Eyeworld

112 | EYEWORLD | MARCH 2020 O UTSIDE THE OR Contact Kahook: malik.kahook@cuanschutz.edu Macdonald: susanmacdonaldeyecorps@ gmail.com Pettey: jeff.pettey@hsc.utah.edu Lessons learned from abroad Susan MacDonald, MD, shared several incor- rect assumptions she previously made about global ophthalmology. One such assumption was that she had all the solutions. "There are a lot of problems that have to do with people living in poverty and not having access to care. It's not a simple solution," she said. Another assumption was that phaco could be the blanket answer for ophthalmologists abroad. However, she found that many eye sur- geons abroad cannot afford to provide phaco routinely. A third was assuming that silence means people agree with you. "Just because someone is silent or not disagreeing doesn't mean they agree with you. It may be they are being polite. To really understand problems, you have to ask questions and listen," she said. Finally, she learned that forging a path in global ophthalmology is much broader than a focus on eyecare alone. "It's about developing a system in a country where people have access to care," she said. Dr. MacDonald had several pearls to help others who plan to make global connections: • Be patient when developing relationships, and it's all about relationships. • Mind your manners, and be kind. Ask ques- tions like, "What do you think?" Then really listen. • Share your knowledge and obtain knowledge from local doctors. Their knowledge is criti- cal. • Carefully build a team with the right skillset. • Find leaders who can make things happen. • Take the time to build those key relation- ships with nongovernmental organizations (NGOs). In Tanzania alone, where Dr. Mac- Donald has spent time, there are 500 NGOs. "Many of them can help you, but it's all about people again," she said. Similarly, plan to build relationships with businesses that want to offer help and support. • Plan to attend government meetings. These are another important building block in de- veloping and maintaining global ophthalmol- ogy programs. questions can help surgeons and their global programs offer the most effective care. For instance, consider what resources may be available locally as this can dif- fer significantly based on whether it is an urban or rural location. In urban areas, just like in the U.S., you likely will find more skilled surgeons and basic access to glau- coma medications. However, there may be limited access to skills transfer, and local doctors may not have access to the new- est devices or techniques. In rural areas, there often are a limited number of trained surgeons and a higher number of patients with end-stage disease. When getting ready to go abroad, give some serious thought to your skillset, Dr. Kahook advised. Some volunteer programs may require a minimum number of years in practice out of fellowship, for example. Also, consider if you have a niche specialty/subspecialty. "One example is pediatric glaucoma. Concentrating on aspects where you are strongest will add a lot of value," he said. Plan to communicate with surgeons onsite in advance of traveling to find out their stress- ors, both clinically and economically. Ideally, you can continue to communicate with your new surgical contacts after the trip as well, so everyone can continue to teach and learn from each other. Sustainability is a major concern, Dr. Kahook said, sharing how he has seen fancy and expensive equipment sitting in a corner in the OR abroad. The reason? There was no one locally who could fix or service the equipment. Because of this, surgeons should focus on prac- tical, sustainable surgical solutions. Dr. Kahook said that cataract surgery may be one of the best glaucoma surgery options in many, but not all, global settings because it low- ers IOP and can be cost effective. Trabeculecto- my also has a role abroad, he said. On his "wish list," for glaucoma surgery abroad, Dr. Kahook includes an inexpensive glaucoma drainage device and a low-maintenance cyclophotocoag- ulation laser with low-cost disposables. Reference 1. Coombs PG, et al. Global health training in ophthalmology residency programs. J Surg Educ. 2015;72:e52–59. Relevant disclosures Kahook: Alcon, Aurea Medical, Equinox, Fluent Ophthalmics, Ivantis, Johnson & Johnson Vision, New World Medical, ShapeTech, SpyGlass Ophthal- mics MacDonald: Carl Zeiss Meditec, Perfect Lens Pettey: None continued from page 110

• Blank Page
• Blank Page (1)