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  • Artemis Alumni: Where Are They Now?

    Since its initiation in 2014, the Academy’s Artemis Award has been presented annually to one Young Ophthalmologist (YO) Academy member who has demonstrated compassionate care and service so exemplary as to be beyond any level of expectation.

    See a slide show of Artemis Award alumni.

    The activities may be domestic or international. Selecting such an individual brings great pleasure to the members of the Academy’s Senior Ophthalmologist (SO) Committee who are charged with reviewing the nominations submitted by academic program directors, department chairs, and subspecialty/specialized interest, state and international societies. During the SO Committee retreat, typically held in late winter, the nominees and their activities are discussed openly by the SO Committee members, after which ballots are taken until an award recipient is selected.

    On one hand, it is remarkably uplifting and enlightening (if not daunting) to review the activities of our junior colleagues who seemingly have satisfied a lifetime of giving in a very short time span. On the other hand, it can be very difficult to select only one candidate as the awardee.

    Typically, we look for activities that are innovative, reach a large number of needy individuals, are reproducible and can be carried on with perpetuity once the candidate has moved further on in their training or professional life. Subsequently, the candidate must be approved by the Academy Awards Committee and the Board of Trustees and the recipient then announced. For us, it is a great honor to recognize the contributions of the award recipient. Few things can equal the pleasure of informing the nominee and nominator of his/her selection.

    The mythological greek goddess Artemis had many attributes. Among them, she was the protector of the vulnerable and suffering, hence the award is given in her name. Interestingly, she was the (older) twin sister of Apollo and the daughter of Zeus and Leto. As lore has it, after Artemis was delivered with ease, Leto’s labor continued with great difficulty and Artemis aided her brother’s delivery as a midwife. Given that, she became known as a healer, nurturer and protector.

    As we are about to recognize our 10th Artemis recipient, we thought that it would be interesting to have a look back at the awardees to see how recognition of their contributions impacted their professional lives, what became of the projects that they initiated and what they are currently doing both personally and professionally. For this issue we contacted John Cropsey, MD, the first recipient in 2014 and Wendy Hofman, MD, the 2015 awardee.

    John Cropsey, MD

    Taking advantage of WhatsApp, I had the opportunity to speak live with Dr. Cropsey at his home in Rwanda.

    John was literally born into international medicine. His father, a U.S.-trained general surgeon native to rural Michigan, moved to Togo in West Africa as a young professional with his wife and four children in tow to establish surgical care for a greatly underserved populous. John was just 2 years old when he left the U.S. and flourished in that environment. However, as a teen he returned to the U.S. when his mother needed specialty care for an acquired tropical disease. He was subsequently educated at the University of Michigan for undergraduate and medical school studies.

    Given his observations in Africa and learning from his father’s own need to learn rudimentary eye surgery, combined with a vast need for eye care in Africa, John went on to Wills Eye for residency, finishing his training in 2009. Just as his parents did, John, his wife Jessica, and two children (they now have three) emigrated to Africa, settling in Western Kenya where he joined a small number of ophthalmologists in providing desperately needed eye surgery for their underserved rural area.

    During his two years at Tenwek Eye Unit, the team provided surgery for more than 4 thousand patients. Along with Ben Roberts, MD, and Sadeer Hannush, MD, he helped establish the first corneal transplant program in Western Kenya. Seizing an opportunity to teach more physicians, technicians and ophthalmologists, John moved to neighboring Burundi in 2013 where he joined the staff of the Hope Africa University’s School of Medicine, training young physicians as he helped establish their first eye department. He remained there until 2021 when the opportunity presented to join John Nkurikiye, MD, and Ciku Mathenge, MD, and their newly founded residency training program at the Rwanda International Institute of Ophthalmology (RIIO) in Kigali.

    Once again, John packed his family and belongings and began a new challenge. Now, at a 4-year-old training program which just graduated its first class in 2022, he and others are training 10 residents from all over East Africa and making a huge impact. Besides teaching, John leads a remarkably full professional life, performing, manual small incision cataract surgery (MSICS), phaco, corneal transplant, glaucoma, posterior segment, pediatric and oculoplastic surgeries.

