Vanderbilt University-Peruvian partnership addresses silent epidemic

Mobile cameras, high-resolution digital imaging and funding from the Centre for the Americas at Vanderbilt University are among the key components of a cross-cultural pilot program to prevent vision loss in at-risk Latin Americans. 'It's a little like magic that I can sit at my Vanderbilt work station and review images of retinas that were created thousands of miles away the previous day,' said Lawrence Merin, assistant professor of ophthalmology and director of the Vanderbilt Ophthalmic Imaging Centre. Vanderbilt has formed a partnership with the Universidad Peruana Cayetano Heredia in Lima, Peru, to help desperately poor diabetic patients receive the eye screenings and follow-up care needed to prevent blindness. The United Nations recently recognised diabetes as one of the key health issues facing humanity.

'Within the next generation there is expected to be 300 million diabetics around the world, each one at risk for blindness, kidney failure and other catastrophic complications,' Merin said. He added that this project in Peru evolved out of Vanderbilt's success through technology to reach out to Middle Tennesseans who historically have not had access to preventive care in ophthalmology.

Merin's specific role is to examine each set of images that are produced in Lima to insure that the quality of the diagnostic procedure meets high standards. He serves as the co-principal investigator of the Peruvian Retinal Screening Project with Sten Vermund, professor of paediatrics and director of the Vanderbilt Institute for Global Health Education. Research objectives are to study diabetics' self-care behaviour, socio-economic and cultural barriers to health care delivery and clinical designs for chronic disease management. Other goals are to train a team of local health care workers and encourage the creation of more cross-cultural outreach projects. 'Since diabetes is a multi-organ disease, we are taking a multi-speciality approach,' Merin said. 'Just dealing with eye disease without taking care of the entire patient and understanding the issues that affect outcomes doesn't make sense.' A multi-speciality work group to tackle these issues resides within the Centre for the Americas, which brings together scholars and innovators to investigate the cultural, economic and political interactions among the countries of the Western Hemisphere and between the region and other parts of the world.

Members of the work group, in addition to Merin and Vermund, are Juan Canedo, graduate student in sociology at Middle Tennessee State University; Dr Luis Caravedo, Universidad Peruana Cayetano Heredia; Michael Fowler, assistant professor of medicine, Vanderbilt University Medical Centre; Dr Eduardo Gotuzzo, Universidad Peruana Cayetano Heredia; Pamela Hull, Tennessee State University Centre for Health Research; Bonita Pilon, senior associate dean for practice, Vanderbilt School of Nursing; David Schlundt, associate professor of psychology and assistant professor of medicine at Vanderbilt; Dr Jaime Villena, Universidad Peruana Cayetano Heredia; and Megan Zoffuto, research assistant at Vanderbilt.

Merin credits the Advanced Centre for Research and Education at Vanderbilt with bringing the technology to transmit over long distances huge electronic files of eye photographs. 'These extremely large files are necessary to detect the subtle findings in the retina,' he said. 'We now have a method whereby the button can be pushed in Lima and the images arrive quickly and safely in Nashville, thanks to this Vanderbilt resource. He notes that screening without a therapeutic solution would be unethical, so he is grateful that the ophthalmologists in Lima have banded together into a consortium that promises to treat patients detected through the screening to be at risk for vision loss regardless of their ability to pay.

'We are hoping that we can build on this successful initiative by obtaining government funding, and we are also seeking philanthropic support for the two-year pilot project,' Merin said. In late 2006 Merin took a memorable trip to Lima to tour some of the impoverished area where many of the patients who use the diabetic screening clinic live. 'When you see people living in straw huts because they have no other means of protecting themselves from the elements, it gives you a view of the world that is much different than what we are accustomed to in the United States.'