• A Young Cataract Surgeon’s Journey in Norway During COVID-19

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    One of the first documented cases of COVID-19 infection in Norway was in February 2020, when an ophthalmologist who had traveled to Italy tested positive for the virus. 

    Before the infection became known, the infection had spread among employees in the eye department in our capital Oslo, but luckily no patients were infected. The largest eye department in the country had to close down.

    With escalating infection rates, the Ministry of Health adopted national measures far beyond what had ever been done before. With Norway's Infection Control Act, kindergartens and schools were closed, except those children whose parents had occupations defined as essential for society, such as health care personnel.

    Grocery stores were kept open, but the population was encouraged not to hoard. Cultural events and sports events were forbidden. Restaurants had to keep 1 meter between guests to stay open. Fitness centers, hairdressers, massage and body care businesses and official swimming pools were closed. Home offices became the new standard for those who could carry out their work from home. 

    Despite the fact that the nation had considered a pandemic as the most likely crisis in the near future, Norway did not have enough infection control equipment and intensive health care equipment to cope with large numbers of infected. The goal became to keep the infection under control by strict traveling restrictions, isolation of infected individuals, infection tracing and quarantine of close contacts. 

    The hospitals had to prepare for large numbers of infected patients and at the same time change hospital activity so that the risk of infection spreading was minimized through social distancing. 

    All elective surgeries that could be postponed were canceled. Waiting areas were divided into zones in order to maintain distance between patients. Anti-VEGF injections were given at intervals based on previous medical history without any further examination. To avoid the risk of having to close the department, the staff was divided into two working groups that worked every other week, with always one group in standby in case of infection in the other. 

    All meetings and internal teaching lectures were held digital. Due to the lack of intensive care nurses, some of the younger doctors were given training in intensive care to be able to assist if the need arose.

    In Norway, which has a population of 5.4 million, 707 people have died during the pandemic, and more than 106,000 people have tested positive for COVID-19 tests by April 2021.

    The national measures proved to be effective. The infection rates declined and in June 2020, surgeries in the hospital increased. We have seen that by introducing strict measures when infection rates are increasing, we are able to keep the infection under control. 

    In Norway, which has a population of 5.4 million, 707 people have died during the pandemic, and 106,224 people have tested positive for COVID-19 tests by April 16, 2021. This is far less than in our Scandinavian neighbor Sweden.

    Sweden did not lock down in the same way. It has had 13,788 COVID-19-related deaths and 900,138 positive tests in a population of 10.23 million. 

    By April 16, 23.4% of the Norwegian population has received the first dose of vaccination. The government distributes vaccines, and these are given according to priority lists. As a member of prioritized health personnel, I happily received my first shot on March 30. 

    Training During COVID-19

    It was with COVID-19 as a backdrop that I began my training in cataract surgery. To specialize in ophthalmology in Norway you must be a trainee in the ophthalmic field for a minimum of five years. If you have other relevant working or research experience, some of that time can be included. The program is mostly based on getting knowledge from supervised working experience.

    There are eight compulsory theoretical courses that end with small exams, but no larger final exam at the end. The ophthalmic departments are divided into two levels of specialization, with a one- to one-and-a-half-year internship that must be completed at one of Norway’s five larger, subspecialized university hospitals.

    My family had to split up temporarily to accommodate my internship, and moving around is not always family-friendly. With a heavy heart, my husband and I decided that the least intrusive was to split up our family: I would take my youngest daughter with me to Trondheim, leaving two sons and my husband behind in Alesund. Separated by a six-hour drive, living with a dear trainee from college and her family, we had an unusual year, but experienced mostly positive memories to take with us for life.

    There was only a shorter period for my training in cataract surgery. For me it was a crucial time, knowing that I wanted to learn as much as possible before moving home. During time on standby I spent some of it watching videos of cataract surgery on YouTube, the Academy’s Online News and Education (ONE®) Network and reading the European Society of Cataract and Refractive Surgeons webpages along with other literature. 

    Despite fewer surgeries, I still got adequate time in the operating room and had such a great support in my experienced teachers and co-surgeons, to become confident and well-prepared to practice as an independent cataract surgeon after returning to Alesund in September 2020. 

    ‘Believe in Yourself’

    I am so thankful for the time my supervising doctors at St. Olavs University Hospital invested in me and the possibility to give them a call whenever help is needed. Getting surgical training is not self-written. It is a combination of being at the right place at the right time, working hard, showing interest and dedication especially during times of crisis.

    Sadly, my chief at St. Olavs University Hospital, which gave the main part of my training, died at only 50 years old in July 2020. But his knowledge, support and meaningful words will always be with me when days get rough: ”Believe in yourself. Don’t let your head get in your way.

    About the author: Elisabeth Romundstad is a senior consultant at the Department of Ophthalmology, Alesund Hospital, Norway. She was one of the founders of the Norwegian YO organization focusing on improving education and a participant in the European Society of Ophthalmology’s Mini Exchange Program . During her internship at St. Olavs University Hospital in Trondheim, she became an independent cataract surgeon during the COVID-19 pandemic.