It’s a winter day at the Illinois Eye Institute, and third-year student Vivien Yip has a jam-packed schedule, filled with classes, clinic and multiple extracurriculars. But she makes sure to carve out time for one particular patient, an 80-year-old coming in for a consultation about his upcoming cataract surgery.
Man Wong is traveling from Chicago’s Chinatown neighborhood–about a mile from the IEI–and he speaks only Cantonese. The language barrier can make the prospect of eye surgery confusing and frightening. Fortunately for him, Yip is fluent in Cantonese and was in the clinic to translate at the man’s initial visit and his pre-surgery consultation. She’ll do her best to be there for any post-surgery visits, too.
“I want to be around so I can explain to him what to expect and what his vision will be like after the surgery,” says Yip, who was born in Hong Kong and grew up in Toronto. “My Cantonese isn’t perfect, but I try my best and I think patients like him appreciate having someone who understands them and where they are coming from.”
To say Chinese-speaking patients appreciate having a trained optometry student accessible to translate is an understatement. The availability of these students at the IEI has been instrumental in bringing in patients from Chinatown who might not otherwise get the vision care they need. In turn, the patients give the students experience learning to communicate about eye exams and treatments in their native or second language.
This patient-student relationship grew out of another equally important partnership: the one forged in 2001 between ICO and the Chinese American Service League. CASL is the largest, most comprehensive social service agency in the Midwest dedicated to serving the needs of Chinese Americans. It provides child services, elder services, employment training services, family counseling, and housing and financial education to more than 17,000 clients each year.
This past December, CASL honored Leonard Messner, OD, FAAO, ICO’s vice president for patient care services and executive director of the IEI, with a volunteer award for his work to establish, maintain and grow the partnership between ICO and CASL. Esther Wong, executive director of CASL and one of the organization’s founders 35 years ago, says the honor is well deserved because the program has brought eye care to people who may have never seen an optometrist before in their lives.
“It has been an invaluable benefit, especially for the seniors,” Wong says. “The Chinese do not emphasize preventive medicine. They don’t do anything until something is wrong. So their eyes are the last thing they think about unless they can’t see. But now they are educated on the importance of eye care, and Dr. Messner has arranged it so it’s affordable for them to get care, and they have someone there who speaks their own language.”
For his part, Dr. Messner says the relationship with CASL is equally as invaluable to ICO.
“It’s a patient population that we’re honored to serve,” Dr. Messner says. “It’s our mission to serve all in need, and with the Chinatown community being right down the street, it’s an obligation and privilege of ours to serve their needs. We recognized very quickly there were a lot of eye care needs within that community.”
The roots of the program began with David Lee, OD, PhD, a longtime ICO professor who now serves in an emeritus capacity. Dr. Lee has been a volunteer with CASL for more than 20 years, including seven on its board. When CASL opened a new youth center around 2000, Dr. Lee–an expert table tennis player–volunteered to teach the game there and discovered the conversation often turned to his day job at ICO.
“There were so many questions as soon as they found out I was an optometrist and a professor at ICO,” says Dr. Lee, who was born and raised in Hong Kong. “Many of them had never gone for an eye exam. So I would answer their questions and then I started giving talks and trying to help those people. If there was something I could do to help, I would, including sending them to the IEI. When I started at ICO in 1981, there were practically no Chinese patients at the IEI even though we were a mile away from Chinatown.”
After seeing the scope of issues within the Chinese community, particularly the senior citizens, Dr. Lee realized there had to be a way to formalize the relationship with CASL and regularly get people to the IEI for exams and treatment. So he brought the idea to his friend Dr. Messner, and together with CASL they began laying the groundwork for a program to educate the Chinese community about their vision health and ensure they received regular vision care.
Dr. Lee began holding lectures about vision issues and meeting with the different CASL groups, not only seniors but also parents of young children and school-age kids, and adult groups. He encouraged them to get regular eye exams and seek treatment for any problems they may be having. What he found was exactly what he suspected: The vision care needs were deep, varied and largely ignored.
