EyeWorld India June 2020 Issue

NEWS & OPINION 58 EWAP JUNE 2020 concern, Dr. Kahook said, sharing how he has seen fancy and expensive equipment sitting in a corner in the OR abroad. The reason? There was no one œV>Þ ܅œ VœÕ` wÝ œÀ ÃiÀۈVi the equipment. Because of this, surgeons should focus on practical, sustainable surgical solutions. Dr. Kahook said that cataract surgery may be one of the best glaucoma surgery options in many, but not all, global settings because it lowers IOP and can be cost effective. Trabeculectomy also has a role abroad, he said. On his “wish list,” for glaucoma surgery abroad, Dr. Kahook includes an inexpensive glaucoma drainage device and a low-maintenance cyclophotocoagulation laser with low-cost disposables. Lessons learned from abroad Susan MacDonald, MD, shared several incorrect assumptions she previously made about global ophthalmology. One such assumption was that she had all the solutions. “There are a lot of problems that have to do with people living in poverty and not having access to care. It’s not a simple solution,” she said. Another assumption was that phaco could be the blanket answer for ophthalmologists abroad. However, she found that many eye surgeons abroad cannot afford to provide phaco routinely. A third was assuming that silence means people agree with you. “Just because someone is silent or not disagreeing doesn’t mean they agree with you. It may be they are being polite. To really understand problems, you have to ask questions and listen,” she said. Finally, she learned that forging a path in global ophthalmology is much broader than a focus on eyecare alone. “It’s about developing a system in a country where people have access to care,” she said. Dr. MacDonald had several pearls to help others who plan to make global connections: • Be patient when developing relationships, and it’s all about relationships. • Mind your manners, and be kind. Ask questions like, “What do you think?” Then really listen. • Share your knowledge and obtain knowledge from local doctors. Their knowledge is critical. • Carefully build a team with the right skillset. • Find leaders who can make things happen. • Take the time to build those key relationships with nongovernmental organizations (NGOs). In Tanzania alone, where Dr. MacDonald has spent time, there are 500 NGOs. “Many of them can help you, but it’s all about people again,” she said. Similarly, plan to build relationships with businesses that want to offer help and support. • Plan to attend government meetings. These are another important building block in developing and maintaining global ophthalmology programs. EWAP Reference 1. Coombs PG, et al. Global health training in ophthalmology residency programs. J Surg Educ . 2015;72:e52–59. Editors’ note: Dr. Kahook is the Slater Family Endowed Chair in Ophthalmology, UCHealth Sue Anschutz-Rodgers Eye Center, Aurora, Colorado, and has relevant interests with Alcon, Aurea Medical, Equinox, Fluent Ophthalmics, Ivantis, Johnson & Johnson Vision, New World Medical, ShapeTech, and SpyGlass Ophthalmics. Dr. MacDonald is clinical associate professor, Tufts University School of Medicine, Boston, Massachusetts, and has relevant interests with Carl Zeiss Meditec and Perfect Lens. Dr. Pettey is vice chair for education, John A. Moran Eye Center, Salt Lake City, Utah, and FGENCTGF PQ TGNGXCPV ƂPCPEKCN KPVGTGUVU