Volunteer Faculty Dr. Malik Kahook shares his experiences on board the Flying Eye Hospital

Common themes across cultures

This was my first time visiting Mongolia, and I was not sure what to expect. I spent some time getting educated on Mongolia’s history, the local traditions and a cursory review of some of the basic words that I could use to show respect before I made the trip. However, as is the case with any new country I visit, nothing I read could have prepared me properly for the experience. The Mongolian people were very welcoming. We interacted most with the medical team members of our partner hospital, and they were all curious about the US and asked many questions about our health care system.

We all took advantage of what little down time we had in taking care of patients or lecturing by asking each other questions about daily life, work, and home responsibilities, and how we each navigated family responsibilities and dealing with the stressors of being in the health care system. There were many common themes between all of us. One example was how to juggle the responsibilities of parenting while engaging in a highly time-demanding profession. While culture, language, and many other aspects of life are different across countries, the stressors and daily responsibilities are amazingly similar, and I find this to be the case with most countries I have visited for medical education and skill exchange trips.

Learning from each other

I was able to engage with many medical students, residents, and experienced ophthalmologists while in Mongolia. Most of my day-to-day activities were with two physicians who are participating in a new fellowship program sponsored by Sidra Tree Foundation in partnership with Orbis International. I am a board member of both Sidra Tree and Orbis and had been interested to get the program started with both hands-on surgery and didactic lectures—and I was not disappointed.

One of the fellows was an experienced surgeon who had performed multiple cataract and glaucoma surgeries over the past few years. The second fellow was less experienced surgically but very enthusiastic about upskilling and utilizing the simulated surgery opportunities on the Flying Eye Hospital. They were both very well-read and eager to learn about new procedures and how to best care for patients in their communities. It was an honor to spend time with them, and I certainly learned a great deal from their experiences.

As is typical with skill exchange programs, both sides usually gain a significant amount from the time together, and this was no exception. On my side, I learned a great deal about how they serve patients with limited resources. They do not have access to many of the medications we use in the US and very little access to lasers for treating glaucoma. We can sometimes forget how lucky we are to have all the options we have in the US. But I am always astonished with how health care workers in low- and middle-income countries manage to find ways to treat very difficult cases of glaucoma and have a passion for making do in a low-resource setting.

Building ophthalmic expertise in the long term

The specific goal for my participation in this Flying Eye Hospital project was to assess the skill level of the two fellows in performing basic glaucoma filtration surgery. I was able to perform much of the first couple of cases with one of the fellows and was able to assess her skill gaps and where she needed some help. She then assisted on the last handful of cases and slowly developed the confidence to do the last case on her own. The progression of her skill and confidence was bolstered by the fact that she was already an experienced cataract surgeon and very comfortable at the surgical microscope. The second fellow was able to participate in laser procedures and asked many questions about technique and surgical planning.

I felt like I was part of the team in the hospital after the first day, and I hope the local team felt like part of the team on the Flying Eye Hospital during the days we spent operating on the plane. A notable advantage to working with Orbis is leveraging Cybersight for patient education before we make the trip to any country and then the ability to continue educating the training participants after we leave through online consult portals.

I am heartened by the fact that the local doctors have reached out about patients we took care of during my time in Mongolia, but also the interactions we have had about new patients who have come in and how to apply the new knowledge we imparted towards enhanced care. It is clear that Orbis’s Flying Eye Hospital visits are just one part of a continuum that will help enrich care in Mongolia for a long time to come.

Sometimes it's the little things that help the most

One patient in particular made an impression on me and will likely stick with me for quite some time. She was an elderly woman who had suffered from glaucoma for decades and unfortunately lost significant vision due to poor adherence to topical therapy regimens and inability to visit the hospital as recommended for both economic and geographic (travel) limitations. We scheduled her for filtration surgery, and she was obviously very nervous. I can usually take time with my patients and talk through expectations and potential outcomes, with the focus on relieving some of the stress involved with surgery. The language limitations were not in my favor, and I had to rely on local interpreters.

However, what I could do was hold her hand while she was waiting for the surgery to start in the operating room. She held my hand firmly and didn’t want to let go. I took the time to sit next to her and allow her the time she needed. We just sat in total silence holding hands, and I think she understood the team was there to help and we would take the best care of her. Her surgery went very well, and she was smiling later in the recovery area when I asked the interpreter to explain that her grip was firmer than my own.

The human moments on Orbis programs always stay with us. It helps recharge the Orbis team members and remind us why we all chose this profession. The team always focuses on the patient above all else. Language limitations are overcome with a real show of empathy and desire to help. In this particular case, she helped me as much, if not more, than I helped her.

Gallery: Mongolia Flying Eye Project moments

A lasting legacy

There were many great moments during the Mongolia project. From spending time with colleagues, to lecturing on the Flying Eye Hospital, to teaching new surgical skills to fellows who have a high desire to be better doctors. My favorite moments, the same as any experience with Orbis, are when I see the training participants gain confidence and new skills to effect change on the ground long after the Orbis Flying Eye Hospital has departed. Our goal is to give the local teams the skills and confidence to care for patients on their own. Watching that process blossom during and after our in-person interactions is always my favorite part of volunteering for Orbis International.