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Sandolsam Cha

"Vision is an integral component of one's quality of life—and early detection via regular vision screening can ultimately save someone's sight," Cha says.

According to the Centers for Disease Control and Prevention, the number of blind and visually impaired people in the U.S. is predicted to double by 2030—with a disproportionate share of that disease burden resting on people who are uninsured and who lack access to preventive vision care and screenings.

In New Hampshire and Vermont’s Upper Valley region, Schweitzer Fellows Sandolsam “Stone” Cha and Edmund Tsui are working to stem that tide. The two Dartmouth Medical School students are promoting visual health among uninsured adults by implementing a vision screening and referral program at the Good Neighbor Health Clinic (GNHC).

“We hope to identify individuals who are at risk of developing potentially blinding diseases, as well as those who have already developed early signs of eye diseases,” Tsui says.

Why did you decide to develop your particular project?

Tsui: Over the past few years, I have become increasingly enthusiastic about working to improve vision health in the Upper Valley in New Hampshire and Vermont.

After beginning medical school at Dartmouth, I discovered that GNHC was a major source of free healthcare to the Upper Valley’s uninsured population. Once we were in contact with GNHC, I realized that we were in a position to create a high-impact and streamlined vision-screening program serving the GNHC’s existing patient base, which was not regularly receiving eye exams.

Vision screening is quick, requires minimal equipment and can provide immediate insight into a patient’s ocular health. Along with community optometrists and ophthalmologists, we aim to streamline the referral process for patients who require additional examination.

Cha: Vision is an integral component of one’s quality of life—and early detection via regular vision screening can ultimately save someone’s sight.

As Edmund said, vision screening is quite low-tech. It’s also relatively easy to perform—allowing us to be trained in a short amount of time and make a significant impact using very little resources.

By working with the uninsured and underserved population already in the GNHC system, we are able to easily reach out to patients visiting the clinic, get the word out about the vision screening program, and refer patients to eye exams utilizing GNHC’s preexisting relationships.

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"I hope this project will expand to the other free clinics in the Upper Valley, allowing us to recruit more medical students to assist in the screening program," Tsui says.

What do you hope will be the lasting impact of your project on the community it serves?

Cha: In the short run, we hope we will be able to help patients with visual acuity problems by helping them to procure new prescriptions. We also hope we can detect eye diseases that would otherwise go unnoticed until they were severely impacting a person’s vision.

In the long run, we hope to encourage annual eye exams—a crucial part of preventive medicine—for GNHC patients. With the Schweitzer Fellowship’s emphasis on project sustainability, I hope that free vision screening will continue to help preserve the eye health of low-income people in the Upper Valley.

Tsui: Our program has been fortunate to have a very positive response from the community. Our vision screening clinic initially ran every other Thursday evening, but given the level of interest in our vision screening program, we’ve been running it at least once a week.

We hope that we have improved the vision health of the Upper Valley community and educated patients on the importance of regular eye exams and the signs and symptoms of potentially blinding diseases.

I hope this project will expand to the other free clinics in the Upper Valley, allowing us to recruit more medical students to assist in the screening program and allowing sustainability of the program after the project year is complete.

What do you think is the most pressing health-related issue of our time, and how do you think it should be addressed?

Cha: The most pressing health-related issue of our time is the lack of universal access to healthcare. It is inexcusable that this country, which leads the world in medical and pharmaceutical technologies, still has 40 million uninsured and underinsured people.

I believe it is far more pressing today to guarantee universal access to healthcare than to develop new fancy equipment or powerful drugs. I see a horrifying discrepancy in the fact that while some are over-diagnosed and over-treated from supply-induced demand or “defensive medicine,” others are unable to receive cost-effective preventive measures and end up in emergency rooms with the end-stages of their diseases. As a society, we should agree on universal access to healthcare as a priority and unite to address this dire need.

Tsui: The lack of focus on preventive medicine is a pressing health issue. For people with no health insurance, preventable diseases become everyday issues, leading to lower quality of life and higher financial burden.

