19 Jan What Haitians Don't See
The recent Haitian disaster underscores the quality of eye care that is available to us in the United States and other, more developed, countries. With over 80% of the country living at poverty level, a country such as Haiti can not afford to train doctors, nor afford the technology that allows us to practice modern techniques. Yes, there are still places in this world, even before natural disasters, that just don’t “see.”
Training Doctors is Long and Expensive – In the U.S., training a physician takes years. It also takes an infrastructure to support this level of sophisticated, specialized training. After high school;
- 4 years of college
- 4 years of medical school
- 1 year of internal medicine (internship)
- 3 years of residency training (ophthalmology)
- 1 year of fellowship training (retina subspecialty training)
In the “old” days in the U.S., training stopped after the one year of internship. These were General Practitioners. After one year of internship, many docs went into practice as “GP’s.”
In the late 60’s and early 70’s residency training became popular and, in the American system, doctors began specializing. My internship, residency and fellowship are bundled together and represent my “training.” Internship year is considered the hardest; long sleepless nights and weeks without a day off. As you rise through the ranks of residency, life gets somewhat better; but you are still training.
I got my first real job as a 31 year old retina specialist. By then we had 2 children. It was at this point we stopped living paycheck to paycheck.
Technology Has Defined Modern Ophthalmology – In the United States, we are spoiled by the availability of health care providers and the level of technology we expect. In ophthalmology, we enjoy the latest in health technology, including injections of anti-VEGF, cataract surgery with implants that allow us to read, sutureless retina surgery, etc.
Our instrumentation is second to none; microscopes abound, diagnostic lenses, computerized scanning, Optical Coherence Tomography, digital fluorescein angiography and don’t forget all the lasers. There are lasers for vision correction (cornea), glaucoma surgery, after-cataract surgery and retina.
“Blindness” – The main topics of this web site are diabetic retinopathy and macular degeneration. These are the two leading causes of blindness in the adult world. Not listed is cataracts.
What Does This Mean? This means we (those of you able to read this on your computer, regardless of country) are extremely fortunate. We live in countries that can afford modern medicine. Haitians, before the earthquake, never could afford modern medicine.
In the United States, we have an infrastructure that is rich enough to subsidize the training of specialty physicians. It took me 9 years after college to complete training. Despite my tuition and working for low wages all those years, it still took subsidies to get my training. Through Medicare, state and federal funds, extra money is pumped into teaching hospitals/training programs to allow this level of training. Haitians never see this level of infrastructure. Over 80% of the country is at poverty or below. Over 80% of college grads leave the country. Most Haitians live on less than a few dollars per day.
It is expensive to train a doctor. The equipment costs to set up a retina specialists office/operating room exceeds half a million dollars.
There are many groups that travel to Haiti (my residency program used to be one of these) to deliver eye care. Eye care ranges from providing glasses to curing “blindness” with cataract surgery. There is no regular eye care in Haiti. Most of our tools and instruments require a level of technology that is simply not available to impoverished countries, but without these tools, we are limited in our ability to help. Most Haitians never see access to rudimentary eye care.
Haitians still go “blind” from cataracts. Cataract surgery is hard to come by in Haiti. If you are blind, you can’t work. It is a vicious cycle. Many “missions” traveling to Haiti are to offer cataract surgery to the thousands that need it.
Without the infrastructure to support the training and the means to provide technology, Haitians are unable to “see” modern medicine. We “see” differently.