• Get Involved in Mission Work: Here Are Your Options and What to Expect

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    Young physicians are increasingly interested in volun­teering overseas, but they are unsure about how to get involved or what they need to know before they go. This article describes the main options, explains how to get started, and discusses what to expect from this type of service.

    What Are Your Options?

    Fellowships, residency programs, and other opportunities of various lengths and capacities are available.

    Residency programs. Not so long ago, U.S. residency programs typically didn’t integrate overseas experiences into their educational program, with one rare exception being the well-established relationship between Aravind Eye Hospital and Wilmer Eye Institute. However, global ophthalmology rotations are becoming more common now that the Accred­itation Council for Graduate Medical Education (ACGME) has made overseas education permissible within ophthal­mology program requirements. “Because residents are not yet competent or qualified to practice independently, the home institution must engage in a program letter of agree­ment [PLA] with the hosting site in order for the extramural experience to be considered part of the educational curricu­lum,” said Andreas Lauer, MD, vice-chair for education and professor of ophthalmology at the Oregon Health & Science University’s (OHSU) Casey Eye Institute in Portland. “The PLA clearly outlines the duration of time that the resident will spend at the location, define the expected learning experience and who will supervise and evaluate the resident, detail the scope of patient care involved, and describe the institutional protections the resident will receive.”

    Fellowships. Currently, there are 5 formal global eye care fellowships offered through academic institutions:

    “These are the best avenues for people who want to pur­sue global eye care; however, there are also less formal pro­grams available,” said Michael Feilmeier, MD, who completed the first fellowship offered by Moran Eye Center in 2009 and went on to create a 1-year fellowship program at Truhlsen Eye Institute, where he is now the medical director of the international division of ophthalmology.

    Volunteer through a charitable organization. There are many organizations that seek to serve the visually impaired, both overseas and in the United States. These include:

    • Orbis International. The “flying eye hospital” is one of the oldest models for bringing surgical knowledge and skills to doctors in developing countries. “Although ineligible to perform surgery, residents can volunteer as an associate ophthalmologist for a week or two and provide ophthalmic education or care to patients,” said Dr. Lauer. It serves more than 90 countries and trains thousands of medical profes­sionals each year.
    • Seva Foundation. Working with local partners in 20 different countries, Seva strives to create self-sustaining programs to preserve and restore vision.
    • Himalayan Cataract Project (HCP). Initially founded to establish a sustainable infrastructure for eye care in the Himalaya, HCP now has programs in 7 countries—Bhutan, Ethiopia, Ghana, India, Myanmar, Nepal, and Rwanda.
    • EyeCare America (ECA). ECA provides an opportunity to volunteer in the United States. “When we think of global health, it is not solely international health—it centers on the idea of basic eye care for all, which includes those who are underserved in the United States,” said Grace Sun, MD, assis­tant professor of ophthalmology and head of the residency program at Weill Cornell Medical College in New York. “Sign up with the Academy’s EyeCare America program to treat uninsured and underinsured patients without charge.”

    Prepare for AAO 2016 by using the Mobile Meeting Guide, which launches on Sept. 7, to see which organizations will have an informational poster on display. The Acade­my is also redesigning its EyeCare Volunteer Registry. To volunteer—or if you work with an organization that offers volunteer opportunities—email intoutreach@aao.org.

    Helping an Isolated Population

    Spanning 5 islands and 2 coral atolls, and serving as home to approximately 55,000 people, American Samoa had only 1 ophthalmologist—and he was slated to retire. Without assistance, the population in this U.S. territory in the middle of the South Pacific would potentially be left without eye care. “David J. Wilson, our chairman [at OHSU], thought that training someone to serve that community would be an important contribution to global health,” said Dr. Lauer. In cooperation with ophthalmology faculty members, university support, and philanthropic backing, Dr. Lauer described a departmental initiative to establish a reciprocal arrangement between OHSU and the Lyndon B. Johnson Tropical Medical Center at Pago Pago, the capital of American Samoa. “The premise behind the initiative was to enable individuals to visit our program and learn from our team, and for our team to learn from other medical communities,” he said. As part of this program, Benjamin Siatu’u, MD, went to Oregon for intensive training in ophthalmology. Now back in Samoa, he is working with Casey Eye Institute to finish building up the other critical elements of a regional eye care pro­gram. (For more information, see the Casey Eye Insitute’s “Vision in American Samoa: Casey Eye Institute’s Collaboration across the Pacific.”)

