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Bascom Palmer Eye Institute

Reflection from Haiti, April 10-17, 2010

One local doctor is very interested in having one resident per year spend 3-6 months observing at a major academic residency program in the U.S., South America, or Europe. Dr. Brennan and I talked about possibly tapping the PAAO Gillingham award ($10,000) to help defray the room, board, and transportation expenses. We need to find other sources of support from within the U.S. (eg. AAO) as well. We must find a way to assure that these candidates will return to practice in Haiti (for at least several years in return) and not go to greener pastures overseas.

Dr. Yuri Zelenski from HUEH and also from DGZ, a public health consulting firm in Montreal, is proposing a program to train paramedical eye personnel (“ophthalmology assistants”) to fill in the enormous gaps in eye care across Haiti. They will be trained in refraction and disease screening/treatment under the supervision of ophthalmologists. Currently, there are only 54 ophthalmologists in Haiti (37 in Port-au-Prince) for a population of almost 9 million people. Dr. Brennan suggested having Joint Commission on Allied Health Personnel in Ophthalmology provide help and consultation in this regard.

HUEH residents have no exposure to optics and refraction. Their pathology, oculoplastics, and pediatric ophthalmology experiences are woefully insufficient. I would suggest the next visiting professor be a pediatric ophthalmologist. I saw many cases of congenital glaucoma, childhood tumors (many advanced cases of retinoblastoma), corneal ulcers (quite a few with underlying vitamin-A deficiency and previous measles infection), uncorrected refractive errors, genetic eye disease, and eye disease stemming from in utero infections. I saw cases of human papilloma viral conjunctivitis presenting as large, exophytic, multilobulated verrucous lesions obliterating the central visual axes, possibly because of underlying HIV infection. HUEH residents also do not have enough night call experience. Their schedule is basically that of bankers’ hours. The HUEH operating room closes at 2 PM and the nurses do not start new cases after 1:30 PM. Residents do not have training in indirect ophthalmoscopy.

Should we have Dr. Jean-Claude Cadet be an invited speaker to the AAO meeting this October in Chicago? Perhaps we can organize a symposium of Haiti talks at the international ophthalmology session.

Some have wondered if Dr. Cadet has enough time to engage in teaching of the residents. He is doing his very best, but he has to travel daily to outreach clinics in rural Haiti. He also has to work at a private practice just to make ends meet, since the salary at HUEH is at poverty level. Residents can possibly travel with him at times to gain experience in private practice and rural ophthalmology.

Dr. Reginald Taverne, a general ophthalmologist specializing in vitreoretinal surgery, has an excellent private clinic with a self-standing operating room which runs with razor-sharp efficiency. He has a phenomenally well-trained and hard-working ancillary staff. Dr. Taverne works long hours, typically starting at 8 AM and finishing if lucky by 9 PM. By the way, Dr. Jean-Claude Cadet, Jr. (son of Dr. Cadet) works with Dr. Taverne. Dr. Taverne’s excellent clinic is the result of years of work, toils, and travails.

Consider rendering more eye care assistance (clinical and educational) outside of Port-au-Prince. Drs. Large and Cadet asked about obtaining grants for clinical and public-health research (eg. vitamin-A deficiency and eye disease in Haiti). I spoke yesterday about this with Dr. Al Sommers, past dean of the Johns Hopkins University School of Public Health and a Wilmer-trained ophthalmologist who is recognized world-wide for his work in vitamin-A deficiency in Africa, Asia, and Haiti. He would like to help. I also spoke with some MPH students at the University of Michigan, who have worked in Haiti and are eager to participate.

Kaz Soong, M.D.

Cornea specialist from the University of Michigan