A life changing experience for Foundation Fellow, Dr Katherine Smallcombe

Few people training to be an ophthalmic surgeon have had the life changing experience Dr Katherine Smallcombe has enjoyed as inaugural recipient of The Fred Hollows Foundation Fellowship.

The Foundation's Fellowship represents a continuation of the commitment Fred Hollows made to teaching registrars and encouraging them to actively participate in ophthalmology outside academic institutions.

Conducted in conjunction with the Royal Australian and New Zealand College of Ophthalmologists (RANZCO), the Fellowship aims to engage junior ophthalmologists in the work of The Foundation by offering a six month period of work rotating to eye programs in Nepal, Fiji and Central Australia.

Having completed her final rotation in Nepal, Katherine shared her unique experiences with us and told us how the Fellowship has impacted her career.

How did you become the first recipient of The Fred Hollows Foundation Fellowship?

In email outlining the Fellowship was sent out by RANZCO to all final year training registrars. After applying, I was interviewed via a conference call and was subsequently selected for the position.

During my formal ophthalmology training, I'd had very limited exposure to international or Indigenous ophthalmology. I was fortunate to have a good reference, as well as being awarded a prestigious medal by RANZCO for excellence in the final year clinical examination.

Where did the Fellowship take you and who did you work with?

I spent my first 10 weeks working in Alice Springs under the supervision of Dr Tim Henderson. I then travelled to The Pacific Eye Institute in Fiji for eight weeks where I worked with Dr John Szetu. My final 10 weeks was spent in Nepal at The Tilganga Institute of Ophthalmology where I was supervised by Dr Reeta Gurung and Dr Sanduk Ruit.    

Dr Richard Le Mesurier, Medical Director of The Foundation, was my overall supervisor throughout the Fellowship. He did an incredible job supporting and advising me.

It's been wonderful to have the legitimacy of belonging to The Foundation which has enabled me to work as part of the local team in each of the programs.

Furthermore, the Fellowship gave me the freedom, financial backing and encouragement to be proactive and seek out as many opportunities as possible on my own terms. It's not often a job like that comes along.

The Fellowship is fantastic because you get to stay in one place enough to get to know the teams very well. It also gives you the opportunity to develop a deeper understanding of eye care in areas that are less fortunate than here in Australia. It's been fascinating to see the direction that certain eye institutes and hospitals are trying to take with eye care, given the challenges they are presented with. The whole experience has really been life changing. 
Tell us about Central Australia.

I had a fantastic time in Alice Springs. Before the Fellowship, I'd never travelled to Central Australia, nor had I had much experience in the delivery of eye care in a remote region, nor significant contact with Indigenous Australians.

Definitely, the highlight of the rotation was the remote community visits which took place every Monday. Although they were long days, typically from 7am - 7pm, I loved flying over the spectacular outback landscape. It was an incredible learning experience seeing what a remote Indigenous community actually looks like, as well as how health care is being delivered to such isolated locations. On these visits, we took a team of  people, including an optometrist and enough equipment to run a specialist ophthalmology outpatient clinic. If needed, we could arrange to bring patients back to Alice Springs for further investigation or cataract surgery.

It was great to work with Dr Henderson and to be a part of this team. Because of his hard work and dedication, the number of patients attending the remote clinics has been steadily increasing over the past few years. That shows people are happy with the service and are becoming better educated about eye health.

What about Fiji?

Fiji was also an incredible experience. Because the population in the South Pacific is scattered over hundreds of islands, a large part of the delivery of eye care needs to involve outreach trips to small hospitals in remote locations.

One of the most powerful moments of the Fellowship occurred during an outreach trip to a remote island in Fiji called Kadavu. In fact, because there are no roads on this island, most of our patients and the outreach team had to travel to the hospital by boat.

On this trip, I met a thirty-two year old man who had gone blind in both eyes over a three year period from cataracts.

Because he was unable to work or contribute to the family income, he was terribly depressed and all he did all day was sit inside his house in the corner. His elderly aunt, his primary caregiver, led him into the clinic. He hardly spoke and showed no emotion on his face. It was so sad.

During the outreach camp, he had both of his eyes operated on, and went from being blind to having normal vision. The change in him was unbelievable! He was a completely different human being, walking around unaided, laughing, joking and interacting with other patients and staff members.

He invited us back to his home and showed us his garden where he excitedly talked about what he was going to plant and where. He also talked about how much he was looking forward to working again and spending time with his family and friends.

As a surgeon, it was a powerful reminder to me how a relatively straight forward and inexpensive procedure can completely change someone's life. It is such a privilege to do something like that for another human being.

Nepal?

I especially loved visiting Nepal and working at the Tilganga Institute of Ophthalmology, which is probably the best known of The Foundation's international programs.

Working with internationally renowned ophthalmologists, Dr Sanduk Ruit and Dr Reeta Gurung, and having them teach me their cataract surgical technique, will be one of the highlights of my ophthalmology career.  

They are inspirational individuals who have both worked tirelessly for many years delivering eye care to some of the poorest people in the world.

As well as possessing an incredible work ethic, they are delightful individuals and certainly are two of the best surgeons I have ever been lucky enough to watch operate.

What is your impression of eye care in developing countries?

In developing regions there is a completely different set of barriers to the effective delivery of eye care, compared to metropolitan Australia. Often there is a total lack of government funding for eye care services as well as a lack of education in the population about eye health. For example, going blind is considered a 'normal' part of growing older. Poverty of course is a major issue, as is remoteness, with many patients needing to travel enormous distances for eye services. The training of enough local staff to provide eye services is a massive challenge, as is adequately equipping local eye care centres.

Quite often, the severity of eye disease is far worse in developing regions because of late presentation and limited treatment options. There are also a number of diseases in developing countries which are not present or fortunately extremely rare in metropolitan areas of Australia - for example lens-induced glaucoma, trachoma and leprosy-related eye disease.

How has the Fellowship impacted on your future direction?

I think the Fellowship has helped solidify the direction of my ophthalmology career. In the future, I plan to continue working in this area - that is, the delivery of eye health to under-developed and remote regions, including parts of Indigenous Australia.

I hope to have a continuing and evolving role with The Fred Hollows Foundation, including visiting more of their international programs.

The Fellowship has certainly opened my eyes to the opportunities available to me and other Australian ophthalmologists, and how to become involved in Indigenous and international ophthalmology. I am really excited about the future!

8 memories of a unique experience
  • The wonderful people I have met in each location and the lifelong friendships and professional contacts I have formed.
  • My first outreach trip with the PEI team to Espirito Santo Island in Vanuatu.
  • Seeing the enormous number of patients waiting, the chaos of getting them examined and operated on. It was also the first time I saw small incision cataract surgery (SICS) being performed.
  • Having Buddhist monks bring me hot tea in the operating theatre at the end of an exhausting 12 hour day of surgery.
  • Working in remote locations where virtually no other westerners or tourists visit and getting to really experience another country and learn more about its people.
  • Watching monkeys try to steal food from the outdoor staff canteen in remote south-west Nepal.
  • Being chased by a dingo whilst cycling in Alice Springs!
  • Being chased by a camel at a remote community in Central Australia!
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