Biography/Disclosures
Biography: Khorram is cofounder and director of Marianas Eye Institute.
December 11, 2018
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BLOG: How to get involved with international ophthalmology

Biography/Disclosures
Biography: Khorram is cofounder and director of Marianas Eye Institute.
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While at the American Academy of Ophthalmology meeting this year, quite a few people approached me, asking, “Hey, I’ve got a week or two available each year. How can I get involved with global ophthalmology?”

When I talk to people about this kind of work, I usually go back to the basic idea that global ophthalmology is all about equity, and that while it is appealing to travel to a faraway place to help those with limited access to eye care, global ophthalmology is also concerned with addressing health equity right here at home. So while you plan a trip abroad, also consider what you can do to address the eye care needs of those in your region, town or neighborhood. Those opportunities are there, and in another column, we can talk about them. Today I’ll discuss international opportunities, but keep the local needs in mind.

The other thing I bring up is that global ophthalmology falls within the larger field of global health, and that as I’ve discussed in previous columns, there are three primary principles of global health: equity of care (justice), universality of care (oneness) and a broad interdisciplinary approach (coherence). With these principles in mind, global health traditionally undertakes three core activities: direct care, capacity building and research. In my mind, there is a critical fourth core activity: empowerment.

Direct care is what it sounds like: taking care of patients. This is what most ophthalmologists envision they’ll be doing on a trip abroad. Direct care is important because there is a large backlog of people in many countries who need an ophthalmologist to go in and take care of them — cataracts, strabismus, plastics cases, glaucoma, retina, you name it.

Traveling abroad to provide direct care, while important, especially to those individuals who receive the care, is not a long-term solution. This is why we emphasize capacity building as a core activity of global health. While a trip may not specifically be set up as a teaching trip, by having this in mind, you can seek out opportunities to build the capacity of people on the ground. I’ve incorporated capacity building into many trips that were set up as trips to do a bunch of cataracts in a week. I’ve helped the local ophthalmologist with new techniques. I’ve worked with an eye technician to build her skills as a scrub nurse. I’ve taught school teachers how to check vision. The possibilities are numerous. You just have to keep it in mind. Those of us who are most involved in global ophthalmology place most of our emphasis on capacity building because it is a key to sustainable long-term health equity.

I encourage those who seek my advice to also incorporate the third activity into their trip: research. Now, this doesn’t mean you have to initiate some big study. What I encourage you to do is to collect some basic data that helps define the extent of disease in a region or helps assess and improve the quality of the care you are providing. Put together a spreadsheet and record preop vision and postop vision. Think not just in terms of the number of cases, but keep track of numbers that reflect the quality of care. If you’re going to refract patients, record and analyze the refractive errors of the population, so on the next trip, more appropriate prescriptions can be taken. Again, just keep this in mind, and plan for it in advance. It adds so much to the “direct care” trip.

Finally, empowerment is an activity that I believe must be incorporated into global health. Individuals on the ground must be empowered to read the realities and needs of their own communities and to see themselves as agents of change, as the ones who will bring about the improvements. Initially, this may take the form of asking individual health care workers what they see as the issues that need to be addressed. Those who are in the communities have a much better understanding of the complexities of situations. The world has a lot of problems, and when each individual in a community sees themselves as protagonists in the process of development, things will move forward more rapidly. Don’t be the expert going in to tell people what needs to be done. Go only if you are invited to be there, ask questions, take on a humble posture of learning.

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All of these core activities combine to ultimately strengthen the health care system, and those of us more fully involved in global ophthalmology spend quite a bit of time on health system strengthening as an umbrella under which the other activities are components.

With this profound and much longer than expected introduction, ophthalmologists who ask me how to get involved in global ophthalmology realize that they got more than they bargained for and are still wondering how to get involved. Here is the short answer: It’s critical to work with an experienced partner organization. There are many organizations out there, but the two that I have had the most experience with are Surgical Eye Expeditions (SEE) International and Vision Health International (VHI), of which I serve on the board of directors.

SEE identifies ophthalmologists around the world who would like a visit from a U.S. ophthalmologist. These individual projects, which number in the dozens, are listed on SEE’s website, and each has a brief description of the need: backlog of 50 cataracts need MSICS surgeon, help ophthalmologist learn phaco, 35 strabismus cases, etc.

SEE works hard to ensure the quality of the surgeons they send, so you must be board certified and U.S. licensed, and fill out a fairly detailed application. The partner sites are also vetted and must have an ophthalmologist who invites you and who is able to take care of the patients postoperatively. Most of the trips are 1-week long. It’s good to have a few months’ lead time because it takes time for the local organization or physician to get you licensed in the country and for SEE to gather and send you the supplies needed for the cases, which you will take with you. While SEE takes care of these details, there are some logistics that you’ll need to take care of yourself. For example, I like to talk to the hosting ophthalmologist to find out what kind of equipment is on site — what kind of microscope, autoclave, vitrector, etc. SEE will provide you a list of the standard supplies it sends, for example, for 50 phaco cases, but you’ll have to go through that list and compare it with the resources on the ground and your personal preferences. You’ll also arrange your own housing and meals, usually with the advice of the local ophthalmologist. If there isn’t a qualified scrub nurse on the ground, you’ll have to arrange to take one with you. Some ophthalmologists go on this kind of trip with a team from their office.

If you’d like to avoid making some of the logistical arrangements, you can go on a SEE trip that has several ophthalmologists going, and the trip leader will take care of many of the details. Or, you could go with Vision Health International. VHI has relationships with several clinics in Latin America and recently has adopted projects domestically — for example, this summer a trip is being planned to a Native American reservation. VHI puts together a team of people to go together to the locations to provide direct care. They work closely with industry partners and with SEE for the supplies. With VHI, you can slip in as a member of the team, and VHI takes care of all the logistics, like getting from the airport to the site, arranging the hotel and meals, receiving the supplies from SEE, organizing supplies and sending them in duffle bags to the participants to carry to the site, bringing microscopes, phaco machines, keratometers and other equipment, and ensuring there are scrub and circulating nurses, PACU nurses, anesthetists and other personnel rounding out the team. The trip with VHI may be only surgical, with a single surgeon or with a few subspecialists. Or the trip may be one that includes surgery and community vision screening and glasses. VHI puts the whole team together. The camaraderie on these trips is one of the highlights.

While most of us in global ophthalmology are seeking to address the broader issues of capacity building, research, empowerment and health system strengthening, there are a lot of centers that request ophthalmologists to go and help them with surgical cases. SEE International and Vision Health International are two organizations that can help you use your skills to provide direct care in a global setting. Both organizations have application forms available on their websites.

Disclosure: Khorram reports he serves on the board of directors of Vision Health International.