DukeEngage | Duke Center for Civic Engagement

Sorry about the delay in blogging! I’ve been incredibly busy the last couple of weeks, not only at work but also with doing med school apps.

The main project I am now working on involves an outreach program for elderly patients who suffer from Age-Related Macular Degeneration (AMD).

The underlying rationale behind developing such a program is that vision loss often causes far more than physical damage; it can also have significant psychosocial, behavioral, and emotional impacts. A program that incorporates education and support may be able to help patients adapt to their low vision and thereby increase their sense of control and aid in lowering their depression.

I suppose that the relationship between vision loss and emotional distress and depression seems somewhat self-evident when you stop to think about it. But I had never taken the time to truly appreciate my eyesight before. Now that I have investigated the literature and spoken with some AMD patients, I have a much better understanding of how devastating vision loss is.

I recall a woman who came in to see if she qualified for the AREDS2 study, which investigates how vitamin supplementation affects the symptoms and progression of AMD. She did not meet the qualification criteria for the clinical study, but agreed to be interviewed for a separate research study regarding how AMD impacts lifestyle. She described how she can no longer drive, read, or do some of her old hobbies like knitting. On the whole, she was actually pretty optimistic and had an active social life, but there were definitely moments when her sadness and distress were apparent.

Unfortunately, there is currently no treatment or cure for AMD. Even without a physical cure, however , there are other ways that patients can cope with their diseases, like using low vision aids or accessing community services, which can improve their quality of life. We hope that our outreach program will be able to help these patients better handle the effects of their vision less, and thereby produce noticeable benefits to their daily lives.

 

A few weeks ago, two other students, Tina and Lilit, joined me in my age-related macular degeneration (AMD) outreach project. They’re both medical students at UCSD going into their second year. Tina went to UC-Berkeley for undergrad, while Lilit comes from UCLA. They’re both interning at the UCSD Center for Community Ophthalmology through the Medical Student Training in Aging Research (MSTAR) program.

Together, we are working on an outreach program to help elderly AMD patients cope with the effects of their vision loss. The project is an exciting mix of service and clinical research. From reviewing previous literature, to designing the program content, to outlining our research study, we have worked as a team all along.

In the past, in laboratory settings, it was more typical for me to work independently. And this year, I thought I would be working alone as well. Now, though, I truly appreciate having two other minds to collaborate with on a daily basis. I really love the teamwork aspect, especially when we come together to solve problems or generate ideas during brainstorming sessions. This has turned out to be a pleasant surprise for my DukeEngage experience. Not only have my new “teammates” turned out to be capable and helpful co-workers, but they have also become my good friends outside of work as well.
 

If I can’t see, I can’t read.
If I can’t read, I can’t learn.
If I can’t learn, what’s my future?

Eye health and proper vision development is pivotal to children's success in school and in life.   This is the underlying belief of the Save Our Children's Sight (SOCS) program, run by the Center for Community Ophthalmology at UCSD, where I'm currently interning.  The program is dedicated to addressing the barriers to proper vision care that are faced by underserved children from low-income families.

Here's what the program entails:

• Vision screening of low-income young children in over 150 locations throughout San Diego County.

• Mobile pediatric clinic on the EyeMobile for Children, which examines all children who fail the vision screening. This service provides glasses and/or referrals to specialists at no cost to their families.

• Empowering parents through community education about the importance of vision care and subsequent follow-up of their children who receive glasses and/or other treatment.
• Determining patterns of eye disease and the impact of early intervention with eyeglasses on the mental and motor functioning of young children.

Save Our Children's Sight is an unprecedented program that serves as a community health model in overcoming barriers to care for the underserved.

About half of the office here works on SOCS.  I see them constantly going out to do screenings, taking the EyeMobile all over the county, preparing educational materials and programs, and doing research testing on how glasses affect the progression of eye disease and cognitive and motor development.   Their work is a great combination of service and research.  Not only are they providing a much-needed service to the underserved/low-income children here, they are also investigating key questions and contributing critical information to a larger body of information. 

