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Training principles for ophthalmic care in developing countries.

Over the past few decades the authors have visited a number of developing countries in Africa, Asia and the Americas, providing both general ophthalmology care and specialised consultation, teaching and service. The programmes initially were largely oriented towards cataract surgery and glaucoma care in more rural areas, then towards teaching in the field of paediatric ophthalmology and strabismus in large city hospitals. There seems to be a never-ending amount of service needed in these countries, although, over time, the ability of colleagues to provide service to their own people has increased. However, as the cataract backlog is reduced, there develops an interest in learning specialised ophthalmic concepts and surgery techniques. 
 
Volunteers visiting a developing country should not make assumptions based on previous visits because perceptions and conditions in the country vary. It is essential to have good communications with colleagues in the country visited. 
 
The recognition and application of three major principles should be observed on medical mission trips: 
 
 
 
Appropriate technology based on the existing infrastructure and the needs determined at both local and national level. 
 
 
‘Empowerment’ of the physicians and paramedical personnel in the country. This should include informal teaching in the clinic, working together with colleagues in the operating room, as well as formal lectures and courses at centres of medical education. 
 
 
Project sustainability. Equipment should be donated to local organisations, such as Lions Clubs or Rotary Clubs with support organisations placed in those Clubs so that return trips can be organised more effectively. There is a need, also, for colleagues in these countries to come for further training in more developed countries. This provides the greatest amount of ‘multiplier effect’, as then a person can return to his or her own country and devote his or her career to service in ophthalmology – particularly paediatric ophthalmology and strabismus, the specialty interest of the authors. 
 
 
 
 
 
Appropriate Technology 
Supporting the improvement in technology in a developing country should be ‘step by step’, rather than by introducing the latest technology, which may remain unused. For example, phakoemulsifiers at small hospitals in the poorly served periphery (e.g., rural areas) may be used by the visiting specialist, after which it may be placed under a dust cover for years. In countries where the water supply is not clean, sediment in the water supply typically contaminates the lenses of lasers, reducing effectiveness and ultimately the use of the laser. It is best to work with colleagues in these countries to select what is appropriate. Surgical instruments are most commonly needed.