    It was interesting to learn of the medical challenges that he routinely faces in Rwanda. As John explained, owing to the lush environment, there is a marked incidence of allergy induced limbal vernal conjunctivitis among youngsters; unfortunately, this leads commonly to eye rubbing, and as he described it, a near epidemic of keratoconus. RIIO has helped to establish programs for distribution of topical cromolyn sodium, which is readily available, inexpensive and very effective for early cases. Unfortunately, more advanced cases require use of topical steroids and other steroid sparing agents that are more costly and less widely available. While already offering corneal transplantation, RIIO will soon offer contact scleral lenses and cross-linking.

    I also asked about the political and social challenges that he confronts. Among the issues is the residue of colonialism which stoked decades of ethnic strife post-independence, eventually leading to the 1994 genocide against the Tutsi. The scars from the era remain deep, but with vision and perseverance, Rwanda is building a bright future for her people.

    So, how does all of this actually work financially? Partnering with many generous individuals, churches and other organizations, John and Jessica raise all the funds for their own employment and many other eye care initiatives in Rwanda, Burundi and Eastern Congo. They do this through SERGE Global, a non-profit (501(c)3) international Christian mission, which is home to the Eye Love Africa Project and the Kibuye Retinoblastoma Treatment Center. In Rwanda, RIIO’s primary training site is at the government district hospital at Kibagabaga.

    Thankfully, the great bulk of the populous has government-funded, low-cost insurance that covers the majority of the facility cost and procedures. Some ophthalmic industries donate products, and quality polymethylmethacrylate (PMMA) intraocular lenses (IOLs) that work well with MSICS and can be obtained inexpensively, from Aurolab, a subsidiary of the Aravind Eye Care System. John also explained that he receives donated corneal tissue from several international corneal banks. He also has had help from private foundations and singled out the David and Molly Pyott Foundation, as being particularly helpful in supporting many programs and trainees in the region over the years. (The Pyott’s are the Orbital Honorees for AAO 2023.)

    I asked John about his family and living conditions. His wife, Jessica, and other volunteers are certified teachers and established a school during their time in Burundi to educate their young children at the time. However, his eldest two children, Elise, 16, and Micah, 14, are now at a boarding school in Kenya while Sam, 11, is in school at home in Kigali, Rwanda. Their home is in a tropical paradise, surrounded with rich green foliage and temperatures typically in the high 70s to low 80s given their elevation of 5,000 feet on the equator.

    John is very satisfied with his professional life and doesn’t see a major change on the horizon. However, he does return to the U.S. about one to five years to maintain and update his skills and to raise funds for their work in Africa. When here, he is very pleased to work part time at the University of Michigan Kellogg Eye Center. He has no illusion, however, that living in central Africa requires ongoing, significant sacrifices from all family members. He readily acknowledges that “it takes a village” to fulfill their family’s mission to train, mentor and equip African eye care providers.

    John remains greatly appreciative of being the inaugural recipient of the Academy’s Artemis award. When queried how it impacted him, he indicated that it opened many doors and enabled him to make contacts with and get support from industry and granting organizations. To further cement and expand those relationships, when possible, John attends the Academy’s annual meeting. It is very apparent that John was and remains an excellent candidate for and a deserving recipient of the Artemis Award.

    Wendy Hofman, MD

    I spoke with Wendy Hofman, MD during her recent visit to the U.S. In 2015, Wendy was the second recipient of the Academy’s Artemis Award.

    I had the great pleasure to chat with her about her professional life and commitment to her mission in Gabon. It was quite evident that much of her support and dedication stems from her strong Christian faith.

    Wendy developed a keen sense of volunteerism for underserved regions while in high school, spending a summer in Ecuador with the Amigos de las Américas program, helping locals learn about dental hygiene. (Serendipitously, one of my sons did exactly the same mission in the 1990s.) In subsequent summers in college, she served in a student exchange program in China, a Bible translation interchange with Wycliffe in Peru, and health missions in Honduras through the Christian Medical and Dental Association.