Since beginning in 2001, the program has screened over 66,000 children in this county!  They screened around 12,000 kids this year alone.  I am so impressed by the dedication and passion of all of the people working on the project. 

Later this week, I will be going out into the community to help with the research testing of the children.  Not only will I be able to learn some public health research methods, but I will also be able to put some of my Spanish skills to use (even if they are a bit rusty!). I am really excited about being a part of this important effort. 

Anyone who wears glasses or has had vision problems (myself included) knows how critical proper vision care is to quality of life.  The children who are helped by this program are the ones who otherwise would not have received adequate care.  Some of them would have had severe vision problems continue unchecked, and would have ended up completely blind.

I will continue providing updates about this program as I work here this summer.  If you're interested in learning more, visit the website.  Inspired? Want to donate? Click here.

 

Last Wednesday, the Save Our Children's Sight (SOCS) Advisory Council held a meeting to discuss the progress of the program, future expansion, and of course, the issue of how to secure funding.  The advisory council consists of people from the Center for Community Ophthalmology working on the project, school nurses, parent representatives, representatives from various local organizations, and other community members.  Some key members include Barbara Brody, who is my DukeEngage supervisor and the director of Community Ophthalmology; Faustina Solis, an esteemed professor emerita who was profilic in public health and social work and has served as a Provost for UCSD; and Carlos Flores, the Executive Director of the San Diego Regional Center, which provides services and support for individuals with developmental disabilities.

In the morning, I helped set up the meeting room.  We had minutes from the last meeting and agendas ready for each council member, as well as two really cute teddy bears in the middle of the table.  These are the same bears that are given to the children when they are screened or examined to help lessen any anxiety they may have. 

The meeting was held at lunchtime.  Once everyone had arrived and settled down around the table, it was time for business. 

First, there was a ceremony to honor Professor Solis.  She's the outgoing director of the council, and Mr. Flores is the incoming director who will be taking over her post starting in July.

Barbara Brody (right) presents an award to council director Faustina Solis (center), whose successor will be Carlos Flores (left).

After the ceremony, which included the presentation of an award to Professor Solis, the talk turned to updates on the program and future directions.  My coworkers presented the numbers: about 12,000 children screened this year, bringing the total number of children screened since the start of the program to over 66,000!  This year, more children were screened than in past years, illustrating the program's continuing improvements in efficiency and effectiveness.

In terms of future directions, there have been several promising developments.  First, there has been an update in the camera hardware and photo analysis software that are used for screening, fueled by the work of a UCSD undergrad team (here's my previous post about this).  Second, we're getting a new EyeMobile!  It will be larger than the current one (with 2 examination rooms instead of just 1), allowing more kids to be seen and allowing expansion of the program.  It will probably be ready by early next year.

The biggest issue of the day was how to obtain long-term funding for the program.  The current goal is to secure funding for the next five years.  As it stands, Professor Brody said, "We are trying to sustain this program day-to-day, hand-to-mouth."

I realized that one of the biggest challenges for community organizations is finding funding, which is essential to making sure they can provide the best possible services to those in need.  More funding would undoubtedly help the program by providing more glasses, upgrades to the EyeMobile, money for fuel costs (no small issue these days, with gas as high as $4.60/gal in San Diego right now), and more resources in general.  These improvements would allow the program to reach more children, children who would otherwise not receive proper vision care.

Funding sources typically come from community foundations, which offer a limited number of grants, and from individuals in San Diego.  However, as Professor Brody said, these funds are limited and do not provide long-term security. 

One council member recommended trying to get a celebrity spokesperson to attract publicity and funding to the program.  With our proximity to Hollywood, this may not be a far-fetched idea.  Of course, other publicity strategies include contacting local newspapers and TV news stations.  Someone even mentioned that they had written about the program to Oprah Winfrey.  However, getting a story on air for the local news is an extremely difficult process, let alone on Oprah's wildly popular talk show. 

Funding - especially for the long term - is something that is on everyone's minds right now.  To sustain the program for the future and to continue providing these important services to underserved low-income children, we need to figure out a way to promote awareness of the program, make its services increasingly known to the public, and attract enough funding for at least for the next couple of years. 

