Sharing of Awards of ICO International Fellowship

Zhao Meng – Beijing Tongren Hospital
An Experience from an ICO Fellow

My name is Zhao Meng. I am an ophthalmologist of Beijing Tongren Eye Center, one of the biggest eye centers in China. Thank you for giving me the chance to learn uveitis and resident training in the New York Eye and Ear Infirmary as an ICO fellow. It’s the first time I try to express my appreciation in English. I hope I could express my feelings and thoughts in English as well as in Chinese, then both you and ICO officer can understand them better. I should have paid more attention on learning English if I knew I would have a chance to write such an important letter in English. I have to divide the important letter into three parts: the first, it is my appreciation; second it is my concerns on ophthalmologist resident trainings in China; the third is my report focusing on what I had learned and how I spent the scholarship. In my consideration, what I am going to tell you in the second part of the letter is by far the most important issue.
I was so excited when I realized I was supported by the Lifeline Express. It is because that all of our young ophthalmologists in Beijing Tongren Eye Center know so well about “健康快车”( the Chinese version of Lifeline Express). Each year, some well-trained cataract surgeons in our hospital are assigned to rural area of China for cataract surgery by Lifeline Express. They always tell us it is a valuable surgical training and they all gain their own wonderful surgery experience from the Lifeline Express trip. To my young friends and me, the feelings of listening to what the cataract surgeons tell us was exactly like the little mermaid ‘s feelings when she is listening her older sisters coming back from the surface of sea talking about the things happened in human world and dreaming of coming up and seeing the human world by herself. Unfortunately the chance of “coming up” in “Lifeline Express” program is so remote and uncertain because there are so many of us and so little chance of surgical training even in this biggest resident training center. We can’t achieve the goal of Lifeline Express for performing so many cataract surgeries per day.
I took the ICO examinations and read the whole set of basic and clinic course of ophthalmology for a better understanding of ophthalmology. I never thought I would have a chance to learn ophthalmology outside China before. It is your kind help that made my “little mermaid dream” as a young ophthalmologist came true. The ICO fellowship supported by the well known Lifeline Express is a fantastic valuable gift to me. It also lights young residents in our hospital up. There are more and more young ophthalmologists in our hospital preparing for the ICO examination each year. Thank you for lighting us up. We see chances of excellent trainings if we work hard on learning ophthalmology by ourselves.
I followed Dr. Kedhar to learn uveitis in the New York Eye and Ear infirmary (NYEEI). He is an excellent teacher. He taught me how to diagnose and treat uveitis, how to perform regular ophthalmological surgeries, how to carry out clinical research. I was so excited for finding lots of new things to learn everyday there. The feelings of learning new materials everyday were so good that I forgot to sleep for looking answers from books and journals into midnight everyday when I got home from the whole day work. I kept put all I had learned on our young doctors’ website. They were excited too. In China, the uveitis specialist is rare comparing with so many uveitis patients. Dr. Kedhar showed me how wonderful it is to become an uveitis doctor. The fellowship helps me to set up my mind to be an uveitis eye doctor helping Chinese uveitis patients. It will be a long struggling way to go, I will try my best. I chose to live in Queen of New York and insisted on cooking for myself every day to save up almost half of the fellowship to buy ophthalmological books recommended by Dr. Kedhar and lens for ophthalmological examinations. I brought a large suitcase to carry all the books back to China and shared them with my young friends. I am using the new lens to examine patients during my clinic work now. I will work with my supervisor to set up an uveitist team in our hospital in the early September. I am working on the diagnosis and treatment monitor tests in our hospital for uveitis patients and some clinical trails protocols on uveitis treatment now. I see more than 50 patients per day and do the research work in my spare time. I am very glad on the thought that I am going to help uveitis patients in China.
Dr. Kedhar also showed me how to be a good teacher to the residents. The ways of learning ophthalmology as residents in China is different from the one in the Unite State. I was trained in this famous ophthalmology center in China. I am proud of being trained and learned how to work as an ophthalmologist in Beijing Tongren Eye Center. I remember when I was a resident, I saw the patient first, and then I got diagnose for the patient directly from my supervisor. I had to look though books to find out how to diagnose certain disease, how to make the differential diagnosis, how to treat certain disease. Sometimes I learned from my misdiagnosis corrected by the supervisor. There was nobody telling me all the materials I need to know about certain disease when I saw my first patient. I can’t tell my residents all the materials at one time about certain disease they need to know even if I learned all aspects of the disease by myself. The similar learning happens in our ophthalmology surgical trainings. The elder eye doctors, our supervisors, believe the theory that you should master certain surgery when you have seen the supervisor performed it for several times. Sometimes I was afraid when our supervisor passed the instruments to me and asked me to perform the surgery without instructions. I don’t think I am a talent surgeon that can learn to perform a surgery by watching. In Dr. Kedhar’s teaching, I saw him talking to residents about all materials of certain disease they need to know when they consulted on him. I saw him talking to residents about the details of certain surgery before they perform it. He also told them how to perform each step better and why they performed it in one way instead the others during surgery. He tried to encourage the upset and nervous resident by finding out the tiny well done maneuver from a whole set of incorrect performance.
