Editor's note: Fellowship programs to expand ophthalmology residents' world view for delivering eye care have proliferated around the country. This is the third in a series of YO Info articles on global ophthalmology fellowship programs.
The year was 2001, and an organized approach to blindness prevention was critically needed around the world.
See a slide show of Dean McGee Eye Institute fellows working around the world.
The Call to China
Dean McGee Eye Institute (DMEI) started its global ophthalmology program in the Sichuan province, China. We started in the Sichuan province because of a large backlog of blinding cataracts (over 1 million), with only 30,000 to 40,000 patients undergoing surgery each year. Training skilled local cataract surgeons was not being addressed.
Sichuan People’s Provincial Hospital in Chengdu in partnership with Dean McGee Eye Institute began an academic exchange program specifically designed to improve the quality and quantity of skilled Chinese surgical residents. Chinese residents were able to watch and learn from senior U.S. ophthalmology residents from DMEI. The faculty were instrumental in setting and achieving realistic training goals for the Chinese residents.
Expansion to Eswatini
In 2011, we identified a burden of treatable blindness in Eswatini, Africa (formerly known as Swaziland). Eswatini provided a different set of obstacles to overcome: endemic diseases such as HIV and tuberculosis, limited number of eye care specialists, and difficulties associated with health care in a poor, rural community.
In partnership with Dr. Jonathon Pons, an ophthalmologist in Eswatini, DMEI initiated a different approach, including the provision of subspecialty ophthalmic care. This provided DMEI’s senior residents an opportunity to experience international ophthalmology and its unique needs in Eswatini. They can travel to Eswatini with our teams as often as twice yearly but not during their senior year when they have increased surgical responsibilities.
DMEI Launches Global Fellowship
In 2014, through the help of Drs. Lloyd Hildebrand and Jacquelyn O’Banion, DMEI started the global ophthalmology fellowship with the goal of providing international experience and a basic approach to treating blindness in diverse locations with unique needs.
Fellows learn how to identify local needs and obstacles, available resources to accomplish goals, and partner with local key players. In Eswatini, for example, senior DMEI residents and global ophthalmology fellows participate in surgery with Dr. Pons. DMEI's global ophthalmology fellows in China are allowed to participate in surgery, but residents do not because of licensing issues.
Serving the Underserved Internationally and Locally
Both residents and fellows learn about culture competence before they go abroad. We teach them unique customs, languages, body language and concerns that native populations may have that are not typical in the United States. The training continues on the ground as participants are exposed to patients' cultural fears in examination and surgery, to local diets and appropriate behavior, not only of different tribes in Africa, various ethnic minorities in China. We review cultural norms not only for patient examination and surgery, but also in the type of dress and unique religious habits common in each region.
DMEI’s global ophthalmology fellowship program also emphasizes public health principles in addressing treatable blindness both internationally and locally. Cornea or pediatric ophthalmology faculty occasionally join the teams abroad, but senior residents can offer their knowledge and experience in glaucoma or neuro-ophthalmology during their subspecialty rotations. They have significant experience in all ophthalmology subspecialties and served as great resources during their time in Eswatini.
Fellows spend five to six months in both China and Africa. Additionally, our fellows learn to use the same approach to apply to local blindness prevention here in the U.S. They then spend the remaining six months working in local suburban and rural communities in Oklahoma.
Global ophthalmology fellows also have the opportunity to work with outstanding faculty at DMEI to further develop their skills in subspecialty areas that will always be needed in global ophthalmology. The DMEI global ophthalmology program goal is to give fellows an opportunity to learn the skills necessary to work in less-than-ideal conditions anywhere for the purpose of addressing treatable blindness, as well as instilling a desire to serve throughout their career.
Combining the resources and efforts of both faith-based and public health-based eye care missions is both a rewarding and effective strategy for the DMEI program. We find this approach effective in order to utilize available resources in a particular region. This is explained carefully to each resident and fellow prior to departure ensure individuals are comfortable with the habits and expectations of each region and their cultures.
You can apply for the DMEI Global Ophthalmology fellowship through the San Francisco Match program. The global ophthalmology fellowship is listed under “other” category. Find more information on the Dean McGee Eye Institute website at dmei.org.
About the author:
Bradley K. Farris, MD, is the director of the International Ophthalmology Program at Dean McGee Eye Institute, as well as director of the global ophthalmology fellowship program. He started his practice at Dean McGee Eye Institute in 1986 as a fellowship-trained neuro-ophthalmologist. He helped found the Ministries of Jesus free eye clinic in Oklahoma City in 2000 and started work in Sichuan China in 2001. He has led teams from DMEI with volunteer faculty since then and started work in Eswatini in 2011. He is now professor emeritus at the University of Oklahoma and Dean McGee Eye Institute. He can be reached at bradley-farris@dmei.org.
Read about other global ophthalmology programs in the series:
Part 1: Moran Eye Center Global Fellowship ProgramPart 2: 7 Reasons to Pursue a Global Fellowship