• Are you considering medical missions and wondering if you should consider a global eye fellowship?
• Looking for advice for ophthalmologists who want to stay involved but aren’t ready to dedicate themselves to a long-term medical mission?
• Wondering if you really need to learn MSICS?
• Seeking any recommendations on how to know which group to join when doing short-term medical mission trips?

You need to read this insightful interview with Dr. Bradley Farris, Director of the Global Eye Care Fellowship Program at the Dean McGee Eye Institute in Oklahoma City.  He will both encourage and challenge you.
by Jason Smart, MD, PGY-3

Q - Why do you spend so much of your time doing mission work?

When applicants come to interview for our residency program at Dean McGee, they often express great enthusiasm that we provide a 2-week ophthalmology mission trip during their final year of training. My question to them is, “Have you done medical mission work, before?” Their answer is usually “yes” or “I really want to.” My next question to them is, “Why do you do that?” Often, their answer is “I’ve never really thought about it, but it makes me feel good.” My reply is then, “So it’s all about you?”

For some, it may be all about them. But if you’re faith-based - is it really all about you? For example, I want to go in and do 100-200 cataracts and then leave. I come home, talk to people, talk to my church, and everybody thinks it is really wonderful. It’s a good feeling to know that I really impacted 100 lives and their families. And it is wonderful! It’s awesome! But how many cataracts does it take to make a dent in the needs of China, with a population of over 1.3 billion? How about the follow-up care? How comfortable were you in a foreign environment and how excellent are your results going to be in a different environment with less than optimal instruments, a different microscope, and questionable follow-up care?

The goal is not to discourage, but to stop and think, “What am I doing and why?” Am I creating an environment of competition with a local doctor on the other side of the mountain who is also trying to do some good? People hear ‘American doctor’ and flock to you for help, but the local doctor has been here the whole time and you come in for a week and leave. You did not have the chance to collaborate and now they may be stuck with your complications.

I think being able to help some of these young doctors before they jump into medical mission work is important, so they understand what some of the local goals are. So they understand it’s not about them. It’s about the country. It’s about the people—whether it’s faith-based or not.

For years, we used to bring loaded suitcases of supplies to China. Why? Because we could, and we presumed a need. So, we would bring IOLs and other supplies, utilize them while we were there, then leave.  The remaining supplies would disappear. We didn’t know where they went. Soon, we realized the people we were working with in China didn’t need supplies, what they needed was education. In China they have a much different way of doing things and training residents. So we quit taking supplies to China years ago and made our focus on educating the doctors and their training system.

In Swaziland, there’s insufficient medication and no one to train. There’s no medical school there. So we train and educate screeners to determine if they need surgery or not, and if they need a subspecialist’s care or not.  We take donated supplies to that type of region.

Q - I want to become involved in missions, should I consider a global eye fellowship?

A global eye fellowship is for those who have finished their ophthalmology residency and have a heart for missions. This may be in the form of full-time or part-time mission work. They may need more exposure in dealing with public health issues and developing their approach to medical mission work. This medical mission work may be faith-based or public health-based, or both, as the two don’t cancel each other.  Sometimes, however, if you are evangelical there’s a goal in mind that may or may not be public-health driven. If you are public health-oriented, then there’s the goal of eliminating treatable blindness in a certain area of the country.

To best answer your question let me tell you about an experience I had several weeks ago. A young doctor called me who was considering our global eye care fellowship while in their last year of residency. There was a long history of helping in short-term medical mission work. I shared with him the work required, which is 3 months in Africa, 3 months in China, and 6 months at Dean McGee to fulfill the need of supporting the fellowship.

Then I asked him, “What do you want to do with the fellowship? Do you want to do your second year at the London School of Hygiene and Tropical Medicine or would you not want to do that second year?” He asked, “What would that do for me?” I answered that it further prepares you to approach a country’s problems from a public health perspective, knowing better how to coordinate bringing in resources that are available. He said “I’m not sure.” I asked, “Where do you see yourself in 5-10 years from now?” He replied “I wanted to spend a year and serve in the mission field, but beyond that I haven’t really thought about it.”