I wish I manage to explaining to you clearly enough for the difference between our ways of learning ophthalmology and the residents’ in NYEEI. I can remember some of the knowledge he told the resident about certain disease very well because I learned these by reading several books and journals by myself and testing them again and again on patients. I can remember some of his surgical tricks very well because I learned some of these details by watching and by my own failures. I think it is better to remember ophthalmological knowledge from learning by oneself, but it is really a much harder and time consuming way to learn. We need to build up a strong mind to tolerate losing confidence for failures on surgical trainings or helpless feelings for seeking answers to our clinic questions. I think it is the lack of formal communication between our attending doctors and residents that makes the difference in teaching. I think we can learn ophthalmology better if we can communicate better. We really need to learn how to communicate ophthalmology knowledge with others when we are growing up as an ophthalmologist. Although the instruments and machines we used to perform surgeries are far behind the ones used in Unite State, the surgeons in China are trying to develop some skills to overcome the disadvantages of the machines and instruments to treat patients successfully. To learn these skills requires more communication and teaching work than to learn how to use a new machine. When I realized the importance of teaching in ophthalmology, I wrote a formal letter to the chief professor in our ophthalmology center who in charge of the resident training about my thoughts. She encouraged me to do more in improving our teaching and communication in the near future under her direction. I also told Dr. Kedhar about my concerning on how to improve our teaching and communicating system. He was very kind and eager to help us. He gave me some valuable advice on how to communicate. He also wanted to help us to set up our new surgical training program for postgraduate students and residents in our hospital, the largest ophthalmological resident training center in China. We will work hard together on it in the coming year. I hope the younger Chinese ophthalmologist can get better and better training in our center in the near future. I remember something Dr. Kedhar told his residents about how to learn surgery. He said he learned how to perform certain surgery mostly from teaching the residents to do it. It is teaching that gives him the chance to understand each steps of the surgery better and better.
The fellowship in New York Eye and Ear Infirmary makes me recall some stories in Chinese history. In Tang dynasty, there were two famous Buddhist monks who help the Buddhism transport into China and Japan. The first is Tang San Zang. He had been an esteemed Buddhism monk in China before he was sent to India for scriptures. He spent seventeen years in India to learn the original scriptures and dedicated his rest life to translating them into Chinese and teaching what he had learned in China. He did a great job to help Buddhism to spread across China. The second is Jian Zhen. He was an outstanding Buddhism monk lived 80 years later than Tang San Zang. He was invited to Japan to teach Buddhism there. He trained 500 students and spent his whole life teaching Buddhism there. He transported the art of China and Buddhism to Japan. I add those two stories here because I want to show you some of my concerns on how to improve the ophthalmology in developing country. Chinese people believe that we should learn from the past. These two stories reflect two different ways of helping people in developing country to learn advanced technique and knowledge. What the first monk did is similar to the way of ICO and you sending me to NYEEI to learn uveitis. The difference lies in that Monk Tang was already an expert and knew exactly what the country needed; while I am a young ophthalmologist knowing little about uveitis or what my country even my hospital is lacking of. Three months fellowship is important for me and my ophthalmology career. To be honest, the training is by far not enough for a young ophthalmologist to help her hospital to set up the uveitis department or to help her hospital to improve the resident training program. The second monk story reflects a different way of education Sending a teacher to the developing country to teach will cost almost the same as sending a student to the developed country to learn. Sending a teacher will be of great worthy to the developing country. More young ophthalmologists in the developing country will be benefit from the teaching program. More attending doctors in the developing country will learn a great lesson from the teacher about how to be a teacher in ophthalmology. When I talked the idea to Dr. Kedhar and some young attending in NYEEI, they were eager to visit us to communicate and teach. When I talked the idea to Dr. Peng, our chief professor for teaching and academic school, she told me that we had set up the platform for international ophthalmological communication and ophthalmological teaching for 4 years and we were waiting for the warm-hearted young foreign ophthalmologists to come. We were lack of money for inviting them and lack of opportunity of finding them. I want to do more than just carrying the notes and books back to my young friends from the advanced ophthalmology world, I try to express my thoughts on helping the Chinese young ophthalmologists here to you. I will help Dr. Peng to find an opportunity to invite the ophthalmological teachers I found in NYEEI to visit us and teach in our hospital in the coming year. I will also try to seek some fund to covering the cost of their trips to China. It is not a one man effort to improve the whole teaching business in our hospital, I will try my best to help it to progress.
Thank you for giving me the chance to learn ophthalmology in NYEEI. Your support has changed my career in ophthalmology. I find I am interested in uveitis and I will try to help the uveitis patients in our hospital in the near future. I will try to invite my new teachers to visit our hospital in China too. They will help our young ophthalmologists to learn more in ophthalmology. My friends and I will try to help Dr. Kedhar and Dr. Peng to improve our existed microscopic surgical training program in our hospital too. I will try even I know I might be going to fail since they are really huge tasks. I am excited on the thought that I can do something for the patients and young ophthalmologists in China and I will try my best.

