Sitting Down With… Gary Barth

Gary Barth discusses his long-term humanitarian work in conflict zones and remote areas of the world.

How and why did you become an ophthalmologist?
 

I spent my junior year in college in India, where I saw so much blindness. Later, I worked as a general physician with the Dalai Lama in his refugee camp. And I realized just how impotent I was as a family doctor. Family doctors can't make much headway in developing countries. But since I did my eye training, I've been back 26 times – feeling each time that now I add a measure of value.

What major projects are you currently involved with?
 

In March, we'll be heading back to Myanmar and Nepal. Of course, Myanmar is a war zone. Last time I had to buy casket repatriation insurance in my wife's name, as well as death and dismemberment insurance. It's a very difficult country to visit, but we stay safe in the cities, and we no longer travel to some of the hospitals we've been to before because they're just too contested now.

Myanmar’s Ministry of Health is basically dysfunctional, and so we’re mostly working in the Buddhist monastery system with abbots and men of faith in the charity sector. There are pretty much no International NGOs working in Myanmar right now, and so we're working under the radar in the Buddhist sector. The Ministry of Health doesn't even know we're there – we work, we leave some money and some strategic plans, we leave, and then we go back again.

Are there things you would still like to accomplish within ophthalmology?
 

In terms of overseas, the private foundation I set up with Jack Blanks and Gary Hahn, BBH Eye Foundation, is very focused on providing access to care in these underserved regions. We've opened 23 – soon to be 25 – primary eye care centers in western Nepal. These are in “eye care deserts” – cities of municipalities of 20 to 50,000 people that have zero access to eye care. We give them everything to start a clinic – lens blanks, frames, edging equipment, medicines, diagnostic equipment, and we turn it over to the municipalities or the government. Everything is given in a trust-based philanthropy way. We want to keep on opening these centers, as much as we can.

If I could do one more thing before I quit, it would be to install a mid-level ophthalmic training school in Myanmar. It's a huge country, but there are no optometrists and no ophthalmic assistants anywhere. The only people that can prescribe glasses are the ophthalmologists, and they're either concentrated in the big cities, or they've left the country because of the war. So there's a real need for optometrists or ophthalmic assistants that can refract and prescribe glasses.

Our foundation tried to start an ophthalmic assistant school there in 2019. We had the syllabus from Aravind, we had classrooms, lodging, food, and we’d even picked out the students. But then COVID-19 hit, and the war broke out soon after. So we have never been able to bring in the teachers we would need from Nepal or India to teach at this school.

What are the main obstacles you have faced in your career?
 

We’re always facing challenges with countries with poor governments that really don't prioritize eye care. That's probably our biggest issue. If we could just shake the ministers of health and finance in these countries and say, “If you let us give people vision and get rid of cataracts, we will improve your tax base, we'll provide you with more workers.”

That is my biggest frustration – these outdated laws and ideas that are unique to each country, without any acknowledgement of those neighboring countries that are doing well because they have licensed ophthalmic assistants.

What are the proudest moments of your career?
 

Over a decade ago, I started an eye bank here in California and we performed a lot of corneal transplants. I was then asked to start the first corneal transplant service in western Nepal. There was only one pre-existing service in Eastern Nepal, in Kathmandu, and so I traveled over with a bunch of California corneas in a box a couple of times, and we set up a viable corneal transplant service that now serves both Nepal and Northern India. That service line is now one of the busiest corneal transplant services in Asia.

I think probably my second biggest success is starting a private foundation. I've worked on many large foundations, and they're fantastic but they can also be cumbersome. They're not nimble; they can't do small projects. For instance, they’re not able to just buy a bus or a microscope, or send someone to get a fellowship on short notice. With our private foundation, however, we can fill in these gaps and deliver money quickly. And because we operate under a trust-based philanthropy model, we don't need follow-ups. We find local nonprofit partners and we coordinate with them.

Strategic partners are also key. We work with the terrific DAK Foundation, which is based in Australia, to fund the cost of surgery, and then our foundation will send out the supplies needed and create the infrastructure that will be needed for surgery. It's a great collaboration that stretches thousands of miles from California to Australia to Myanmar and Nepal. The DAK Foundation is the number one private provider of cataract surgery in the world. It has funded over 500,000 free cataract surgeries since its inception.

I would say that if you’d really like to help these underserved regions of the world, consider creating a private foundation and partnering with nonprofits in the area. And then hopefully, you will be able gradually to improve access for people with eye care challenges, and improve the efficiency and training of the local ophthalmic professionals.

At the end of the day, it’s a wonderful feeling knowing that somebody thousands of miles away is getting surgery because of a plan I was able to set up from here in Sonoma County, California, sitting up here in wine country.

What future developments would you like to see within ophthalmology?
 

I've been thrilled with the success of the Light Adjustable Lens (LAL) made here in America. It gives me enormous pleasure to help people get better than 20/20 vision. It’s having that ability to give patients the vision they choose, because they can keep coming back until they have refined it in the way they want. I believe the penetration of this technology should be greater. Ideally, more surgeons would have access to it, but at the moment it's just too expensive for many people.

What are the most important changes you've witnessed in your career?
 

In America, I think the success of eye surgery brings more patients to the surgeons. Patients are no longer afraid; those who would have once delayed their surgery are now accessing it earlier. That’s probably the biggest shift I've seen – the penetration of surgical success has percolated down now to people in their sixties, and they're eager to improve their vision and maintain their current lifestyles. That's very rewarding to see. From wine country to the developing world, the goal is improving access to care and making a difference in quality of life.