Off the Beaten Track: Tosin Smith

What are the most remote locations you’ve worked in?

I’ve done mission work in Africa for over 15 years. I tend to go on two types of trips: either the kind where I treat patients, or the kind where I train doctors. We hold symposia and surgical training, and help create alliances with important companies within the industry, so that they can thrive after we’ve left. Last year we went to the Tilganga Institute of Ophthalmology in Kathmandu, Nepal and partnered with them, training close to 100 ophthalmologists from all over the country. We also collaborated with the Eye Foundation Hospital in Lagos and Glaucoma Society of Nigeria in a similar model to train local doctors, with the hope they will return to their home regions with the additional skill to treat patients and help train the other ophthalmologists. A lot of the companies have been supportive of our cause. They understand that if you train someone in a particular region, that effect will trickle down and, ultimately, help everyone. Teaching is one of the most important things you can do because it potentially impacts the whole nation.

What are the most common conditions in these locations?

We mostly deal with cataracts and glaucoma, though sometimes your job can be as simple as giving someone glasses to correct a refractive error. Rarely, I also encounter children with congenital glaucoma, varying retinal diseases, retinal detachment… it’s an array. On some missions, people wait for hours to be seen because there is no public recourse for the provision of eye care – this might be the only chance they have to get help. It gets really desperate at times.

Any experiences that stand out?

There are lots, but one struck a particular chord with me. We were in a village in Africa and a woman came to us for an eye exam.  She was in her 40s and already completely blind from glaucoma. I checked her eyes knowing there was nothing we could do to help her. She wailed when I told her. There was not a dry eye in the room. After a while, we managed to calm her down and explain that her life wasn’t over just because she was blind. It’s a difficult conversation to have because she’s in a place where there is no support for the visually impaired – even now she was being cared for by her daughter. I said to her: “Your daughter is here, let me take a look her, too.” I found that this young girl, probably no older than 22, had glaucoma as well. Her pressure was high and, medically, her situation wasn’t far behind her mother’s – and she had absolutely no idea. We were able to help her, but we didn’t make it in time for her mother. That’s something I still think about. I can think of a happier story from a 50-year-old NGO in Mombasa, Kenya, called The Lighthouse for Christ. When you walk through the gates, you see a big stack of wooden walking sticks. That’s because patients come in blind with cataracts, led by a family member holding on to the proximal portion of the stick while the patient holds on to the distal portion as they are led around. When they come out after their cataract surgery, seeing for the first time in years, they don’t need the stick anymore, so they add it to the pile. It’s testament to the life-changing work that is being done out there.

What skills have you been able to transfer to your everyday practice?

I’ve learnt to be more efficient, a lot less wasteful, and to improvise when needed. There are many skilled surgeons out there that make the most of the resources available to them, and do a beautiful job.  To put things into perspective, I was once in a government hospital in Owerri, Nigeria and noticed the staff didn’t use the slit lamp very much, they used a pen light instead. That seemed odd to me, so I pulled the slit lamp out and started using it. Every time I stepped away from the slit lamp, somebody would come over and turn the light off.  I couldn’t work out why so after a while, I asked: “What are you doing?” The woman replied: “If the bulb burns out, we may not get another one to replace it.” I had to sit down for a second to think over her remark. You go home with a completely different mindset and skillset.

Any additional words of advice?

You don’t have to go half way across the world to offer help, you can do it in your own city! For instance, there are several organizations in the Dallas, Fort Worth area, both governmental and non-governmental, that serve the community. Examples include Grace for Impact, or Project Access Dallas run by the Dallas County Medical Society, to name a few. The Cure Glaucoma foundation also has access to care programs. The Division for blind services of the TDARS is run by the state. At a national level, the American Academy of Ophthalmology (EyeCare America, Foundation of the American Academy of Ophthalmology) as well as the American Glaucoma Society (AGS Cares) have their own programs that provide assistance. These programs provide free eye screening and exams to people without insurance and help fund surgery when needed – and they’re always looking for volunteers.

If your worry is about the cost, there are grants available to support this type of work and an example is one funded by New World Medical, which offers an annual grant to individuals or organizations who want to fund their outreach work at different levels. Many companies in the ophthalmic industry will support missions and provide medication and instruments to help your cause.  If your preference is a more global approach, find an organisation that travels and join their effort by volunteering in a capacity that you feel most comfortable.

There are many programs out there; all you need to do is find the perfect fit for your current life situation.