Zhao Meng report of my ICO fellowship at New York Eye and Ear Infirmary
I arrived at New York on April 27th 2010 and began to fellow Dr. Kedhar to learn uveitis on May 4th 2010. I have learned a lot from him on uveitis, surgeries and clinical research. I also brought some text books of ophthalmology and some instruments back to China. Here is the list of what I have learned and how I spend the fellowship.
1           What I have learned
1.1        Uveitis:
1.1.1     The SUN classification of uveitis;
1.1.2     The diagnosis tests for uveitis;
1.1.3     The common differential diagnosis tests for uveitis;
1.1.4     The basic principle of systemic and local proper usage of steroid to treat uveitis;
1.1.5     The classification of immune suppress medications;
1.1.6     The basic principle of using immune suppress medications instead of high dose steroid to control the inflammation;
1.1.7     The principle of monitoring the side effects of immune suppress medications;
1.1.8     The timing of treat the complications of uveitis;
1.1.9     Some special kinds of uveitis that are rare in Chinese population, such as birdshot choroidretinopathy, sarcoidosis, toxoplasmosis, ocular lymphoma.
1.2        Surgery:
1.2.1     The basic adjustment of the surgical chair and microscope;
1.2.2     Microscopic suture technique;
1.2.3     Pterygium extraction and limbal stem cell transplant;
1.2.4     PHACO cataract emulsification and intraocular lens implantation;
1.2.5     The setting of infinity machine;
1.2.6     DESAK for treating bulbular keratopathy.
1.3          Clinical research
1.3.1     The basic idea of how to read paper;
1.3.2     The basic idea of how to write a systemic review;
1.3.3     The basic idea of how to describe data from cohort study;
1.3.4     The basic idea of survival study;
2           How I spent the fellowship


Amount of money
A room of an apartment in Queen
$550 per month
Three months
Round trip of Air China
Basic travel plan
$80 per month
Three months
I cooked for myself everyday to save money
$200 per month
Three months
Surgical techniques in ophthalmology series:cataract surgery
Surgical techniques in ophthalmology series: retina viteous surgery
Phacodynamics: mastering the tools and techniques of phacoemulsification surgery
Ophthalmic microsurgical suturing techniques
Surgical management of inflammatory eye diseases
Fundus fluorescein and indocyanine green angiography
Uveitis: fundamaentals and clinical practice:
Survival analysis self earning
Meta analysis in medicine practice
Welch Allyn 13000 ophthalmoscope head
VOLK superfield lens
VOLK Digital clear lens
VOLK three mirrors lens
English pod
$69 per year
Total: $6980.26
3           Some pictures at NYEEI
My friend FRANCIS, Jasmine Helen M.D., the 2011 class resident, at the eighth floor uveitis clinic
Ms Ruth Moses, the kind lady helped me to settle down in NYEEI.

TinkuBali-Razdan M.D. (the other ICO fellow), Ronald Gentile, M.D, Sanjay Kedhar M.D. and I. After a successful complicated surgery of sclera suture fixed IOL and vitrectomy at second floor operation room 6. 
My supervisor Sanjay R Kedhar M.D. On my last day at NYEEI in his uveitis office
Best regards,


Zhao Meng M.D.
Beijing Tongren Eye Center