Dr. Scott Lee on formal grand rounds with ophthalmology residents at a government
Scott Lee, MD ’02, MPH, FACS, is an orbit, ophthalmic and oculoplastic surgeon. After graduating from medical school at UCLA, he completed a residency in ophthalmology at the University of California, San Francisco and fellowship training in Australia at the Sydney Eye Hospital. Currently, he is adjunct assistant professor at the Stanford University School of Medicine, where, in 2013, he received the Plager Teaching Award. He also holds a faculty appointment at the University of California, Berkeley School of Public Health, where he teaches global public health and the epidemiology of eye disease. Dr. Lee is founder and CEO of the nonprofit iCare, which partners with other non-governmental organizations to train local ophthalmologists, while conducting international medical missions in Bolivia, Cambodia, China, Haiti, Honduras, Kenya, the Republic of Macedonia, Myanmar, Morocco, Swaziland and many other countries.
I spent three months of my fourth year in medical school doing an OB/GYN and palliative-care rotation in Bangalore, India. Fortunately, they were separate departments, but what fascinated me was the extraordinary quality of care provided at a very low cost. Even now, I marvel at the adaptation of healthcare systems around the world to provide amazing care with very limited resources. I am often the one being taught, even as I am invited by these governments to share knowledge in new technologies and surgical techniques that often have been available in the developed world for 30 years.
I recently returned from Haiti and the Republic of Macedonia. Both countries have amazing surgeons who have worked through difficult circumstances. In Haiti, I brought several boxes of sutures, some of which were expiring that month. They were thrown out at customs upon arrival at the airport. Customs officials told me that after the earthquake, in 2010, many visiting surgeons did not have good outcomes; this was blamed in part on expired sutures. The government has since implemented a strict policy on any outdated equipment or donations. With the plethora of aid workers and donations, the customs officials felt they could be very picky in what they chose to allow into the country. In exasperation, I explained that the outcomes they described were likely not due to expired sutures but to other factors. This fell on deaf ears, as many of our other donations were thrown out as well. In hindsight, after working with the local surgeons, I felt grateful in many ways that all of the precious donations that I had accrued for weeks were thrown out, as we had to improvise with the equipment and sutures that the local surgeons had. It made me realize that the surgical techniques I was teaching in Haiti were much more sustainable because the supply chain and infrastructure for the surgical materials on hand were in place. As one example, we had to use a mallet and chisel to do a dacryocystorhinostomy (treatment to open blocked tear ducts) because they did not have a rongeur. We had to improvise from the equipment and supplies to which they had access.
In the Republic of Macedonia, I came prepared to give grand rounds and to lecture and teach in my subspecialty, orbit and oculoplastics, but I found that the local surgeons wanted to learn strabismus, glaucoma, pediatric glaucoma, cataract and a variety of other subspecialties outside my typical realm. I find that we in the U.S. have become so subspecialized that we forget what it means to be able to treat a variety of conditions within our own specialties. I thought about some of the old-school mentors I had in medical school and during my residency who did it all. They were inspirational to me in that they did not box themselves into the narrow confines of a subspecialty. I spent much of my time teaching surgeries outside of my immediate specialty because that is what was needed and what the local surgeons wanted.
It is humbling when visiting these countries that, instead of being the one teaching, I often am learning far more than I have to offer. It also is humbling that my efforts often are in vain. Some of the surgical techniques or interventions we bring are not incorporated, even with the technology available. We have begun studying the effect of visiting surgeons in Third World countries and the factors resulting in better standards of care.
To learn more about iCare, go to: compassionvision.wordpress.com