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Educational project in Prague aims at improving health care in Eastern Europe
Short-term, intensive teaching programs offered to select ophthalmologists address low vision services, causes of avoidable vision impairment.
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The Lions Ophthalmology Educational Center in Prague, Czech Republic, was opened in March 2002 in a newly constructed building adjacent to the Charles University Department of Ophthalmology, Vinohrady Teaching Hospital. Co-funded by Charles University and the Lions Club as part of its SightFirst program, the project is aimed at training young ophthalmologists in Central and Eastern Europe in specific subspecialties and addressing causes of avoidable vision impairment with a special focus on public health care services.
“We provide specialized, short-term, intensive teaching programs that cover the main causes of avoidable vision impairment, such as glaucoma, AMD, diabetes, cataract. We also have a highly specialized course on low vision services, an area that is insufficiently developed in almost all countries globally, and definitely in Eastern Europe,” Ivo Kocur, MD, World Health Organization Medical Officer, said. In the early 2000s, he worked as an ophthalmologist at the Vinohrady Hospital university eye department led by Pavel Kuchynka, MD, coordinating the project to develop the Lions Ophthalmology Educational Center (LOEC) and, since its opening, has supported the department through jointly conducting international training programs.
Born and educated in the former Czechoslovakia, Kocur has an inside, objective view of the health care situation before and after the fall of the Berlin Wall.
“There is a misconception that in the socialist area everywhere in Eastern Europe, services were poor and that the political changes precipitated everything into chaos. As a matter of fact, there were countries where health care was well developed with efficient and granted access to everyone at no cost. The transition to a more commercially based system was in fact a loss in some ways,” he explained.
Ivo Kocur, MD, World Health Organization Medical Officer, teaches a class at the Lions Ophthalmology Center in Prague.
Image: Kocur I
However, what was missing compared with the West was the level and availability of subspecialty services in eye care. Some areas, such as vitreoretinal surgery, were poorly addressed and lacked human resources. Specialists experienced in diabetic retinopathy, pediatric ophthalmology and low vision are still mostly available only at tertiary eye care establishments.
“The LOEC is addressing these unmet needs. We have specialists who train young ophthalmologists so that this specialized care can be provided. The objective is to promote improvements in quality and comprehensiveness of eye care services throughout the subregion,” Kocur said.
Low-budget, high-quality project
Since 2002, 1,400 ophthalmologists have participated in more than 70 LOEC teaching programs. Most of them run 3 to 4 days over the weekend, with both morning and afternoon teaching sessions. Interactive surgical sessions allow students to either join the surgeon in the OR or be remotely connected through a live-surgery video transmission. Teaching sessions at outpatient units as well as visits to other eye care establishments in the city are regularly arranged.
“Classes are small, up to 30 participants, and very interactive. The atmosphere is very friendly. Students come up with their cases, project their slides, discuss, ask questions. No one is going to be blamed for a seemingly silly question,” Kocur said.
Independent review of participants’ feedback shows a high degree of satisfaction. They express enthusiasm and gratitude for what they have learned and for the overall experience of learning in a somewhat different way and with a different approach that is more than purely clinical.
“Every time I see quite a few confirming that they have never been exposed to something so intense, friendly and helpful. And yet we don’t provide special dinners or any form of entertainment. Students eat in the hospital canteen and sleep in shared rooms. Nothing fancy. It’s purely about getting the knowledge,” Kocur said.
Attendees are selected by the national eye societies of their respective countries. They have to pay their own travel expenses, while the course, food and accommodation are free.
Principal lecturers are recruited from leading universities in Europe, from Israel and, in the case of the low vision specialists, from New York.
“It’s the generous contribution of highly recognized eye care experts who come on economy class tickets, teach, spend 3 or 4 days with the students, donate time and knowledge. They teach on a voluntary basis, as do the experts from Prof. Kuchynka’s university eye department and some others in the Czech Republic. Quite unique,” Kocur said.
Six to eight teaching programs are offered per year. More could be done, but additional funding is needed. The economic downturn since 2009 has made LOEC lose international donors and produced the need to find new ways to manage available resources, including generating income through domestic donors.
“The problem is that teaching is hard to convert into an immediate measurable outcome. We had major promises, but potential donors are often hesitant due to the inability to measure the impact of educational programs, as opposed to measurable outcomes of direct treatment of patients, for instance. Nevertheless, we all believe sharing knowledge and skills is the best investment for the future of eye care,” Kocur said. – by Michela Cimberle
- For more information:
- Ivo Kocur, MD, can be reached at World Health Organization, Avenue Appia 20, 1211 Geneva 27, Switzerland; email: kocuri@who.int.
Disclosure: Kocur, World Health Organization Medical Officer, organizes training programs for the Lions Ophthalmology Educational Center.
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Klara Landau, MD
This is one of the year’s highlights for me: an invitation to yet again teach at the LOEC course in Prague. My first assignment dates to 2004. Seven young ophthalmologists from seven Eastern European countries came together to listen how to perform an ophthalmological evaluation in an infant, to learn about strabismus management, to explore issues in pediatric neuro-ophthalmology and, most importantly, to get in contact with each other and with the state-of-the art knowledge in a field that needs to be developed in order to promote the eye health of children in their respective countries. This February, for me the 11th time in a row, there were 40 participants from 11 countries: Bosnia and Herzegovina, Bulgaria, Czech Republic, Estonia, Hungary, Lithuania, Republic of Moldova, Romania, Serbia, Slovakia and Slovenia.
It is wonderful to see this course growing and having more impact every year. To name just one example: Dr. Kadi Palumaa from Estonia, who attended my first course in 2004 as a young resident, has since become a senior staff member of the Department of Ophthalmology in Central Hospital in Tallinn. Moreover, she is a scientific collaborator and a personal friend — this is what a successful teaching concept like the LOEC course in Prague is supposed to promote.
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Victoria Verejan, MD
Last February, I had the opportunity to take part in the pediatric neuro-ophthalmology course at LOEC.
For me as an ophthalmologist, the workshop has been a great help because I was able to exchange ideas, experiences and information with other young colleagues. I believe this is important because we, as young doctors at the beginning of our careers, greatly need each other’s support. Communication encourages us to progress and to make positive changes in our work and in our attitudes toward patients.
The organization was extraordinary. We had productive working sessions, but the teachers also allowed us time for sightseeing and discovering the magical beauty of Prague. After the workshop, I went back home with the clear intention of applying to participate again, and I have remained in touch with my colleagues from other countries, who are also eager to apply for future sessions. During the workshop, we established good relationships with each other and exchanged emails. This allows us to continue talking about topics of common interest, discuss our clinical cases and even plan for future projects.
We hope this program will develop even further, involving other countries, reaching an increasing number of young ophthalmologists and helping them to develop professional networks.
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