New case study seeks to enhance perspectives in international ophthalmology partnerships

University of Colorado ophthalmologist Michael Chen, MD, worked with an ophthalmology colleague from Kenya and an ophthalmology colleague from Nepal to develop an exercise and case study helps US ophthalmology trainees traveling overseas foster better relationships with local partners.
(Image credit: Michael Chen, MD/University of Colorado) 

With more than 1.1 billion people globally affected by vision loss, international ophthalmology partnerships play a vital role in preventing blindness and improving quality of life. Michael Chen, MD, associate professor of ophthalmology at the University of Colorado, collaborated with colleagues from Kenya and Nepal to create an exercise that helps U.S. ophthalmology trainees foster better relationships with local partners during overseas work.

The exercise, available on MedEdPORTAL, highlights power dynamics and cultural differences through case studies, encouraging trainees to approach global health partnerships with humility, curiosity, and shared goals for better patient care.¹

“Personally, I wanted to create this so that others don’t make the same mistakes that I did when I became interested in global health work,” Chen, ophthalmology division chief at Denver Health Medical Center, said in a University of Colorado news release. “I want them to be aware that as American ophthalmologists we are coming from a position of relative power and privilege, and we need to be mindful of how our actions and attitudes affect our interactions with our local partners.”

Highlighting differing perspectives

For many ophthalmology trainees, international trips often ignite a passion for global health. This was the case for, who first visited Ghana as a medical student and was deeply moved by the impact of cataract surgery. His subsequent work in Kenya further shaped his perspective, inspiring a four-part educational exercise available on MedEdPORTAL. This exercise presents narratives from different viewpoints in an international ophthalmology partnership, encouraging discussions on power dynamics, cultural differences, and ethical dilemmas. Feedback from participants has been overwhelmingly positive.¹

“During training, I took every opportunity to travel abroad, so a lot of my younger self is written into this case study,” says Chen, who then spent two years working in Kenya following his fellowship training.

Prior to publication, 30 ophthalmology residents and medical students from 2 American universities were asked to read the narratives and discuss motives, ethics, and other questions that shine a light on power dynamics, cultural differences, and ways to improve international partnerships that aim to serve patients who need eye and vision care. All said the exercise was worthwhile.¹

The 4 characters each represent differing perspectives in the partnership. Sarah, a first-year American ophthalmology resident, is excited to accompany her attending Dr. Smith, who is embarking on his second trip overseas to work with Eastern African University.

The other 2 characters in the case study — Manu, a senior ophthalmology resident at the African university, and Dr. Enzi, who leads the university’s ophthalmology department — offer different perspectives.

Each of the 4 characters has noble aspirations but find themselves in situations that sometimes call for trade-offs and compromises. In each part, readers learn how well-meaning actions can help or hinder relationships and the overarching goal of the partnership.

For example, when the American resident Sarah asks to perform a cataract surgery, local staff and trainees oblige. The discussion after the passage asks whether this move was fair to the patient, who may not have known her skill level. Readers also discuss the resident’s attitude toward local staff and whether she may have unintentionally communicated a message of implicit condescension.

Striving for healthier partnerships

According to Chen, the case study serves as a reminder that relational, motivational, ethical, and logistical issues are common in international partnerships and they’re important to acknowledge.

“When American ophthalmologists travel abroad, there are a couple of approaches we can take. Sometimes we go in with a savior mentality and we might not realize it, but our hosts, who may have been on the receiving end of other previous well-intended forms of assistance, are very privy to this,” Chen explained “They pick up on it right away, and that can destroy a partnership.”

A healthier way to maintain the partnership, Chen added, is to approach the situation with curiosity and humility.

“Going in as a learner, as opposed to a savior, can make a profound difference – even fully trained American ophthalmologists have more to learn,” he sayid.

Chen added that with the challenges faced in the U.S. health care system, chances are that if physicians listen to their international partners, they are going to open thier eyes to things that are going to help patients back at home, too.

“When thinking of the term partnership, we may at first think it is simply one in which each party gets what they want out of the relationship. But it needs to go further,” Chen concluded. “A healthy partnership is one in which there are shared goals, values, and purpose. The hope is that we collaborate and commit to helping each other come out better in the end.”

Reference

1. Mason K. New Case Study Seeks to Enhance Perspectives in International Ophthalmology Partnerships. Cuanschutz.edu. Published October 21, 2024. Accessed October 22, 2024. https://news.cuanschutz.edu/ophthalmology/new-case-study-seeks-to-enhance-perspectives-in-international-ophthalmology-partnerships