There was a chance of me going to Nepal in February to accompany Omaha ophthalmologist Dr. Michael Feilmeir and a team of doctors and residents who perform hundreds of eye surgeries there, mostly to remove cataracts. I met the good doctor preparing this story for Metro Magazine (http://www.spiritofomaha.com/) and when I informed him of my interest in doing some international reporting he and his wife Jessica, who does development work for the Global Blindness Prevention Division he heads up at the University of Nebraska Medical Center, encouraged me to join the winter trip he was leading to that Himalyan land. In applying for an international journalism grant offered by my alma mater, the University of Nebraska at Omaha, I proposed making one or the other of two trips: traveling with that medical mission team to Nepal or going to Africa with world lightweight boxing champion Terence Crawford of Omaha. I had no real expectation of getting the grant, which goes by the name The Andy Award. As it turned out, I did get it but it was awarded too late for me to join the group going to Nepal. However, I will be traveling to Rwanda and Uganda, Africa in June. Much more to come on that. For now, read about the good works of Feilmeier and Co. in giving the gift of sight to people who otherwise would either remain blind or go blind.
UNMC makes international eye care a priority through Global Blindness Prevention Work
Giving the gift of sight to the world
Global medical missions and fellowships making a difference
©by Leo Adam Biga
Originally appeared in Metro Magazine (http://www.spiritofomaha.com/)
It is no play on words to say the leaders of the University of Nebraska Medical Center’s Global Blindness Prevention Division and its professional home, the Stanley M. Truhlsen Eye Institute, share a big vision.
The personnel behind these endeavors want nothing less than to create an army of well-trained international eye physicians to retain addressing preventable blindness around the world.
This cadre of care is already providing international ophthalmology training and surgical opportunities to a next generation of eye physicians. Teams of medical students, residents and physicians are going to remote places and giving the gift of sight to hundreds of patients during weeks-long medical mission trips to developing nations on different continents. Global Blindness Prevention Fellows are spending a year or more overseas learning how to deal with complex vision problems, training local eye medical professionals and performing life-altering procedures.
In some instances eye physicians from the developing world are coming to Omaha for advanced training and clinical research unavailable in their home countries.
Taken together, this international focus is extending its reach wherever people are in need.
Returning sight and much more
For the Omaha ophthalmologists leading this charge, making a difference beyond borders brings personal and professional satisfaction. Dr. Michael Feilmeier, medical director of the Global Blindness Prevention Division, was a fourth year medical student at UNMC when he got his first international ophthalmology experience. He’d already had his eyes opened to the “incredible need throughout the world for well-trained health care providers” on trips to Nicaragua and Belize. But his passion for global blindness prevention was stoked when he joined the Himalayan Cataract Project of Dr. Geoffrey Tabin.
He spent several weeks in Nepal assisting Tabin and his team give sight to people who’d hiked in from long distances. Over and over again he witnessed people’s lives changed by a short, inexpensive procedure that saw people come in blind and walk out sighted.
The impact of it all, Feilmeier says, “hit me like a lightning bolt.”
“When you take the patient’s patch off after surgery they just kind of light up,” he says. “This person who was previously maybe an empty shell of themselves kind of fills up and comes back to life. So for me it was like, This is it, this is how I want to spend a major part of my career.”
There and on subsequent trips to Haiti he’s observed parents regain sight and thus be able to see their children for the first time and he’s witnessed children’s lives turned around by sight restoring surgery.
“Being a parent I understand that joy of parents seeing their child or having their child get the health care they need. Those are the stories that resonate most with me. You could put together an amazing book of stories of the life changing transformations of people undergoing cataract surgery. We always ask patients the question, ‘What are you going to do now that your sight’s restored?’ It’s amazing the way people respond. The overwhelming majority say, ‘I want to work, I want to contribute.'”
Gaining a new perpspective
The experiences, Feilmeier says, “changed me a great deal,” adding, “We all have these pivotal moments in our lives and going to Nepal was one. It really changed the course of my life forever. It changed the trajectory of my life at a very young age and I’m grateful for that. It changed my perspective in a lot of ways.
“Obviously it makes you appreciative of what you have. It makes you realize your problems are so small relatively speaking to the problems of the majority of people who live in the world.”
Feilmeier’s wife Jessica accompanied him on trips to Nepal, Ghana, Haiti and the Dominican Republic and their experiences overseas compelled them to form the Division in 2011 with the help of donations. She’s development director for the Division.
