It was not the most exotic location I could think of to serve. When my husband questioned the local safety and political atmosphere in the country, I smiled and said, “it’s no big deal; it’s luscious Ecuador. “ I conveniently forgot to mention to him that San Lorenzo was often referred to as the crime capital of Ecuador.  A Christian mission group was holding a cataract camp in San Lorenzo, Ecuador and was looking for one more ophthalmologist to complete their team. I jumped at the opportunity, as I was looking for just this type of camp, utilizing the Manual Small Incision technique popularized in India; which is cost effective, efficient, and safe.

On day one, we awoke to a hot and humid 85 degree-weather day. I untangled myself out of the makeshift mosquito canopy I had propped ill fittingly over the bunk bed the night before. As we walked to the clinic entrance, the waiting area was crowded with 80-100 locals, hoping to get scheduled that week for surgery.  Young adults brought their elderly parents while spouses guided their cataract-blinded loved ones to the sparse seating in the waiting area of the clinic.

Although the clinic exam rooms were impressively outfitted with slits lamps, eye charts, and flown over keratometers, the rooms were stifling. With no breeze (and obviously no AC), the heat quickly built up with the influx of patients. Many of the patients had been screened with known cataracts or other surgical diagnosis and asked to return that week. It was an assembly line process of screening the patient and getting scheduled for surgeries that week.

Cataracts seen in the developing world are not the same as those seen in the US; they are often white, dense cataracts you can see a mile away. Because of lack of healthcare access, many conditions are “end-stage” or far worse than what one would see in the US.  Furthermore, in America, cataracts are operated on sooner.

Despite my initial nervousness, I was performing the procedure on my own the first day. Once I completed the first one and rolled the patient to recovery, I was secretly patting myself on the back. It was an amazing feeling to accomplish a new surgical procedure. As surgeons this is what we live for — finding the problem, fixing the problem and having a grateful patient. These feelings of appreciation and genuine gratitude are often scarce in the US healthcare system, where patients can feel a sense of entitlement.

One memorable patient I met was a gentleman with bilateral light perception cataracts. His wife led him into clinic, as everything was a blur to him.  After successful back-to-back surgeries, when his patches were removed, he was ecstatic to see the world in front of him. He no longer needed help to climb up the stairs or walk through the corridors. He could now be a productive member of his family. He kept shaking our hands unwilling to leave the clinic, making sure he had personally thanked each member of the team. This was the norm of that week. By the end of the week we had completed over 65 surgeries, mainly cataracts, but also some lid and conjunctival cases.

Since the age of eight, I have gone on numerous trips to India to help with mobile clinics and rural health measures. In fact, I had just returned the previous winter from a week-long health camp in India.

What makes a physician travel to remote areas of the world, leaving their family behind and risking loss of revenue from their practice, simply to offer their skills and services to those in need? It may just be a yearning for the satisfaction of helping someone, saving a life by removing a deadly tumor, or restoring vision by removing a blinding cataract.  But it also may be that medicine in the United States has lost its glory. Bureaucracy has taken over so much that the time constraints on encounters, billable minutes, and correct modifiers has superseded the physician’s desire to “hear” and diagnose the patient. With hospital regulations dictating how long surgeries should last, which instruments to use, and which intraoperative medications are available, there is loss of autonomy. Patients now have a “concierge” type service mentality, which has led physicians to focus less on clinical acumen and more on waiting room ambiance and mocha selections.

While Ophthalmologists are hardly “saving lives,” often the ayah from the Quran “…and if any one saved a life it would be as if he saved the life of all mankind” (5:32) comes to mind when offering medical care. Health care providers have this additional opportunity from God to do additional good deeds. In fact, the Quran and Hadith are scattered with numerous references to helping the needy, poor, and orphans –So much so that Muslims are divinely mandated to attend to the social needs of others, not as a philanthropic gesture, but as a condition of faith itself. Therefore, helping the needy and poor is not just a good and rewarding act, but more importantly part of  a Muslim’s religious obligation.

In additional to being a spiritually uplifting adventure, mission work is a truly educational experience. Even as we taught local staff about post-op care and surgical cases, they also taught us how they handle cases without many of the latest and greatest instruments we take for granted. Medical camps in the developing world are a collaborative effort. A large portion is actually transferring our skill-set to enable them to sustain their own country’s health care.

There are many organizations involved in international medical care. Non-medical to surgical positions are readily available. You come back rejuvenated and looking forward to the next opportunity to pull out your passport.

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Dr. Zaiba Malik is a Board certified comprehensive Ophthalmologist in Ohio. Her interests include medical education, curriculum development, and public outreach.  She is passionate about international health care; setting up sustainable health clinics.[/author_info] [/author]