    Know Before You Go

    Expect the unexpected. Not everyone has the moxie to work in locations where things can be unpredictable. Challenges are common when providing care abroad—from encountering a lack of supplies to operating with outdated equipment. “If you have international travel experience, you probably under­stand that the unexpected is almost always to be expected, which requires patience and flexibility. And, although you are there to share your expertise, you are also a guest and must be respectful even if procedures are different from what you might be accustomed to,” Dr. Sun cautioned. When selecting a fellow for a mission, Dr. Feilmeier evaluates both qualifications and personality. “The most important aspects aside from these items are the resident’s motivation, career aspira­tions, and anticipated end result,” he said.

    Seek long-term, sustainable improvements. “The best kind of mission work involves creating connections that build with each visit. The goal is to develop long-term and mutually beneficial relationships that improve the existing situation in an underserved location and to facilitate these changes in a sustainable way,” said Dr. Feilmeier.

    Ten important considerations. According to Drs. Feilmeier, Lauer, and Sun, these are the top 10 things that every resident should know or do before engaging in a mission:

    1. Think about not only where you want to go and your goals but also where you will have the greatest impact.
    1. Go to a country that welcomes you—not just somewhere you want to visit.
    1. During your first few trips, choose a mentor and go with someone who is experienced with the site you’re visiting.
    1. Study and respect local customs.
    1. Focus on the sustainability of your service and work to­ward the long-term improvement of eye care delivery.
    1. Make sure that all of your credentialing is up to date. Depending on your destination, you might need to apply for a temporary medical license. Know the requirements.
    1. Make sure that your malpractice insurance is up to date and will cover you while serving abroad.
    1. Interpreters are provided in most locations, but it is help­ful to learn the words used during a basic eye exam.
    1. Get the appropriate immunization(s).
    1. Take advantage of Academy resources:
    • Go to the Global Ophthalmology (GO) Guide and scroll down to “Education” for 3 online CME courses from the Johns Hopkins Bloomberg School of Public Health: So You Want to Work Overseas?; The Major Caus­es of Blindness; and Assessing Outcomes in Global Health Programs.
    • At AAO 2016, attend 2 free events—Meet With an Interna­tional Expert (Saturday, Oct. 15, 11:30 a.m.-1:30 p.m. in the YO Lounge, Grand Concourse) and the Global Forum and Volunteer Fair (Sym27, Monday, Oct. 17, 8:30-11:00 a.m. Room S101ab). For more information, go to aao.org/programsearch and search by topic “Global Ophthalmology.”

    Reap the rewards. People who engage in mission work “experience a sense of satisfaction because they are able to donate their skill set and abilities to others who would not otherwise have access to that type of care. This just feels good, and it is the right thing to do,” said Dr. Lauer.

    Mission work may change the way you practice medi­cine and look at how health care is delivered. “My mission work experiences have led me to become significantly more resourceful, flexible, and comfortable—both in the clinic and in the operating room,” said Dr. Feilmeier. Dr. Sun agreed, adding, “You develop an understanding with these experi­ences that things can be done well elsewhere, even when done differently than how we were taught during medical school.”

    ___________________________

    Michael R. Feilmeier, MD, practices at Midwest Eye Care in Omaha, Neb., and is on the YO International subcommittee. Relevant financial disclosures: None.

    Andreas K. Lauer, MD, is vice-chair of education and professor of ophthalmology at the Casey Eye Institute at Oregon Health & Science University in Portland. Relevant financial disclosure: None.

    Grace Sun, MD, is assistant profes­sor of ophthalmology and head of the residency program at Weill Cor­nell Medical College in New York. She is chair of the YO International subcommittee. Relevant financial disclosures: None.

    For full disclosures and the disclosure key, see below.

    Get Involved in Mission Work: Here Are Your Options and What to Expect—Full Financial Disclosures

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