{"id":37953,"date":"2016-12-09T17:11:43","date_gmt":"2016-12-09T16:11:43","guid":{"rendered":"https:\/\/blogs.bmj.com\/bmj\/?p=37953"},"modified":"2016-12-13T13:38:52","modified_gmt":"2016-12-13T12:38:52","slug":"bmj-christmas-appeal-training-eye-teams-is-vital-to-producing-change","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/bmj\/2016\/12\/09\/bmj-christmas-appeal-training-eye-teams-is-vital-to-producing-change\/","title":{"rendered":"BMJ Christmas appeal: Training eye teams is vital to producing change"},"content":{"rendered":"

\"orbis_vietnam2\"The BMJ has chosen Orbis for this year’s Christmas charity appeal<\/a>. Orbis has been working in Vietnam since 1996, and over the past 20 years has helped to establish five paediatric ophthalmology centres and rural paediatric eye health services; helped develop Vietnam\u2019s first national eye bank; and funded the first wet lab in Vietnam, in Hanoi, where ophthalmologists can practise surgical procedures.<\/em><\/p>\n

The World Health Organization recommends one paediatric ophthalmology centre per 10 million citizens so, with a population of 90 million, there is still much to be done. Training eye teams is vital to producing long term change. Orbis volunteers share their skills with ophthalmologists, anaesthetists, nurses, and biomedical engineers to help build robust services that can help more people, treat more conditions, and tackle the 80% of blindness that is avoidable or treatable.\u00a0<\/em><\/p>\n

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Below one of these volunteers, Ian Fleming, shares his experience of the struggles and successes of teaching anaesthetic\u00a0techniques in Hue, Vietnam.<\/em><\/p>\n

I never understood why colleagues said “anaesthesia is stressful.” Then I started teaching. Watching someone else do something, whether it is a regional block or laryngoscopy, and stopping yourself from interfering or taking over is difficult. Now try teaching a foreign trainee through an interpreter, with 15 people watching you, and it all being filmed.<\/p>\n

I\u2019m in the Central Hospital in Hue, Vietnam, on an Orbis Flying Eye Hospital programme, teaching local anaesthetist Le Viet H\u00f2a the finer points of subtenons anaesthesia. Thank God for air conditioning: it\u2019s 35C and 90% humidity outside. I\u2019m still sweating slightly.<\/p>\n

He\u2019s watched the lecture, seen the demo, and practised several times on sheep\u2019s eyes in the wet lab we ran (yes, we\u2019ve moved on from “see one, do one, teach one”). I’m not sure which of us is more nervous.<\/p>\n

We\u2019ve got the patient’s consent and prepared her eye with topical proparacaine (why do all drugs have to have four different names?) and betadine. Dr H\u00f2a picks up the forceps and scissors. This is always a difficult moment for us needle and syringe loving anaesthetists\u2014subtenons is a bit “surgical.”<\/p>\n

My usual joke about “don\u2019t worry about buying the equipment, just steal them off the surgeon” backfires slightly\u2014half of those watching us turn out to be local surgeons. I worry he is going to be too tentative. He is. A small prompt, through the interpreter, reminds him to take a decent bite with the forceps.<\/p>\n

His hands are shaking slightly, but he steadies himself. He makes a small incision and passes the subtenons cannula perfectly. He injects slowly, just as I taught him. Now the hard part, waiting to see if it has worked. Now he looks really nervous.<\/p>\n

Two minutes pass and we check the block. Through the interpreter we ask the patient to try and open her eyes and to look left and right. She cannot. Total akinesia and no chemosis. A perfect block. The look on his face says it all and reminds me why I come out and teach on Orbis programmes.<\/p>\n

We walk the patient through to the operating room or “OR” (got to get used to American jargon) and the operation goes smoothly. It takes a while, nearly two hours. However, the patient is comfortable throughout and the surgeon compliments Dr H\u00f2a on an excellent block.\u00a0Five successful cases later, we pack up.<\/p>\n

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Everything takes longer on an Orbis programme because they are teaching programmes. Everyone is doubled up. I\u2019m teaching and so are the surgeon and the nurses. Somewhere else in the hospital, Orbis biomedical engineers are teaching their local counterparts how to repair and maintain the equipment. They are all equally important members of the Orbis “family,” without whom it just wouldn\u2019t work.<\/p>\n

The fact that Orbis recognises this in its aim to eradicate preventable blindness worldwide\u2014understanding that you need to support every part of the ophthalmic pathway\u2014is why I am still here, 10 years on, volunteering with them.<\/p>\n