Peter Cackett, Tim ffytche and Dr Irina Gout reflect on historic ophthalmic aid sent to Eastern Europe. This article was written prior to the horrific events in Ukraine. An appeal for funds and equipment may be made by OAEE later this year when the situation in Ukraine becomes clearer.
Introduction to OAEE
by Mr Tim ffytche
Sometime in the 1980s, whilst a consultant at St Thomas’ and Moorfields, I was selected by the College to become a member of the Advisory Committee of the International Council of Ophthalmology (ACICO), and later of the International Agency for Prevention of Blindness (IAPB), giving me the title of ‘Representative for Foreign Affairs’, much to the amusement of my friends.
Through this I was able to meet senior ophthalmologists from countries all over the world and learn first-hand about the situation in their national eyecare services. My interest was particularly directed towards the countries in Eastern Europe, at that time part of the Soviet Union, when it soon became obvious that many were very neglected, particularly in centres outside their main cities. Sadly, although these were on our doorstep there was very little that could be done apart from listening sympathetically.
All that changed when the Berlin Wall fell down in those exciting few days in November 1989, and a small organisation called Ophthalmic Aid to Eastern Europe (OAEE) was set up in early 1990 to try to help. It was later registered as a Charity in 2001 (No. 1086676).
The initial aim was to provide ophthalmic instruments, equipment, textbooks, and journals for post-graduate centres in Eastern European countries. Accordingly, many consultants and eye units in the United Kingdom were contacted asking if they had ‘used but still usable’ ophthalmic instruments and equipment which they were replacing, and whether they would be willing to let OAEE have them rather than throw them on the skip. The response was encouraging enough for a small basement room in St. Thomas’ Hospital to be commandeered. It soon became an Aladdin’s cave full of a variety of functioning, broken and even obsolete items, some of which had historical value and would have been better off in a museum. In addition, there were numerous books and journals and a variety of non-ophthalmic instruments including items from anaesthetic and paediatric departments.
Delivery of the journals was easy as they could be sent by post, and a scheme was set up whereby UK consultants were ‘twinned’ with heads of ophthalmic clinics in various centres in the region and encouraged to pass on their once-read BJO and Eye magazines. This saved the problem familiar to many of the disposal of accumulating copies of journals before they were eventually thrown away years later. The idea caught on and was even later adopted by the rheumatologists.
Delivery of instruments and equipment posed more of a problem, as they had to be transferred by road over long distances without incurring too much expense. But who on earth would be so foolhardy as to take time off to drive over what were uncharted and possibly dangerous routes to remote European countries, with nothing more than a small grant to cover basic running costs? The answer was St. Thomas’ Hospital medical students – and sure enough in the early 1990s groups of these intrepid adventurers left London in hired vans and cars to remote destinations such as Tallinn (Estonia), Lviv (Ukraine), and Zilina (Slovakia), making deliveries to eye clinics along the way.
Since its conception, OAEE has expanded its activities by organising teaching visits to Armenia, Bulgaria, the Czech Republic, Moldova, Poland, Romania, Slovenia, and Ukraine. It has supported blindness surveys, in Bosnia, Moldova, Romania, Tajikistan, Ukraine, Uzbekistan and Western Russia. More recently, among other things, it has helped fund workshops in Moldova, Romania and Russia addressing the problem of retinopathy of prematurity by donating indirect ophthalmoscopes and sponsoring leaflets translated into Russian and Romanian on guidelines for its prevention which were distributed to healthcare workers in the region. OAEE has also financed the production and publication of three ophthalmic dictionaries in English / Russian, English / Polish, and English / Ukrainian.
Boarding school for blind and partially sighted children Lviv, 2002.
It has also helped to fund visits by young eye doctors from Eastern Europe to attend specialist clinics at Moorfields as observers, and has given travel bursaries to Moorfields doctors wishing to present papers at national eye congresses in the region.
Over the period of its existence OAEE has seen substantial improvements in eyecare within the region, with many centres on equal terms with those in Western Europe. However, in the poorer Eastern European countries the gap between services in main cities and provincial ones remains large and unbridged. For all the right reasons most eye charities now concentrate their efforts outside Europe, but there is still a need for help and support in these more remote eye clinics in countries which are our near neighbours. Thus, there continues to be a place for the initiative shown by those small groups of medical students nearly 30 years ago.
