John A. Hovanesian
Surgeons making volunteer visits to a developing country always do some
good, but the amount of good depends not just on the work they perform during
their visit but on what knowledge, skills and supplies they leave behind. As we
learn in this article about Dr. Jonathan Walkers project in Nicaragua,
the most effective volunteer surgical missions concentrate just as much at
building capacity in the developing country as on performing surgery during the
John A. Hovanesian, MD
Delivering eye care to those in need around the world can be a richly
rewarding experience, one that can change lives for the patients and the
However, maintaining that level of care after ophthalmologists return to
their practices is important to sustaining affordable ophthalmic services
worldwide, Jonathan D. Walker, MD, said.
Patients line up for evaluation at CENAO.
Images: George D
In a telephone interview with Ocular Surgery News, Dr.
Walker said fostering sustainable medical care in developing nations is key to
meeting long-term ophthalmic needs, beyond those met during brief surgical
I think the standard mission story is, the doctors pack everything
up, they go to some faraway place, they do a bunch of surgeries, everyone feels
like they are Alan Alda in M*A*S*H and its really cool, and you do
have a great time and you meet great folks, Dr. Walker said. But
then you come back home, and youve helped a bunch of people, but you
leave no improvement in the system.
Dr. Walker along with John T. Pajka, MD, Mark E. Drabkin, MD, and
Richard M. Feist, MD, volunteers at the Centro Nacional de Oftalmologia
(CENAO) in Managua, Nicaragua. He and fellow volunteers call the disconnect
between providing services and sustainability a logjam that can be freed by
providing new and appropriate equipment to hospitals.
It can make an exponential difference in terms of what physicians
there can do, Dr. Walker said. So in addition to doing a bunch of
surgeries, the goal is to go down there and leave something they need, so they
can treat more patients on their own and also be better able to teach the
doctors in training.
Dr. Walker and volunteer colleagues bring equipment and assistance to
CENAO in an effort to support sustainable health care in the region. CENAO, the
only teaching and charity hospital in Nicaragua, serves some of the poorest
people in the region who might not otherwise receive health care, Dr. Walker
Patients await surgery at CENAO.
He was introduced to CENAO by Dr. Pajka about 5 years ago. Since then,
Dr. Walker has traveled to Nicaragua many times, gathering grants and donations
for the hospital. He said physicians at CENAO are experienced at performing
ocular surgery but often do not have the proper tools to perform procedures.
From meeting the doctors in Nicaragua, it is apparent that they
have devoted themselves to helping the poor and teaching new doctors.
Unfortunately, neither the government nor their impoverished patients can
provide revenue to pay for the equipment they need, Dr. Walker said.
Ways to assist
Donations to CENAO have included operating microscopes, surgical
machines, lasers, slit lamps and even simple things such as ophthalmology
textbooks in Spanish, Dr. Walker said.
More help is always needed in achieving sustainable care, not only at
the hospital in Nicaragua but also in other outreach programs and missions
around the world, he said. There are numerous ways that physicians can take
part in achieving lasting outreach work many of which do not involve
traveling to another country and performing surgery.
use the microscope donated by John T. Pajka, MD.
Being creative about gathering funds or equipment for outreach programs
is important to try to make these programs self-sustaining, Dr. Walker said. He
suggested informing stateside patients and working with church and service
groups such as Lions Club International to encourage and coordinate donations.
For instance, Lions Club members near his Fort Wayne, Ind., practice have
donated money and transportation and even created custom crates to send
equipment to developing countries.
These guys just love doing that in their barn, and they bring
these incredibly packed things, and then people help with loading and shipping
the stuff. Its fun, he said.
By donating equipment to the staff at hospitals in developing nations,
physicians are helping provide universal and sustainable eye care in those
countries, Dr. Walker said, adding that not all ophthalmologists can leave
their busy practices, professorships or personal lives to participate in
outreach around the globe.
For those physicians, giving funds or equipment may be the best option
for volunteering while staying close to home.
Doctors who are uncomfortable with operating on missions or
dont think they have the time
you can contact someone who does go
on a mission and ask them what they need, and buy something for $50 or $100 or
and without leaving your office, and you can get a dramatic
return on the investment, Dr. Walker said. If someone can travel
but does not have the inclination or wherewithal to do a full surgical mission,
then simply visiting a facility to learn about their needs can be a much easier
and shorter trip. The knowledge gained can then be used to help them from back
in the States. For instance, physicians routinely interface with
representatives from the manufacturers and are well-positioned to ask for help.
Even a tiny intervention in a country far away can make a big
difference. by Erin L. Boyle
- Jonathan D. Walker, MD, can be reached at Allen County Retinal
Surgeons, 7900 W. Jefferson Blvd., No. 300, Fort Wayne, IN 46804; 260-436-2181;
fax: 260-436-2567; e-mail: firstname.lastname@example.org. For more
information about CENAO, contact Dr. Walker.