A special guest post from Battambang, Cambodia by Dr. Gary Barth, ophthalmologist and Seva volunteer
After posting Dr. Heng Ton's linguistic odyssey through French and English to become an eye surgeon (see Physician Education Redux), my late night reflections were focused on the optimal method for the developed countries and NGO's to assist a country such as Cambodia, stable country still emerging from the nightmares of a lost generation of professionals.
After a few weeks in Cambodia, my commitment to the Seva model is even stronger. Rather than spend money on western doctors to travel to do good works, theirs is a multi-pronged approach: 1) identify key local personnel and arrange for them to get excellent training - often as in Dr. Heng Ton's case, outside of the country 2) try to establish a beachhead teaching institution to teach both the physicians and staff and 3) introduce a sound business model that facilities high-volume, high-quality care and village outreach to insure that those that can't travel can be rescued from unnecessary blindness.
Seva has been using this model for 35 years in Asia and is now very active in eastern Africa and Central America. See the Seva website www.seva.ca in Canada or www.seva.org in the US for more information.
As an example of this outreach model in action, the attached photograph is of a 60 year old woman I "worked up" today and did pterygium surgery on with a free autograft. She also has a dense cataract in that eye and is legally blind in her other eye. She was screened at a village 90 km from Battambang last week. She and 17 others, mostly women, were brought in to the Battambang Ophthalmic Care Center (BOCC) today for surgery the same day. They will head home tomorrow and return as a group in one week for follow-up visits. All the surgeries and transportation were free of charge. She will return in a few weeks for cataract surgery in this eye once the central cornea clears up enough to make surgery safe.
In Battambang, where I write this, Seva's country representative, Dr. KC, Mr. Ek Sarou and several local health leaders worked hard to establish a non-governmental charity and teaching eye center (BOCC) that could sponsor this type of orchestrated eye care. Neither the regular private practice model nor government clinic model could coordinate the outreach and cost efficiencies enough to develop effective outreach not to mention the same day surgery and transportation required.
In Cambodia, a free standing NGO ophthalmic surgery center was not allowed in the communist Vietnamese-controlled government and subsequent administrations. All eye surgery was done at governmental facilities or in private practices. As I described in a previous posting, due in part to a lack of incentives to work hard to reduce the backlog of blindness, these governmental facilities did not have a terrific track record of increasing access to sight saving procedures.
For instance in Battambang, Cambodia's second largest city, only 500 cataract surgeries were done on average each year until the newly approved NGO, Battambang Ophthalmic Care Center was opened about 4 years ago.
As an example of this outreach model in action, the attached photograph is of a 60 year old woman I "worked up" today and did pterygium surgery on with a free autograft. She also has a dense cataract in that eye and is legally blind in her other eye. She was screened at a village 90 km from Battambang last week. She and 17 others, mostly women, were brought in to the Battambang Ophthalmic Care Center (BOCC) today for surgery the same day. They will head home tomorrow and return as a group in one week for follow-up visits. All the surgeries and transportation were free of charge. She will return in a few weeks for cataract surgery in this eye once the central cornea clears up enough to make surgery safe.
In Battambang, where I write this, Seva's country representative, Dr. KC, Mr. Ek Sarou and several local health leaders worked hard to establish a non-governmental charity and teaching eye center (BOCC) that could sponsor this type of orchestrated eye care. Neither the regular private practice model nor government clinic model could coordinate the outreach and cost efficiencies enough to develop effective outreach not to mention the same day surgery and transportation required.
In Cambodia, a free standing NGO ophthalmic surgery center was not allowed in the communist Vietnamese-controlled government and subsequent administrations. All eye surgery was done at governmental facilities or in private practices. As I described in a previous posting, due in part to a lack of incentives to work hard to reduce the backlog of blindness, these governmental facilities did not have a terrific track record of increasing access to sight saving procedures.
For instance in Battambang, Cambodia's second largest city, only 500 cataract surgeries were done on average each year until the newly approved NGO, Battambang Ophthalmic Care Center was opened about 4 years ago.
Battambang Ophthalmic Care Center in Cambodia
This rented four-storey building is right downtown about a mile from the government hospital. With active outreach targeting women, 4,500 eye surgeries were done last year. Two thirds of the surgeries were on women, mostly in their 50 and 60s. On an average week BOCC does upwards of 100 cataract and pterygium surgeries. At this moment the clinic is 95% charity work and the funds have to come from NGO's outside of the country. Part of my reason for journeying here is to encourage those that have benefitted from cataract surgery to consider supporting Seva's efforts to make this center more sustainable and eventually able to create their own destiny by obtaining their own building. One successful initiative was the installation of a high-quality surgical microscope with a teaching viewing arm. The microscope was a joint project of donors in the California Bay Area and several Rotary groups that were spearheaded by the El Cerrito Rotary. The upgraded microscope will play a key role in improving the surgical access and in training of ophthalmic personnel.
