Student conducting vision screening.

In a rural Alabama Head Start center, the lights are off and the windows are covered with black plastic. A line of preschoolers sits surprisingly quietly in the dark, cross-legged, small hands picking at the carpet of the trailer. Once their pupils dilate, they'll get to have their pictures taken.

For these photos, it's the eyes—not the smiles—that matter. Volunteers from an area college campus have arrived to conduct vision screenings. It's a new experience for the children.

When it's Austin's turn, the three college students doing the screening hit a snag. The five-year-old is tall for his age, and he needs to bend his knees for his eyes to show through the faceplate.

The three volunteers try to explain the bent-knee concept.

"Just kind of squat down," says one, demonstrating.

"Act like you're shrinking."

"Like you're looking through a really short window," adds another.

No sale.

Finally, extensive pantomime meets with success. Austin is told to look at the dots, not to blink, and he's smiling when he turns away, photo successfully snapped. The whole process took no more than a couple of minutes. In six weeks, the Head Start center and Austin's parents will receive his results in the mail. If there's a problem, there will be follow-up calls about treatment, and if money or transportation is a problem, they'll get help with either.

The screenings and the follow-up come through the efforts of Focus First, one of several service-learning initiatives created by a non-profit group called Impact Alabama. Impact founder and president Stephen Black raises all funds for FocusFirst from private donors.

Not counting funding for personnel—two AmeriCorps VISTA-funded staff members working solely on FocusFirst and the Impact executive director who oversees multiple programs—FocusFirst costs less than $50,000 each year and screens thousands of children. It helps that Vision Research Corporation, the company that analyzes the screening photos, does so at a reduced cost.

Why Earlier is Better

In Alabama, all kindergartners receive vision screening in school. But for many children, that's too late. For example, if amblyopia, or lazy eye, is diagnosed at age six, wearing an eye patch for six months is likely to restore 65 percent of a child's vision. But if started at age three, just a week of treatment can restore full vision. Among Alabama's largely rural population, thousands of children lack access to eye care—it's too far away or too expensive or too low a priority. Only an estimated 21 percent of preschool children in the state receive proper eye exams.

The gap in care affects more than eyesight. Undiagnosed vision problems shape the way a child sees herself.

"If you're four or five and you're sitting there trying to read, you don't know you can't see well," said Black. "You just can't distinguish between 'a' and 'b.' You're not learning the way other kids are, and it makes you angry. You act out. You get labeled bad or slow, learning disabled or attention deficit disorder—this happens way into the middle class, not just to poorer kids. It's a terrible hindrance to any child."

Approximately 60 percent of the children screened by FocusFirst have Medicaid or All Kids (Alabama's state-funded insurance program for low-income children) and approximately 40 percent are uninsured. Medicaid does not cover vision screening, though it does pay for follow-up eye care.

Covering a Lot of Ground

Launched in 2004, FocusFirst holds screenings at Head Starts and other daycare centers in low-income areas.

Screening a large number of children—especially over a widespread area—takes a large number of screeners with a specific set of skills. To pay hundreds of staff people would have wrecked the budget of a program before it ever got off the ground. So Black filled that personnel gap with a labor force that's free, motivated, and eager to help: college volunteers.

And it's a group hungry for meaningful opportunities to help, according to Black.

"When you say to a college class that 9 million children don't have health insurance—don't you think that's wrong? They'll say that's wrong; they'll say that needs to change," Black said. "But they feel they have less ability to do anything about it than any generation before them. This same group is incredibly charitably driven, putting more time into volunteering than any other age group, taking off years before graduate school to volunteer their time. They want to make a difference, but they don't have a sense of being able to bring about structural change."

He hoped to bring students face to face with a systemic problem—and to show them that their efforts could help address it. And a campus-based, student-driven program also addressed a logistical problem: how to reach rural areas effectively. A wide network of campuses—and students willing to drive up to an hour to screening sites—means FocusFirst can cover most of the state.

Volunteers Rise to the Challenge

After receiving three hours of training on how to operate specialized cameras, students conduct testing with state-of-the-art photo screening technology. In small groups, they travel to the daycare centers and run the screenings from beginning to end.

Initially, the idea of student volunteers taking on a task usually carried out by paid technicians met with skepticism.

"My biggest skepticism was the use of college students," said Jeff Haddox, president of Sight Savers, an Alabama nonprofit that coordinates eye care services for children in need. Sight Savers partners with FocusFirst to provide follow-up when the screenings turn up vision problems. "I was worried that volunteer students wouldn't do the same job as a paid employee. But I'm very impressed with the quality of the students—I'm not sure I would have believed it if I hadn't seen it."

"A lot of volunteer work it seems like you're picking up the pieces and doing the little things, but here you're running it," said Rachel McWhorter, student coordinator for FocusFirst and a member of AmeriCorps. "The volunteers are the heart of it, and it makes people have a much more invested interest."

The results attest to the quality of the students' work.

By the time she came to a Focus First screening in the spring of 2005, Inge Washburn had already taken her three-year-old daughter Marcia to a pediatric ophthalmologist after her pediatrician noticed an irregularity in an eye exam. The specialist recommended glasses, which the then-two-year-old had no interest in wearing. At the FocusFirst screening in Golden Springs, Alabama, a problem was discovered that needed a much more serious fix than glasses: a cataract in Marcia's eye.

She had surgery in July 2005 to remove the cataract, and an artificial lens was placed in her eye. With the right treatment—she's wearing a patch over her good eye to force the weaker eye to self-correct—by the time she's 10, she shouldn't even need glasses.

Student Volunteers See Bigger Picture

Emily Dueitt, a senior at Huntingdon College in Montgomery, had volunteered through her church and with Habitat for Humanity before connecting with FocusFirst through a New Testament class.

"I've always been a person who's wanted to do service learning, but I never really felt like I had an outlet that went very far," she said. "This is something a lot bigger than myself and a lot bigger than the few trainings that I do. Its goal is to screen as many kids in the state of Alabama as possible. It's a very lofty goal, and it's possible."

With 200 trained student volunteers on 14 campuses across the state, the program screened 4,400 children in its first year, with 600 of those children needing some type of follow-up care. The numbers will likely climb to 8,000 children screened this year. The students are only one piece of the puzzle—FocusFirst's partnership with non-profit partners like Sight Savers and for-profit companies like Vision Research are key to providing analysis of the screening photos and comprehensive follow-up.

That follow-up process is crucial. "Children from low-income households often do not receive the necessary follow-up eye care because their parents are unable to afford the cost or lack transportation," Haddox said. "The follow-up service coordinates vision care through the completion of treatment, ensuring that the effort and cost of vision screening was not wasted."

And students get to see their own role in a multi-pronged, comprehensive effort.

"They all know that they're part of a machinery that deals with the delivery of healthcare year after year," Black said. "Sometimes the justice answer is legislation—in this case the justice answer is a unified, organized effort by university students serving the needs of poor children near those campuses. In this case that's the structural answer. In this case, this is the long-term."

Seeing is Understanding

Although it's a structural answer, it's also a very personal interaction. Some students don't know the difference between Head Start and other pre-schools when they start volunteering. Looking at forms listing children's medical histories, college students see how many children have never been to a doctor. Or who've been told they need glasses but couldn't afford them.

"Students may realize the situation before they see the kids," said McWhorter. "They know it intellectually, but they've never seen it. It gets more of an emotional response there."

"The children are what keep volunteers coming back," Dueitt said. "These kids are just precious, and you can't help but realize that no matter what, a child is a child. None of the surface differences really matter, and that helps you realize the injustice that much more."

Gin Phillips is a freelance writer based in Birmingham, Alabama.