I wanted to continue my review of Dr. John Cheatham’s booklet Reaching The Blind Poor. John died in 2009 and his obituary ( “A Life Without Furniture” ) is posted here on Global Sight Network. His family foundation ( Mathias Eye Foundation ) continues to support eye clinics in Guatemala and elsewhere.
Before I begin I would like to make a special request for a used A-scan for a young local ophthalmologist working in central Haiti. Currently, he is putting in a +21.00 D IOL in everyone. Presently he is probably doing more cataract surgery than 80% of all Haitian ophthalmic surgeons.
If you have a broken or used A-scan you are not using ( gathering dust in a closet ) please get in touch with me. I have a friend that can probably repair any broken unit. My hope is to hand-carry an A-scan to my ophthalmic friend in Haiti next year. Over the last couple of years, I have given him a second cataract set, a Perkins tonometer, and a three-mirror lens. He needs an A-scan.
Excerpts from Dr. John Cheatham’s booklet “Reaching The Blind Poor” – Part 2.
- Continued Excerpts from Dr. John Cheatham’s booklet: Reaching The Blind Poor
As a general rule, we will find more work and surgical rewards in the regions that are difficult to reach, off the tourist routes, troubled, etc. - We should draw upon the experience of the major eye organizations. CBM and Sight Savers have the greatest overall exposure. The SEVA Foundation’s influence, accomplishments, and effectiveness far exceed its smaller size and limited financial resources. The International Eye Foundation is a good organization with a great deal of knowledge and experience.
- The best partners are the young capable local ophthalmologists who will benefit professionally and economically from an association with an outside group. Once again, good eye groups can help us find them. It is not realistic to expect these doctors to be primarily motivated by charitable considerations. They must have the opportunity to attain some degree of economic security. In my experience, the widespread unwillingness to pay competitive salaries to capable staff is both shortsighted and self-defeating. These capable people almost invariably leave for private practice— or leave the country.
- Initiating a program based entirely on visiting, volunteer doctors is an almost certain recipe for failure. If the area under consideration has no good, available local ophthalmologists, thought should be given to locations that do.
- My experience is that government entities make bad partners. [” This has certainly been my experience also. Usually, you can not beat a missionary hospital or dedicated Roman Catholic nuns as far as things running smoothly” ].
- Be very careful with poor country charitable eye organizations. Some are excellent; others use outside support principally to treat the private patients of the senior staff. [ ” Ideally we should be operating on poor patients, not the middle class. Often it is difficult for North Americans to distinguish initially between the middle-class patient and the truly poor patient” ].
- Prominent developing world ophthalmologists usually have excellent medical and social skills but often lack experience in relating to the needs of the poor in their own countries.
- The best way to maintain some degree of control is to slowly increase participation on a cautious, step-by-step basis. Groups often make large initial expenditures and then find themselves with little management influence.
- We must always bear in mind that ” causing an eye surgery to take place” is a lot more complex than performing the surgery. A great hospital such as Aravind in India is great in large part because it knows how to reach the blind and can administratively move through the entire sequence of restoring sight to them. Aravind will do almost 200,000 cases this year— roughly two-thirds of which are free of charge. [ “John often would actually hike into remote roadless isolated areas of Guatemala looking for blind patients. He would sometimes pay village health workers to bring him blind patients. Also, my experience is many visiting surgical teams do not understand nor appreciate the effort that goes into triaging pre-op cataract patients and logistically getting them to the ophthalmic O.R.”].
I hope these impressions/observations from Dr. Cheatham are helpful as well as my comments. Certainly, most of them are still right on.
Peace,
Baxter McLendon MD