Tailor ophthalmic mission efforts to needs of developing countries

Ophthalmologists engaged in volunteer efforts in developing countries must be sensitive to what the local community needs and can use, according to several surgeons experienced with this type of care.

The appropriate technology should be determined based on existing infrastructures, and local physicians should be educated on useful techniques. These considerations are key to ensuring successful missions in developing countries, the physicians said.

T. Otis Paul, MD, R. Scott Foster, MD, and Bradley Black, MD, with Oakland (Calif.) Children’s Hospital, have visited countries in Africa, Asia and the Americas to provide general ophthalmology and specialized consultations. They explain in the Journal of Community Eye Health that their efforts were initially focused on cataract surgery. But as local physicians have been trained and the cataract backlog reduced, subsequent training programs have focused on pediatrics, strabismus and other specialized techniques.

Among the keys to successful missions is appropriate technology selection, according to the authors. Phacoemulsifiers at small hospitals in rural areas may be used by visiting specialists and then sit idle for years. The authors recommend working with local physicians to determine what technology is appropriate, given geographic limitations. For instance, some developing countries lack clean water supplies, affecting the usefulness of lasers.

Inadvertently leaving a message that the visiting physician can perform procedures the local physicians cannot does a disservice to the region, the authors said. Local physicians must be trained and empowered, along with other personnel, to alter local patients’ perceptions.

“Some countries, such as Mexico, restrict the type of volunteer organizations allowed by requiring a letter of support from local Mexican physicians or local medical societies – before any organization is allowed to work within that country,” the authors noted. Other problems may occur with getting goods through customs if local organizations have been overlooked in the mission trip planning.

Missions to developing countries should include experienced surgeons, the authors noted. Otherwise, the message is sent that the visiting surgeon is merely there to perfect his or her surgical skills. Once on the mission, visiting ophthalmologists should work side-by-side with local ophthalmologists, allowing the local ophthalmologist to present the bill.

“An important rule in making any decisions in developing countries is to include not only the local ophthalmologists in these decisions, but actually adopt their preferences whenever possible,” the authors said.

The authors also note that developing countries recovering from war may be undergoing the “CPR” phases. In the “crisis and chaos” phase, eye care will be largely in response to trauma, and any help is useful. “Peace and poverty,” the second phase of recovery, is a time of limited health care funding from governments, which must spend most of their health budgets on indigenous diseases and epidemics. In the third phase, “recovery and resourcefulness,” medical schools are reopened and ophthalmic training reestablished. Until this stage, pediatric medical needs are usually ignored, the authors noted.