Where to go and how to go?
There are many French and foreign ophthalmological humanitarian associations which seek qualified and motivated personnel.
Terres d'Ophtalmo works in Morocco and the Comoros and you can contact us to leave with us, but there are other associations:
- For Eyes of the World (PLYM) acts in Cambodia and Madagascar for 15-day missions
- Ophtalmo Sans Frontière (OSF) acts in West Africa for training and care missions lasting several weeks to several months
- Friendship acts in Bangladesh for one week missions
This list is not at all exhaustive. Most associations can be found through their website, but it is also possible to go through national associations such as the SFO or the AAO to ask them for contacts.
For French associations, it will generally be necessary to start by going to the annual general assembly (AG), to meet the members and to make themselves known. People present at the GA and active for the life of the association will have priority to go on a mission. Associations generally seek confirmed doctors.
Each association has a privileged mission field, a country or a region of the world. In fact, ophthalmology missions require equipment that is difficult to transport and personnel on site who can at least be trusted for stewardship. The choice of the area where you want to go will influence the choice of your association.
It should not be forgotten that humanitarian aid can be provided near you, in France, with Médecin du Monde or other associations that organize care for the poor and people without social security coverage such as migrants. It is possible to envisage a day of consultation from time to time, unpaid, to help the most underprivileged of which you will be able to continue the medical and surgical care in a hospital environment.
Before departure: costs, tips and tricks, equipment:
Once you have found the association and you have found a team and a mission date, you will have to organize your departure. Associations usually have staff on site to welcome you.
You will have to organize the plane ticket yourself, or with your team, which will be your responsibility, with no reduction possible with the airlines. You will also need to ask for time off. If you are in the hospital sector you can request "solidarity leave" (paid leave to which you are entitled in addition to your annual leave).
To pay the membership of the association and for the expenses related to the mission (plane tickets and expenses on the spot) you will be able to put a part of your expenses in “donations to works” (box 7UF of your declaration) thanks to the tax receipt provided by the association. During your mission you will most often be accommodated and fed.
You will need to bring medical equipment with you. For that it will be necessary to recover the inventory of the available material made during the last mission to know the needs on the spot. You will then have to canvass the laboratories to obtain this equipment and possibly ask your hospital or clinic manager what he can give you.
This equipment takes up a lot of space (usually a full hold bag) and you will therefore need to inquire with your airline the cost of a second hold baggage for your personal belongings. Also anticipate that there may be customs problems on arrival for medical equipment that must be anticipated with your association so as not to have to pay additional costs.
There is no specific insurance to provide for humanitarian missions, except your repatriation insurance. Credit cards with insurance can be helpful.
On site: medical and surgical activity
Humanitarian missions must provide quality care. It is undesirable to bring obsolete implants, to carry out surgeries on the spot that you cannot control, to rush through the consultations and to act without respect for local customs and traditions.
Humanitarian action is governed by laws and principles, and if cultural relativism presents the limits of a model that we wish to defend, we must know how to maintain the principles of a conventional western medicine without disregarding customs and traditions of local medicine.
It is desirable, as soon as the opportunity arises, to train the personnel who will remain on site to potentiate the assistance provided, but you will often meet particularly qualified doctors. Local ophthalmologists on humanitarian mission grounds are often very surgical-savvy since they operate a lot.
You may be led to even serious cases, sometimes moving, especially since the patient could have healed if he had been taken care of in a care structure with the means and skills. You must know not to try everything, and you must also know or refer the patients if the case exceeds the capabilities of the mission (vitreo-retinal pathologies, cancer).
The means on site are of lower quality than what you know in your daily practice. For example, the operating microscope may have a zoom and / or focus problem, there may be no backlight, there may not be an optic for assistance, there may be power outages in full intervention, etc.
Most of the procedures are cataracts, but you may also need to work on glaucoma, wounds and evisceration / enucleation.
Cataracts are often very advanced, and with or without a phacoemulsification machine it is very useful to master extracapsular and phaco-alternative techniques. The MSICS or SICS (Manual Small Incision Cataract Surgery) technique is very suitable for dense cataracts encountered on mission sites and has the advantage of leaving a clearer cornea than with phacoemulsification. Furthermore, once the technique has been mastered, it can be performed as quickly as a phacoemulsification. If you want to train in this technique you can register for the wetlab that we organize in partnership with Alcon.
The sterilization conditions are often less drastic than the one you know, the latest generation autoclaves are expensive and difficult to transport, so we will have to redouble our efforts to maintain the best possible sterility conditions (disposable equipment) .
End of mission :
At the end of the mission it is necessary to carry out an inventory of the remaining medical and surgical equipment. It will also be necessary to tidy up the mission site.
Once the mission is over, you will be able, if the area you are in allows, to carry out a “post mission”, that is, a visit to the country to rest and relax. These missions are often exciting but trying and it is better to plan a rest period before resuming your professional activity.