Perspective from Klara Landau, MD
Perspective from Victoria Verejan, MD
October 10, 2014
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Educational project in Prague aims at improving health care in Eastern Europe

Short-term, intensive teaching programs offered to select ophthalmologists address low vision services, causes of avoidable vision impairment.

Perspective from Klara Landau, MD
Perspective from Victoria Verejan, MD
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The Lions Ophthalmology Educational Center in Prague, Czech Republic, was opened in March 2002 in a newly constructed building adjacent to the Charles University Department of Ophthalmology, Vinohrady Teaching Hospital. Co-funded by Charles University and the Lions Club as part of its SightFirst program, the project is aimed at training young ophthalmologists in Central and Eastern Europe in specific subspecialties and addressing causes of avoidable vision impairment with a special focus on public health care services.

“We provide specialized, short-term, intensive teaching programs that cover the main causes of avoidable vision impairment, such as glaucoma, AMD, diabetes, cataract. We also have a highly specialized course on low vision services, an area that is insufficiently developed in almost all countries globally, and definitely in Eastern Europe,” Ivo Kocur, MD, World Health Organization Medical Officer, said. In the early 2000s, he worked as an ophthalmologist at the Vinohrady Hospital university eye department led by Pavel Kuchynka, MD, coordinating the project to develop the Lions Ophthalmology Educational Center (LOEC) and, since its opening, has supported the department through jointly conducting international training programs.

Born and educated in the former Czechoslovakia, Kocur has an inside, objective view of the health care situation before and after the fall of the Berlin Wall.

“There is a misconception that in the socialist area everywhere in Eastern Europe, services were poor and that the political changes precipitated everything into chaos. As a matter of fact, there were countries where health care was well developed with efficient and granted access to everyone at no cost. The transition to a more commercially based system was in fact a loss in some ways,” he explained.

However, what was missing compared with the West was the level and availability of subspecialty services in eye care. Some areas, such as vitreoretinal surgery, were poorly addressed and lacked human resources. Specialists experienced in diabetic retinopathy, pediatric ophthalmology and low vision are still mostly available only at tertiary eye care establishments.

“The LOEC is addressing these unmet needs. We have specialists who train young ophthalmologists so that this specialized care can be provided. The objective is to promote improvements in quality and comprehensiveness of eye care services throughout the subregion,” Kocur said.

Low-budget, high-quality project

Since 2002, 1,400 ophthalmologists have participated in more than 70 LOEC teaching programs. Most of them run 3 to 4 days over the weekend, with both morning and afternoon teaching sessions. Interactive surgical sessions allow students to either join the surgeon in the OR or be remotely connected through a live-surgery video transmission. Teaching sessions at outpatient units as well as visits to other eye care establishments in the city are regularly arranged.

“Classes are small, up to 30 participants, and very interactive. The atmosphere is very friendly. Students come up with their cases, project their slides, discuss, ask questions. No one is going to be blamed for a seemingly silly question,” Kocur said.

Independent review of participants’ feedback shows a high degree of satisfaction. They express enthusiasm and gratitude for what they have learned and for the overall experience of learning in a somewhat different way and with a different approach that is more than purely clinical.

“Every time I see quite a few confirming that they have never been exposed to something so intense, friendly and helpful. And yet we don’t provide special dinners or any form of entertainment. Students eat in the hospital canteen and sleep in shared rooms. Nothing fancy. It’s purely about getting the knowledge,” Kocur said.

Attendees are selected by the national eye societies of their respective countries. They have to pay their own travel expenses, while the course, food and accommodation are free.

Principal lecturers are recruited from leading universities in Europe, from Israel and, in the case of the low vision specialists, from New York.

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“It’s the generous contribution of highly recognized eye care experts who come on economy class tickets, teach, spend 3 or 4 days with the students, donate time and knowledge. They teach on a voluntary basis, as do the experts from Prof. Kuchynka’s university eye department and some others in the Czech Republic. Quite unique,” Kocur said.

Six to eight teaching programs are offered per year. More could be done, but additional funding is needed. The economic downturn since 2009 has made LOEC lose international donors and produced the need to find new ways to manage available resources, including generating income through domestic donors.

“The problem is that teaching is hard to convert into an immediate measurable outcome. We had major promises, but potential donors are often hesitant due to the inability to measure the impact of educational programs, as opposed to measurable outcomes of direct treatment of patients, for instance. Nevertheless, we all believe sharing knowledge and skills is the best investment for the future of eye care,” Kocur said. – by Michela Cimberle

For more information:

Ivo Kocur, MD, can be reached at World Health Organization, Avenue Appia 20, 1211 Geneva 27, Switzerland; email: kocuri@who.int.
Disclosure: Kocur, World Health Organization Medical Officer, organizes training programs for the Lions Ophthalmology Educational Center.