2019 has been an interesting year for us. There are a number of factors outside our control that have and will continue to affect us this year. I will address these briefly.

October 2019 Bolivia went to the polls to choose either to keep the current president or choose a new one. The country was quite divided on this point with very strong support for and against change on both sides. The election ended in farce. The current president won but was accused of cheating. Bolivians took to the streets in massive numbers demanding that democracy prevail and an end to corruption. For this reason, our surgical trips didn’t run during November as normal. We will however be active in June and July 2020 surgically and will continue with teaching and training of Bolivian doctors and health care workers throughout the rest of this year and into 2020 year.

We were also affected by a drive within Bolivia to regulate healthcare more stringently. Driven by the department of health SEDES, there have been sweeping changes. All organisations that are involved in health in any way were affected. There have been raids on shops and any out of date products removed and destroyed. Pharmacies that sell medicines but do not have a registered pharmacist have been closed and medical organisations such as AMM have had to re-register all our staff and provide detailed plans and adhere to a new approach. NGO’s working here without these permissions have been shut down. Hospitals, pharmacies and NGOs using out of date medicines or without refrigeration of medicines again have had stock confiscated or have been shut down.

Hospital staff have been threatened with imprisonment if they cooperate with an unlicensed NGO and for the first time ever, we cancelled a trip in October 2018 because new regulations were sprung on us and we knew that we would not be able to complete all the paperwork in time.

Our stance on this is that whilst it is a bit frustrating, it is a good thing for Bolivia in many ways. NGOs have been working here for years without any checks or controls. We like to think that we have provided a good service ourselves but I am aware of cases with other groups where surgery has been unnecessary or not at all successful. There needs to be regulation and coordination of services in order for patients to receive the best health care. It will in the short term mean that some services stop and some may never return which is a shame but those organisations who are here for the long term will make the effort to try and comply with and help to support the attempts by SEDES to regulate and improve quality standards.

The way that AMM handled the situation was by holding meetings with SEDES to understand their aims and to explain our goals for Bolivia and build on our relationship. This strategy proved successful and we were granted permissions to continue working. We subsequently entered into an agreement with the Medical College of the Beni and the Ophthalmology Society of the Beni to work in a coordinated manner to reduce blindness here. This has been a big win for patients as together we can make a much bigger difference.

We believe that a coordinated approach to reducing blindness is best. The emergence of glaucoma services and diabetic screening, management of trauma and improved training services are much more likely to develop as a result. In this new era of cooperation, patients will be better served and we hope to see blindness levels drop as a result. The agreement with the college will add credibility and interest amongst local village doctors to involve themselves in our eye care teaching programme and we can certify competencies through tests and practical demonstrations. This means that patients will receive faster and more appropriate initial care with trauma and eye emergencies and better advice through a closer working relationship with village doctors and Bolivian specialists.

There is still a part of Northern Bolivia that has Cuban ophthalmologists working. At this point in time they are apart from our agreement. We have been informed that they are reluctant to engage with the ophthalmology society and that they perform surgery with poor results. We don’t know that this is true and we aim to hold talks with them over the next few months. If we can involve them and work with them to improve patient’s outcomes, then we should look at ways to include them if they choose to remain after Bolivia’s recent change of government.

Our vision is of a Beni where AMM, Local services and government work together. We still have 7,000 blind people in the Beni (100,000 people are blind in Bolivia as a whole). 80 % of this blindness is potentially avoidable.