January 15, 2007
4 min read

Surgeons learned as much as they taught in outreach program to Kazakhstan

Organizer said meeting helped foster good working relationships with the government and medical community of the former Soviet republic.

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Ophthalmic Outreach logo

Forging international relations and sharing information about different practices and techniques are two important aspects of an ophthalmic outreach program that builds teaching programs in developing nations.

Robert Ritch, MD, FACS, who organizes the outreach program, invites doctors from all subspecialties in ophthalmology and other fields of medicine to lecture and take part in surgery and clinics overseas. He has since helped set up residency and teaching programs in Thailand and other countries.

Recently, he led a 2-day outreach group to Kazakhstan. In a telephone interview with Ocular Surgery News, Dr. Ritch said he became interested in conducting a program there after three Kazakhstan officials were patients in his New York City office.

“We had the largest number of people respond and come for one of these [Kazakhstan] meetings,” he said. “Usually, I have to send out 40 e-mails to get six people to come. We had 12 people [participate].”

John A. Hovanesian
John A. Hovanesian

On the first day of the program, U.S. doctors gave lectures in their subspecialty to an audience of about 250 Kazakhstani medical professionals at a hotel in Almaty. Dr. Ritch gave a lecture titled “New understanding of exfoliation syndrome.” All lectures were translated simultaneously into Russian, he said.

The second day, U.S. doctors performed demonstration surgery and spoke in small discussion groups, talking with scientists or seeing patients in the clinic. Dr. Ritch, a glaucoma specialist, demonstrated glaucoma surgery. He said the meeting helped forge good working relations with the Kazakhstani medical community and government.

Developing a connection

Marilyn T. Miller, MD, an ophthalmologist and former president of the American Ophthalmological Society, also took part in the Kazakhstan meeting. She gave a lecture on craniofacial syndromes, went on strabismus rounds. She said the program allows doctors from different countries to exchange ideas and compare treatment options.

She had taken part in several previous teaching outreach programs with Dr. Ritch, including one in Myanmar. In a telephone interview with OSN, she said she learns more than she gives at the teaching programs.

One of the best parts of participating is developing connections with doctors in other countries, Dr. Miller said. On the trip, she met a young Kazakhstani ophthalmologist who contacted her upon her return.

“She sent me a nice e-mail saying she’s working on her English and hopes to come and visit me in the U.S.,” Dr. Miller said. “If you can facilitate a few people doing things like that, that’s good, too.”

Another participant was Sally Atherton, PhD, a vision researcher and former president of the Association for Research in Vision and Ophthalmology. She lectured on the latest research concerning herpetic eye diseases and treatment options. It was her first time taking part in the outreach program.

Outreach group in Kazakhstan
The outreach group in Kazakhstan. From left to right, Barry Winkler; Robert and Marguerita Dolgoff; Marilyn T. Miller, MD; Elena Ilitchev; Robert Rich, MD, FACS; and Riyo Saito.

Images: Ritch R

In a telephone interview with OSN, Dr. Atherton explained why she found the experience to be rewarding. “A lot of the things that we do in science is people-to-people,” she said. “There’s a lot you can do by teleconference, but when you’re face to face and I’ve got my slides up on the computer and we’re sitting there talking about it and they can ask me questions – that’s really fun.”

Dr. Atherton said the teaching program was an educational experience, designed like a master class for Kazakhstan doctors to learn about Western techniques.

“I never got the sense that it was like these … people are coming in and talking down to these people who don’t have access to information,” Dr. Atherton said. “It was really an exchange of ideas and individuals who were really willing to learn and interested in some of the news things.”


Kazakhstan, rich in oil reserves and other natural resources, declared independence from the Soviet Union in 1991.

Since then, it has been slowly modernizing, with the arrival of Western technology there, according to the doctors. Dr. Atherton said after spending a day talking with a corneal doctor and her team, she learned that doctors in Kazakhstan do not have easy access to up-to-date research and literature. Computers seemed scarce and Internet access limited at best, she said.

Robert Ritch, MD, FACS with Deputy Minister of Health, Aikan Akanov
Robert Ritch, MD, FACS with Deputy Minister of Health, Aikan Akanov.

“It opened my eyes to how individuals in a country that doesn’t have as advanced a health care system as we do may have no access to information or limited access,” Dr. Atherton said. “The ability to get up-to-date information probably hinders the delivery of health care.”

Dr. Atherton said she also noticed during the group’s tour of the hospital that patients’ families were staying there. The topography of Kazakhstan, which is the world’s ninth-largest country, is largely steppe terrain. She said that seemed to help shape the country’s medical system.

“Many patients come in from the countryside. There’s so much country there, much semi-desert and much open area, that they would have to come in and stay at the hospital for awhile,” she said.

Dr. Miller said she found the hospital well-equipped. She said they had pyramid system of medical care and the hospital in Almaty appeared to be the most advanced for ophthalmological care in the country.

She said she noticed that doctors in Kazakhstan did not seem to have as rigid an educational program, without certain times for certain stages of study, as in the United States.

“There were certain differences in treatment … that probably represented attitudes and treatments from the Russian system vs. the Western system,” she said. “But they were not insurmountable or so dramatically different that one couldn’t compare advantages and disadvantages.”

According to Dr. Ritch, the next outreach program is planned for Bulgaria in 2008.

For your information:
  • Robert Ritch, MD, FACS, is a professor of clinical ophthalmology at the New York Eye and Ear Infirmary. He can be reached at 310 E. 14th St., New York, NY 10003; 212-673-5140; fax: 212 420-8743; e-mail: ritchmd@earthlink.net.
  • Sally Atherton, PhD, is a professor and chairs the Department of Cellular Biology and Anatomy at the Medical College of Georgia. She can be reached at 1120 15th St., Room CB2915, Augusta, GA 30912-2000; 706-721-3731; fax: 706-721-6210; e-mail: satherton@mail.mcg.edu.
  • Marilyn T. Miller, MD, is a professor of ophthalmology at the University of Illinois Eye and Ear Infirmary; 1855 W. Taylor St.; Chicago, IL 60612; 312-996-7445; fax: 312-413-4916; e-mail: marimill@uic.edu.
  • Erin L. Boyle is an OSN Staff Writer who covers all aspects of ophthalmology.