In the first three years (1998, 1990 and 2000) of our annual summertime trips to Ecuador we have examined in total l3,750 patients, fitted 2,610 pairs of glasses, 800 pairs of sunglasses, treated 450 conditions, and performed 265 operations, primarily cataract removal and lens implants totaling 173; ptergygium operations totaling 18; strabismus operations totaling 6, and miscellaneous other procedures, as well as referred 16 patients for specialty care to collaborating doctors in Guayaquil. This was accomplished through the efforts of three separate groups, numbering from 10 to 26, spending 10-18 days of their personal time at their own expense in Ecuador in July of each of the past three years.

The Rotary funds raised at the local level totaled $36,500 and multiplied at the District level to $73,000 and at the Rotary International level to $130,000 and resulted in deliverance of $200,000 in supplies, $240,000 of permanent equipment, and $1.3 million of medical care (priced in U.S. dollars) to Ecuadorians in need.

Our efforts have been focused on the Salinas - La Libertad - Mongoralto region, and have resulted in the establishment of permanent ongoing facilities at Virgin of the Swan Clinic in La Libertad, where we have established and equipped a clinic providing eye examinations, glasses, and medical and surgical treatment at little or no cost to the patient, based on what they can afford to pay, if anything, to yield a self-sustaining operation that continues to require funds and supplies. We have trained two opticians and provided them with the equipment to edge and mount lenses and make glasses for individual patients' needs, and we continue to raise through contributions and purchase of frames and lens blanks for their needs.

The long-term goal is to develop a regional eye care center for those in need. To help it achieve some financial self-sufficiency, the goal is to charge nothing or only minimal payments to those most needy and to charge proportionately to others according to their ability to pay. Hopefully, the reputation of the clinic will grow to the point that it does attract people able to pay so that money can be used to support the care of the less fortunate.

A home-based permanently established clinic is the Rotary Eye Clinic at the Virgin of the Swan Clinic in La Libertad. Its ongoing needs at this time are:

* Ongoing supply of frames and lens blanks

* Financial resources to fund complex prescriptions that may have to be made in this country and shipped down if we cannot develop a local source at a reasonable price.

* Funds to cover transportation costs from Mongoralto, specifically, but other outlying areas as well. This may average one to two dollars per patients.

Exam costs average $1 per patient for those unable to pay anything until such time as the program may become self-sufficient. This money enables the clinic to pay the optician a living wage for his work.

* Funds to cover the costs of more complex surgery that is done in Guayaquil by the consultants. An example is Dr. Matamoro, retinologist, for his vitrectomies or his laser photocoagulations for diabetic retinopathy. We will develop a prioritization scheme in view of our limited resources in this area. The cost per patient is on the order of $60 per patient.

l Cataract surgery supplies, i.e. sutures, lens implants, medications, will require a budget of $15,000 annually. This is based on doing 4 to 5 cataract removal and lens implants per week for 50 weeks for a total of 200 to 250 procedures. The approximate costs of supplies per cataract removal and lens implant surgery is $50, with half of the materials donated.

l Also needed will be funds to train a refractionist, who ideally will be a nurse or someone with a medical background who wishes to learn eye evaluation and assessment for disease and refraction for refraction errors. This person will be sent to a training program in Guyaquil. It is hopeful that after initial support from Rotary that this position can become self-supporting through patient payments. Anticipated cost is $1,000 for training and $5,000 for additional support for the first year.

Also proposed is an Outreach Screening Program, with small screening teams traveling to outlying villages to assess villagers and refer those in need to further care at the main clinic as well as gather demographic information on public health visual needs. Other goals include:

* Developing an inexpensive source of quality low-cost, high-quality reading glasses for village screening projects for presbyopic patients.

* Develop a low-cost resource for quality anti-infective ophthalmic, as well as other topical medications to treat local needs.

Also to be considered is the establishment of an ongoing visiting M.D./O.D. program, in which physicians from the U.S. travel to Ecuador for a month to teach, assist, treat, and evaluate the program to improve it and to help it reach its goal. The cost is figured at $1,000 per round-trip ticket from western U.S. to Ecuador and $1,000 to cover lodging and meals.