resident’s diary
MORAL obligation Leigh Spielberg ponders what he owes the world
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hat sort of moral Geoff Tabin, co-founder of obligation do the Himalayan Cataract Project, we, as young, calls cataract extraction “a well-trained little miracle – the single most ophthalmologists effective medical intervention on have to the rest earth.” This is particularly true of the world? What is expected of when the vision of patients with us in terms of “giving back” to a mature cataracts and functional world that has been so generous blindness can be restored for to us and so much less generous less than €20 per patient. And to the rest of humanity? this operation can be repeated This question has been popping hundreds of thousands of times up with increasing frequency with outcomes comparable in my mind, largely due to the to those seen in Europe. A connections between our eye National Geographic journalist, hospital in Rotterdam and an observing Dr Tabin examining extraordinary clinic in Rwanda: patients postoperatively, wrote, the Kabgayi Eye Hospital. It all “Dozens of patients who have started with a recent vitreoretinal regained their sight stand to (VR) surgery fellow, Dr Piet Noë. sing. Sometime in my life, I Dr Noë is a Belgian may hear a sound that expresses ophthalmologist who lives and joy more purely. But I can’t works full time in Rwanda. imagine when.” There, he performs thousands of eye operations of every sort Responsibilities and per year. He came to Rotterdam possibilities for an intense surgical training So, back to my original question: programme. Since Dr Noë What is our responsibility, returned to Rwanda, two of my as residents and young colleagues have gone to work ophthalmologists, to the world’s with him. blind? With few exceptions, One colleague went to teach; we have all been handed the the other went to learn. Marc “We can permanently improve world on a silver platter. We Veckeneer, a senior retinal a person’s quality of life with just have benefited from excellent, surgeon, went to Rwanda for inclusive educations in safe several months to operate. He also one operation” environments. Our futures put the finishing touches to Dr Marc Veckeneer look rosy, despite our general Noë’s VR skills. Peter van Etten, tendency towards fear and ophthalmology resident, spent a obsession over every financial “crisis” of our highly developed month assisting Dr Noë in the clinic and in the operating room. and generally stable economies. In an email to us during his first week there, Peter wrote: “What And besides our responsibilities, whether they are measured Piet Noë does here is truly amazing. Here’s an example of today’s in financial or surgical assistance, what are our possibilities? operating schedule: one enucleation for retinoblastoma, two Can we just get up and go to Rwanda or Bhutan, live there for a congenital cataracts, two corneal perforations, three vitrectomies year or two and operate as many cataracts as we possibly can in for retinal detachments, a conjunctival flap for a Mooren ulcer, that time? Half of the residents in my programme have children. debulking of what seems to be a periorbital lymphangioma, a few They have bought houses and have bank loans to pay. Getting pterygia, 10 cataract extractions and a dacryocystorhinostomy to away isn’t easy. drain an orbital/ethmoidal abscess. Oh, and a trabeculectomy.” And if we were able to leave our lives for a year or so, how useful could we be to the treatable blind? Could we successfully Quality of life operate a mature cataract? A post-traumatic cataract? A Impressive. I must admit, it’s difficult to concentrate on treating congenital cataract? The old maxim of “See one, do one, blepharitis (Is it anterior? Is it posterior?) when I know that teach one” might apply when it comes to placing an IV or a more significant problems exist just a half-day’s flight from my vaccination, but intraocular surgery is a complex skill. We get doorstep. It’s interesting to consider how many thousands of euros just enough surgical training to handle basic, uncomplicated can be spent on a single cataract operation in western hospitals, cases after graduation. Can someone train us to be of surgical knowing this amount of money could be spent treating hundreds help in Ethiopia? Or will we just get in the way of those who are of people in poorer countries. already there? “It’s amazing to fully realise that ophthalmology is really such After I graduate, I will probably follow a well-worn path a surgical profession and thus ideal for the tropical countries. We through fellowship and straight into practice. But maybe we can permanently improve a person’s quality of life with just one should all try to blaze a path outside our comfort zone and into operation,” Dr Veckeneer wrote in an email from Rwanda. the wider world, where we are greatly needed, while we still can. Eurotimes | may 2014
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