Report: St. Jude Hospital (St. Lucia) laser program for diabetic retinopathy, by Jeevak Lal, MD
I have been volunteering at St. Jude Hospital, St. Lucia, since 1992. I was introduced to St.Jude by Bishop Felix, head of the Catholic church on the island. A story of our meeting will be sent shortly. A couple of years ago he was made a cardinal by the Pope, the first from the English speaking islands of the Caribbean.
Our thrust since 2002 has been the management of diabetic retinopathy. There were no lasers in St. Lucia at that time. So, we raised funds and purchased two, a green light diode and a portable YAG.
The following report gives an idea of the work so far. It's a desponding situation. While we have treated some patients, the untreated patients are probably very many.
Diabetes is a growing global health crisis. Diabetic retinopathy is of considerable concern to ophthalmologists. It is the commonest cause of irreversible visual loss in adults. Presently, much verbiage is being expended on the problem. But unless ophthalmology rolls up its sleeves and gets to work swiftly, the profession will be reduced to its knuckles and knees. And the duel with retinopathy might well be lost.
St. Lucia is rated to have one of the highest incidences of diabetes in the world. It is a major health issue on the island and retinopathy is an affliction that burdens many. Conservative estimates are that approximately15% of the population of 160,000 is diabetic. This translates into about 24,000 diabetics (48,000 eyes) on the island. World Eye Mission (WEM) is finding a retinopathy rate of about 30%. If this is reasonably accurate, it would suggest that about 14,000 eyes have retinopathy.
Since there were no lasers available in St. Lucia for indigent patients, WEM acquired two portable units. Since August 2002, these have been brought to St. Jude Hospital on 24 occasions. There have been 3954 clinic visits and 689 laser procedures have been performed. The vast majority of procedures are for retinopathy but some are also performed for narrow angle glaucoma and opacifying posterior capsules.
The visits are busy. Work spills over late into the evenings. Week-ends are corralled to complete the lasering. It would be impossible to do it all without the unstinting support of the eye-clinic’s staff. They never complain. To them, a tip of the hat.
WEM’s present resources are inadequate to solve St. Lucia’s problem. But we will continue to do what we can. Our effort, specifically targeting diabetic retinopathy, may well be the only one of its kind in the Eastern Caribbean. As such, it could serve as a stimulus, a template, for others to emulate and expand upon. For all who support WEM, that would be a gratifying development. Many eyes would be preserved and more lives, families and communities enriched. That is what this is all about.