> Going global
Stanford Ophthalmology fights blindness internationally
About 1.3 billion people worldwide live with some form of visual impairment, 80 percent of which could have been prevented or is treatable, according to the World Health Organization. However, in many parts of the world, access to appropriate vision care and supplies is not readily available. In response to this need, Stanford Ophthalmology has taken innovation in patient care beyond the local community and indeed outside the U.S. Two of the department’s most recent global outreach efforts include collaborations with the Stanford Belize Vision Clinic (SBVC) and the Himalayan Cataract Project (HCP, www.cureblindness.org).
Establishing the Himalayan Cataract Project
Two years ago, the Department of Ophthalmology recruited Geoff Tabin, MD, professor of ophthalmology, to be the inaugural Fairweather Foundation Professor of Ophthalmology and Global Medicine. Co-founder of one of the most successful global ophthalmology programs dedicated to wiping out reversible blindness, Tabin recalls discovering his career calling.
“After summitting the peak of Mount Everest in the 80’s, I was in Nepal and met a Dutch medical team performing cataract surgery on a woman who had lost her vision for years,” Tabin said. “When I saw the miracle of sight restored, I began pursuing a career in global ophthalmology.”
When Tabin completed his ophthalmology residency and fellowship training, he returned to Nepal in 1994. A year later, with his Nepali partner, Sanduk Ruit, MD, Tabin founded the HCP. Their mission was to cure needless blindness with the highest quality care at the lowest cost.
Cataracts lead to loss of vision as the lens of the eye becomes opaque. While this disease is easily treatable, eye surgeons are not easily accessible in most parts of the world. The HCP harnesses Ruit’s method of small incision cataract surgery, a procedure that now takes less than 10 minutes and costs $25 in materials, to start reversing cataract blindness in that part of the world.
“We seek not just to help current and future ophthalmologists in other countries, but to transfer skills through training, so that we can all work together to eliminate global blindness one surgery at a time.
Since its inception, HCP and its partners have provided screening and basic eye care for more than six million patients, including 860,000+ sight-restoring surgeries to transform lives, families, and communities in under-resourced areas of the world.
Tabin and Ruit realized early on that high-quality surgery was the cornerstone of eliminating cataract blindness and that the majority of surgeries must be performed by trained local eye care personnel. Thus, in addition to delivering cataract surgery, they train eye care providers and surgeons to develop self-sustaining systems of eye care.
“We seek not just to help current and future ophthalmologists in other countries, but to transfer skills through training, so that we can all work together to eliminate global blindness one surgery at a time,” Tabin said.
HCP’s academic home is Stanford, and its home base abroad is the Tilganga Institute of Ophthalmology, a world-class treatment and education center in Kathmandu, Nepal. With support from HCP, Tilganga has expanded from an eye center to a central training facility for partners worldwide. The Stanford residency program is linked with Tilganga’s, where all senior residents at Stanford are invited to gain exposure to the global burden of eye disease and share their education in a month-long elective. Asian and African doctors are also receiving subspecialty training with Stanford faculty helping develop the skills of the teachers for the next generation of ophthalmologists in the developing world.
During the past 20 years, HCP has been working to replicate that same successful eye care service delivery model across South Asia and sub-Saharan Africa with active programs in Nepal, India, Bhutan, Myanmar, Ethiopia, and Ghana. The Stanford faculty, fellows, and now residents are involved in all of these countries.
Stanford Belize Vision Clinic delivers adult and pediatric eye care
In August 2016, Hurricane Earl devastated the town of San Pedro, located on the tropical island of Ambergris Caye, in northern Belize. Shortly after the hurricane, a donor contacted Caroline Fisher, MD, clinical assistant professor of ophthalmology at Stanford, asking if she could establish an eye clinic in that area to reach the significantly underserved population there.
“I realized the great need for an eye clinic in San Pedro,” Fisher said. “There is very limited access to medical care, limited medical supplies, and limited medical training, with most people getting their care in Guatemala or Mexico if they can manage the travel.”
After doing a site assessment, Fisher presented the idea of starting an eye clinic in Belize to Michele Barry, MD, director of Stanford’s Center for Innovation in Global Health (CIGH) and to the department leadership. With strong support from the department and the School of Medicine, Fisher started Stanford Belize Vision Clinic (SBVC), a program that promotes eye health and care for adults and children in Ambergris Caye and surrounding areas.
“SBVC began thanks to the interest and vision of Don Listwin, founder of BelizeKIDS.org, which is a non-profit aimed at helping children in Belize,” Fisher said. Listwin is also the founder and chairman of Canary Foundation, a non-profit organization focused on early cancer detection.
Fisher also established collaborative relationships with the Belize Council for the Visually Impaired (BCVI), a local non-profit that provides glasses and follow-up eye care for patients shared with SBVC.
Since starting SBVC, diseases often diagnosed include cataracts, glaucoma, diabetic retinopathy, dry eyes, and pterygium; the clinic has also dispensed nearly 600 pairs of glasses.
“Stanford provides full-spectrum clinical care for adult and pediatric SBVC patients, and in the future, we hope to expand to offer needed surgical treatment as well,” Fisher said.
Training new global leaders at Stanford
Through SBVC and Tabin’s connections to clinics around the world, Stanford faculty, fellows, and residents are getting crucial exposure to the current state of global eye care, while bringing their strong educational backgrounds to communities abroad. For example, at SBVC, residents and accompanying faculty spend every day in the country running a comprehensive clinic and seeing 20 to 30 patients a day.
“My trips to Belize continue to be exceptional experiences both personally and professionally,” said Jill Beyer, OD, clinical assistant professor of ophthalmology. “It’s a very fulfilling experience.”
Carmel Mercado, MD, traveled to Belize before graduating from the Stanford residency program and was deeply moved by how much impact she could bring in even a short time.
“Seeing that there is this need for eye services outside of the United States has inspired me to continue to be involved in global health in the future,” Mercado said. “And my experience in Belize helped me be better prepared for my subsequent fellowship in pediatric ophthalmology and strabismus.”
With Tabin’s arrival at Stanford in June 2017, the Byers Eye Institute established a new Global Ophthalmology Fellowship. This one-year post-graduate clinical training program is certified through the Association of University Professors of Ophthalmology. Current fellow Allison Jarstad, DO, has literally traveled the world providing care and teaching while learning how to deliver the highest level of care to the least-resourced patients. She spoke about her upcoming trip to a refugee camp in South Sudan.
“Going to South Sudan will be a wonderful, full-circle experience for me, because I went there as a medical student after I matched into ophthalmology for residency,” Jarstad said. “At the time I wasn’t able to perform surgery and I knew I wanted to return. I now get to see that dream come true and help this community that I met years ago.”
Tabin speaks warmly about the experience of taking students and fellows abroad and exposing them to global health opportunities, and Jarstad’s experience has fulfilled this promise.
“Working side by side with ophthalmologists in various countries has allowed me to develop professional relationships that I hope to foster throughout my career and that will give me the ability to continue international ophthalmology in the future,” Jarstad said. “I am impressed and pleased that Stanford cares about global medicine, not just ophthalmology, and makes outreach a priority at this institution. Leveraging Stanford University’s support has made our impact truly incredible.”
“We want to build a global network of ophthalmologists as we train future leaders,” Fisher said. “What I love about the Stanford environment is that a simple idea has the capability to blossom into something so much bigger.”
By KATHRYN SILL
Kathryn Sill is a web and communications specialist for the Byers Eye Institute in the Department of Ophthalmology, at Stanford University School of Medicine. Email her at email@example.com.