As an affiliate surgeon with the Cure Blindness Project (formerly the Himalayan Cataract Project or “HCP”), Audrey R. Talley Rostov, MD, cornea, cataract and refractive surgeon, and founder and owner of Precision Vision of Bellevue, Wash., has participated in numerous global outreach projects over the last 16 years. Most recently, she worked in Eritrea and Ethiopia to help provide surgical training that would help these countries increase the level and access to ophthalmic surgical care.

Much like the proverb of teaching a man to fish in order to feed him for a lifetime, the Cure Blindness Project emphasizes long-term “sustainability. This means recognizing that using visiting doctors to help train surgical residents during their time abroad goes much further than just having them perform surgeries themselves.

“In Eritrea, there are only four ophthalmologists in the country who perform surgery, but they also started the first-ever residency training program about a year ago,” Dr. Talley Rostov explains. “They have three residents in their second year as well as some incoming residents, new to the program. I assisted in corneal transplant surgery training and cataract surgery training, teaching technique all the way through to follow-up care.”

Dr. Talley Rostov urges that the follow-up care is critical, as even a flawless procedure could go wrong postoperatively if surgeons are not trained on what to look for in terms of rejection or suture removal.

Contending with clinical challenges and…monkeys

As one would imagine, working in third-world countries is accompanied by many challenges. This includes serious concerns, such as a lack of access to laboratory testing. That means that when treating infection, you don’t really know what you’re dealing with, Dr. Talley Rostov says.

“There is also no access to things like bandage contact lenses, so in some situations, you just make your best guess and you make do with what you have,” she says.

Since these countries do see quite a bit of infectious keratitis, the lack of an on-site lab is a setback. To address this,
Dr. Talley Rostov says they hope to set up a basic lab where residents can have microscopes and the ability to perform a Gram stain and a KOH to at least determine whether the infection is bacterial or fungal.

“Even these basic improvements would make a big difference in guiding treatment,” she continues. “It would mean practicing evidence-based medicine.”

There are also challenges that are more comical in nature, such as monkeys stealing medical supplies. 
“The monkeys are incredibly clever and will break into a room and steal things or take them right from you and try to bargain,” Dr. Talley Rostov recalls. “I once had a monkey come out of nowhere and had my cell phone and a banana, so I threw the banana of course. We also had a monkey break into a training room, so we had to keep those windows closed.”

Dr. Talley Rostov says that working in the global health sector means being adaptable. 

“You have to be flexible,” she continues. “You have to go into it knowing that the equipment you need might not be available, so you’ll have to figure something else out.”

Long days, memorable cases

She says the days were long and full—but also extremely rewarding. 

“The fact that we weren’t just there to do perform a bunch of surgeries and leave—but to actually train local surgeons in their own environment and their own equipment was very meaningful,” she says. “The residents were so eager to learn. They were bright, motivated and collaborative—and we had a lot of fun.”

Dr. Talley Rostov says she encountered many cases that were memorable during her time there—including some that were quite complex. A little boy from a nomadic tribe who had suffered a corneal perforation from a stick was one that stood out. The team did not have tissue for him, but his family's life as nomads would likely have impeded long-term follow-up care, anyway, Dr. Talley Rostov notes.

“But we were able to glue the perforation and I was able to create a bandage through a thin piece of sterile drape that I cut. We kept a pressure patch on it, and it did heal.”

In Hawassa, Ethiopia, Dr. Talley Rostov was also able to train the single corneal surgeon residing there on DSEK.
“He had some training previously but wasn’t ready to perform surgery on his own,” she recalls. “We did some DSEKs on some complex cases. He’s now ready to perform that procedure himself.”

Giving is contagious

The eye-care industry has been generous in its support of global outreach programs. Dr. Talley Rostov says that MicroSurgical Technology (MST) had provided instruments that could be used for teaching and training including stripping forceps, helpful for complex cases. She ended up leaving these as donations. Stephens Instruments also made a generous contribution of instruments for corneal transplant procedures.

Overall, Dr. Talley Rostov says that her time in these countries was incredibly rewarding—and she looks forward to returning. Previously, she had done work in Ghana, India and Nepal. Globally, she says the need is great.

“We need to continue to reach the unreached,” she urges. “Our goal is to provide a sustainable model for the prevention and treatment of global blindness. There is still much work to be done.” OASC