Health Education Strategies Utilized by Two Unite For Sight Partners in Rural Ghana

Unite For Sight's partner eye clinics develop and implement health education strategies to eliminate patient barriers to care. This health education report was compiled by Unite For Sight Global Impact Fellow Page Crew.

Health Education by Crystal Eye Clinic

Crystal Eye Clinic is a private eye clinic located in Accra, Ghana, that serves a vast patient population throughout southern Ghana. This clinic offers ophthalmic exams and surgeries in Accra in addition to providing mobile outreach services for underserved communities in rural villages. Dr. Ernest Awiti, an optometrist at Crystal Eye Clinic, usually facilitates the outreach visits and often examines more than one hundred patients per visit, including children and adults. Patients are invited to the outreach, where they listen to a health education talk designed to introduce them to eye health education and the outreach process. Next, patients participate in a visual acuity assessment and receive an eye examination by an optometrist or ophthalmic nurse. Depending on the patient’s eye condition, he or she may receive medication, reading glasses, distance glasses, or be referred for further review by the ophthalmologist at Crystal Eye Clinic in Accra. In addition, patients who are diagnosed with cataracts or pterygium receive UFS-sponsored surgery at Crystal Eye Clinic.

The Crystal Eye Clinic practitioners utilize three main health education strategies to target rural populations in Ghana: stipended local community eye health workers, school presentations, and the health education talk presented at the beginning of every outreach. Local community eye health workers are community members who have expressed interest in serving their villages and are committed to encouraging patient participation in outreach and follow-up care. Sometimes these community eye health workers are appointed by the chief of the village in an effort to emphasize the importance of the outreach to the village and recognize community eye health workers as leaders. Having a prestigious appointment also facilitates trust between the community and the local eye health workers, which helps the eye clinic staff encourage attendance at outreach. Local community eye health workers are trained by an experienced Crystal Eye Clinic doctor or nurse at the clinic in Accra, where they learn basic eye health, primary eye care, and often observe cataract and pterygium surgeries in the operating room. Because local community eye health workers are educated about the technical processes of eye surgery and the importance of eye care, they serve as valuable community resources for patients who are referred for surgery. In addition, they receive practical eye care training and learn how to properly administer eye drops and assess patient visual acuity so that they can assist with outreaches.

The role of local community eye health workers is quite comprehensive. First, they advertise that the Crystal Eye Clinic mobile outreach team will be sponsoring a visit to their community. Community eye health workers will also identify people with eye problems and encourage them to attend the outreach. During outreach, the community eye health workers often assist Unite For Sight Global Impact Fellow volunteers with translation. After outreach has concluded, the community eye health workers hold a special session to counsel patients who are referred for cataract or pterygium surgeries. During this session, the community eye health workers reaffirm the patient’s decision to have surgery and discuss any residual concerns about the procedure. They also emphasize the importance of adhering to any pre-operative medication regimens and review the travel arrangements for surgery. The local community eye health workers are invaluable patient advocates who remain with the patients throughout the entire process of traveling to the clinic, having surgery, and returning to the village. In some cases, local community eye health workers assist in monitoring post-operative medication use in patients who are at increased risk for complications or may have trouble adjusting to a medication regimen. The local community eye health workers serve as an important liaison between the patients and the Crystal Eye Clinic staff and improve the clinic’s ability to reach underserved patients.

The Crystal Eye Clinic promotes eye health education among school-aged children by conducting health education talks at schools. This program targets children ages six to 14 and teaches them about eye anatomy and eye health at an age-appropriate level. The session also focuses on injury prevention and uses techniques such as playing games or acting out scenes to illustrate concepts related to eye health. Additionally, the health educators explain the dangers of using traditional medicine to treat eye problems. Often, the health educators will instruct teachers on how to identify children with common eye problems and where to refer these children for help. 

An additional important component of Unite For Sight's program is the health education talk by Crystal Eye Clinic's ophthalmic nurses and optometrists. Presented at the start of each outreach, the health education talk lasts between 25 and 45 minutes, depending on the size of the outreach, and is designed to target rural populations living in southern Ghana. Often, rural communities have little or no eye health knowledge prior to an outreach visit. For many patients, it is their first time seeing an eye doctor, as local hospitals do not usually have an eye doctor on staff. Within these communities parents with children, elderly patients, illiterate patients, and patients with comorbidities such as diabetes or hypertension require special attention during the health education talk. Cultural beliefs are also an important consideration in the health education program, and the health educators tailor each session to the specific culture and speak in the local language, using translators as necessary. 

According to Dr. Awiti, rural communities tend to rely heavily on traditional medicine, while urban communities have greater exposure to western medicine. For this reason, it is extremely important to address traditional medicine when communicating with rural populations in Ghana. The dangers of traditional medicine can also be difficult to explain since patients have been exposed to traditional medicine used by their parents, grandparents, and other relatives whom they trust. In addition, some Ghanaians believe that diseases are spiritual consequences that require religious intervention, rather than medication, or that blindness is a normal part of aging and an act by God that does not require medical care. The local practitioners carefully consider these cultural beliefs when providing health education in rural Ghana.

Goals of the health education talk

Components of the health education talk by the local eye doctors

After the health education talk, the local eye doctor introduces the UFS volunteers, doctors, nurses, and local community eye health workers to the community, and patients are then directed to the start of the clinic process, beginning with patient registration.

Health Education by Charity Eye Clinic

Charity Eye Clinic in Kumasi, Ghana, provides eye health outreach services to various rural villages throughout the Ashanti Region of Ghana. Dr. Kate Gaisie, the optometrist at the clinic, believes that providing the health education talk at the beginning of outreach and utilizing local community eye health workers are the most effective health education strategies are. Often, local community eye health workers have had cataract or pterygium surgery, so they can share their experiences as former patients of Charity Eye Clinic and serve as valuable peer resources for patients who are referred for surgery. The primary roles of local community eye health workers, however, are to assist with clinic announcements and advertising for outreach visits and translate the health education talk when necessary.

The health education seminar begins with introductions of the Unite For Sight volunteers, local community eye health workers, and clinic staff facilitating the outreach. According to Dr. Gaisie, when addressing adults living in rural settings in the Ashanti Region, it is important to describe the services provided by Unite For Sight, explain how the normal eye works, and provide information about cataracts and glaucoma. Like Dr. Awiti at Crystal Eye Clinic, Dr. Gaisie believes that traditional medicine is an important issue that must be addressed in each presentation. Common cultural principles create barriers to eye care, such as believing that eye problems are a normal part of aging, that eye problems they should not be treated since visual impairments are created by God, or that the eyes are removed during cataract surgery. According to Dr. Gaisie, these beliefs are common throughout Ghana and are not unique to rural populations. Thus, the health education talk is a vital tool to provide public health outreach and to encourage patients to seek eye care.

Components of the health education talk by Charity Eye Clinic's optometrist