BLOG: Building eye care capacity in Haiti, part one
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For this blog, I have asked Daniel C. Alter, MD, PhD, from Midwest Retina Consultants, to share some insights gained from developing eye care in Haiti over the past 8 years.
He was instrumental in getting me to Haiti in 2018 and has inspired others to contribute to developing ophthalmology there. Here, Dr. Alter shares his experience.
Eye care in Haiti
What if your mission in life was to make your job obsolete? I first went to Haiti in 2014 to help set up and teach vitrectomy surgery to Reginald Taverne, MD, in Port-au-Prince, Haiti. Dr. Taverne had completed a residency in both Haiti and Israel many years ago and was the only doctor in Haiti doing retinal lasers and scleral buckles. He had an intense desire to learn vitrectomy surgery and was already an accomplished anterior segment surgeon. He had acquired an Alcon Accurus vitrectomy machine and a Zeiss Opmi CS microscope but needed many other items such as a widefield viewing system, compressed air, laser, filters and supplies. After a few months of planning, I arrived with everything needed, and we were doing complex vitrectomies on day 2. A parallel project was started with Dr. Dupuy Pierre in Cap-Haitien, Haiti, in 2016. More than 25 trips later and with visits by other retina surgeons, we now have two trained vitreoretinal surgeons in Haiti.
During my second trip, I visited the state hospital, HUEH, where the ophthalmology program starts four new residents each year and found a poorly equipped and supplied clinic but with enthusiastic residents. I started collecting equipment and supplies, and on subsequent visits, I really learned how little they had and how there was no operational budget to run the department and only part-time attendings who were very poorly paid. Improving the residency program was a matter of addressing the problems head on. The external problems of political instability with frequent strikes at the general hospital were mostly out of our control. The internal problems were infrastructure insufficiencies, equipment, supplies and lack of full-time attending physicians.
By 2016, Matthew Thompson and William Myers had joined and began training the residents in small-incision cataract surgery. We were all SEE International volunteer surgeons, but we eventually needed our own organization to be able to directly address all of the problems we found because partnering NGOs all had their own restrictions on use of funds and would not consider supporting the infrastructure construction projects, utilities or salary support that were needed. At that time, Dr. Marilyn Miller offered to have the three of us join the board of FOCUS Inc. to further the project. The FOCUS mission is to increase eye care capacity in Haiti through training, education, equipment and supply of local Haitian eye care providers. We strive to remove any barriers to this mission and foster collaboration with other stakeholders, organizations and individuals both in Haiti and abroad. We take special care to fill in where other organizations cannot due to their charter. This often takes the form of physical plant improvements, utilities including electric and water, and even salary/stipend support. We strongly believe that all problems need to be addressed to make real sustainable progress.
Part two of this blog will continue to look at the work FOCUS does in Haiti.
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