Focus on Lviv
by Mr Peter Cackett
In Europe and America there’s a growing feeling of hysteria
Conditioned to respond to all the threats
In the rhetorical speeches of the Soviets
Mister Krushchev said, “We will bury you”
80s music buffs will spot these words, sung hauntingly by Sting in the track Russians in 1985 whilst I was in high school. I was already fearful of a nuclear war growing up during the Cold War in the 70s and 80s with the terrifying film Threads, an apocalyptic drama depicting the devastating effects of such a war on Britain released a year earlier in 1984. This song by Sting left me worrying if the Russians loved their children too.
I was, however, developing an interest in Communism and life behind the Iron Curtain which was bordering on an obsession. An overland school trip to Poland, Czechoslovakia, Ukraine, and the USSR the following year, the summer of 1986, which I had planned to go on, was cancelled due to the nuclear reactor accident at Chernobyl in April that year, and left me feeling very frustrated. The irony that it was fallout from a nuclear accident rather than a nuclear war, which I had most feared, that led to several weeks of unsettling existence in the UK at the time was not lost on me.
With the subsequent appointment of Mikhail Gorbachev as General Secretary of the USSR in 1985, his economic reforms (perestroika) and a more open form of government (glasnost), the USSR eventually dissolved in February 1990 and the Communist party surrendered its monopoly on power. With it evaporated my chances to witness life under Communism.
Three years later, however, in 1993, during my fourth year at medical school, an opportunity arose to witness the aftermath of Communism in some of the countries I had missed out on visiting. Mr ffytche, Consultant Ophthalmologist at St Thomas’, Founder of the Charity Ophthalmic Aid to Eastern Europe, was looking for a team of medical students from my year to deliver ophthalmic equipment to his contacts at various Eye departments in Poland, Ukraine and the newly formed individual countries of Czech Republic and Slovakia. Obviously, I jumped at the chance.
Focus on Lviv team 1993. L to R: Stephen Evans, Gurpal Gosall, Peter Cackett,
Frauke Naumann, Cecily Don, Ramesh Chelvarajah, Alex Philpott.
The main destination for equipment was the city of Lviv, formerly Lvov (Russian rule), Lwów (Polish rule) and Lemberg (Austro-Hungarian Empire rule) in Ukraine, and hence the project was given the title ‘Focus on Lviv’. A group of six students including myself formed to organise and carry out the trip. Readers will be reassured that member selection was not on the basis of ability, but solely on a willingness to take part. Therefore, the whole trip effectively amounted to a comedy of errors where almost everything that could go wrong, did go wrong. A complete account of the trip would fill this edition of Eye News, therefore in order to keep things concise I will narrate the story as a set of selected highlights of the mishaps:
“If you fail to plan, you plan to fail”
The mission was six medical students with a 3500 mile round trip in two brand new vehicles, a car, and a van, provided free of charge courtesy of Hertz, to transport medical supplies to various hospitals in Eastern Europe. We each had jobs to prepare for the trip. My job was to negotiate the free hire of said vehicles from Hertz, which I like to think I achieved. However, there is some dubiety as to whether I did in fact scratch the car on a bollard as we left the student halls of residence upon our departure. I still maintain it was just some chalk dust on the side of the car.
However, Alex from our team was required to purchase maps for the trip. Note the plural – ‘maps’. As we pulled away from Ostend following our night ferry from Dover, as navigator I asked for the map to get us to Erlangen in Germany, the home of Professor Fritz Naumann, friend and colleague of Mr ffytche, and the first stop on our trip. I was handed a 1:5 million map of Europe. Even Cairo was on it. This was the only map we had for the entire trip, and every stage involved sinusoidal paths, wrong directions, backtracking and late arrivals. We had failed to plan.
“There’s no I in team, and definitely not a me”
Setting off on the second day from Erlangen, in command of the new Ford Mondeo, I was exhilarated at the thought of unrestricted driving on the German autobahns heading to our next stop in Prague. With my foot down and sunroof open we disappeared over the horizon. However, my own desire for speed meant I had not kept the sluggish van in sight and we lost the van team. In the pre-mobile phone era we also had no way of communicating with them. We therefore did not find out that trying to keep up, the van engine had burnt out whilst trying to overtake a BMW and broken down. It was two days before we managed to meet up with the van crew again. I take full responsibility for that mishap as it resulted from my priority: me.
