14 May 2009
Dear Colleagues (& Friends 'in the know'),
Hello again.
I hope this finds you well and gainfully engaged/employed in your area of specialty.
I thought you might be interested in reading accounts of the time I spend at the eye projects I am volunteering in this year as i traverse the breadth of the globe (or at the very list you might like to look at the attached photos) so I’ve added you to this email list.
Last month I completed two weeks at the An Najah University, which is located in they city of Nablus (Biblical 'Shechem') in a Palestinian area of the West Bank, assisting with their students in the Optometry Bachelors program. The School of Optometry is on the new campus. On account of the newness of campus (which I had seen in pictures on the internet) and the size of the school (four years each with about 20 pupils) I assumed that there would be at least 3 or 4 full time lecturers in the department. I therefore thought that I would lending a little support, an extra set of hands really, with the practical sessions for each year (which is also what the email I received outlining my responsibilities seemed to indicate); I assumed much too much.
The department has just one fully qualified part-time lecturer, who has other responsibilities within the university that cause her to be out of the department far more often than she is in. (She is a very capable lady of whom many requests are made.) As such, I found myself in a mild state of shock when, having just arrived in the department, I was not introduced to all the members of the academic staff and offered sweet Arabic coffee, but rather, was directly asked, 'What will you be lecturing the second and third year students on today Dr Luke?' (It was soon after the question was asked that I realised that the noisy students in the corridor were waiting for me to think of something I could teach them with zero preparation time).
The School of Optometry is only in its fifth year of existence; Nablus is the first centre of learning to offer a course in optometry within Palestine. It is poorly equipped.
The biggest issue by far is the lack of qualified or even just experienced teaching staff. In addition to the part-time lecturer (the dean of the school) there are two junior lecturers. They are no more than the top two grandaunts from last year’s class (which was the first year the school ever graduated) who moved directly from being full-time students to be full-time teachers in the same institution. This is both far from ideal and the best arrangement possible at the present time in the young school. Because of the limited availability of the dean, these two juniors are responsible for the large majority of the teaching load; unless, of course, there happens to b a volunteer in town, in which case they - or rather ‘I’ - do most of the teaching. Being unprepared for the task of lecturing, and having very few resources with me, I decided I was going to need to cover topics that I knew well and major of the practical aspects of those same topics. (As I have ten years of experience as a practitioner, not a lecturer.) So for the following two weeks I basically delivered a morning and afternoon lecture (which I prepped the night before) and supervised a practical session in between the two. I taught on aspects of contact lenses, binocular vision, and low vision. Thankfully the topics I felt most confident in teaching were also topics that the students were yet to cover. I am even more grateful that the students English was far superior to my Arabic.
Continuing on the theme of being poorly resourced: The practical session involving soft contact lenses was cut short because the department did not have any contact lens cases to store the conventional lenses in once opened; The retinoscopy and ophthalmoscopy lessons were made difficult by the fact that the department only has six handles and heads (of which only five work); And all my advice on the strengths and weaknesses of various magnifiers for patients with low vision will be hard for the students to implement as the school does not have so much as a hand held magnifier in its possession.
The students responded well to the material I was presenting, probably because of the practical nature of the sessions, and I really enjoyed interacting with them. It was fun. Outside of class time the students were very keen to take me to see the local sites (including the new sports facilities on campus) and to sample the local cuisine (as shown in the attached photographs). They are a generous and good-natured bunch, who I missed greatly when my time was through.
There is a Palestinian ophthalmologist who travels over two hours each way from where he lives to train the students in pathology. (The drive should be less than an hour according to the distance separating the two cities, but because of the check-points - and his Palestinian status – the trip takes much longer.) On the day he is present he delivers a long lecture (so the students say/complain) and supervises the final year students as they refract and examine patients. He is a really wonderful man who I greatly admire. In addition to spending his time helping to establish the new profession of optometry by teaching in the university (knowing the optometrists will eventually end up seeing the patients that are currently being refracted by ophthalmologists), he is also doing all that he can to establish an eye department in the public hospital in his home town. His home town is Hebron, the catchment area for the hospital covers some one million people, incredibly there is presently no public eye care available for these people. Dr Akram is really sticking his neck out for the good of the Palestinian people as plenty of hospital officials and ophthalmologist (all Palestinians themselves) do not want to see the eye service established or the profession of optometry operating in their local area because they stand to lose money that would otherwise be theirs. But Dr Akram is determined to push through the resistance and is making good progress. While in Palestine I was able to get the Australian Ambassador to Palestine to agree to visit the Hebron hospital which will hopefully speed the opening of the new eye department (in which Dr Akram hopes to train optometry students in addition to seeing patients who can’t afford private care).
Despite all the difficulties just described, I was impressed with the level of knowledge of the final year students. It’s upsetting to think that most of them will be fully qualified and unemployed in a matter of months (as are most of last year’s graduates). There simply are not jobs for optometrists in country that has no history with or understanding of the profession. The ophthalmologists do the refracting and the opticians make the glasses up according to the ophthalmologists’ prescriptions. To become an optician you really need to be the offspring of an optician; that’s the way it works. As such the infrastructure necessary for the creation of optometry jobs just isn’t in place. The young profession of optometry needs to prove its worth and thereby establish itself in the local health providers’ scene. I encouraged many students to apply themselves to this task for the sake of the profession and all their fellow Palestinians who would benefit from existence of the profession. Admittedly, its asking a lot of kids who are only just out of university and their teenage years. Those who want to use their skills will need to move to other Arabic speaking nations where optometry is better established (Jordon, Syria, Lebanon, or further afield to places like Dubai). Another, more difficult option, is to further improve their English, so that they can sit the difficult exams they are required to pass in order to practice elsewhere. It’s such a shame - especially considering that there is a shortage of optometrist across the globe - to have these bright young people unemployed. This is explains why the top two students from last year were both eager to be employed by the university. Unlike the Australasian context, the alternative to remaining in the education system at the end of your degree is not a high paying job in private practice (in the location of your choosing) - it is unemployment (or exile).
The two junior lecturers are both hoping to spend the next academic year obtaining Master’s degrees in the United Kingdom (one will leave her two young children, both under the age of three, with their father for the year in order to take up the opportunity to further her education); Which means that the two top students from this year’s class will again be responsible for doing the majority of the lecturing for the years beneath them next year. In the year following that, the two Masters students should return to the lecturing positions with the proper qualifications for teaching students at the Bachelor level. In this way the department will up-skill and enlarge its teaching staff (admirably) with home-grown talent.
The university officials have made it clear that they would be happy to organise me into a full-time teaching position there if I wanted it. I will certainly consider the offer alongside at the end of this year of travel alongside all the other opportunities that present themselves. It is an incredible part of the world, and seeing places that I have read about for almost all of my life (in the pages of the Bible) is rather surreal and very exciting. Presently, I am thinking that returning for a semester of next year might be very helpful for the department as they will again have two junior staff members lecturing material for the first time (without having the benefit of any practical experience in the workforce).
My next (unconfirmed) assignment is in Guatemala in July. The volunteer opportunities come thick and fast after that. I’ll endeavor to send out a report after each episode.
Peace be with you …
lucas