To help address this issue, preventive care can be integrated into screening programs. Blood pressure and vision screening clinics, glucose monitoring services, and smoking and alcohol counseling programs can identify at-risk individuals, provide an opportunity for patient education, and/or refer patients to the appropriate medical provider. Medical students can establish and oversee these screening programs, as evidenced by the numerous screening clinics set up at Dartmouth Medical School and across the nation.

What has been the most surprising element of your experience as a Schweitzer Fellow?

Cha: The unity and sense of fellowship with other Schweitzer Fellows. It felt great to do a group fundraising activity with the Dartmouth Medical School Schweitzer Fellows. Meeting and getting to know other Schweitzer Fellows in the NH/VT region was also deeply encouraging. It was refreshing to be with people who share the same passion and vision for service, and who are equally eager about their own projects and sharing tips and ideas with one another.

Tsui: The fact that many adults in the Upper Valley do not receive regular eye exams was a very sobering realization for me. Despite receiving annual physical exams from their primary care provider, some of our patients have not received a full eye exam since childhood. Vision maintenance is often a low priority in the patients’ minds, and in turn, they believe that their deteriorating or abnormal vision is the norm. We hope that our Schweitzer project has been a small step to turning this tide.

What does being a Schweitzer Fellow (and, ultimately, Fellow for Life) mean to you?

Cha: Being a Schweitzer Fellow is closely tied to the reason why I decided to become a physician. Because mental and physical suffering is a universal human condition, the physician’s role in helping patients alleviate such suffering (to varying degrees of success) has universal applications, and provides an opportunity to connect with people in profound and meaningful ways.

Bring a Schweitzer Fellow means carrying out service now instead of postponing service until after medical school, after residency and fellowship, after “I pay off my student loans.” The Schweitzer Fellowship oriented me as a medical student to focus on my vision of serving others, amid a flood of basic science facts to memorize. It grounds me in the reality that those without healthcare access and those who are struggling with health issues do not wait until I am done with residency. They’re also not only living in far-off lands; they can be found right here where I live.

Participation in the Fellowship has shaped my ideas about what it means to be a physician in rural or underserved areas. I am certain that being part of the Fellows for Life network will allow me to gain valuable insights about service, not only from current physicians, but from nurses, lawyers, and other professionals with whom I will certainly be cooperating with in providing healthcare. I also hope to eventually become a mentor myself for future Fellows.

The Schweitzer Fellowship has engrained in me a clear mantra of being a leader in addressing health disparities and serving the underserved. In many ways, this mantra is just as important as the training I receive in medical school to become an excellent clinician.

Tsui: I am very grateful for the experiences I have gained through the Schweitzer Fellowship. From the patients I have met at the clinic, I now have a better understanding about barriers to health care access, and I have learned how to teach the importance of eye care health.

From the other NH/VT Schweitzer Fellows, I have found inspiration in the changes my peers are making in our local and larger community. I am learning that there are many commonalities in establishing community projects, and I am gaining valuable insight regarding successful problem solving. I think the opportunity to work with like-minded individuals is a great platform for inspiration, education, and improvement.  As a future Fellow for Life, I hope to impart curiosity to probe into the needs of our community, passion to make a difference, and guidance for prospective Schweitzer Fellows.

Stone Cha and Edmund Tsui are Schweitzer Fellows in New Hampshire-Vermont. Click here to read more about The Albert Schweitzer Fellowship (ASF)’s NH-VT Schweitzer Fellows Program and the Fellows like Cha and Tsui it supports in creating and carrying out yearlong direct service projects that improve the health and well-being of vulnerable people and communities. To make a gift to the NH-VT Schweitzer Fellows Program—which is supported entirely by charitable grants and contributions— click here.

Each week, Beyond Boulders delivers a new installment of “Five Questions for a Fellow” – an interview series with Schweitzer Fellows across the country and in Gabon, Africa who are leading the movement to eliminate health disparities. For an archive of previous “Five Questions for a Fellow” interviews, click here.

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