Article

Is International Ophthalmology for You?

What you gain can exceed what you give

“Maya” had been begging on the streets of Kolkata, India, when I met her. She was about my age and, like me, had two young children. She and her husband, a construction worker, had made a good life for their family until tragedy struck and her husband was killed on the job. Now a widow, she went to work as a housekeeper to make ends meet and put food on the table.

This story might have continued on a predictable trajectory, with the woman eking out a living and the children growing up in their poor but loving household, except for one important detail: Maya has diabetes. Without access to medical care, she was blind within 5 years. Unable to work or care for her children, she gave them away to someone she hoped could at least feed them. She ended up literally begging for her own survival. This is just one of countless stories of human suffering that results from untreated diabetes, an epidemic that is growing at an astounding rate, particularly in the poorest countries in the world. It has become one of the main focuses, along with treating cataracts, for those of us who participate in international ophthalmology.

VISION AND HOPE RESTORED

I was in India with Orbis, an international nonprofit organization that brings together medical professionals — physicians, anesthesiologists, nurses, photographers, and so on — to mentor and train local eyecare teams to fight avoidable blindness in their own communities. A focal point of these missions is the Flying Eye Hospital, a state-of-the-art teaching facility complete with operating room, classroom, and recovery room.

After 2 days of screening hundreds of people, we had selected the best candidates for surgery. As we were moving patients to and from the plane, a staff member heard there was a woman we needed to see.

We had completed the screening process, so this was highly unusual, but then, so was Maya’s story. Upon examination, I learned Maya had vitreous hemorrhages in both eyes causing her blindness. I performed a vitrectomy and endolaser photocoagulation, an efficient 15-minute surgery that’s performed routinely in the United States, and she was able to see again. When last I heard, Maya was working as a housekeeper again and searching for her children.

This was a humbling experience in terms of how bad things are in developing countries. If I could have treated Maya when she started losing vision, can you imagine all the suffering that could have been avoided, including losing her children? On a much more optimistic level, however, this experience shows how good things can be if we provide access to medical care that already exists in wealthier countries.

On a mission with Orbis to Kolkata, India, Dr. Dugel operates in the OR of the Flying Eye Hospital.

GROUPS THAT MAKE A DIFFERENCE

I have volunteered with Orbis and the Himalayan Cataract Project once or twice a year for more than 20 years. Both are well-established nonprofit organizations with the underlying goal of eradicating preventable blindness. Although their approaches differ — and it’s fundamentally important to know the differences — I want to stress that one is not better than the other. They each bring vital services to people in need, and they each offer unique and gratifying experiences for volunteers.

Orbis (www.orbis.org ), with headquarters in New York City, carries out its mission through education, traveling to Africa, Asia, and South America. I serve on its board of directors. Many surgeries are performed at the Flying Eye Hospital, but the idea is not so much about volume, or “giving a fish,” but teaching people how to fish. Everything they do is centered around building relationships with the host country and encouraging interactions between the local physicians and the volunteers. Orbis is all about teaching and leaving behind something of value from an educational point of view.

I also participate in Cybersight, an affiliate of Orbis, which is an online training and mentorship service for eye health professionals in developing countries. By sharing and discussing cases online, I get to know my host and some patients before we meet in person.

The Himalayan Cataract Project (www.cureblindness.org ) provides services in remote areas of Africa and Asia under the leadership of an extraordinary man, Sanduk Ruit, MD. Volunteers often meet in Kathmandu, Nepal, where the organization is based, fly to a remote city, and then hike or trek for days to get to where they need to be. They set up cataract camps and perform as many surgeries as possible. It’s incredible how efficient and successful this organization is. What it accomplishes is miraculous.

These are two very different types of humanitarian organizations. A mission involving the Flying Eye Hospital must be pristinely organized, often a year in advance, with advance scouts and specific protocols in place. The Himalayan Cataract Project, by its very nature, is more loosely organized, because it operates in remote areas where people have no access to medical care. Both organizations do valuable work and are successful in carrying out their missions. Whether you choose to work with one or the other really depends on your personality and, perhaps, your sense of adventure.

WHY I GO

I’m an immigrant to the United States, so I feel an ethical and moral obligation to participate in international ophthalmology, but my sense of obligation is not necessarily the only driving force behind my continued participation. I derive enormous satisfaction from providing specialized eye care in places where I can have an immediate impact in a way that I cannot in wealthier communities.

But there’s more. It’s not just about giving back; I honestly feel that I get more than I give. For me, it’s not only an obligation, it’s also fun.

When I travel with Orbis, for example, my preparations begin long before my departure. I spend a great deal of time reading — something I love to do, by the way — to learn about the host country’s language and culture.

In particular, I love learning about cooking and food and discovering what people from different cultures eat. I find food to be a fantastic “unifier,” a common bond, regardless of how different the culture is, and I always try to eat like a local. Importantly, when the hosts see that I’ve taken the time to learn about their country, it changes everything. Suddenly, they realize I’m not just there to tell them what to do but to find out what they can and can’t do in terms of resources. It’s a nuanced and seemingly small distinction, but to them, it’s enormous, and it creates an entirely different experience for everyone. I am there to learn as much as to teach; it is a sincere dialogue.

IS IT FOR YOU?

International ophthalmology is a wonderful opportunity to enrich one’s self professionally and personally. I think of it as an essential part of what I do, not just as an ophthalmologist, but as a human being.

To anyone interested in participating in international ophthalmology, I recommend keeping an open mind and having clearly defined goals. Know what you want to accomplish and have a realistic idea of what’s going to happen.

How you prepare before you leave for your mission will enhance your experience exponentially. Learn as much as you can about your destination, its people, and how they live. This can make the difference between a good experience and a great experience.

The time commitment is whatever you want to make it. Usually, it’s about 1 week to 10 days, depending on travel time. You may or may not be expected to pay your own way, but all medical supplies are provided by the sponsoring organization.

The best way to learn about what to expect is to contact someone who has done a great deal of international ophthalmology work and ask about their experiences. I think it’s important to know what each organization offers and then decide what fits your personality and your timeline in life.

GLOBAL OPPORTUNITIES

We are doing fine here in the United States, but we act as though we are fairly isolated. With current technology, however, there is absolutely no advantage to not interacting with the rest of the world. Whether a country is rich or poor or somewhere in the middle, every part of the globe has an influence on the other. We have to make sure we are sensitive to conditions around the world at every level.

International ophthalmology gives us an opportunity to restore vision through cataract surgery and to have a significant impact on the raging epidemic of diabetes. NRP