    Native to the Seattle area, Wendy attended medical school at the University of Washington and then had her ophthalmology residency at the University of Minnesota. The Minnesota Academy of Ophthalmology nominated her for the Artemis Award. Once her training was completed, Wendy became affiliated with Samaritan's Purse, a Christian humanitarian aid organization and opted to plan for her professional future in Gabon on the west coast of central Africa. Before establishing life there, however, she and her husband took an intense and immersive course in conversational French, and then did a three-month fellowship in MSICS on the Africa Mercy ship on the coast of Benin; she describes the program as “Orbis with a boat,” referring to the international nongovernmental agency (NGO) that promotes eye health.

    Ultimately, she and her husband, Eric, an actuary by training, settled at Bongolo Hospital in rural Gabon, more than 350 miles from the capital city of Libreville; the hospital is maintained, and Wendy is salaried by the Christian & Missionary Alliance. She was the first ophthalmologist at Bongolo and now trains a single resident over a four-year period.

    For a new Eye Clinic at Bongolo hospital, opened in 2020, she obtained a $600,000 grant from the United States Agency for International Development (USAID), $300,000 from the government of Gabon and $100,000 raised from private sources! She has been elevated to medical director for the entire hospital. Although she trains a resident, there is no accreditation for the program as there are no other ophthalmology residencies in the country; she is hopeful that the government-run medical school will co-sponsor accreditation with her program.

    With her resident and her Congolese colleague (a former resident), they see about 6000 patients and perform roughly 500 surgeries per year. The great majority of cataract procedures are done by MSICS. The program performs about 75% of annual cataract surgeries in Gabon, she estimates. She is comprehensive by necessity, performing a wide variety of glaucoma, plastic, strabismus, and some posterior segment procedures. However, corneal donor material is generally not available, and she has had poor outcomes in a small number of penetrating keratoplasties resulting from limited compliance and poor follow up care. She is hopeful of expanding the care model for posterior segment disease in the foreseeable future and ultimately hopes to establish corneal banking, although she indicates that acceptance of human donor material may be problematic in her region due to cultural beliefs.

    Among other challenges is the absence of ocular surface microbiology and lack of CT scanner, as well as unstable electricity. But she remains quite optimistic for the future as she will be joined by another U.S. ophthalmologist in 2024. She also gets great satisfaction from having outreach programs in local villages and having the opportunity to eliminate bilateral blindness with cataract surgery for some of the villagers.

    Although Gabon is an oil-rich member of OPEC, wealth doesn’t appear to trickle far down. However, the great majority of the population has government sponsored health care insurance that pays the hospital $40 per cataract surgery, leaving the patient to pay $160. These prices are a tenth of the cost for cataract surgery in the capital city, and no patients are turned away at Bongolo for lack of funds. She is able to keep surgical disposable costs low by purchasing from Aurolab, an Aravind Eye Care System subsidiary. She also gets some support from African Mission Healthcare (an NGO), the U.S.-based Christian Ophthalmology Society, and some Industry.

    I queried Wendy about her living conditions and her family. She now has 3 children between the ages of 8 and 12 and who were initially home schooled, but now a certified teacher has been provided by the Christian & Missionary Alliance. Along with her husband, who has become the chief accountant for the hospital, she and her children live in a modest but comfortable brick house, albeit without air conditioning. The region is lush and tropical, with high humidity, and malaria is endemic. As a result, she is maintained on low dose doxycycline for prophylaxis. TB, HIV, and microfilaria rates are also high in Gabon.  Given her very rural setting, she and her family return to the U.S. annually for about two months, during which they visit family, take care of personal medical needs, visit supporters, etc.

    It is very evident that Wendy was a perfect candidate for the Artemis Award, and she feels that the recognition that she received helped greatly in knowing that she wasn’t all alone in her efforts to restore vision in a remote region.

    Artemis Award Alumni