Learning from different cultures can be fun when you’re abroad and starting a global ophthalmology fellowship. It can also be stressful if you’re not prepared for the changes.
See a slide show of Dr. Bal at work.
Here are some other things to keep in mind as you immerse yourself into another culture:
Be Adaptable
“Human nature is water, not stone.”
― Marty Rubin
Do you know how to set up the back surgical table? How to set up each surgical tray for the surgeries you are performing? How to draw up all the necessary medications? These are things that, fortunately, we do not need to worry about while operating in our home theaters.
Working in global settings often means that resources you normally have access to, including human resources, aren’t there. During my first global ophthalmology trip as a resident, I prepared by securing donations for all necessary equipment and spent most of the time in that country setting up the surgical trays and acting as the scrub nurse. I learned more during that week about the equipment and surgical process than I had throughout residency.
Adaptability does not mean you need to have all the answers; it just means that you are flexible and willing to learn in order to help out the team as best as you can! And remember to share your own unique experiences with the communities you are joining.
Know Your Limits
“Do the best you can until you know better. Then, when you know better, do better.”
― Maya Angelou
So you’ve done your first 200 phaco cataract cases, and you feel confident. Now you are facing a brunescent cataract and learning how to perform manual small incision cataract surgery.
We often are faced with dense, mature cataracts in rural settings, which require more skill and patience to remove. This, combined with less familiar surgical techniques and operating room settings, increases the risk of complications. It is important to be aware of your own limits and to ask for help when needed, in order to provide your patients with the best care and to also enrich your own experience.
Get Comfortable With the Uncomfortable
“No pains, no gains — no sweat, no sweet.”
― R. C. Trench
As ophthalmologists, we are trained to do everything we can to help restore and protect sight. We think very little about what resources are available to us and go above and beyond for every patient.
Sometimes in global settings, however, you are forced to navigate uncomfortable situations. For example, you have a patient with proptosis, but there is no imaging on the island. Should you recommend that they pay hundreds of dollars to fly off island?
You have a child with severe vitamin A deficiency causing xerophthalmia and irreversible corneal scarring. Should you eviscerate so that they are no longer in pain or wait for vitamin A replenishment? You are operating on a complex case and there are no retina specialists in the region if anything were to go wrong. Does that mean you should not provide sight-saving surgery?
You will have to face difficult questions and uncomfortable situations. But ultimately these situations will make you a stronger clinician and surgeon.
Manage Your ‘Ships’: Relationships, Partnerships, Mentorship
“People may hear your words, but they feel your attitude.”
― John Maxwell
Arguably the best part of global ophthalmology is the people. You have a unique opportunity to build relationships and partnerships with surgeons and staff in very diverse settings. Learn everything you can, from everyone you meet. I learned just as much from our support staff in the field and at home as I do from the surgeons I work with. Some of my closest mentors are ophthalmic nurses, outreach directors, and surgeons only a few years ahead of me in practice. Through global outreach you have the opportunity to develop unique relationships that last a lifetime!
Have Compassion for Yourself
“Where we think we need more self-discipline, we usually need more self-love.”
― Tara Mohr
As residents, we slowly progress to more complex cases. We all know the data ― the more ocular comorbidities in an eye, the higher the rate of complications. This can be extremely challenging since we are used to a very controlled surgical environment at home where we optimize and minimize surgical risks, in eyes that have one or two comorbidities.
However, when working in places where resources are limited, many (if not all) of the eyes will have several comorbidities, and every case you see will feel like the most complex case you have faced.
Have compassion for yourself as a surgeon and as a person. Remember that your team is often the best chance this patient has to restore sight. Don’t forget to lean on your mentors, and don’t be ashamed to ask for help!
About the author: Sila Bal, MD, MPH, is a University of Utah School of Medicine global ophthalmology fellow. She is a member of the Academy’s YO International Subcommittee and Global Education and Outreach Committee. Dr. Bal completed her cataract, cornea, and refractive surgery fellowship at Harvard’s Massachusetts Eye and Ear. She is dedicated to improving eye health in diverse communities locally and globally, advocating policies and strategies that promote health equity worldwide.
Sila Bal, MD, MPH: A Global Journey