Mission incredible

Your skills will never be more needed than they are in these corners of the world.

By Karen Blum, contributing editor

In the 1980s, New Jersey ophthalmologist Saveren Scannapiego, MD, worked with Filipino operating room nurses who frequently discussed the poverty and lack of modern equipment in their homeland. So Dr. Scannapiego, an avid traveler, went there with friends to check things out.

Seeing the conditions sparked an idea to return as a volunteer, treating indigent patients with eye diseases. “The local ophthalmologists wouldn’t treat any of these people because they had no money,” he says. “There was no health-care insurance there, so if you didn’t have the money, you got nothing.”

Dr. Neely (left) and the Orbis crew in Trujillo, Peru.

With his OR nurses’ help, he reached out to two or three hospitals in the Philippines and asked to be granted privileges to perform surgery. Next, he contacted churches there, whose pastors let it be known that an American doctor would be visiting. He set up screening clinics in the churches’ rooms or backyards and paid to ship medications and the necessary medical/surgical supplies. It was so successful that he returned at least 10 times more over the years. Later on, he did similar work in Tanzania, asking his safari guides to bring him to local villages located 200 miles from the nearest hospital; and in Nanjing, China, he saw patients from the hinterland who wouldn’t normally get to a hospital. More recently, he has joined a group of ophthalmologists who travel to the island of Grenada in the Caribbean.

“It’s very rewarding for a couple of reasons,” Dr. Scannapiego says. “Number one, it’s pure medicine — you don’t have to worry about [dealing with] an office, billing or insurance companies. You’re doing it for the joy of doing it.” Number two: these are patients with no other recourse: “I’ve had people, who knew I was coming to the Philippines, walk 10 or 12 miles and stand in line for hours just to be seen.” For some, he was the only physician they had ever encountered.

Help wanted

Dr. Scannapiego is one of many ophthalmologists who engage in such humanitarian work. At least eight organizations are looking for ophthalmologists who want to serve those in need of ophthalmic care (for more information, see the online version of this article). One of them is Orbis International. For about 15 years, pediatric ophthalmologist Daniel Neely, MD, professor of ophthalmology at Indiana University, has traveled for Orbis to places such as Vietnam, Cambodia, Jamaica, India, Peru, Zambia, Uganda, South Africa and Mongolia. The organization has a full-size, MD-10 airplane outfitted with a 46-seat classroom and OR suite. Dr. Neely spends one week a year on the plane participating in a teaching program and a second week working with ophthalmologists one-on-one in a clinic or hospital. In addition, he has had nearly 1,000 telemedicine consultations with physicians worldwide through Orbis’ Cybersight program.

“Orbis is about skills transfer, so you pick a few cases that are good teaching cases and then you may demonstrate something and assist a local doctor while they do it,” Dr. Neely says. “The goal is for them to keep doing it after you leave. That’s what I really like about it — it’s sustainable.”

When he first went to Zambia, for example, no one could treat congenital glaucoma effectively. “These kids were just going blind because no one really knew the technique or had the instrument,” he says. “I went and worked one-on-one with a local doctor there, and simply by giving them a $150 instrument [a set of trabeculotomes] and doing a couple of [trabeculotomy] cases with them … they are able to do those surgeries on their own and kids who would have gone blind now don’t...[That] really highlights it for me.”

Looking toward the future

SEE International also organizes eye-care missions. Through one of its programs, Joseph Coney, MD, a retina specialist with Retina Associates of Cleveland, Inc., traveled to Port au Prince, Haiti, this spring. “Diabetic retinopathy is very common in Haiti, and, with no retina specialists on the island, unfortunately there are a substantial number of people going blind from diabetes that ordinarily could have been prevented with early diagnosis and treatment,” Dr. Coney says. He is committed to assisting the transfer of retinal surgical skills to a local ophthalmologist who can provide retinal care, ultimately resulting in the training of future retinal specialists.

While Dr. Coney was visiting, the local hospital was forced to close due to a lack of medical equipment. Currently, SEE International volunteers perform the complex retinal cases, and emergent cases are outsourced to the Dominican Republic, Cuba or the United States when possible. Dr. Coney provided second opinions and screened patients with the local ophthalmologist. The majority of eye diseases developed from complex tractional retinal detachments, a complication of uncontrolled diabetes and sickle cell disease, which is prevalent on the island. Dr. Coney, the local ophthalmologist and his staff worked long hours performing complex vitrectomies. With an assistant scope, the local doctor learned basic surgical principles in managing advanced ocular complications. “By the end of the week, the local doctor was more comfortable in operating,” Dr. Coney says.

