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Retinal surgery in the Dominican Republic is as fundamentally different as the lives of the Dominican people. The people we have served are usually poor-and often are very poor. The "camposinos" live in the villages or "campos" surrounding Santiago. The family pictured lives together in a 12-by-12-foot wooden shack with no electricity or plumbing. They do odd jobs for the rice farmers in the area, for about $2.00 a day. Still, their diet today is better than it was a generation ago. Unfortunately, this has led to a severe increase in the incidence of diabetes, which is dramatically undertreated. As a result, we see many severe cases of diabetic traction retinal detachments. Add to that untreated cases of retinal detachment, trauma, infections, and assorted other conditions, and there is a lot to do. And this is just 1 island and a million or so people.
The need to address retinal surgery exists throughout Latin America and, indeed, the rest of the third world. Retinal patients in the third world are radically underserved. This is due to the complexity and variability of retinal diseases, the relative dearth of well-trained surgeons, and the operational difficulty of delivering retinal services. In Pakistan, for example, there are barely any retinal surgeons working for a population of 165 million people. My partner, who is from Pakistan, has a son who is a retinal surgeon. He tried to return home to Karachi and asked local authorities for help in establishing a retinal practice, but was told that they would only support anterior segment surgery. Why? Because it is more difficult to address retinal surgery, so all attention is devoted to the easier and more prevalent cataract surgery.
That does not mean that more difficult retinal diseases are not important or cannot be addressed. Retinal problems, primarily from diabetes, trauma, retinal detachment, and retinopathy of prematurity, have reached crisis proportions.
Populations that have subsisted on starvation diets in the past, but which now have more food, are seeing rapidly increasing incidences of diabetes. Unfortunately, they have very little access to care and virtually no access to treatment for severe retinal diabetic complications. Common problems such as retinal detachment and trauma are also left untreated. Unmonitored and untreated retinopathy of prematurity is an ongoing and utterly preventable tragedy.
Dr Sebastian Guzman and I have been doing complex, high-end retinal surgery in the Dominican Republic for 2 1/2 years now, and along the way we have learned how to make this complex service efficient and successful.
The need to address retinal surgery exists throughout Latin America and, indeed, the rest of the third world. Retinal patients in the third world are radically underserved. This is due to the complexity and variability of retinal diseases, the relative dearth of well-trained surgeons, and the operational difficulty of delivering retinal services. In Pakistan, for example, there are barely any retinal surgeons working for a population of 165 million people. My partner, who is from Pakistan, has a son who is a retinal surgeon. He tried to return home to Karachi and asked local authorities for help in establishing a retinal practice, but was told that they would only support anterior segment surgery. Why? Because it is more difficult to address retinal surgery, so all attention is devoted to the easier and more prevalent cataract surgery.
That does not mean that more difficult retinal diseases are not important or cannot be addressed. Retinal problems, primarily from diabetes, trauma, retinal detachment, and retinopathy of prematurity, have reached crisis proportions.
Populations that have subsisted on starvation diets in the past, but which now have more food, are seeing rapidly increasing incidences of diabetes. Unfortunately, they have very little access to care and virtually no access to treatment for severe retinal diabetic complications. Common problems such as retinal detachment and trauma are also left untreated. Unmonitored and untreated retinopathy of prematurity is an ongoing and utterly preventable tragedy.Dr Sebastian Guzman and I have been doing complex, high-end retinal surgery in the Dominican Republic for 2 1/2 years now, and along the way we have learned how to make this complex service efficient and successful.