With more than 1.1 billion people living with vision loss around the world, international ophthalmology partnerships have become a crucial piece in the effort to prevent blindness and maintain quality of life.
To improve these partnerships, Michael Chen, MD, associate professor of ophthalmology at the University of Colorado School of Medicine, worked with an ophthalmology colleague from Kenya and an ophthalmology colleague from Nepal to develop an exercise and case study that helps U.S. ophthalmology trainees traveling overseas foster better relationships with local partners.
“Personally, I wanted to create this so that others don’t make the same mistakes that I did when I became interested in global health work,” says Chen, ophthalmology division chief at Denver Health Medical Center. “I want them to be aware that as American ophthalmologists we are coming from a position of relative power and privilege, and we need to be mindful of how our actions and attitudes affect our interactions with our local partners.”
For many ophthalmology trainees, trips abroad can cement a passion for global health. It did for Chen, who first traveled to Ghana as a medical student over a decade ago and realized that quick and inexpensive cataract surgeries can have a tremendous impact on a person’s life.
“During training, I took every opportunity to travel abroad, so a lot of my younger self is written into this case study,” says Chen, who then spent two years working in Kenya following his fellowship training.
Michael Chen, MD, performs a trachoma screening in Ethiopia during his internship training in 2009. Photos courtesy of Michael Chen.
The exercise, which can be found online at MedEdPORTAL where educators can download the materials for free to use in their own teachings, is designed in four parts. Each is a narrative from a different perspective surrounding a fictional international ophthalmology partnership scenario between an American ophthalmology department and an Eastern African ophthalmology department.
Prior to publication, 30 ophthalmology residents and medical students from two American universities were asked to read the narratives and discuss motives, ethics, and other questions that shine a light on power dynamics, cultural differences, and ways to improve international partnerships that aim to serve patients who need eye and vision care. All said the exercise was worthwhile.
The four characters each represent differing perspectives in the partnership. Sarah, a first-year American ophthalmology resident, is excited to accompany her attending Dr. Smith, who is embarking on his second trip overseas to work with Eastern African University.
The other two characters in the case study — Manu, a senior ophthalmology resident at the African university, and Dr. Enzi, who leads the university’s ophthalmology department — offer different perspectives.
Each of the four characters has noble aspirations but find themselves in situations that sometimes call for trade-offs and compromises. In each part, readers learn how well-meaning actions can help or hinder relationships and the overarching goal of the partnership.
For example, when the American resident Sarah asks to perform a cataract surgery, local staff and trainees oblige. The discussion after the passage asks whether this move was fair to the patient, who may not have known her skill level. Readers also discuss the resident’s attitude toward local staff and whether she may have unintentionally communicated a message of implicit condescension.
Chen says the case study serves as a reminder that relational, motivational, ethical, and logistical issues are common in international partnerships and they’re important to acknowledge.
“When American ophthalmologists travel abroad, there are a couple of approaches we can take. Sometimes we go in with a savior mentality and we might not realize it, but our hosts, who may have been on the receiving end of other previous well-intended forms of assistance, are very privy to this,” Chen says. “They pick up on it right away, and that can destroy a partnership.”
A healthier way to maintain the partnership, Chen says, is to approach the situation with curiosity and humility.
“Going in as a learner, as opposed to a savior, can make a profound difference – even fully trained American ophthalmologists have more to learn,” he says. “And with the challenges we face in our own U.S. health care system, chances are that if we listen to our international partners, they’re going to open our eyes to things that are going to help our patients back at home, too.”
“When thinking of the term partnership, we may at first think it is simply one in which each party gets what they want out of the relationship. But it needs to go further,” Chen adds. “A healthy partnership is one in which there are shared goals, values, and purpose. The hope is that we collaborate and commit to helping each other come out better in the end.”