David Khorram, MD, focuses his blog on global ophthalmology and issues related to combating global blindness.

BLOG: Residency in Haiti a fulfilling opportunity

Are you looking for something meaningful to do for a week or longer? There is tremendous opportunity for high-impact service in Haiti. The residency program is in need of ophthalmologists to staff the clinics and provide training and mentorship to the residents for a week at a time. A group of us are trying to organize a rotation of ophthalmologists that would be willing to spend a week or longer in Haiti at the residency program to staff the clinics and attend surgeries. The Hopital de l’Universite d’Etat d’Haiti, or HUEH, in Port-au-Prince is the state hospital that houses many of the country’s residency programs. It was severely damaged in the 2010 earthquake but is functional once again.

Haiti is the poorest country in the Western Hemisphere and has a critical need for ophthalmologists. While many U.S. ophthalmologists travel to Haiti to provide direct patient care, the ultimate solution to Haiti’s eye care needs, as in any country, will come from training a rising number of local ophthalmologists. With approximately 12 of Haiti’s 60 ophthalmologists providing surgical care to a country of 13 million people, Haiti has one of the lowest number of surgical ophthalmologists per million people.

The residency program at HUEH graduates two to four ophthalmologists per year, and many finish without being comfortable performing surgery. So, while it will be many years before Haiti reaches adequate levels of access to ophthalmic surgeons, every well-trained Haitian ophthalmologist massively increases access to ophthalmic care. The program is staffed by three attending physicians; however, they are not able to provide full-time coverage due to the meager state salaries. A recent addition of five more part-time staff will help strengthen the program. Global ophthalmology fellows from Wills and Moran, along with a few other volunteers, provide training during a few weeks of the year; however, the education can be significantly improved with more volunteer attending, rotating through for one or more weeks of the year.

Haitian Creole and French are the predominant languages, but most of the ophthalmology residents speak English well. I had no difficulty communicating with them in English. The residents need help in all aspects of ophthalmic care. Some practical clinical skills that one could teach include how to use clinic diagnostic equipment, how to think systematically and comprehensively when faced with a patient, and how to approach common diagnostic problems. Surgically, the training is focused on cataract surgery using the manual small-incision cataract surgery (MSICS) technique, and anyone planning to teach cataract surgery should be a skilled MSICS surgeon. But surgical training in plastics and glaucoma is also needed. There is a dedicated ophthalmic OR that has a good Zeiss microscope with a teaching scope and a monitor. A wet lab and dry lab are being organized and should be available in the coming weeks.

Many people ask me about the safety of conditions on the ground in Haiti. A group of us were there in late July, just after the drama over fuel price increases. Things were quiet, and it did not appear to be any different from any of the other countries I travel to. Generally, when a country lacks ophthalmologists, they also lack other elements of infrastructure and governance. Participating in global ophthalmology intrinsically entails going to places that face a broad spectrum of challenges, and Haiti is no different. When our team traveled to Haiti, the U.S. State Department had downgraded the alert situation from “red” — do not travel — to “orange” — reconsider travel. Haiti rarely improves beyond the orange status. A range of housing options is available, including the luxurious Marriott Hotel, located close to the hospital.

When our team traveled to HUEH, it was composed of two ophthalmologists and two medical students. It was definitely more enjoyable to spend the time in the company of others, and the medical students proved to be very helpful scrub techs and circulators in the OR. Even on a purely clinical trip, there is room for more than one trainer. Optometrists, ophthalmic technicians, residents and fellows can be of tremendous help teaching clinical skills, giving lectures and transferring knowledge. As in most of these situations, those traveling will need to cover all of their own costs, in addition to volunteering their time.

Those of us organizing coverage at the residency program can help guide you with various logistical issues. If you will be providing surgical training, the first step is to register through SEE International. Those who would like to provide clinical (non-surgical) training can fill out a short interest form here.

While there are many opportunities to travel to countries to provide surgical care, this is a rare opportunity to provide training, at a location less than 2 hours from Miami. You can have impact that will last far into the future. Consider it. It’s a highly rewarding experience.