Seeing Clearly

Last summer graduate student Natalya Surmachevska traveled from the Ghanaian city of Kumasi to a small village near the border of the Ivory Coast. The remote village was located near a refugee camp established after post-election violence. Surmachevska carried a suitcase filled with nearly 600 pairs of gently used eyeglasses from the United States, which she and fellow volunteers from the organization Unite for Sight would dispense to patients in need.

Desperate for care, residents of the village and refugee camp alike flooded the organization’s makeshift clinic. Surmachevska could describe the day only as “crazy.” A workday estimated to end at 3 p.m. finally came to a close six hours later. Surmachevska finished the day exhausted but energized.

This was Surmachevska’s second trip to Ghana. Her first came in 2008 as an undergraduate student at Lehigh University through the Global Citizenship program. Global Citizenship is a cross-college, multi-disciplinary certificate program designed to accommodate students from all fields. Through a curriculum and two experiences abroad, students examine the questions of meaning and value associated with the theme of citizenship within today’s global world.

“Having that experience freshman year changed a lot of our career goals,” she says of the program. “It was abrupt and shocking, and for many of us, it was the first time traveling out of the country. It was a springboard into other international work I did.”

Guided by Compassion

In many ways Surmachevska is the epitome of the Lehigh student—curious, tenacious and determined. Her research is rooted in the common good, and her educational path is guided by a compassion for others. As an undergraduate student she culled the knowledge she gained through her three majors—biology, international relations and economics—into an interest in public health. She studied abroad in Hong Kong during her sophomore year and shadowed doctors at a medical clinic in Lima, Peru, during the spring break of her senior year.

These experiences encouraged her to stay to pursue a master’s degree at Lehigh, where she now works with Judith Lasker, professor of sociology and an expert in the field of public health.

Eager to stay active between her first and second year in the program, Surmachevska linked up with Unite for Sight for that return trip to Ghana, a decision that provided clarity and direction for her graduate research. The organization supports eye clinics in Ghana, India and Honduras with financial and human resources to eliminate patient barriers to eye care. They partner with existing clinics where eye doctors are unable to meet the patient demand.

Access to Care

On this trip to the West African nation, Surmachevska and other volunteers provided outreach to villages located two to three hours by vehicle from major cities. Clinics in Ghana are located in cities, but the people in need are most often in remote villages.

At each stop, volunteers set up an intake station and a visual acuity station to determine patients’ vision. Using simple instruments, optometrists are able to diagnose patients quickly and easily. Once diagnosed, patients visit a dispensing station where they may be prescribed anything from surgery to simple reading glasses. The glasses and the surgery are provided at minimal cost.

Surmachevska most enjoyed her work at the clinic’s dispensary. It was there that she noticed that patient after patient was suffering from glaucoma, a group of diseases that damage the eye’s optic nerve, according to the National Eye Institute. Left undetected and untreated, glaucoma can result in serious vision loss and blindness.

“This really impacted me because Ghana has the second highest prevalence of glaucoma in the world,” she says. “I saw it a lot. I was finding 20-year-old patients blinded from glaucoma.”

The Glaucoma Association of Ghana estimates about 700,000 people in Ghana are living with glaucoma, about 60,000 of whom have been blinded by the disease. Surmachevska is hoping her master’s thesis will shed light on the reasons behind glaucoma’s prevalence in Ghana.

Research with Vision

Surmachevska, who plans to graduate in May, says there are a variety of complex barriers to glaucoma care in low-resource environments. Glaucoma can be treated medically and surgically. Most optometrists treat the disease medically, using eye drops. But even simple eye drops were a challenge to dispense in Ghana.

“Barriers for using eye drops are financial and psychological,” Surmachevska says. “People don’t really believe that eye drops work. This is both cultural and educational.”

Her data are qualitative and culled from field notes and a blog she meticulously maintained during her work at the clinics. By using a data set of 900 patients from that outreach, she’s looking at the prevalence of glaucoma by age and by symptoms. Working with an optometrist with a shared interest in the topic, Surmachevska analyzed data from 1,000 patients according to gender, age and location to determine the demographic prevalence of glaucoma among patients at her clinic in Kumasi. The study will also help inform her thesis.

“Natalya’s research considers the role of an American volunteer organization in addressing eye health needs in Ghana,” says Lasker. “She is looking at the accomplishments of this NGO in reaching many people without eye care but also the barriers faced by patients in obtaining treatment for a condition that could cause blindness. Experts in the field of global public health are intensely interested in understanding these barriers to improved health.”

As part of her research, Surmachevska conducted a thorough literature review, which turned up few studies examining glaucoma in Ghana—a frustrating, but telling, discovery.

“There’s so little research at the top,” she says. “My literature review rests on research from around the world, but mostly from developed countries. That’s where the research exists because the resources are there.”

While Surmachevska hopes to attend medical school, she plans to switch gears and work in maternal health. Strong research skills, an understanding of how policy and practice are often at odds and an ease of working with patients of varying ages and needs should serve her well.

“Her research, based on direct experience over the course of many weeks, has greatly enhanced her understanding of the problems of accessing health services in poor areas, which will serve her well when she becomes a physician,” adds Lasker.