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77 EW IN OTHER NEWS November 2014 by Michelle Dalton EyeWorld Contributing Writer The course was designed to be typical of fellowship-level topics, Dr. Asbell said. For example, in Myanmar it is common to use amniotic membrane to fill the hole after treating a corneal melt, which impressed Dr. Asbell. the American Vision Center in Yangon, a privately run vision center. Lectures were attended by stu- dents, residents, and current faculty, and the question and answer period "was totally pertinent and quite well thought out," Dr. Asbell said. Prof. Tin Win, department head of the Yangon Eye Hospital, served as the surgeons' host during their time in Myanmar. Dr. Asbell said the country started an eye bank in 1993, and receives between 100–150 corneas a year, but "Prof. Win shared with me that he has a waiting list of 3,000 patients who need corneal transplant surgery." And the gov- ernment is of little help, spending anywhere from 0.5% to 3% of its GDP on healthcare, leaving patients to pay for medicine and treatment even in public clinics. According to the RANZCO Eye Foundation, Surrey Hills, Australia, the country has a backlog of more than 600,000 cataract surgeries, and less than half the ophthalmologists in the coun- try are trained to perform surgery. RANZCO notes that Myanmar has an 8.1% blindness prevalence rate, caused by cataracts (64%), glaucoma (17%), trachoma (4%), and other causes (15%). Low vision is ram- pant—40.4% in rural areas, 70% of which is attributed to cataract. Covering the bases The HEF-organized course covered a range of topics from cataract and corneal external disease to glaucoma and retina issues. "We even managed to squeeze in some instruction on pediatric ophthalmology and refractive laser surgery," Dr. Asbell said. Throughout the 4-day Myanmar Eye Meeting course, if the surgeons were not lecturing, they were invited to share their expertise in clinic. "We wanted to share our knowl- edge and invited the clinic person- nel to bring back any patient they wanted an additional consultation on," she said. As almost everyone is bilingual, language barriers were not an issue. In addition to HEF's donating equipment, the Singapore division of Carl Zeiss Meditec donated equipment as well, Dr. Asbell said. "Myanmar has some pretty modern equipment they're be- ginning to accumulate, including optical coherence tomography," she said. Clinics were run at Prof. Win's site, and the surgeons also visited S ome surgeons not only embrace teaching oth- ers, but choose to do so outside their comfort zone and outside the U.S. For decades, Myanmar (also known as Burma) had closed borders that prevented foreigners from entering the country—and that included medical personnel on training missions. When Penny Asbell, MD, heard about a medical mission to Myanmar for the purpose of training residents and surgeons on various corneal surgical techniques, she quickly volunteered her time and expertise. The teaching exchange was organized by John M. Corboy, MD, Hawaiian Eye Foundation (HEF), Mililani, Hawaii, which is well known for its philanthropic work in the South Pacific and Southeast Asian region. Dr. Asbell has regularly participated in HEF-organized teaching missions in Vietnam. Myanmar has roughly 60 million inhabitants—and only 350 oph- thalmologists; 70 practice in the country's largest city, Yangon. There is only one cornea-trained specialist, Dr. Asbell said. In Myanmar, it takes 6.5 years to become a doctor, before any specialty training, she added. "After getting their medical degree, they do a year of internship, then 2 years of government service. Then they have to pass an exam to see if they can get into ophthal- mology," she said. "There are about 12–20 residents a year specializing in ophthalmology, but only 4 programs country-wide." Although previously a wealthy country when it was under British rule, the Human Development Index ranks the country as having one of the lowest levels of human development in the world, likely a result of decades-long civil wars and ethnic cleansing after the British withdrew. Currently, estimates of per capita income are about $230 (although data is unreliable). "We're certainly indebted to HEF for having organized this course," Dr. Asbell said. "It was a wonderful experience." Ophthalmologist leads knowledge, outreach trip Cornea consultation at Myanmar with Prof. Win. The traditional male dress, a longyi, is very comfortable in the warm, humid weather. continued on page 78 Dr. Asbell discusses surgical techniques with Prof. Win and other faculty members.