Zulma is from Tarija by origin and by feeling. She has a degree in nursing and works in one of the departments with the highest rates of inequality and poverty in Bolivia, where the wealth derived from the gas reserves does not reach the most vulnerable people.

She spends time and effort on long and difficult journeys to ensure that eye health reaches the poorest populations, making sure that activities and projects have the involvement of local authorities to ensure their sustainability.

Zulma constantly generates ideas, proposes improvements and promotes actions to favour the progress and reach of the Eyes of Bolivia project to the most disadvantaged groups, mainly women.

She has already achieved important goals with determination and, at Eyes of the world, we are counting on her to make progress in the eradication of avoidable blindness in Tarija. A complex but possible challenge, which is also the biggest of her dreams.

What are the main challenges that Tarija’s population faces in terms of access to eye care?

Tarija is a department with 619,784 inhabitants. Currently, in the public system, there are six professionals specialised in ophthalmology, of which only one provides cataract surgery services within the framework of SUS (Universal Health Insurance) in the capital city. This factor is one of the main causes of avoidable blindness in the elderly population and one of the main challenges faced by Tarija’s society. As there is no capacity for timely resolution of clinical cases in the public health system, this results in a long wait for ophthalmological care, which goes hand in hand with the economic factor.

Geographic barriers are another challenge because the population lives in very dispersed areas of the department, which makes access to specialised services inequitable.

The lack of information among the population about visual self-care is another challenge that has a negative impact on the healthy lifestyles they should adopt to prevent visual impairment, and also affects the population’s lack of awareness of receiving regular ophthalmological care, thus delaying timely diagnosis and treatment. This is especially true for women, as there is a high prevalence of visual impairment among women.

What specific strategies are you implementing to overcome these challenges and ensure equitable access to eye care?

Within the framework of public administrative policies, strategic alliances are being made with public and private institutions that share the same objectives and interests. Agreements are signed with these institutions to work in a cross-sectoral manner.

Advocacy is carried out with public health institutions to ensure that ophthalmological care services are provided under the SUS umbrella and that the population can exercise their right to health.

The population in general, especially women, are also empowered in eye health issues so that they are the operative arms in promoting self-care in their families and prevention in risk groups in their communities.

In the education system, work is being done to strengthen social participation through the local authorities of the communities, who are accompanied and advised in the process of planning eye health plans. This initiative works towards improving student eye health because they are the ones who advocate and influence municipal governments to invest in eye health and ensure it is sustainable in the long term.

What services does the Eyes of the world project offer in Tarija and how does it benefit women in particular?

In the absence of sufficient services in the public health system, we generate interventions that allow the population to have access to ophthalmological care through care campaigns in vulnerable populations (with access and economic barriers). These initiatives go hand in hand with the training of health professionals on the early identification of visual deficiencies for subsequent referral, the diagnosis of eye diseases with their respective treatment, the identification of people with cataracts for subsequent referral and others.

The San Juan de Dios Hospital in the city of Tarija was strengthened with ophthalmological operating theatre equipment, where free cataract surgery is currently being performed thanks to the support provided by the Foundation.

In the public education system, teachers are trained in visual acuity and educational units are equipped for screening. The aim is to identify children and adolescents with visual impairment at an early age so that they can receive timely and free treatment for their condition through the ophthalmological brigades that visit educational units. It is important to acquire preventive behaviours from an early age and, in this sense, awareness-raising talks on visual self-care are being given by Eyes of the world technicians and teachers themselves to all students in the intervention areas.

Participation of women through social organisations is another area of action. Women are sensitised to the importance of generating appropriate eye health care behaviours in the environment in which they live. They are also trained in early identification of visual deficiencies and identification of cataract cases for subsequent referral to the health system. In return, they receive ophthalmology care through brigades in their organisations and priority is given to women with cataracts during the provision of services, facilitating access to a quality and warm service.

What impact has the project had on the community so far? Can you share a success story that illustrates how our intervention changes people’s lives?

The programme has a great social and economic impact on the people and families involved, especially the most vulnerable population, such as children, thus guaranteeing their education; on the elderly, giving them back their sight; and on women, exercising their right to health. With these actions we are helping to mitigate poverty and contributing to improving the quality of life of the inhabitants of the Department of Tarija.

This is a life story like many others. It fills us with joy to make her dream “to be able to see again” come true. Mrs. Cira Matirayo, 73 years old, lives in the community of Pampa Grande. She lives with her husband and two of her daughters. Their income was from farming, and now they live on the economic support of their children.

Approximately four years ago, Mrs. Cira began to see in the dark, her eyesight began to blur, and she could no longer do many things on her own for fear of falling or of something happening to her. This situation had a big negative impact on her life because she depended on her daughter to hold her hand, she had to stay still waiting for attention, she could not take care of her garden, which was what she liked the most, and much less meet her grandchildren who lived next to her.

The Eyes of the world Foundation scheduled an ophthalmology care activity in the community where she lives. Marcela, Mrs. Cira’s youngest daughter, found out that Eyes of the world staff were coming to the community school to check the children’s eyes and that they were also going to attend to the adult population, so that afternoon she went to look for her mother and took her to be seen. During the medical evaluation, the ophthalmologist diagnosed her with cataracts and told Marcela that her mother needed surgery, but that she should not worry because the Eyes of the world Foundation was going to help them.

Once she had the operation, the next day, at the 24-hour post-surgery check-up, Mrs. Cira could not hold back her tears when she saw again: she was thrilled to be able to see more clearly so soon. Weeks passed and the other eye was operated on. Mrs. Cira and her relatives are grateful for the help given because now she can see her garden again, she was able to meet her youngest grandchildren for the first time, she feels happy and now shares her testimony with other grandparents, who may be in the same situation, and who for fear do not want to have an operation. Mrs. Cira now helps in the kitchen again, peeling potatoes or peas, and no longer needs someone to take her by the hand; she feels more confident.

What are the project’s future plans for the coming years? What specific areas are you planning to address?

To continue to influence local institutions through the eye health committees that have been formed with social and intersectoral participation in actions to prevent the two main causes of preventable blindness: refractive errors, especially in the rehabilitation of people with low vision, and cataract surgeries, through local health services with the capacity to resolve them. More ophthalmologists need to be trained to provide this service in those municipalities where qualified human resources are not yet available. And monitoring compliance with eye health plans submitted by local authorities to municipal governments.

Personally, what lessons have you learnt so far in facilitating the population’s access to eye health? In addition, could you share a good practice or an innovative practice that you have carried out?

The leadership role is important because by empowering the organised population, they will demand their rights from the competent bodies and will be able to exercise, in the medium or long term, the equitable right to eye health, contributing to the long-term sustainability of the programme.

It is important to improve the response in terms of access to ophthalmology care through health centres, thus ensuring that first-level services are available to the population living in remote areas. The responsibility for ensuring that the population has access to ophthalmological care is a multidisciplinary team effort, so that, from the visual health promoter, the assistant nurses, nursery assistants, nursery graduates, doctors, and other professionals, they have the capacity to detect, refer, treat, prevent and promote healthy lifestyles.

Working with people with limited resources and managing to change their lives, even if it is only by giving them back their sight, makes a difference. I see how important it is to be in direct contact with the neediest population, as we can get to know their reality better and detect factors that have a negative influence on their health. In this sense, one of the different activities that were implemented in the project was to visit the families of elderly people with cataracts; in this way we were able to learn more about the reality of each family’s consent to the surgery. In these meetings we were able to clear up doubts, beliefs and misinformation about the surgery, promoting people’s autonomy in decision-making and providing holistic care for the patient.