“I was struck by here’s this major component of human suffering that we haven’t cured that costs about 20 dollars and can be done in about 5 minutes and can be taken anywhere in the world,” Michael Feilmeier says.
“I always knew I was fortunate to grow up in the U.S., but never realized how truly blessed I was compared to the rest of the world,” Jessica says. “I never knew the conditions that individuals living needlessly blind faced each day and the knowledge I gained from witnessing their struggles to complete the simple tasks we take for granted: walk unassisted to a bathroom, navigate across a busy street or meet the gaze of a laughing child changed me in the most profound way. I came to understand my true capacity in terms of what I could be doing personally and professionally to see that as few people as possible lived their lives in needless darkness.”
A broadened perspective is exactly what Dr. Quan Nguyen, professor and chair of opthalmology and director of the Truhlsen Eye Institute, endorses. He and his physician wife, Diana Do, came here from Johns Hopkins University with years of international medical travel behind them. Do serves as vice chair for education at the Institute.
Nguyen says, “We as physicians should recognize when we treat patients the care of the patient not only depends on the surgical-medical skills of the physician but also on the ability to incorporate the social-economic needs of the patient in order to achieve a successful outcome. I think that is the most valuable lesson for our residents, trainees and fellows when they travel like this. I truly believe the most important experience of traveling like this is to be able to gain additional perspective of what other people need so we can serve them.
“Yes, they will also have opportunities to operate on a number of patients and to enhance their own surgical skills but I think the most important aspect, which I hope is a lifetime experience for them, is to recognize and remember what the people there value and need. Then when they return home they can be advocates to help these people.”
The ongoing program aligned perfectly with the arrival of Nguyen and his expanded vision for the Department of Opthalmology by way of the international mission he’s put in place at the Truhlsen Eye Institute, which opened last year. A large photographic mural entitled “The Gift of Sight” in the center’s lobby dramatically expresses that global reach and the work being done by entities and individuals to prevent blindness. It pictures patients whose sight was restored and physicians who performed the surgeries.
“In the past. global eye care has never been a focus of the department,” Nguyen says. “The Truhlsen Eye Institute was founded on the basis of not only serving the citizens of Neb. but patients from every corner of the world with the best possible eye care. To do so we must first demonstrate our expertise and our mission in education to bring people over and to train them.
“We would like to make it a place that serves patients wherever they live in the world. Whether it’s global or local, our goal is to preserve vision, prevent blindness and restore sight to people of different economic and social backgrounds.”
UNMC is doing that in several ways, One is by sending teams to high-need areas where they can directly benefit individual patients through what Feilmeier’s calls “blitzes” of intense, concentrated surgical visits.
Nguyen says, “We are at the same time training eye physicians and surgeons who can continue with our mission long after we have left a specific country because we know it is not possible for just a group of physicians and surgeons from Omaha to be able to prevent blindness across the globe or even in one country, So we know that as part of our mission teaching is very important to be able to train the next generation of surgeons and eye physicians to carry on the work.
“We look for how do we spread the disciples from the Truhlsen Eye Institute in Omaha across the globe.”
A blitz may also impact underserved populations right in our own backyard. For example, the Division regularly provides eye services to Native Americans in Omaha.
Collaboration with local partners is key to ensure high quality eye care continues after visiting teams leave. Before a team ever arrives, locals get the word out about their coming and do screenings.
“Your success in a country depends not upon how much you want to do there and how much money you have, it’s who your local partners are,” Michael Feilmeier says. “So we continue to search for good in-country local partners – young, motivated people who work together as a team and who have good skill sets. We’ve found those in all of the places we’ve worked so far. We’re really fortunate.”
Paying it forward
Feilmeier wanted to create a vehicle for aspiring or emerging eye care physicians to have the same experiences he did overseas and thus the Global Blindness Prevention Division came about.
“We work with people at different levels in their training,” Feilmeier says. “For medical students we’ve developed a one-month rotation similar to what I did. We arrange everything for them for their experience in Nepal. They spend a month in Kathmandu. They’re mostly observing and feeding off the experience.
“In residency we take the third-year residents for one or two weeks abroad to actually engage in screening the patients, doing the surgery and being part of the whole process. Our two fellowship programs are for people who have graduated from residency. They spend a full year or a full two years working abroad. So at different points in the training process we can engage people.”
For Feilmeier, it’s paying forward his own eye-opening experiences.
