize that all the hours spent studying and practicing were all worth it. This is what I love about my job as a NECO instructor. Helping my students “see” for the first time, and (hopefully!) remember forever.

I feel lucky to have found a profession and a career that I feel so passionately about. I never expected to enjoy myself so much at my job! I work with second and third year optometry students at a community health center in the outskirts of Boston, and together we tackle challenging cases and manage a diverse array of problems. I have great colleagues at NECO and in the community of Boston. We often get together and talk about eye diseases and teaching and our craziest case of the day. And when I’ve over-loaded myself on optometry (which happens often), I try to relax with some mindless reality TV or watching the Red Sox (only when they’re playing well, of course!). But by morning, as always, I’m ready to do it all over again.