My View: Ingenuity at the end of the road

Sheila West, the El-Maghraby Professor of Preventive Ophthalmology at the School of Medicine, vice chair for research at the Wilmer Eye Institute, and an internationally known expert on trachoma and blindness

Credit: Sheila West

"Trachoma is still the leading infectious cause of blindness in the world, but patients who need surgery are in the most resource-poor countries and reside in those communities at the end of the road or, in this case, where there is no road. Research requires flexibility and ingenuity, qualities fortunately abundant in partners in these countries. In Ethiopia or Niger or Tanzania, how do you assess vision when you need light and there is no electricity? The sun, with a chart attached to a tree, works. But how can you use letters on a vision chart if people do not read, or their alphabet is Amharic? You explain that the 'E' is really a three-legged table and ask, which way do the legs point?

"The vision testers realize their patient is struggling to see the line, as she keeps losing her place on the chart. Maybe she can see the 'E' but is reading the wrong line. The vision tester tries pointing a small finger at the line, but it does not help. Take a pair of scissors, a cardboard box to cut up, and we have a good pointer. The patient can read the line once she knows where on the chart to look.

"I use my particular skills to design studies and get the money, but going to the field while the research is under way energizes me in special and unforgettable ways. Resilience and creativity, in patients and team members, are truly special gifts."

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