In August 2010, the Taliban massacred 10 medical volunteers, including six Americans, in Afghanistan. The Taliban claimed that the volunteers had tried to convert Afghans to Christianity.1 The group of doctors, nurses, and logistics personnel were attacked as they were returning to Kabul after their 2-week mission treating eye disease and other ailments in the Parun Valley of Nuristan province, about 160 miles north of Kabul. Team leader Tom Little, an optometrist from Delmar, NY, who was killed in the massacre, had worked in Afghanistan for more than 30 years, where he supervised hospitals and clinics dedicated to treating eye disease.
Until the attack in 2010, Volunteer Eye Surgeons International, Ltd. (VESI; Bay Shore, NY), a charitable organization that sends volunteers to upgrade teaching programs in poor countries that do not have access to the sight-saving technologies of modern ophthalmology, worked in Afghanistan to train local ophthalmologists in retina, pediatric ophthalmology, glaucoma, and cataract and refractive surgery. The organization, which was founded in 1986 by Yale Solomon, MD, Chairman of VESI, has also sent volunteers and donated surgical equipment to Vietnam, India, Pakistan, Bangladesh, China, Nicaragua, Honduras, Guatemala, Bolivia, Brazil, the Baltic States, Serbia, Mozambique, Angola, and Paraguay.
THE NEED FOR INTERVENTION
Of Afghanistan’s estimated 28.5 million citizens, approximately 200,000 are blind and 80% do not have access to eye care services.2 Trachoma is a major cause of blindness among the Afghan people. Approximately 10% of blindness is caused by corneal opacity, and less than half of the cataract operations performed in Afghanistan include IOL implantation.2
Of the 79 ophthalmologists in Afghanistan, 20 are IOL surgeons, three are trained in general ophthalmology, and only ten are accredited.2 More than half of the country’s ophthalmologists are located in the central provinces of the country: the southwestern provinces have one ophthalmologist per 2.75 million people.2 Eye care personnel such as technicians, nurses, opticians, and pharmacists are also scarce. As a result, the delivery of ophthalmic services is significantly limited.
Training for ophthalmologists and related medical personnel is also lacking. Two of the four ophthalmic training programs are based in Kabul; the others are in Mazare- Sharif and Herat. Ophthalmic technicians can be trained in Kabul only, while ophthalmic nurses receive training on the job and through courses in specialized clinics and hospitals.2
REQUEST FOR RETINAL SUPPLIES AND EQUIPMENT
In a letter posted on the VESI Web site, Dr. Solomon described the security situation in Afghanistan after the massacre as “too perilous” to send volunteers. As a result, VESI has been unable to provide local ophthalmologists with training and supplies. One ophthalmologist in particular, Hossein Frogh, MD, the only retinal surgeon in all of Afghanistan, is struggling to maintain his practice in Kabul because he lacks medical and surgical equipment. Dr. Frogh is the first recipient of the Larry King Jr., MD, Memorial Fellowship, given in honor of the late Dr. Larry King, a former VESI volunteer and member of the board. Dr. King was a fellow under Charles L. Schepens, MD, at Harvard University and a captain in the US Navy, and he retired as former Head of the Ophthalmology Department at the Bethesda Naval Hospital. He also was in private practice in Bethesda and affiliated with the George Washington University Medical Center, Washington DC.
At the 2005 American Academy of Ophthalmology Annual Meeting, Dr. Zia, President of the Afghan Eye Society, invited VESI President Rogers Pierson, MD, and Dr. King to be the guest lecturers at the Society’s second Annual Meeting in Kabul in 2006. As a result, VESI— under the leadership of Dr. King—started a program in Chennai, India, with Dr. S.S. Badrinath, who founded the Vision Research Foundation, to train ophthalmologists in the subspecialty of retina. Dr. King arranged a 2-year retinal fellowship for Dr. Frogh at Dr. Badrinath’s institution (Figure 1). VESI provided partial funding for Dr. Frogh’s fellowship.
After completing his fellowship in India in May 2010, Dr. Frogh returned to Kabul to set up a retinal practice. He is currently practicing at Noor Eye Hospital. According to VESI, “the organization’s efforts to obtain equipment from donors have been hindered by the deteriorating military and political conditions in Afghanistan.”3 Additionally, the US government has not provided aid for eye programs to Afghanistan. In recent correspondence with Dr. Pierson, Dr. Frogh indicated that he is currently able to perform vitrectomy, scleral buckling, and laser, but that the equipment he is using is outdated, and he lacks access to vital instruments such as a vitrectomy machine, a scleral buckling set, indirect laser ophthalmoscopes, lenses, and light sources (Figure 2).
“Dr. Frogh needs the simplest of retinal equipment,” Dr. Pierson said in an interview with Retina Today. “There is no way to repair sophisticated equipment; therefore, items that can easily be sent and maintained such as surgical instruments and buckle sutures are needed.”
VESI also welcomes retina specialists to volunteer for the organization’s various projects outside of Afghanistan. To learn more about VESI, please visit https://sites.google.com/site/vesiorg. To donate surgical supplies and equimpment to Dr. Frogh’s practice or to inquire about volunteering, please contact Dr. Pierson via e-mail at firstname.lastname@example.org; or tel: +1 802 658 4018.
- Wyatt K, Reid RH. International assistance mission massacre: 10 civilian volunteers killed in Afghanistan. The Huffington Post. August 8, 2010. http://www.huffingtonpost.com/2010/08/08/international-assistance_n_674995.html. Accessed May 3, 2011.
- The Fred Hollows Foundation. Afghanistan. http://www.hollows.org/Afghanistan/Facts/#3. Accessed May 3, 2011.
- Solomon Y. Halting steps in troubled Afghanistan. VESI Web site. https://sites.google.com/site/vesiorg/report. Accessed May 3, 2011.
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