Dana Hornbeak
Duke University School of Medicine
Project to ARMENIA
January-March 2010
Dana's article: The Armenian Eyecare Project
What problems did you encounter? How would you correct them?
My primary problem was the language barrier, which was more significant than I had anticipated. Whereas most of the physicians and resident-trainees I worked with spoke English, most of the patients and local people did not, making everyday life challenging. I adapted by learning as much Armenian as possible, attending cultural events to learn about local customs, and spending more time with the English-speaking physicians and residents. I also joined a wonderful English-speaking international church, which became my faith community there. This challenge was very valuable, as it helped me realize the importance of language. In future medical missions, I would like to speak the local language, so that I can relate to people and share the Gospel more easily. Thus I have started thinking more closely about Latin America, as I am fluent in Spanish and really enjoy working with the Latino population.
What are needs/issues that could be addressed?
Armenia is a resource-poor country, and as such has limited general medical services. This is especially true in rural regions, which have minimal infrastructure and few available physicians. In particular, Armenia and the other post-USSR countries have some of the highest multi-drug-resistant tuberculosis rates in the world; this issue is the primary target for Doctors Without Borders’ work in Armenia. Ophthalmology services are also minimal (or nonexistent) in rural regions, and much of the available technology is behind the rest of the world. Even when services are available, patients are often unable to afford treatment, resulting in the advanced severity of patients’ pathologies at the Malayan Ophthalmologic Center in Yerevan (where I worked).
What did you learn?
I learned an enormous amount clinically, both about ophthalmology in general (including pathologies and ocular examination skills) and about practicing ophthalmology in a resource-poor setting. I saw a range and severity of conditions that I would have never seen in the U.S., as well as certain conditions (such as genetic syndromes, Behcet's disease, and pseudoexfoliation syndrome) that are extremely rare in the U.S. but common in the Caucacus (Armenian) population. Some of the pathologies and procedures are discussed below in the question “What have you learned that can be transferred to the U.S.?”. I also learned about the medical education system in the developing world, including general medical and specific ophthalmology training.
In my free time I wrote an article on the humanitarian organization I was working with, the Armenian EyeCare Project (AECP), and was blessed to have it published in their online and print newsletter (readership of 35,000). The article is linked above. Also attached are several photos of me working at the eye hospital, including photos with patients, doctors, and ophthalmology resident-trainees. These were taken by the AECP photographer and some were included in the article.
How do you see this experience affecting/changing your personal and professional life?
Desiring to learn as much as possible about different opportunities for doing international medical work in the future, I met with a physician team from Doctors Without Borders, and toured their Yerevan facility. I also met with a primary-care physician working with the U.S. State Department in Armenia; and with a research-physician working with the Fulbright Organization. All three organizations were interesting and do admirable work, but I realized that without a faith component, working with these governmental and secular NGO organizations would have limited personal meaning for me. I think I would grow discouraged over time, feeling like I am trying to meet unending physical health needs without addressing spiritual health. Thus in the future I plan to do medical missions with a Christian organization that addresses both the physical and spiritual health of the people it serves.
What have you learned that can be transferred to the U.S.?
The clinical skills I learned in Armenia are directly applicable to my upcoming residency training. Specifically, during my rotation I worked in each ophthalmology subspecialty clinic of the Malayan Ophthalmologic Center: Retina, Cornea, Glaucoma, Pediatric, and Ambulatory (1 week each). I also spent 1 week assisting with visual acuity examinations in elementary school screenings in Yerevan. My clinical work at the Malayan Ophthalmologic Center included assisting in all aspects of the eye examination: fundus and slit lamp exams, corneal refraction, intraocular pressure measurement, retinoscopy, and visual acuity. I also observed physicians during a wide range of surgeries: for example, amniotic membrane transplant for chronic neurotrophic corneal ulcer, exonteration for advanced basal cell carcinoma, corneal prosthesis for chemical injury, laser retinoectomy for retinal detachment, trabeculectomy for glaucoma, intravitreal avastin injection for diabetic retinopathy, phacoemulsification and extracapsular lens extraction for dense cataract, and extraocular muscle correction for strabismus. All of these experiences serve as a valuable foundation for my ophthalmology training and career in the U.S.
What is the significance and probable impact of the project?
I was the first medical student to work with the Armenian EyeCare Project (AECP) in Armenia, and I think my involvement – and particularly the article (attached) – will encourage further involvement of U.S. medical students and ophthalmology residents, as well as donations from AECP newsletter recipients. More personally, I developed close friendships with many of the doctors and resident-trainees, and joined a wonderful English-speaking international church, and I look forward to maintaining these friendships for many years to come.
How has this experience expanded your world awareness?
Prior to this experience, I had never visited the Middle East/Caucacus region, nor any CIS (Commonwealth of Independent States) county (CIS is a union of 11 former USSR countries that still maintain strong economic political ties with Russia. They include Armenia, Russia, Moldova, Belarus, Macedonia, Ukraine, Tajikistan, Kyrgystan, Uzbekistan, Turkmenistan, and Kazakstan). My time in Armenia gave me in-depth exposure to both, and particularly showed me the health needs of CIS countries: significant ophthalmologic pathologies as well as general health issues, such as one of the highest rates of multidrug-resistant tuberculosis in the world.
Posted on
Tue, May 25, 2010
by hornbeak