17 July 2010
Posted in
Pearls in Ophthalmology
By M. Kelly Green, MD
I interviewed my employer, Dr. Gene Kirby, who went on his first mission trip in summer of 2009 to Guatemala. He was inspired to go and help people in a developing country who do not normally have access to surgical eye care. The organization he worked with is a U.S.-based group called Health Talents International (HTI). Dr. Kirby found this group through contact with some individuals who have worked with HTI in the past.
Dr Kirby suggests making contact with your host agency at least nine months prior to when you would like to travel. HTI works specifically in Guatemala and provides physicians from several specialties including orthopedics, gynecology, and general surgery at varying times of the year. Ophthalmology participates twice per year, and there is a wait list for those physicians who wish to attend.
It is not required to bring a technician, but Dr Kirby found it very helpful to have his surgical technician along to help him operate. Dr. Kirby provided the travel funds and meal stipend for his technician. It was the technician’s first trip of this kind, and he thoroughly enjoyed it. Dr. Kirby discussed his trip with his malpractice insurance carrier prior to going.
Upon arrival Saturday for a one-week stay, the team drove from the Guatemalan capital to Clinica Ezell, where they lived in a dormitory next to the hospital. Dr. Kirby was on a team with another ophthalmologist and his technician. As there was one operating microscope, the non-operating physician was screening and examining patients while the other was in the OR. A Guatemalan family medicine physician also screened and assisted with patients in clinic. All surgeries were done with retrobulbar anesthesia without MAC; there was no anesthesia support available at that time.
The team performed a total of 35 cataract extractions, some of which were extracapsular cataract extractions without phacoemulsification. Many of the cataracts were so dense that they were not able to be removed with phaco. The phaco machine was about 35 years old, and this too made the surgeries more challenging. The cost of disposable items, however, with a newer machine, would have been potentially prohibitive. There was a manual keratometer, and an ultrasound machine for preop measurements. Other surgical cases included pterygium excision, and excision of eyelid malignancies.
When I asked Dr. Kirby what he would recommend bringing, the first thing he mentioned was lightweight clothing, with plenty of changes of clothes! He and his team took 3-4 showers per day. Certainly take a camera as well. Dr. Kirby produced a hardbound book with photos of his trip to give to his technician, and to those who sponsored the effort. He took his own instruments, including manual I&A. Alcon donated viscoelastic, sutures, and disposables. These items were brought into Guatemala by other groups who arrived prior to Dr. Kirby. Dr. Kirby brought with him 250 implants in suitcases, and this resulted in his being held in customs for a lengthy period of time. In order to minimize the chance for this snag, he recommends having a letter from the Department of Health which authorizes the importation of the supplies needed. You can also consider shipping items ahead of time, but shipments can take months to arrive.
In terms of day-to-day things, those attending the trip ensured that they had current immunizations such as yellow fever, tetanus, and polio. There was also a malaria prophylaxis. Dr. Kirby and his team ate locally-prepared food and drank bottled water. He did not have any trouble with illness related to his journey.
Dr. Kirby found the local population to be so grateful with the services he and his team provided. Dr. Kirby expressed that he felt it was important to respect the local customs and local people, and to discuss thoroughly (through your interpreter) the surgeries planned and performed, just as we do here at home. Even though you will be practicing medicine from a non-traditional standpoint, and this may at times be technically challenging, the gratification is enormous, because patients are so appreciative. He hopes to attend future similar trips for many years.
