Return to Main Menu

Experience centers on global cooperation by Heather Woolwine Public Relations Medical outreach to foreign countries is commonly thought of as health professionals traveling to a Third-World country, spending a week conducting procedures or handing out medications, and then heading home patting each other on the back for a job well-done.   This is exactly the type of experience that M. Edward Wilson, M.D., MUSC Storm Eye Institute (SEI) director and ophthalmology chairman, wants residents to avoid.   A pediatric patient recovers from cataract surgery. “Other university programs established rotations to places like the Dominican Republic, Haiti, or Costa Rica for the sole purpose of doing lots of cataract procedures,” Wilson said. “For us, the international experience is meant to be more of an education in the global cooperation needed to cure preventable blindness. We need to be teaching the teachers and supporting sustainable new capacity. My hope is that the residents will understand the concept of appropriate technology and cost-effective outcomes. Our U.S. way of doing things may not be the best for all regions of the world. I also want the residents to have an experience that will lead them to a commitment to give back internationally throughout their career. The international experience is two way, meaning that we learn as much from them as they learn form us and the relationships are long lasting via e-consultation and follow-up visits.”   The program outlined by Wilson is dubbed “twinning,” meaning that MUSC and the SEI pair up with other higher learning institutions in foreign countries who want to host MUSC residents and in turn their physicians become fellows for advanced study in ophthalmology at MUSC.   The beauty of the program is it provides a sustained level of communication and contact between the movers and shakers of modern ophthalmologic procedures here in the States with those who must rely on older, but often more practical methods of patient treatment.     Drs. David Hayes, left, and Stacey Kruger, Miami-based  ophthalmologist, perform cataract surgery. “These physicians and surgeons are just as smart as anyone else is, but what limits them is the lack of access to money that will buy them the new equipment, not many local teachers, and they have much more government bureaucracy to deal with than we do,” said David Hayes, M.D. and fourth-year ophthalmology resident. “We just have to be careful in how we offer help to other cultures in less developed nations. An exchange of knowledge, technology and ideas is what’s needed so that they can learn to treat their own people the best way possible and not have to depend on us to do it for them.”   Hayes visited Guatemala July 1 through 15. Self-described as a global citizen, Hayes participated in numerous exchange programs throughout his education. He plans to continue to involve international outreach efforts throughout his career.   “Ophthalmology really lends itself to international mission work because of the nature of preventable blindness,” he said. “Conducting cataract surgery for adults and children is something that can make a huge difference right now, and it’s something that local surgeons can begin to do more for themselves through increased opportunities to become teachers themselves.”   The SEI has ongoing relationships with eye departments in Ethiopia, Vietnam, Nepal, and Guatemala. In addition, the SEI is visited by eye doctors from many other countries such as China and India. “Our twinning relationship with Addis Ababa University Department of Ophthalmology in Ethiopia began five years ago and resulted in a commitment from the College of Medicine in Addis to double the teaching faculty and improve residency numbers,” Wilson said. “This occurred and we have hosted about 10 clinical fellows from there at a rate of two per year. Our faculty, including myself, Al Walker, M.D., Arman Farr, M.D., and Gene Howard, M.D., traveled on mentoring trips with the fellows after they completed their fellowships. Currently we have an Ethiopian and two Vietnamese fellows, with two due to arrive from Nepal in January 2006.”   Initially, the exchange begins when a SEI resident and faculty member travel to one of the participating countries and spend time performing surgeries, observing that culture’s methodology and patient issues, and exchanging knowledge with local health professionals. After they return, a fellow from the designated country comes to MUSC and residents play an important role in helping them acclimate.   Upon completion of their time here, the fellows return to their native country with an SEI mentor who will see how they apply their newfound knowledge back home.   To continue the program’s momentum, Wilson will receive input from the SEI’s newest edition to the Board of Directors, Byron Stratas, M.D., a former SEI resident who practices in Wilmington, N.C., with a history of international outreach. Stratas is committed to focus on international efforts and the International Center at Storm Eye Institute. Medical Tourism vs. Outreach The idea of medical tourism, or going on a mission trip, performing a few surgeries, drinking a few beers in the afternoon and coming home thinking you’ve converted a country’s physicians, is the outreach effort that Wilson wants his residents to guard against.   