UI part of ORBIS Flying Eye Hospital team
The Big Ten is famous for competitions but that doesn’t keep the conference schools from teaming up for the right cause. Representatives from several Big Ten schools, including The University of Iowa, recently participated in a volunteer effort organized by ORBIS International to help physicians in Vietnam improve how they treat and prevent blindness and other serious eye conditions.
Two UI Health Care ophthalmologists completed one-week trips in March and April on the ORBIS Flying Eye Hospital — a state-of-the-art clinical and teaching facility housed on a DC-10 aircraft — and in local hospital settings in Da Nang. They trained Vietnamese doctors in the latest diagnostic and surgical techniques — from treating cataracts, to assessing glaucoma, to rebuilding eye sockets.
Dr. Keith Carter, head of UI ophthalmology and visual sciences, served on the recent trip, his third for ORBIS and first-ever to Vietnam. He led training in oculoplastics, which is surgery to repair or rebuild eye socket bones and surrounding skin and mucous membranes.
“It was a very positive trip. We contacted our host city physicians ahead of time to learn about the case mix, and once there, trained them so they can best take care of their own patients,” said Carter, who performed 10 surgeries on the trip. “It’s inspiring to be able to share expertise that we take for granted here.”
Carter worked with Drs. Nguyen Hai and Nguyen Van, Vietnamese eye plastic surgeons, and was aided by an interpreter. He was impressed with their drive to learn clinical skills, as well as the appreciation shown by all the people he met.
“Dr. Hai and Dr. Van are skilled ophthalmologists who are trying to build an oculoplastic center in Da Nang,” Carter said. “The only limiting factor on ORBIS trips is time — in the United States we have two years to train a fellow in a specialty, while here we have only one week to teach as much as possible. Yet it’s a very important week — I can’t praise ORBIS enough for allowing us to train doctors who have little or no chance of coming to the United States to learn.”
The idea for ORBIS International began in the 1970s when Dr. David Paton, head of ophthalmology at Baylor College of Medicine in Texas, was concerned that the high costs of tuition and international visits prevented most doctors and nurses in developing countries from participating in overseas training. Even if study abroad was affordable, their opportunity for direct clinical experience was limited because licensing laws often prevented them from performing surgery. His solution was a mobile teaching hospital, and by partnering with Pan American Airlines founder Juan Trippe and others, the first ORBIS plane, a DC-8, made its inaugural trip to Panama in 1982.
The latest ORBIS plane, a DC-10, includes an operating theater with all the equipment you would expect to find in an American teaching hospital and a 48-seat auditorium where physicians and other health professionals can watch live broadcasts of surgeries.
“The ORBIS plane is like operating here at the UI. There also are recovery and exam rooms,” Carter said. “The city hospital in Da Nang was functional but not as equipped.”
Indeed, there is often quite a contrast between host city hospitals and the ORBIS plane, notes Dr. Jeffrey Nerad, UI professor of ophthalmology, whose many ORBIS trips include one to Vietnam in fall 2007. On that visit, he performed surgery at a local hospital and experienced how the setting could not easily accommodate doctors’ eagerness to learn.
“There were 25 people in the surgical room crowded around the table watching me while I operated on a child. One doctor actually got on the table, straddling the patient, to get a better view of what I was doing,” Nerad recalled. “In contrast, the ORBIS plane classroom has the advantage of AV equipment, so many people can be seated in another room, yet easily see your hands and other important close-up views while you’re operating.”
Nerad made his first ORBIS trip in 1985 to Swaziland. It opened up the world of international exchange for him, and since then he’s done surgery or lectured in more than 30 countries, including many ORBIS trips.
“ORBIS is more about teaching than service. Although we help specific patients, which is wonderful, ORBIS provides learning opportunities for doctors who wouldn’t otherwise have them and helps them set new goals, all to provide better care for their patients,” said Nerad, who also is an expert in eye plastic surgery.
On a trip to Albania, Nerad helped train an ophthalmologist for whom he later set up a four-month training at the UI.
“The Albania physician I met was a neuro-ophthalmologist, yet his country had only one CT scanner in the entire country. Learning about imaging here at the UI changed his outlook in terms of what could be done at his clinic,” Nerad said.
Like Carter, he points out that U.S. doctors also get something important out of the experience.
“We see things that we wouldn’t see here in the United States, such as orbital cancers that have gone untreated,” he said. “It’s a good experience to get early in your career.
“ORBIS gets a lot of credit for organizing these trips. They help us visit locations that would be difficult and maybe even unsafe to travel to on our own,” he added.
Dr. Young H. Kwon, UI associate professor of ophthalmology specializing in glaucoma, who served on the recent Vietnam trip and two previous ORBIS trips, agrees that the experience is valuable.
“Doctors in Vietnam face an enormous challenge because there are so many cases of advanced glaucoma and cataracts. The ophthalmologists are overall providing good treatment. However, they often don’t get to see patients until there’s significant vision loss in advanced stages of disease,” he said.
“An additional challenge is that the Vietnamese doctors don’t have experience with the standard (Western) devices for measuring accurate eye pressure. Instead, they were using an old Russian method of measuring the eye pressure, which was substantially less accurate,” Kwon added.
To help the Vietnamese physicians improve their ability to diagnose glaucoma, ORBIS donated Goldmann tonometers, which measure eye pressure accurately. Kwon also provided the physician with whom he worked, Dr. Luu Thi Thanh Tam, a set of DVDs of glaucoma surgery that he has produced at the UI, so she can use them to learn and teach other physicians.
Kwon says he was very impressed with the Vietnamese. “In my mind, I had images of the war and devastation from the prolonged conflict with the U.S. But everyone was very friendly to Americans, and they are eager to learn the latest knowledge, skills and technologies,” he said. “And while I went there to teach, I learned so much about the Vietnamese people. It truly was an exchange of ideas and culture.”
In addition, to Carter, Kwon and Nerad, other UI ophthalmologists who have volunteered for ORBIS include Drs. Lee Alward, Kenneth Goins, and Stephen Russell, who alone has served on 16 ORBIS trips.
June 13th, 2008 at 9:37 pm
you guys rock. when are you going to start taking former UI residents and fellows with you?