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  • What We’re Doing Today: Meet Paul Runge, MD

    Paul Runge, MD, was born in Milwaukee, Wis. and later moved to Southern California. His medical studies were at Flinders University in Adelaide, Australia.

    Dr. Runge did pediatric residency at the Hospital for Sick Children in Toronto and later pediatric training at the University of California, San Diego. This was followed by a fellowship in pediatric ophthalmology at the Hospital for Sick Children in London.

    He received further ophthalmology training at the Cook County Hospital in Chicago. Remarkably, another fellowship was in medical retina with John Heckenlively, MD at UCLA followed by surgical retina with Steve Charles, MD in Memphis, Tenn. Most of his subsequent career was in private retinal practice in Sarasota, Fla.

    Most recently, he returned to the Charles Retina Institute in Memphis. However, as the reader will soon learn, he has recently been very active in another capacity.

    Alfredo A. Sadun, MD, PhD: Hi Paul, thanks for doing this interview. I noted that you have and continue to work with someone I know. What is your relationship with Steve Charles?

    Paul Runge, MD: Steve Charles is both a mentor and friend. He is an amazing surgeon and great teacher. I was fortunate to be his fellow and stayed on with him for a year after my fellowship before joining a private practice in Florida.

    Dr. Sadun: We’re here to learn of what you are doing in Ukraine. Did you have a special connection with that country? Please explain.

    Dr. Runge: When I initially decided to volunteer in the Ukraine, I had no prior experiences there or connections. I sent emails to various hospital and clinics in Lviv, in the far west of Ukraine, and after several initial enthusiastic responses, I was disappointed that no one followed up. Eventually, through a mutual friend, I was connected with an ENT surgeon, Roman Fishchuk, MD, who connected me with the doctors I continue to work with today.

    Dr. Sadun: Had you Dr. Runge previously traveled to Ukraine or other countries in Eastern Europe?

    Dr. Runge: No, I had never been to any country in Eastern Europe. However, I did volunteer work in Magadan, Russia from 1989 to 1996 as part of a medical exchange sponsored by the State of Alaska in association with the Institute of Circumpolar Health. And, as it turned out, my experiences in Magadan helped me understand medicine in the Ukraine. Both regions have inherited the medical system as developed by the former Soviet Union.

    Dr. Sadun: Something must have inspired going to Ukraine. What was your emotional reaction to Russia’s invasion?

    Dr. Runge: I identify with the Ukraine’s position and am horrified with what has occurred. I recently visited Hiroshima, Japan, which I believe every person should experience. Robert Oppenheimer is quoted as saying “Now I am become death, the destroyer of worlds,” after the atomic bomb he helped create was completed and later used in the complete destruction of Hiroshima and Nagasaki. We carry the burden Oppenheimer alluded to. We must learn from history.

    Dr. Sadun: What was your primary concern? What were your considerations of the geopolitics? War in general? Civilian suffering? Specific medical needs?

    Dr. Runge: I was primarily concerned with what were obvious medical needs. That was something I could address.

    Dr. Sadun: When did you first go to Ukraine?

    Dr. Runge: My first trip there was, ironically, Independence Day for us, July 4, 2022.

    Dr. Sadun: What was your initial emotional as well as intellectual reaction?

    Dr. Runge: My reaction to what I first observed in southwestern Ukraine related mostly to what I saw as great differences in healthcare delivery. My first two visits were to Ivano-Frankivsk National Medical University where I worked primarily in a general ophthalmology clinic as part of a general hospital. Most of the patients I saw were coming in for second opinions. And, for the most part, I agreed with the doctors who had made the initial diagnoses. Ukrainians tend to doctor-shop to a great degree and rarely accept their initial doctor’s opinion. The other thing that struck me is that  in Ukraine there is a great deal of homeopathic medicine and other unconventional therapies of little or no proven value.

    Dr. Sadun: What about the Ukrainian state of mind and reaction to the invasion?

    Dr. Runge: Ukrainians have a common cause. All they talk about is how the country has pulled together to defeat these tyrants. They’re not thinking that they’re anything but winning this war.

    Dr. Sadun: There must have been some frightening moments? Can you relate the worst?

    Dr. Runge: I’m not sure that I was ever really frightened. I was drafted into the U.S. Army in 1966 and subsequently spent a year in Vietnam in two infantry units. We were often under fire, so perhaps I am less impacted by these situations than most. In fact, another one of my major influencers in life was Sgt. Mears, my drill sergeant in basic training, who always repeated the same mantra, “Pay attention to detail.” His mantra has served me well in life and my training under his tutelage probably helped save my life.

    Over the many months that I have been coming to Ivano-Frankivsk, Ukraine, there has been a great increase in the number of air raid sirens which now occur three or more times daily. We generally go into basement bunkers when the sirens occur until we receive the all clear. But now that the sirens have become so frequent, people seem to be less affected, and often they do not go into the shelters. My phone has an app that tells me when to go to the shelter and when it is safe to leave. There is a large power plant 20 miles north of our city, and while I was there it was hit by cruise missiles. This got my attention, as I could hear the thud of the incoming missiles.  

