The three keys to pursuing experiences in global ophthalmology are intent, proper preparation and mentorship.
First, you need to ask yourself why you want to pursue global ophthalmology. It’s easy to become interested in it because of the adventure: traveling to new places and seeing different health care systems.
There isn’t anything wrong with that, but it can’t be the primary motivating factor. We took the Hippocratic oath to do no harm, and pursuing global ophthalmology without proper insight can certainly have unforeseen consequences even in well-intentioned hands.
To ensure that I was approaching this career in the most thoughtful manner, I pursued a master’s in public health in eye care at the London School of Hygiene and Tropical Medicine (LSHTM), followed by a global ophthalmology fellowship at the Moran Eye Center in Salt Lake City. The year I spent in London completely changed the trajectory of my career and how I view and try to problem solve visual impairment and blindness in various communities. I went from being very surgically oriented to being very health systems-oriented. The former is very physician-patient oriented, and the latter is community/public health-oriented with the goal of making measurable change.
Global ophthalmology fellowship programs are a great option for the latter: making measurable change. They provide the opportunity to make connections with partners around the world andcan also provide a framework for building a global ophthalmology practice. In the U.S., there are now eight global ophthalmology fellowships programs, and each has a unique strength and specific niche.
If this is something you are hoping to pursue, make sure to talk with a graduate from each of the programs to find out the experience of each one. Keep in mind, however, that in the midst of COVID-19, new global ophthalmology fellowships have emerged, and we will continue to see an evolution of these programs in the future. Many of these fellowships are driven by the fellows themselves, and it’s important to have set objectives before starting the year.
When looking for a job after training, hold out for that opportunity that will be fully supportive of the time you want to carve out for global ophthalmology. I looked at both private practice and academic positions. One of the private practices told me that they loved that I was passionate about global ophthalmology but I would have to do it on my own time outside of a full-time practice.
Other private practices offered one day off a week when I could pursue my goals. I considered these practices but ultimately decided that without structured time, I would have a hard time staying true to my aspirations. If you are going to go the private practice route you will have to know yourself well and that you will truly dedicate that time to global ophthalmology. I would recommend partnering with a nongovernmental organization (NGO) and find a position with a group to which you feel comfortable contributing.
I ultimately decided on an academic position. I wanted to be somewhere where I could feed off of the success and energy of colleagues who were also pushing the envelope in research or other worthwhile projects, even if it wasn’t global ophthalmology. For me, I found that supportive environment at the Mayo Clinic.
Although academic jobs may have a strong support structure for this type of work, it’s important to find out what tools you will be given to succeed. In other words, you should be able to clearly outline what you have to offer in terms of experience and knowledge, but you should also find out how you will be supported for your endeavors. Is there already a global ophthalmology team in place? What type of structure is already in place? ? Are there short field-based surgical camps? Long-term, outcome-based programming and research? Are there internal or external grant opportunities? If so, are there any mentors that could help you apply and ultimately receive such a grant?
Global health and global ophthalmology are fields that are gaining popularity and traction because there is a growing generation of physicians that are interested not only in the patient in front of them but also the patient that isn’t. We don’t accept health disparities simply as the way that things are.
We also view our global colleagues as equals, collaborators, and friends. Whether or not you have the time to complete a master’s in public health or a global ophthalmology fellowship, you will want to join an effort with mentors who have experience in capacity building, long-term programming (with five- and 10-year goals) and that look at evidence-based and sustainable solutions.
If you do that, I have no doubt that you can create a successful career in global ophthalmology.
About the author: Ashlie A. Bernhisel, MD is a cornea specialist in Rochester, Minn. She completed her residency at the University of Utah, Moran Eye Center. Dr. Bernhisel is also a member of the Academy’s YO International subcommittee.
Photo caption: Orientation week for the Public Health in Eye Care program at the London School of Hygiene and Tropical Medicine (LSHTM) in the fall of 2019. Dr. Bernhisel, second to left. Credit: Romulo Fabunan, International Centre for Eye Health at LSHTM.
Global Fellowships: New Opportunities in Ophthalmology Training