“At the end of the talks, they would have so many questions they wouldn’t let me go,” he says. “A lot of these folks were first generation immigrants. They weren’t highly educated–they came from rural China, some of them maybe 30 or 40 years ago, and were not rich or wealthy. They had not seen an eye doctor for many years, and those who did were refraction-only. Many of them had hidden eye problems.”
Finding the Translators
After the first wave of talks and meetings with residents, Dr. Lee identified about 100 seniors who needed to come to IEI for exams. “That meant we had a huge problem because none of them speak English and I cannot see 100 of them at the same time,” he says.
Unlike when Dr. Lee had to rally a couple students to help him out in the early days of the program, those who are bilingual now sign up through ICO’s Multicultural Student Association to be translators. Currently, about 11 percent of ICO students are of Chinese descent, and a fair number of them speak the language. If a Chinese-speaking patient schedules an appointment, clinic staff tries to ensure a fluent student is in that day. If there isn’t a student available or the patient did not schedule in advance, IEI staff will try to find a student around campus to come to the clinic and assist.
“It worked very well from the patient standpoint and gave them a great sense of relief,” Dr. Messner says. “What we didn’t anticipate was the benefit to the optometry students. They enjoy giving back to their heritage and their community.”
After they had seen just the first 39 patients, the need became very clear. Among them, a staggering 67 percent needed glasses and more than 50 percent had some form of eye disease that required medical or surgical intervention.
With that data in hand, Dr. Messner went to the ICO board–of which Esther Wong was a trustee from 2000 to 2003–to make the partnership official. They agreed immediately and the partnership has been going strong since. “The way Dr. Messner created the program, the board was delighted to see this is what we are doing for our local community, so it has continued,” Dr. Lee says.
For patients without health insurance, IEI created the Vision of Hope Health Alliance to take care of their eye and vision needs. With CASL on board as a founding VOHHA partner, the program was ultimately funded by the Robert Wood Johnson Foundation.
“CASL is a wonderful organization for us to be partnered with,” Dr. Messner says. “We try to support each other, and that is easy to do because we have aligned missions–taking care of the communities in which we reside.”
Growing and Evolving
Since that first wave of patients in 2001, the partnership has grown into an integral part of the training at IEI and the services offered at CASL. Grant money from the NIH has funded some vision screenings at CASL, involving several faculty and staff members for a day, and those patients are referred to the IEI as needed. ICO professor and assistant dean for research Yi Pang, MD, OD, PhD has been part of those screenings and says it is always gratifying for both the patients and the students.
“These patients really want to have their vision taken care of, but the big thing for them is that language barrier. They have no idea what to say or what they should do,” Dr. Pang says. “And many of our Chinese students want to see Chinese patients and learn to treat them. Many will come to me to ask for these opportunities. So this is rewarding for both the patients and the students.”
Before she left to do her externship in North Carolina, Stephanie Kwan was often one of the students called to assist because she is fluent in Cantonese. The fourth year is grateful to have had the experience because after graduation she is planning to go back to Toronto and treat the Chinese community there. She says her experience trying to treat the IEI’s Hispanic patients without knowing any Spanish has made her understand even more what Chinese patients feel like if she or another translator is not available.
“I can understand how tough it is for patients if the communication isn’t there,” Kwan says. “They want to tell you something is wrong with their vision but they can’t get their point across. The Cantonese-speaking patients are more comfortable when I walk in and they ask me if I speak Cantonese. When I say yes, they tell me everything.”
Wong says Kwan’s plans are precisely the result she wants to see from the program–optometry students trained to treat patients in their own language, then going back into those communities to set up practices.
“We are from the social services side, so we like to see Chinese students go back and serve their own communities,” Wong says. “If they graduate and don’t know what a cataract is in Chinese, they won’t go back. It’s a good learning experience for them.”
Jacqui Cook is a freelance writer in the Chicago suburbs. She may be reached at firstname.lastname@example.org.