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Module 10: The Importance of Doctors Working Together

The Importance of Collaboration

It is important to provide physicians in developing countries with professional development opportunities.  The focus of visiting physicians should be to provide skills transfer and professional development while simultaneously providing care to local populations.  Doctors working together can be one important facet of continuing medical education.  Continuing Medical Education (CME) is required of medical professionals in the United States to maintain their licenses. Every few years, physicians complete a mandatory number of credits through CME approved courses, which are regulated by the Accreditation Council for Continuing Medical Education. CME is important because it helps prevent the deterioration of the quality of care by helping physicians to maintain their position on the cutting edge of knowledge and practices in the field.(1)  CME is not available in many developing countries, and educational opportunities by visiting physicians are therefore important and beneficial. By partnering closely, doctors can learn complementary skills from each other and improve their individual and group-work skills.(2)  Collaboration between doctors is also very important because quality of care and fiscal savings have both been shown to improve when health professionals work together well.(3)

Furthermore, innovation increases as contact with other professionals increases.  “Eye surgery is not static and keeps improving.  To improve our own surgery, we need to observe other surgeons and, occasionally, copy their techniques,” according to Dr. Walia, an ophthamologist and medical director of the Kikuyu eye unit in Kikuyu Kenya.(4)  The technology and techniques available to surgeons are continually improving, and it takes collaboration with other surgeons to perfect techniques that can lead to better surgery outcomes for all patients.

The Limitations of Visiting Surgeons

Unfamiliar surgical techniques can be a stumbling block for visiting surgeons.  In “Short-Term Visits by Eye Care Professionals: Ensuring Greater Benefit to the Host Community," Andy Pyot states that many training visits abroad are unsuccessful because the visiting surgeons are unfamiliar with the surgical techniques being used.  For example, there is a relative lack of emphasis on suturing techniques in Western medical training.  While this can be rectified through collaboration with other practitioners abroad, these visits must be carefully thought out such that junior doctors are not using disadvantaged populations to experiment with new, unfamiliar techniques.(5) It is important that visiting surgeons do not attempt procedures or surgeries that cannot responsibly be performed with the available technology and within the existing healthcare system.

Dr. Aron Rose, Associate Clinical Professor of Ophthalmology at Yale University, explains the challenges experienced by visiting ophthalmologists:

"One of the things that I love doing work overseas is that as a microsurgeon, it is extraordinarily challenging to be out of your element. In this society, we are used to using absolutely top notch equipment and we are extraordinarily picky about the quality of the microscope that we use, the microinstrumentation that we use, and so on. And what I have found is that working overseas challenges a surgeon tremendously, and you have to call upon your own inner resources, and you have to learn to improvise. Once during surgery in Ghana, I asked for a cautery, something to slow down slight ooze from a small blood vessel. I smelled smoke a few moments later and realized, somewhat to my shock, that a small fire had been built on the stand that holds the instruments, and it had been made by cotton balls that were soaked in mineral spirits, and they were holding an instrument in the flame until it became red hot, and they said 'here is your instrument, doctor.' I'm not used to this, and I said 'what would that be called?', and they said 'that is a hot point, sir.' So that was an example, using fragments of razor blade and using instruments that are not in pristine condition makes one much more adaptable. And yet the quality of what is done can be absolutely terrific. In many ways, i think that surgeons operating in underdeveloped or developing countries have to be even better doctors because number one they are dealing with an array of pathology which is much greater than what we see in the developed world and number two, they are being forced to use what they have, and as a doctor and as a surgeon, those are incredible tools. I end up learning so much more when I travel than anything I can possibly teach.

It was terrific to work with my Ghanaian counterparts. I worked with two doctors...and I found both of them to be extraordinarily talented, extraordinary humanitarians, with boundless energy. These are doctors who work enormous numbers of hours under difficult conditions, seeing an extraordinary array of pathology and a huge number of patients per day, their energy is tireless, their idealism is inspiring. I was really quite amazed how their level of energy to carry out this level of work on a regular basis. In addition, they had a wonderful sense of humor, and they were light with patients. It is not easy being a doctor around very sick patients. Patients look to you for a tremendous amount of support, and you alone realize what some of the risks are taking care of that patient, and they maintain an ability to do terrific level work at the same time as be a resource for strength among their patients, and I think that is an incredible combination. I was very, very impressed."(6)

Go To Module 11: Eye Disease and Mental Health >>

Footnotes

Community Eye Health Online Course

• Table of Contents
• Module 1
• Module 2
• Module 3
• Module 4
• Module 5
• Module 6
• Module 7
• Module 8
• Module 9
• Module 10
• Module 11
• Module 12
• Module 13
• Guidelines For Evaluating Eye Care Work