The large hospital and community resource center where Hayes worked this summer stands before one of Guatemala's volcanoes. Some groups with the best of intentions can do more damage than good. By performing advanced surgeries that local physicians cannot duplicate and providing locals with expensive medications they cannot afford once the handouts are gone, these groups actually do a disservice to other outreach efforts and promote a backlash against groups that have a desire to help through teaching.   “These local people decide if a procedure really worked for them and if it didn’t have a good outcome because they couldn’t afford follow-up medication or surgery, then they will go back to their community and tell every one not to bother with mission groups or local physicians because they don’t solve the problem or they make it worse,” Hayes said. “It completely defeats the purpose of going if you’re not going to be considerate of their culture and lifestyle when deciding how to best treat them.”   “If you’re really trying to provide international outreach, then you must be able to appreciate that each individual culture has a given lifestyle and economic situation that will serve to help assess what their needs really are,” Wilson said. “In terms of cataract surgery, most patients in the poorer regions of these foreign countries don’t seek out medical attention until they’ve already become blind, so our latest technology may not be the most medically effective or cost effective way to operate these very advanced cataracts. They need us to help them maximize the use of appropriate technology rather than merely adopt the techniques used here.   “Currently in Ethiopia, there are 62 ophthalmologists serving 65 million people, so they can only operate on those who cannot work because of bilateral eye disease,” he said. “If we can help them to increase their capacity, then they could begin to work through the gigantic backlog of those out of work. Once they catch up there, they can move on to the patients who can’t read. It takes a few years but they’re on their way.”   Programs concerned with the ramifications of its outreach find some way to involve those who live in that country and who will be there once outreach personnel leave.   And like Wilson’s international residency program, it’s not just about teaching physicians about the newest thing. For instance, modern cataract surgery can involve power-modulated ultrasound pulses, postoperative lasers and up-to-the moment wavefront analysis of optical aberrations. While it is great for Ethiopian physicians to understand it, at the end of the day they still won’t be able to perform it because of equipment and financial issues. Instead, Ethiopian physicians can learn to teach and become better at the more cost effective ($12 procedure versus $700) and appropriate manual cataract surgery. If performed using modern surgical principles, it provide equivalent outcomes for the advanced cataracts when compared to more modern procedures.   “Just because a patient is treated using less expensive technology doesn’t mean that he or she is receiving sub-par treatment,” Wilson said.   With SEI’s twinning program in ophthalmology as the only one currently in the United State’s, Wilson hopes that it will be seen as a model for other universities around the world and help facilitate success for the World Health Organization’s Vision 2020 program which is geared towards curing preventable blindness.   A global non-profit blindness prevention organization called Orbis International is currently funding the SEI program and hopes to launch other programs like it in the U.S. and Canada.    “We’re talking about helping people who are otherwise generally healthy and who need surgery that is relatively inexpensive. It’s a chance to really make a difference. We can’t be all things to all people but we can select a niche to help the developing world,” Wilson said.   “The reason that everyone chooses medicine to begin with is because we all want to help,” Hayes said. “But you have to embrace the concept of teaching someone to fish instead of just giving them a fish. I want to make this kind of international outreach a part of the contribution that I make as a physician, and I want to do it the right way. Once I go out on my own, finding an organization with a good record of involving the local surgeons and appropriate screening practices, etc. will be paramount. I think that throughout my career it will be important to remember that this is always a two-way learning opportunity and that Americans haven’t cornered the market on quality eye care.”   “Understanding the challenges of world blindness and helping people rise to the task in their own country is much better than flying in and doing surgery only to have everything revert back as soon as you leave,” Wilson said. “I want the residency program at SEI to teach those concepts to all residents whether they choose to travel while in the program or not.”     Friday, Aug. 12, 2005 Catalyst Online is published weekly, updated as needed and improved from time to time by the MUSC Office of Public Relations for the faculty, employees and students of the Medical University of South Carolina. Catalyst Online editor, Kim Draughn, can be reached at 792-4107 or by email, catalyst@musc.edu. Editorial copy can be submitted to Catalyst Online and to The Catalyst in print by fax, 792-6723, or by email to petersnd@musc.edu or catalyst@musc.edu. To place an ad in The Catalyst hardcopy, call Community Press at 849-1778.