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Young Ophthalmologists
Going Abroad: How YOs Are Taking the Lead in Global Blindness Prevention
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According to the World Health Organization (WHO), more than 285 million people, or 4 percent of the world’s population, are visually impaired. Of these, 39 million are blind and 246 million suffer from low vision. The biggest tragedy of all, however, might be this: despite the progress of surgical techniques in many countries, more than 80 percent of this impairment is avoidable through treatment or prevention.

Faced with this global burden, the WHO and organized medicine have launched initiatives such as Vision 2020 over the past decade to help stem the tide. Young ophthalmologists, however, are not sitting on the sidelines. A small but growing number of institutions around the country have created international fellowship programs to help YOs put their training at home into practice abroad.

Providing sustainable care for the future
The Moran International Fellowship program at the John A. Moran Eye Center in Salt Lake is the oldest such program. Developed by Geoff Tabin, MD, director of international ophthalmology and head of the international division, the one-year program encourages residents to work independently in a variety of different environments and health care delivery systems. Participants typically spend six to eight months in areas like Nepal, Haiti, Ghana and India, with the balance of their time spent at home in the Moran Eye Center. Future fellows might work in Kenya, Malaysia, Vietnam and Ethiopia.

Participants are hired as limited-term faculty and encouraged to build a global network with overseas organizations such as the Himalayan Cataract Project, ORBIS International and Tissue Bank International. “The goal of our fellowship is to gain a broad and in-depth exposure to international ophthalmology,” said Jeff Pettey, MD, former international fellow and current residency director. “The end goal [is] understanding how to work independently in the varied international theaters.” He added, “Graduates come to understand the importance of sustainable initiatives, which involve key individuals in foreign governments, nongovernmental organizations (NGOs), hospitals and service organizations.”

Teaching ophthalmologists to ‘fish’ on their own
Some graduates may also go on to start other, similar fellowship programs. Beginning this summer, the Stanley Truhlsen Eye Institute at the University of Nebraska Medical Center (UNMC) will also offer a one-year program that was developed by a former Moran fellow. The Prevention of Global Blindness Fellowship was developed by Michael Feilmeier, MD, UNMC’s medical director of the international division of ophthalmology.

Two men examining Nepalese woman
Dr. Feilmeier in action in Nepal. ©Michael Feilmeier, MD

“My goal is to create and offer the most high-yield international fellowship available,” said Dr. Feilmeier, who completed the first Moran International Fellowship offered at the Moran Eye Center in 2009. He designed the Nebraska program to train ophthalmologists in global blindness prevention through a combination of domestic and international education.

While abroad, fellows will have a high level of autonomy, both clinically and surgically, and will observe and experience a wide variety of eye care delivery platforms. One applicant per year will spend a total of seven months abroad, including one month at the Tilganga Institute of Ophthalmology in Nepal. During their month there, fellows will learn sutureless extracapsular cataract extraction (SECCE) and observe Tilganga’s self-sustaining system, developed to provide affordable world-class eye care.

Fellows then spend two months each in Ghana and Ethiopia working on residency education development and teaching phacoemulsification and other surgical techniques to residents and faculty. The final two months will be spent in northern Haiti working on eye care delivery models and focusing on public health and epidemiology.

Domestically, fellows will work alongside Katherine Johnson, MD, at Mountain View Medical Center in Fairbanks, Ala., providing clinical care to Fairbanks residents and outreach care to individuals living in rural areas of the state. Once back at UNMC, the fellow will staff the free SHARING eye clinic and teach SECCE to residents.

“What makes this fellowship unique is the wide range of eye care delivery systems to which the fellow will be exposed,” Dr. Feilmeier noted. “It’s designed with the explicit goal of providing the fellow with the tools necessary to launch a career in global ophthalmology.”

Breaking down barriers around the globe
Similar to the UNMC fellowship, the Dean McGee Eye Institute’s new, one-year Global Eye Care Fellowship provides experience in several countries. Although the program grew out of work in the rural Chinese province of Chengdu teaching surgical skills and providing knowledge-based lectures, the goal is to teach fellows a public health-oriented approach to eye care both abroad and at home.

“Despite all of the exciting opportunities abroad, we felt that it was important not to forget the needs at home,” said Jacquelyn A. Jetton, MD, the Oklahoma program’s first and current fellow. “Many of the same challenges that people face in a developing country are dealt with by people in our own backyard.”

For half of the year, Dr. Jetton will spend two months each in rural China, Swaziland and Peru working on vision screening and blindness prevention programs. Her time in the Sichuan Province of China will involve teaching residents phacoemulsification and participating in their blindness prevention programs to help eliminate the blindness that more than 1 million people in the region face.

Jacquelyn A. Jetton, MD, examines a patient
Dr. Jetton in Swaziland during an AIDS task force. ©Jacquelyn A. Jetton, MD

She will also be tasked with developing a similar program in Swaziland, where ophthalmologists are just beginning to understand the systemic problems of a local population suffering from blindness due to cataract and HIV-related complications.

“The opportunity in Peru is a relatively new one located in Lima that includes work at a state-of-the-art eye care center that provides top-notch care to Peru’s most poorly neglected populations,” Dr. Jetton said.

For the half of the year when she isn’t traveling the world, Dr. Jetton will work locally in Oklahoma in community free clinics and affiliated hospitals as a limited-term junior faculty member, teaching residents and developing eye care programs that serve the needs of her home.

“Upon entering medical school, I thought I wanted to specialize in infectious disease and move to South America,” Dr. Jetton explained. “Through my rotations, I fell in love with ophthalmology and have strived to coincide my love of ophthalmology with my desire to understand and help others in far-away countries.”

Have residency, will travel
All three international programs are currently taking applications and accept one fellow per year. Dean McGee’s Global Eye Care Fellowship Program accepts applications on their website. Applications for the 2014/2015 fellowship are due Sept. 1 of this year. Only U.S. citizens who have completed an Accreditation Council for Graduate Medical Education-accredited residency are eligible.

Those interested in the 2014/2015 Moran International Fellowship should apply through SF Match’s Ophthalmology Fellowship Matching Program by Sept. 1 as well. Because the program is intended for the second year of a fellowship, interested residents should pursue fellowship training in their chosen subspecialty and apply during their subspecialty year. For more information, contact Elaine Peterson.

UNMC staff are currently selecting the inaugural 2013 fellow for the Prevention of Global Blindness Fellowship. For more information or to apply directly, email development director Jessica Feilmeier or call 402.305.2852.

Preparing the future for global ophthalmology
In its efforts to support those individuals and institutions ready to start a career in global ophthalmology, the Academy recently joined with the Johns Hopkins Bloomberg School of Public Health to host two free online courses about working abroad. These CME-bearing courses, “So You Want to Work Overseas?” and “The Major Causes of Blindness,” review critical issues in global eye health and prepare U.S. ophthalmologists to conduct mission work in the developing world. Both can be found under the global ophthalmology courses on the Ophthalmic News and Education (ONE®) Network.

The Academy’s Annual Meeting also includes a variety of symposia, courses and networking opportunities on global ophthalmology. This year’s meeting in New Orleans, Nov. 12 to 16, will include the symposium “International Opportunities for Young Ophthalmologists” and “Modern Technologies and Techniques for YOs to Know,” a joint session with YOs from the Academy, the European Society of Ophthalmology and the Pan-American Association of Ophthalmology. For information on 2013 Annual Meeting courses, visit the Academy website later this summer.

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About the author: Mike Mott is a former assistant editor for EyeNet Magazine. This is his first feature for YO Info.

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