“I look at the opportunity someone gave me to engage in this kind of work and how it changed my life forever. My main focus is becoming more about engaging other people and making it easy for them to have an opportunity like that themselves because it will have the same impact on everybody who gets a chance to experience it. It will influence their life and career.
“I’ve never met a single person who did a medical mission who didn’t want to do another one. Then you think about the ripple effect that those people have and all of a sudden you have this army of people who are aware of this problem and who care about this problem and who are actively engaged in dealing with it and finding solutions.”
Count Dr. Shane Havens a member of that army. As a senior resident he went to Cap-Hatien, Haiti in 2013 as part of a team led by Feilmeier.
He had one “touching experience” after another with patients overjoyed at getting their sight. back.
“A lot of times it gives them their life back.”
Feilmeier says, “It’s just really remarkable the amount of faith the patients put in the whole process and the emotional transition and transformation of patients and their family – seeing people laugh and dance and cry.”
Or in the case of one young man who regained his sight at the hands of Feilmeier and Havens, picking up his two surgeons in celebration.
Aside from the emotions elicited, Haven says a mission “offers you invaluable, unparalleled training experiences in the operating room and clinic you just cant get from a textbook or any training program,” adding, “I think the skill set it takes to manage the mature or complex cataract we see there really benefits the patients we treat back here.”
On these trips, Feilmeier says, “you really get out of your comfort zone in a new environment and you really test the limits of your abilities. You learn to have a new set of tools in your tool box. The most beneficial surgical training I have is when I’m sort of tested and I don’t have everything I’m used to having.” It means adapting to rough conditions, even operating by flashlight when electricity and generators go out.
Havens says opthalmology is “a ready-made speciality” for international medical service “because it’s one of the few where you can go for a trip of a week or two weeks and maximize your clinical experience and leave a lasting impact.”
Feilmeier feels the earlier people have these international experiences the better.
“We want to make a difference early on in careers. I think that’s probably the most impact we can have. I could sit at the scope 13 hours a day and do thousands of cataracts but ultimately I think it’s far more impactful when you engage young people. It’s about having that experience and feeling it in your heart and soul.”
Fellows and funders
The Global Blindness Prevention Fellowships are unique. The newest is in partnership with Orbis International, an NGO dedicated to saving sight worldwide.
“There’s been two Fellows thus far,” he says. “Starting next year we’ll hopefully have two per year, maybe even three per year, all working full-time in developing nations. The two-year fellowship with Orbis will be started July 2015. With that one we’re trying to groom some of the next generation of leaders in public health and global eye care. Fellows get a certificate in public health after completing it. They spend five months with us and seven months on the Orbis Flying Hospital – a fully functional, state-of-the-art operating theater – and they travel around the world for a year. It’s just sort of the next level of being involved from a global standpoint
“We want the Fellows to see things they’ve never read about, they’ve never dreamed of seeing. We want them to expand their skill sets and to experience things they would never see here in the U.S.”
Nguyen says it’s the only fellowship of its kind in the world. He and Feilmeier say there’s strong interest in both fellowships from applicants around the country.
Sustaining these international efforts requires financial support. The Global Division is an unfunded arm of UNMC, therefore the Feilmeiers work hard to find donors. Two fundraisers help. The annual Bike for Sight charity ride in April is growing in popularity. A Night for Sight celebrates the life-changing work of these global initiatives. The Oct. 25 event staged a Masquerade Ball for guests.
The Feilmeiers volunteer their time with the Division, covering all their own hard costs (food, travel, lodging) in order to give 100 percent of donated funds to curing blindness.
“We’ve made a pledge that for every $20 we receive, the cost of the consumables, we will give one free surgery to someone living needlessly blind and fortunately the community of Omaha has supported us and donated generously, which has allowed us to perform 1,000 free surgeries to date,” Jessica Feilmeier says.
“Our overall goal would be some type of endowment with naming rights to the Division,” Michael Feilmeier says. “If we could come up with a million to a million and a half dollars in endowment that would secure what we want to do over the course of time. We want to provide eye care to people who desperately need it, assist in training opportunities for international ophthalmologists in sub-Saharan Africa or Asia or Haiti to enhance their skills. And we want to provide these opportunities to medical students, residents and fellows because it’s expensive to get involved in this type of work and you never want that to be a limiting factor.”
The next Bike for Sight is April 25. Follow UNMC’s global eye care efforts and events at http://www.unmc.edu/eye/international.htm.