Dr. Coney (third from left) and crew in Haiti.

He calls it the most rewarding experience of his life. “I was sad to leave Haiti because there’s so much more work that needs to be done. You really don’t know how blessed you are until you go to places where access to care or access to any of the basic necessities of life are just not present.” In the United States, diabetic eye complications often occur because patients are noncompliant with their medication or they neglect controlling their blood sugar and blood pressure, says Dr. Coney. In Haiti, people don’t have access to the appropriate medicines. “Most of these people are younger who are going blind, and it is through no fault of their own but through lack of access to the proper care.”

Dr. Crandall and a patient in South Sudan.

Dr. Crandall with a patient from the Navajo Nation.

Inspiration

Many ophthalmologists are inspired to do mission work through mentors or colleagues. Cataract and glaucoma expert Alan Crandall, MD, of the University of Utah’s Moran Eye Center had volunteered with Orbis, but it was a patient who turned him on to a larger goal.

About 20 years ago, one of Dr. Crandall’s glaucoma patients traveled to her ancestral roots in Ghana, West Africa, to set up education programs; she asked Dr. Crandall if he would accompany her since many people there were blind. He did, and made contact with Komfo Anokye Teaching Hospital. “Much of developing Africa sort of had ophthalmology programs and sort of had teaching, but it wasn’t and still is not as organized as it needs to be to develop ophthalmologists to take care of the local system,” Dr. Crandall says.

He worked to establish regular visitations there and to bring some of their physicians to the University of Utah for training. Around the same time, he recruited Geoffrey Tabin, MD, co-founder of the Himalayan Cataract Project, a group that does medical mission work in Nepal, India and African countries. The two now co-lead the eye center’s International and Local Outreach division. Five to six staff technicians and public health experts perform outreach; five to six ophthalmologists treat patients locally and abroad. The group trains doctors, nurses and other eye-care professionals in more than 25 countries, including South Sudan, Ethiopia, Kenya, Indonesia, Bhutan and Bolivia, bringing the most promising international surgeons to Utah for intensive training and sending university residents abroad. They work frequently with rotary and Lions clubs. In Utah, they provide charitable care to Salt Lake and Summit county residents and the Navajo Nation in the southern part of the state.

“The goal is curable blindness,” Dr. Crandall says. “That’s what we want to do.”

One of his favorite images is a row of canes left behind because blind patients were led in to the clinic by a neighbor, son or daughter, and walked out so they didn’t need them anymore. “You also have to realize the economic improvement you give to the local area,” he said. Frequently the youngest child cares for a blind parent or grandparent; when the blind person is cured, he or she as well as the caregiver can go back to work.

Balance

Balancing volunteer work with your day job admittedly is challenging, those interviewed say. Dr. Coney says his partners readily cover his time off, and his patients are very supportive.

“Every patient I saw for the next month or so wanted to hear about my trip.”

“As people go through their careers they get into a routine,” Dr. Neely explains. “It’s nice to have something not in your routine.” Volunteering has become just as meaningful to him as spending time with family or taking a vacation. “I think it adds balance.”

There are various ways to get involved in mission work, though most interviewees recommend going with an organized group to start, or going to locations where programs already have been established. Before traveling, reach out to volunteers who have been to that location, so they can tell you about their experiences and what you might need to know or bring with you.

In addition, learn about the culture where you’re going, Dr. Crandall says, and know the language or have an interpreter with you. Make sure you know how to manage complications, he adds. And have the right mindset going in — it’s not a vacation; you’re there to help by teaching and/or treating patients.

“If you go once with a good team, you’re going to be hooked and you’re not going to get in trouble,” Dr. Crandall says. From every trip “you’ll have a memory with a face or a touch or a smile.”

Dr. Neely examines a patient in Zambia on the Orbis Flying Eye Hospital.

Ophthalmologists can contribute on any level, Dr. Neely points out. If being out of the office because of family obligations or expense is prohibitive, you can volunteer online by teaching or answering Cybersight telemedicine consults for Orbis.

“That’s extremely valuable, too,” Dr. Neely says. “And it’s something you can do on your lunch break.” OM