You sometimes hear the phrase, “One plus one equals three,” and I have been struck by the power of that notion in my work with Helen Keller International through the partnerships we create with local organizations. I recently sat down with Dr. David S. Friedman, HKI’s Senior Ophthalmologist and Eye Health Advisor, to talk about his experiences in public health and his perspective on building partnerships to achieve success. Dr. Friedman most recently was awarded the prestigious Alcon Research Institute award for his contributions to ophthalmic research.
The good fortune of helping others: “I’ve always felt fortunate to have the life I’ve had, and that I should use my skills to help others. I studied Mandarin Chinese in college and took a semester off to live in Beijing and teach English while I used my new language skills. I enjoyed the language so much that I held off on going to medical school for a year while I studied in Taiwan at the National University there. My strong desire to work in locations where doctors were scarce and my skills would be most useful led me to take a year off from medical school and work in Indonesia on a research project to improve care for those with vitamin A deficiency. Dr. Al Sommer, the research pioneer for vitamin A at Johns Hopkins and former Dean of the Johns Hopkins School of Public Health, oversaw the project and this connection led me to join the faculty at Johns Hopkins after I completed my ophthalmology training. When I turned 40, I realized I wanted to have a direct impact on programs to improve eye health in developing countries. I started by working with Orbis International as a consultant for a year, and then decided to join Helen Keller International.”
Biggest surprises about his job: “I’m pretty good at getting things done, but find that it’s more challenging to complete projects than I thought it would be: working in remote areas creates barriers and there are more details to be addressed. Will power isn’t enough to succeed; identifying really good partners to make sure things keep focused and move along is the key.
I most recently helped HKI establish diabetic retinopathy treatment programs in Indonesia and Bangladesh, and figuring out which cameras and data management tools to buy, how to implement quality controls, and ultimately adjusting the approach to the reality on the ground enabled us to make huge strides. And, all of this has to be done within very tight budgets. In Indonesia and Bangladesh the screening has to be streamlined and inexpensive because there are few resources although the numbers who need the screening and care are enormous. Even if we could screen all the people with diabetes, only 1 person in 20 has a serious enough problem that they require immediate treatment. We identify these people by taking pictures of the inside of the eye (the retina).
Sometimes it is hard to recognize the impact of my work, but I recently visited our partner in Bangladesh and asked the photographer to show me how he enters patient information and takes photos. It just so happened that the man we screened had severe diabetic eye disease, but still had good vision so he wasn’t aware of his condition. Thanks to all we had done to get the camera there and arrange this screening, we were on the road to saving that man’s sight!”
Most exciting moment working at HKI: “I’d have to say it’s the moment when you identify a strong partner and you are able to agree about how to move ahead. That is very exciting. Our work really succeeds when we help a good partner get better, or help a partner excel. Chittagong Eye Infirmary and Training Complex in Bangladesh is an excellent example of this. It was already an outstanding non-profit organization and through our collaboration on diabetic retinopathy it is now offering a blindness prevention service that would otherwise not be available. We hope to keep working with them to expand the work we have started there.”
Most rewarding thing Dave is currently working on? “Fostering the cataract partnership at Zhongshan Ophthalmic Center (ZOC) in rural Guangdong Province in south China. Dr. Mingguang He, HKI’s Country Director in China, runs this project which extends care to rural regions of Guangzhou and other areas (Watch Our Video: New Hope for the Elderly in China). Our approach is to send highly qualified doctors to train local doctors in their own hospitals, where they have their own patients and where they can build successful practices. HKI’s VP for Eye Health Nick Kourgialis and I visited Dr. He in Guangzhou to evaluate our successes and failures; after a long discussion and probing of the obstacles to training we came up with a system that has been hugely successful. If Helen Keller International had not been there, the program would not have happened. It’s a great example of capacity development and teamwork. Some might think that because China is becoming wealthier, international aid should go elsewhere to help poorer countries. However, benefiting the poor in developing economies is often a sustainable approach because if good programs are developed, there are resources in the country to keep them going.”
Least favorite buzzword: “I guess I’d say ‘sustainable’ because people use it when it may not be achievable. Some forms of care require on-going inputs that do not necessarily pay for themselves. The key is to figure out models that can work which involves identifying a stable revenue stream for the program. In some cases, one needs government subsidies because the target population just doesn’t have the resources to cover the service. I often worry about these programs, however, because the winds of politics can destroy programs overnight. Eye programs can sometimes avoid this problem because many of the solutions are affordable; cataract surgery can be done for $50, for example.”
The Inspiration of Helen Keller: “She inspires me because she demonstrates how everybody can live a full life regardless of disabilities. If we can give people some ability to see, we give them a tremendous opportunity.”
Watch David Friedman’s journey from med school to midlife in scenes from “Doctors’ Diaries” on PBS’ NOVA (Running time 10:31)