    Dr. Sadun: How were you providing help there?

    Dr. Runge: My first two trips to the Ukraine were spent mainly in a general eye clinic offering second opinions. The clinic consisted of a young senior ophthalmologist and two first year residents. I primarily offered second opinions but also spent a great deal of time teaching the residents. At one point, the senior ophthalmologists went to [the European Society of Cataract and Refractive Surgeons meeting in Milan and left me in charge of the clinic. I enjoyed teaching the residents, and I believe that they enjoyed the experience as well. On my third visit, my second day back at the general eye clinic, the head ophthalmologist announced that she would leave for Canada the next day. Another resident, stated she was also going to attend a wedding in Odessa.

    However, later, instead of returning to Ivano-Frankivsk, this resident left for Normandy, France. As a consequence, the need for my services teaching at this clinic diminished greatly. Luckily, I had also been working at the children’s hospital as well and so I shifted my efforts there. I am board certified in both pediatrics and ophthalmology and have a special interest in retinopathy of prematurity (ROP). This children’s hospital is the regional high-risk perinatal center where all treatments for ROP occur. I am now focusing my attention on the premature babies but I also consult on eye problems of children and occasionally an adult will seek my advice in this hospital as well.

    I managed to obtain a Norlase LION laser from the company in Copenhagen which we now use to treat babies with threshold ROP. We treated the first baby on March 8. Everyone in the OR was amazed and almost euphoric about our ability to address this risk of blindness. Previously they used something similar to an Iridex 810nm laser which was difficult to use at best. I am trying to get them to use anti-VEGF injections as well, and eventually we will do so.

    I have also become involved with teaching medical students. The Ivano-Frankivsk National Medical University is a very large institution which was founded in 1953. Medical school in Ukraine lasts six years, and there are 450 students per year. This university also has faculties of dentistry, physiotherapy, and pharmacy. There are many foreign students from India, Africa, and western Europe, and I met one student who is from Stuart, Fla.

    While there, I also gave lectures to students and staff on diabetic eye disease, macular degeneration, lasers and ophthalmology and the differential diagnosis of the red eye. I have also given lectures to staff and students on the new Norlase LION. These laser talks also included a demonstration of the laser where each participant was able to use the laser to treat a photo of the retina. These demonstrations were amazing. To watch the expressions on the faces of all those who were able to use the Norlase LION was incredible. Nearly 150 individuals had the opportunity to try the laser, and many more are planned.

    Dr. Sadun: How did your perspective as an ophthalmologist influence your thoughts and actions there?

    Dr. Runge: Throughout my career I have always been involved in teaching. I believe that it is our most important role as physicians. Whether the teaching be to medical students, doctors in training, our patients or our colleagues, teaching is the most significant of all of our roles. I do feel strongly that we have an obligation to pass our knowledge on to the next generation and to do the best job possible of educating our patients. I now feel that I am achieving these goals.

    Dr. Sadun: Did this change you as a person?

    Dr. Runge: Sure. Everything we do in life changes us. I expect that I am a different human being for this experience in Ukraine. Our experiences mold us and hopefully help us improve ourselves, our relationships and how we view the world. I have always maintained that we should all try to leave the world a better place for all those who follow. I hope that my efforts helped achieve this goal.

    Dr. Sadun: What further plans do you have there?

    Dr. Runge: When I first came to Ukraine, I did not know what to expect and everyday there I learn something new. I have achieved more than I imagined was possible over a relatively brief period. There is still much more to do. One thing I have begun to work on is developing an app to track all of the high-risk premature babies in our hospital (to prevent any baby from going blind from ROP), which I hope to expand to the region and eventually entire country. This app could evolve into an opensource electronic medical record which would be distributed free to anyone interested in using it.

    Ukraine has many bright programmers and if this talent pool is brought to bear on this problem the outcome will help us all. Currently, patients bring their medical records with them to their clinic visits. These booklets contain all of the patient’s medical information. The doctors write their progress notes into these booklets and patients have the only copy. This is the same system I experienced in Magadan, Russia years earlier. If this notebook is lost, then the patient’s medical record is lost with it. We can do better.

    One other issue is obtaining additional medical equipment. Several companies and individuals have donated medical and educational materials and equipment. I thank Norlase, Volk, Goodlite, several of my retired colleagues and the Academy to mention a few. We need at least one good slit lamp for the pediatric eye clinic and one of the ophthalmologists there has requested a refractometer.

    Dr. Sadun: You are a seasoned ophthalmologist who brought many specialty skills as well as perspective to Ukraine, where your teaching and help must have been both critically useful and inspiring. Thank you. Anything more you wanted to say?

    Dr. Runge: Ukrainians are very bright, very motivated and well intentioned and would certainly benefit from training in North America. Ukraine produces many more physicians than it can support. So, I’m thinking that Ukraine may be a source of physicians, trainees and trained physicians to help fill the gap for America’s unmet health care needs. I’d like to put this out there as a reader may have some ideas as to what is possible.