 

The Presentation

On Tuesday morning, several UCSD undergrads came to our office conference room to give a presentation.  These students, who were all engineering majors, were part of a program at UCSD called TIES, Teams in Engineering Service. 

A little bit about TIES, taken from their website:

"Teams In Engineering Service is an innovative service-learning academic program putting UCSD undergraduates and their technical and creative skills to work for San Diego non-profit organizations. Multi-disciplinary teams of UCSD students design, build and deploy projects that solve technology-based problems for community partners."

The students presenting on Tuesday were working on a project to assist the Save Our Children's Sight program, which is run by the center where I'm interning.  That program screens thousands of low-income children across San Diego County and provides vision care when necessary.  Photos are taken of the children's eyes and subsequently analyzed as part of the screening process.

However, the existing camera and software had some problems.  The camera was old and its production has been discontinued.  The whole device was also quite bulky and inconvenient to transport.  Furthermore, the software being used was only compatible with this old camera, was slow, and had some problems with accuracy.

To address these issues, these TIES students, known as the Digital Vision Screening Team, split up into two groups: 1) hardware, and 2) software.  They developed a flash unit and adaptor that could be used for newer digital cameras, and they showed us the circuit board and what modifications they made in order to accomplish that.  On the software side, they improved the compatibility of the software (so it can be used with any camera in the future) and improved some of its analysis tools. 

All of these improvements will surely be helpful for the program to be able to reach more children and more accurately analyze the photos of their eyes, thereby increasing the quality of screening. 

This project was part of an engineering course at UCSD, so the students received course credit for their work.  For some, this was the first quarter they had worked on the project.  Others, however, had devoted several quarters to this work, providing some continuity to the service. 

 Two students presenting their future goals for the software program, Vision Builder.

The students presenting in the conference room.

 The whole class, with their instructor, Dr. Dirk-Uwe Bartsch Ph.D. (far right).

 I was really impressed by the presentation, and by the amount of progress that the students were able to accomplish in a single quarter.  UCSD is on the quarter system (as opposed to the semester system), and each quarter is only 10 weeks long.   Their work is still not done, since both the hardware and the software still have some issues that remain to be resolved.  Nonetheless, it's remarkable how many improvements they made in just ten weeks.

 

Starting something similar at Duke

Maybe we could take UCSD's program as an example. 

There are many amazing service-learning programs at Duke, like the Research Service Learning Program, the Hart Leadership Program, LEAPS, and of course, DukeEngage.  Most of these programs have more of a public policy slant to them and are not focused on technology.  Based on anecdotal evidence, I've found that non-engineering students are more likely to take service-learning courses than engineering students, probably as a result of the time-intensive course schedule and more requirements in engineering curricula. 

The Pratt School of Engineering at Duke does have some great service opportunities, like Engineers Without Borders and Engineering World Health.  However, as far as I know, these are usually international projects conducted during the summer and typically do not offer course credit.   These are really amazing programs, but what about also offering something that helps community organizations in Durham with their technology needs? 

By offering course credit, such a program might be able to lure engineering students into service work, so they wouldn't have an additional extracurricular burden on top of their intense course loads.  Instead, the service work would serve as one of their courses.  In addition, some students might prefer to engage in service experiences during the academic year, so such a program would be accommodating for students who cannot devote an entire summer to service. 

Also, by focusing on projects in Durham, we can maintain better continuity than we might be able to through a single summer project.  Duke students could provide much-needed technical assistance to the Durham community for the long-term, and by doing so we could improve town-gown relations along the way. 

Finally, having students complete a team-based engineering/technology project would undoubtedly add great experience to their resumes, which would bolster their chances of landing top internships, jobs, or admissions to graduate programs.  It's a mutually beneficial relationship - the students would get additional technical experience and would reap the personal benefits of service work, while the community organizations would get the help they need free of charge. 

I don't know the feasibility of this idea, but I think that many students at Duke would be interested in service-learning courses that have more of a science/technology/engineering component.  And given the popularity of existing service programs, it might not be too difficult to adapt the current models and extend them in this direction. 

So, TIES at Duke, anyone?