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It took 2nd-year UNC Ophthalmology resident Dr. Davis Anugo a one-week international rotation to seal his interests in global health service as an integral part of practicing ophthalmology. In December 2022, Dr. Anugo traveled to Tema Christian Eye Center (TCEC) in Ghana accompanied by a glaucoma specialist who served as his surgical teaching mentor. As a U.S.-trained resident learner with advanced diagnostic skills, he joined a global corps of volunteer eye specialists who visit TCEC year-round to contribute critically needed expertise in a country with approximately 100 Ophthalmologists serving a population of 30 million.

Over five full clinic days, Dr. Anugo helped TCEC’s staffed eye specialists conduct comprehensive eye exams at a high-volume clinic. He guided TCEC’s one comprehensive ophthalmologist through learning differential diagnosis for advanced glaucoma cases. Together, Dr. Anugo and TCEC’s ophthalmologist examined patients with glaucoma to diagnose severe, complicated cases and prepare them for afternoon surgeries in TCEC’s OR.

He noted: “TCEC’s skilled ophthalmologist is a trained cataract surgeon and educated in-continent. To prepare for and optimize the number of complex glaucoma surgeries that highly trained, volunteer ophthalmologists perform during their visits, teaching the onsite ophthalmologist to handle post-operative care for these advanced cases is critical for when the visiting physicians leave.”

Traveling to Ghana, Dr. Anugo sought firsthand exposure to how an under-resourced clinic successfully provides ongoing clinical and procedural eye care to a large port city population. Carrying donated medical equipment on flights to Ghana, he witnessed how vital medical supplies brought by visiting physicians from well-resourced countries help generously stock and sustain TCEC’s clinic and OR inventory.

He noted: “Other international medical missions to Africa provide short-term aid but ultimately leave a void when they depart. This is not the case at TCEC. Patients receive eye care at a modest cost, largely due to visiting physicians who donate surgical, clinical, and imaging equipment that offset shortages in an under-resourced clinic and provide critically needed procedural expertise.” 

In a country that ranks highest worldwide in glaucoma prevalence, TCEC lacks staffed glaucoma expertise to offer procedural intervention to a multitude of glaucoma patients who will experience total blindness without surgery. For 25+ years, volunteer glaucoma specialists have visited TCEC four times annually to help mitigate this critical void.

Dr. Hanna Kim, a U.S.-based glaucoma specialist in private practice, mentored Dr. Anugo through acquiring fundamental surgical skills to treat advanced glaucoma that an ophthalmology resident must learn to graduate to independent practice. A former Bascom Palmer Eye Institute glaucoma fellow trained by UNC Ophthalmology Chair Dr. Don Budenz, Dr. Kim now joins a team of volunteer private practice glaucoma experts organized by Dr. Budenz that visits TCEC every few months to perform surgeries. Paired by Dr. Budenz, Drs. Kim and Anugo traveled to TCEC as a two-physician team, performing 10-13 glaucoma surgeries each day.

Dr. Kim noted: “My experience working in Ghana with Dr. Budenz and other ophthalmologists at TCEC led me to choose ophthalmology. Mentoring Dr. Anugo was my first time working with an ophthalmology resident in Tema and I really enjoyed the experience. Dr. Anugo was very helpful in seeing the patients in the clinic, helping with post-operative care, and assisting in surgery.”

Dr. Anugo witnessed a pervasive gratitude in patients and Tema locals during his fast-moving, yet deeply engaging week. He concluded:

“Even before their procedures, the patients expressed a kind of gratitude unlike anything I had ever experienced. I could sense their relief, knowing that finally someone was going to help them preserve what vision they had left, despite their social and financial circumstances.  We encountered so many patients with interesting stories who were extremely thankful for us being there.

Ghana joins a range of developing Africa nations that lack a robust ophthalmology training program and access to specialty care, adequate resources and trained specialists. Traveling to Tema and making connections as a resident has solidified my decision to keep taking international trips to learn from both providers and patients as I work toward making global ophthalmology a part of my future career.”