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.