So basically, this young man had a heart to serve, but had not thought about how this fits in to his long-term goals. I responded, “I would encourage you to spend a weekend – go out to dinner with your wife, talk about where you see yourself in the future. Be totally honest with her and her totally honest with you, and give yourself some time to dream. As a medical student and resident you don’t have time to dream, you just focus on obtaining the next goal, and then the next goal. But if you sit back and dream a little bit, it helps to re-invoke passion into what is most important to you. I don’t want you to spend a year of your life doing a medical mission fellowship, if that ultimately isn’t going to be your passion. If it is, think about that second year as seriously catapulting you into this field.”

The holidays passed and I got a call back from him a few days later. He said, “I had never done what you recommended, before, but I did it. My wife and I realized that we don’t want to do full-time missions. I want to do it on occasion, but I don’t want to spend a year of my life to prepare myself for ‘possible’ long-term missions.” Good to know that about yourself now before embarking on a 1-year global health fellowship.

Q - Do you have any advice for ophthalmologists who want to stay involved but aren’t ready, at least not yet, to dedicate themselves to a long-term medical mission?

I think short-term mission work is terrific. The best way to go about them is to partner with someone on the ground, already in the country that you want to become involved in.

I was talking with someone we partner with in Swaziland and told him that because he is so talented, gifted, and more experienced with this type of work than I, I’m not sure what I can offer when I come out there.   I was simply unsure of how I could be of help.

So I would recommend to anybody that has a desire to do just a 1 or 2-week mission trip – go. Partner with local people. Ask them what they need and how you can help.

I’m a neuro-ophthalmologist, what can I do? Our full-time colleague in Swaziland told me once, “You know, it can get so lonely out here. Just you being here makes such a difference to have someone here supporting me.” To those who feel they cannot bring a certain skill level or that their skills may not be needed, just being there and helping in some way with an attitude of helpfulness will make a difference.

So I can be there, I can free up clinic so the surgeon can operate. I can offer my advice on difficult cases that they have. I can laugh with them, and I can cry with them.  Being a subspecialist, they hold onto difficult neuro cases so that when I come I can help avoid having to send them out of the country with their already limited resources. Same thing with medical retina or any other subspecialty.

Q - Do I really need to learn MSICS?

If you are a cataract surgeon, you have a great skill. If you have the ability to do MSICS (manual small incision cataract surgery) then you are in great need all over the world. What does that mean to the phaco surgeon who is terrific and wants to do medical mission work? Figure out how to do MSICS. Go train yourself. Find a place to learn MSICS and make it happen because you are a much more effective MSICS surgeon, throughout the world, than you are a phaco surgeon. You can be the world’s greatest phaco surgeon and really run into trouble with MSICS if you’ve not done it. But you will develop the skill rapidly.

I think it’s important to establish a good relationship with a really good MSICS surgeon. One who is willing to be patient and has a desire to teach. Ask them if they could teach you either stateside or internationally. This is important, because, like in cataract surgery, after the first 5 or 6 cases you understand the steps; after the first 20 you start feeling comfortable; after 100 you feel like you can begin to fly on your own.

Make sure that this is done in an ethical way so that we are not just finding patients who need surgeons and practicing on them. Wet labs are helpful. When transitioning to real cases, do 1-2 steps of the surgery and then let the experienced surgeon take over. Gradually, the experienced MSICS surgeon will feel more confident in your skills and you can learn the technique well under their guidance.

If you want to go and do 100-200 cataracts, that’s wonderful, but make sure it’s what they need. Make sure it’s part of the ongoing long-tem process. Make sure you have people screening before you get there so you can begin running on day 1, and make sure there is adequate postoperative care. Also, make sure you are not only doing the work, but that you’re training the people that are there full-time.  And most of all, have fun!

Q - Any recommendations on how to know which group to join when doing short-term medical mission trips? There are so many out there.

There are many organizations that are either faith-based or not with good help and support. If there is an organization that you feel attracted to or that you have heard about, my recommendation is for you to find out what doctors have worked with that organization and talk with them.