Introducing Optometry to the World

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In between completing her bachelor’s degree in 2003 and starting optometry school, Sara McGowan, OD, MS, FAAO, took some time to travel the world. That trip started with three months volunteering in a township outside of Cape Town, South Africa, and the trip was extended to include nine more months of traveling through Europe. In optometry school, she served as Student Volunteer Optometric Services to Humanity (SVOSH) president. After completing a residency in ocular disease at the University of Miami’s Bascom Palmer Eye Institute, her University of Alabama at Birmingham SVOSH faculty advisor Marcela Frazier, OD, MPH, FAAO, introduced her to the work of the Brien Holden Vision Institute.

She conducted her interview with two representatives via Skype while on a VOSH trip in Colombia. The power and wi-fi in her hotel were out, so she went to a nearby five-star hotel and plugged her phone into a hallway outlet there. She was hired to teach at the Mzuzu University School of Optometry in Malawi, starting in July 2012. The Brien Holden Vision Institute, Sightsavers International and Optometry Giving Sight implemented the program in 2009. “I had the impression initially that taking the job wasn’t necessarily going to be a career move, but teaching appealed to me, and I appreciate the model of sustainability. I thought I could do it for a one-year contract,” she recalls. She has since extended the contract twice, and last year was promoted to head of the department.

Most of the students who enter the program to earn their bachelor’s degree are between the ages of 17 and 22. “Students here grow up learning and being taught by rote memorization. In secondary schools there can be 40 students, one room, and one textbook. When the students enter university, they don’t have the background for critical thinking, and teaching clinical decision-making can be a struggle,” she says.

When school is in session, Dr. McGowan typically spends about 20 hours in clinic or teaching. Plus as department head, she faces the creative problem-solving of vying for resources that are limited, or potentially unavailable. Spotty wi-fi and limited computer access are common complaints amongst the students, “But you may be surprised at the number of students that have a laptop and/or a smartphone,” she says.

The nation of Malawi has eight ophthalmologists, and a larger mid-level cadre of ophthalmic clinical officers. Optometry still has to carve its niche. There’s no question that there’s a need for access, and the ophthalmology community has welcomed the graduate optometrists into their clinics and have been impressed with their level of skills. “A few of our graduates are now heads of department and the chain of patient care is adapting to their presence in clinic. I have optometrists telling me that, in their hospitals, the ophthalmologists are insisting that many patients see the optometrist first. The MDs have developed a trust in the optometrist’s abilities to handle patients and make appropriate referrals.”

Currently, the optometry program covers four years, but Dr. McGowan says the school will almost certainly switch to a five-year program to ease the academic rigors for these young students. Students don’t necessarily choose optometry; when they apply to the university, they rank the programs in order of interest. In the first few years, selecting the relatively unknown program seemed like a smart move in order to get accepted. “The level of training is comparable to any optometry school curriculum, but many students don’t have the basic coursework in math and biology, and, again, the critical thinking ability takes time to develop. If we add a fifth year, at the very least, students will get more time in the clinic.”

Initially, graduates of the program have been assigned to four of the nation’s central hospitals where they complete the civil service requirement, a requirement for anyone who receives a government scholarship. There are another 25 or so district hospitals that will likely bring on future graduates, she says.

Dr. McGowan says that while she enjoys her regular trips back to the U.S. (she almost always comes home for the American Academy of Optometry meeting so she can complete her CE), she doesn’t anticipate a permanent move back to the U.S. soon. “Living the expat life still appeals to me for now. She recently bought a car, “and that’s made life a lot easier.” A large chain grocery store opened in Mzuzu last year, so now she can buy specialty products, such as cheese and celery, year-round, even though she still shops at the large produce market often. She buys her clothes through the huge second-hand market, since new clothes are expensive, often of cheap quality and not readily available. Amazon doesn’t deliver, so when she returns to the U.S., she often goes with a large wish list for electronics, which are extremely expensive to acquire locally, if even available.

As the optometry department begins hiring some of the program’s graduates and other staff, Dr. McGowan is also beginning to consider what her next move with be. “I get along with the students, and I like the challenge of daily life where I have to be creative and flexible to get things done, whether that is teaching a clinical skill or accomplishing the most mundane departmental administrative tasks. I never would have thought of “patience” as a professional skill,” she says, laughing at the sometimes frustratingly slow pace. “At some point I think I will feel accomplished enough here in Mzuzu to move on. The Brien Holden Vision Institute is constantly working on new programs all over the world and I get excited over potential opportunities and possibilities, but where in the world I will end up next I don’t know yet.”