Experience Abroad during Training: Four perspectives
Spending time abroad during training can be a rewarding experience and help to shape careers and perspectives. However the route is one not often travelled and so four ophthalmologists have shared their experience to help others interested in international eye care.
- Jack Gormley, St5, Yorkshire to Malawi
- Jonathan Roos, St7, East of England to Uganda
- Sri Gore, St5, East of England to South Africa
- Jennifer Kim, ST6, North Western Deanery to Cambodia
As Chair of The College’s International Committee, Mr Will Dean offers some advice:
“Involvement in ophthalmology internationally is invariably an invaluable and rewarding experience. We aim to find ways to further enable and support trainee ophthalmologists. Whether for a few weeks over a few years, a few months of out-of-programme experience, or longer periods of work or research; it can be a career-defining opportunity. It can lead to long-term partnerships. It can lead to a much deeper appreciation of the NHS. These mutual benefits of international volunteering have been described in what is called Global Citizenship in Healthcare. If you are interested, then talk with fellow trainees and consultants in your region, contact the International Committee of The College, or reach out to local VISION2020 LINKS. There will always be a way to gain experience abroad during training.”
Jennifer Kim, ST6, North Western Deanery to Cambodia
In October 2018, I travelled to Cambodia with a group of Consultant Ophthalmologists, Senior Optometrists and Specialist Registrars from Manchester Royal Eye Hospital (MREH) led by Mr Leon Au, through a non-profitable organisation, The Khmer Sight Foundation (KSF). Professor Sunil Shah from the Birmingham and Midlands Eye Centre is the International Medical Chairperson for KSF and has encouraged and organised many Ophthalmologists and Allied Healthcare Professionals to participate in voluntary work through the organisation, including this trip that I joined. I took a week of annual leave and luckily I was granted a travel bursary which covered flights and living expenses.
Cambodia is a country with a relatively-recent tragic past. The Cambodian genocide carried out by the Khmer Rouge regime under the leadership of Pol Pot, led to the death of 25% of the population in the late 1970s. The regime arrested and executed anyone described as professionals (including doctors and nurses), intellectuals and ethnic minorities. As a result, there are currently only 38 practicing ophthalmologists serving a population of over 15 million – one of the lowest number of ophthalmologists per capita in the world. As a result, over 180,000 Cambodian are blind where 90% of blindness is avoidable.
One word I would choose to describe my week at Phnom Penh is ‘intense’. Every morning we would travel to work and encounter humid air and hundreds of bicycles, tuk tuks and motorcycles darting around in every direction, in what seemed to be organised chaos. We would arrive to a large waiting area full of patients to be seen and operated on, including those from distant rural villages that had been specially brought in by coach from village screening missions. Initially I was overwhelmed by the speed and efficiency required to work in this seemingly hectic environment. However, it did not take long before I could see the order within. My role varied greatly and encompassed the entire patient journey; from taking visual acuities to examining patients in clinic, to gowning patients and preparing them for theatre, to assisting as a scrub nurse and operating as a surgeon. During our stay, we performed over 150 cataract operations, as well as treating other common eye conditions in Cambodia such as pterygium and glaucoma. We visited rural provinces of Cambodia where people have limited access and exposure to healthcare in order to screen patients for treatable eye conditions. In the afternoons, we provided teaching and training to healthcare professionals in Cambodia with a view to sustainably improving the healthcare available to the local population. Whilst we manage highly complex cases in the UK, the volume and variety of pathology I saw in Cambodia was much more intense. Such advanced cataracts that are nowadays seldom seen in UK clinics, and are only read about in textbooks, were seen routinely in Cambodia. Cataract extraction was much more challenging, especially with the limited resources available, however the difference that cataract extraction made to these patients was unmeasurable. At post-operative review it was a delight to see the difference that we had made, and that patients who were previously unable to even navigate were now able to walk around and function more independently.
Working in the NHS, we can find areas that can be improved on an almost daily basis, and it is easy to forget how lucky we actually are. We have access to medical equipment, investigations and human resources, which have become second nature to us. It is easy to forget why one decided to become an Ophthalmologist. For me, I want to help people to see better and I am grateful to have received the training and acquired the skills to do so. From my time in Cambodia, I have realised that voluntary work does not always require special skills or a lot of time. There is so much to learn outside textbooks and clinic rooms, for example, I developed my leadership and teamwork skills through working with the fantastic multidisciplinary team from various backgrounds and cultures. I have also learnt to be more flexible and resilient in situations where resources are limited, and stress levels are high. Certainly, this has been a humbling experience and seeing what a life-changing difference that we made to these patients made the whole experience invaluable. I would unreservedly recommend the experience to all trainees interested in International Ophthalmology – it is an experience that you will never forget.
Please contact Professor Sunil Shah (firstname.lastname@example.org) for further information on how to get involved.
Figure 4 & Legend: A) Assisting during pterygium removal. B) Screening in rural villages and C) the patients waiting to be seen. D) 15 year old girl at pre-op assessement prior to cataract surgery. E) Patient holding her clinic card equivalent to medical notes. F) Checking vision during screening.
Will Dean- Chair of International Committee- RCO
Involvement in ophthalmology internationally is invariably an invaluable and rewarding experience. We aim to find ways to further enable and support trainee ophthalmologists. Whether for a few weeks over a few years, a few months of out-of-programme experience, or longer periods of work or research; it can be a career-defining opportunity. It can lead to long-term partnerships. It can lead to a much deeper appreciation of the NHS. These mutual benefits of international volunteering have been described in what is called Global Citizenship in Healthcare. If you are interested, then talk with fellow trainees and consultants in your region, contact the International Committee of The College, or reach out to local VISION2020 LINKS. There will always be a way to gain experience abroad during training.
Figure 5 & Legend: Mr Dean has been called by a veterinarian at the Lilongwe Wildlife Centre to examine Bella, a one-eyed pseudophakic lioness. Happily, the patient was anesthetized for the examination.