Ophthalmologist Christian El-Hadad, left, and his colleague Nishaant Bhambra.McGill University/Supplied
While working at a clinic in the village of Puvirnituq in Nunavik, ophthalmologist Christian El-Hadad and his colleague Nishaant Bhambra encountered many Inuit patients who were unilingual.
In this remote, fly-in village on the Arctic coast of Quebec, Inuktitut, not French or English, is the language most residents use. But the visual-acuity charts, also known as eye charts, that ophthalmologists rely on to test patients’ vision are typically printed in Latin script. To the visiting doctors, this was an issue in need of a remedy.
Their solution? A visual-acuity chart that uses the letters of the languages of patients.
Dr. El-Hadad, an assistant professor in the department of ophthalmology and visual sciences at McGill University, and Dr. Bhambra, who recently graduated from McGill’s medical school, developed the first known visual-acuity chart in Canadian Aboriginal syllabics. CAS is a system of writing used for multiple Indigenous languages, including Inuktitut, Cree and Ojibway.
The creation of the chart contributes to serving a demand for more culturally appropriate and patient-centred care.
“The idea is to kind of make them feel more comfortable in their own culture, especially as we are visiting them in their home locality,” Dr. El-Hadad said. “So at least they feel safe and they feel that they can speak their own language without shame.”
As Dr. Bhambra explained, there are other ways of testing eyesight if patients don’t read the Latin alphabet. For instance, there are charts created for people who don’t read Latin script and there are visual-acuity charts that use different symbols, such as a house or apple, or varying orientations of the letter “E.”
But using the latter type of chart could be perceived as pejorative, treating patients as though they may not be literate, he said. “Which is simply not the case.”
Dr. El-Hadad and Dr. Bhambra created the new chart based on the standard Latin visual-acuity chart, introduced by Dutch ophthalmologist Herman Snellen in 1862. As they described in a study, published in the Canadian Journal of Ophthalmology in February, the modern version of the Snellen chart consists of 11 lines of letters, printed in decreasing size, in bolded, sans serif font.
Not every CAS character is used in all Indigenous languages, so the doctors chose ones that are common to those that are widely spoken, Inuktitut, Cree and Ojibway.
As with Latin-based languages, some characters are pronounced differently, depending on the language. So, the doctors created an accompanying table, to be used by technicians who are non-Canadian Aboriginal syllabics readers, with corresponding consonant sounds for each letter in the various languages.
As they showed in their study, the doctors and their team tested the chart on a group of patients from Nunavik, who were staying at the Ullivik residence in Montreal to receive health services in the city. Their results provided validation of the chart, showing it yielded highly similar visual-acuity measurements to the standard Snellen chart.
The response from patients has been positive, Dr. El-Hadad said. More than 40 copies of the chart have now been distributed to 14 villages across northern Quebec. It is included in packages for doctors travelling to northern communities, and it is available online for other populations across Canada to use.
“It’s a great idea,” said Rita Novalinga, the director of Ullivik who is from Nunavik, noting it will allow patients to feel more comfortable seeking care.
The project represents a small step toward addressing the numerous challenges patients face in Nunavik. Dr. El-Hadad, who has been travelling there to provide services for the past three years, said that many communities have high rates of an eye condition called angle-closure glaucoma, which puts patients at high risk of blindness.
In addition, a lack of cellphone coverage and, until recently, a lack of high-speed internet make communication difficult, he said. And a housing shortage means patients wishing to travel from other areas to see him while he’s visiting have nowhere to stay.
Moreover, he added, travel to and from northern communities is expensive and heavily dependent on the weather, which is a barrier to timely care. And cultural and language barriers contribute to delays in care.
In regard to the latter, Dr. Bhambra expressed hope that the new eye chart will help put patients at ease.
By using it, he added, “we also show an acceptance of the Indigenous culture in medicine, especially in Canadian health care.”