“Be mindful of other countries’ rules”
We established on arrival in Prague, via a phone call to Frauke Naumann, daughter of Fritz, at home in Erlangen, that the van had indeed broken down. We decided to head back to Germany to meet up with them again. It was late at night as we crossed the border into Germany and headed onto the autobahns back to Erlangen. Ramesh, the driver, noted too late that the petrol was running low. With a few miles left in the tank he pulled off the autobahn in search of a petrol station, but, forgetting he was in Germany and not the UK, onto the left hand side of the road. Into the path of an oncoming vehicle. Fortunately, the sight of the rapidly approaching headlights prompted Ramesh to swerve out of the way. Onto the kerb. Which resulted in two blown out tyres and the car crew sleeping the night in the car until the garage opened.
“Many hands make light work”
On arrival back in Erlangen the following morning, the car crew found out that the van crew had been given another brand new van by Hertz Nuremberg and had spent a comfortable night in Prague. Frauke, who had been disturbed twice now from studying for her university exams, gave in and was persuaded to join the trip. She became a valuable extra member, especially as, not being a medical student, she had sensible advice to give.
“Sometimes lateral thinking doesn’t help”
Several days later, we finally arrived in the Ukrainian city of Lviv, our main destination. However, all the street signs were written in Cyrillic, we had no map or dictionary to help, and we had to find the hospital. With a bit of lateral thinking, we decided to follow an ambulance to what must surely lead us to the hospital, we reasoned. It took us on a painstakingly slow journey to a house in the suburbs to drop off a patient. After a couple of hours, we eventually found the hospital to drop off the donations, but I seem to recall it was more by luck than anything else.
“Charity leads to happiness”
I like to think that most of the equipment that we dropped off at the various ophthalmology departments was useful. I have since been informed by the young ophthalmologist Andriy Hudz, who met us in Lviv and who is now professor of the department, that the portable light coagulator which we delivered was indeed of great benefit to them.
OAEE in Ukraine
by Dr Irina Gout
In 1993 ‘Focus on Lviv’ was the first humanitarian support to Ukrainian ophthalmologists from a Western European country and was organised and funded by OAEE. The equipment (ophthalmoscopes, slit lamps, photocoagulators, visual field analysers, portable autoclave, ophthalmic surgical equipment, medical journals etc.) was delivered by medical students from St Thomas’ Hospital.
It was a timely and very valuable support for ophthalmologists at Lviv Medical University, especially after the collapse of the former Soviet Union and the deterioration of funding in medicine. It gave valuable help to Ukrainian ophthalmologists, especially at the beginning of Ukrainian independence when there was a lack of medical equipment and difficulties in purchasing modern Western medical textbooks and journals. This obstructed the training of doctors and reduced the rate of exchange of knowledge and expertise between East and West.
This original humanitarian support was followed by further shipments of ophthalmic equipment to the Centre of Eye Microsurgery in Kyiv and Lviv Medical University in 1996 and 1997.
Kyiv ophthalmic training visit 2002. L to R: Jack Kanski, Paul Rosen, Tim ffytche and Irina Gout.
In 2002, OAEE organised short-term ophthalmic training programmes in Ukraine at post-graduate level, which were conducted by leading UK ophthalmologists, including Jack Kanski, Tim ffytche, Paul Rosen and Chatan Patel. They gave a series of lectures on various topics of clinical ophthalmology in the Centre of Eye Microsurgery in Kyiv, Lviv National Medical University and Crimea. These trips were organised by Irina Gout.
These lecture courses inspired ophthalmologists from Lviv Medical University to prepare for publication an Ophthalmic Dictionary in four languages: English, Ukrainian, Russian, and Polish. This effort was coordinated by Tim ffytche and Irina Gout. In 2006, the Dictionaries were published in Ukraine and Poland with the funding provided by OAEE. The proceeds from the distribution and sale of these dictionaries ($3,000) were given to the school for blind and partially sighted children at Lviv boarding school and used for the refurbishment of classrooms.
OAEE has also played an important role by providing grants to Ukrainian ophthalmologists for short-term training placements at Moorfields Eye Hospital in 2014 and 2017. This gave young ophthalmologists from Ukraine an excellent opportunity to gain valuable experience in the modern approach to diagnosing and treating different eye pathologies, enabling them to bring back to Ukraine new techniques in investigation and management which they could implement in their everyday practice.
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