As a young medical student from the Netherlands, Dr. Danny Haddad did not pass up a unique opportunity that offered him the chance to work with the well-known Prof. Jan Worst. While participating in an eye health mission in Pakistan, Dr. Worst saw long lines of people needing cataract surgery but lacked the consumables, like sutures and surgical blades, to perform the surgeries. With his mantra, Necessity is the mother of invention, Dr. Worst created tools, like needle-bending pliers to make his own consumables for cataract surgery. Working alongside this resourceful and innovative ophthalmologist, Danny watched and learned how to repair and make his surgical tools, but also how to repair surgical instruments, especially the very delicate micro-surgical instruments used in ophthalmology. Together, they assembled an Appropriate Technology Toolbox containing everything to make your own consumables and repair your (micro)surgical instruments. He packed four of these in his backpack. He traveled for three months through Ghana, visiting every eye clinic and training nurses and ophthalmologists to use all the techniques and the toolbox, leaving one behind in each of the clinics he visited. After that trip, he began using all his free time and vacations during the rest of his studies and internship to explore the world and implement this innovation.
While working for Helen Keller International (HKI) in West Papua (Indonesia), Dr. Haddad realized he wanted to specialize in public health and not limit himself exclusively to clinical ophthalmology. His global interest was further expanded when he was introduced to work on tropical diseases, especially onchocerciasis (or river blindness) and trachoma while working with HKI in West Africa. At Atlanta’s Emory University, Danny went looking for opportunities for students in public health in eye health care. Surprisingly, while working on the US needs in Georgia, he recognized that even in America, there is a great need for more inclusive health care. This deficiency became even more evident when one of his students began a screening program for migrant farmers in Georgia.
At this point, Dr. Haddad saw the need to develop a vision 2020 plan in Georgia. He rallied organizations working in eyecare, like Prevent Blindness Georgia and the Lions Lighthouse Foundation, to come together at Alcon and develop ways to identify children’s vision needs early. They planned to work together to build an early-detection screening strategy that could be used throughout all the schools in Georgia. This collaboration continues even today with annual World Sight Day presentations and screenings, which are all still vital for eye care amongst marginalized families.
He recognized the opportunity to look globally again when offered the position as the Global Programs Director for Orbis International, where he worked to find a global avenue to share lessons learned through managing programs developing telehealth and training. CyberSight, specifically, was designed to provide technological training opportunities to reach many audiences. These programs ultimately were a vital framework that was in place and ready to assist on-the-ground programs through the upcoming COVID pandemic.
Today, Dr. Danny Haddad is in his second year as the Inclusive Eye Health Director for the Christian Blind Mission’s Global Disability Inclusion, and it has been a fantastic experience. He began working with CBM Global recognizing the role as an opportunity to give back more directly to the global community of eye healthcare. CBM Global has ongoing programming spanning 12 countries, including Bangladesh, Bolivia, Indonesia, Kenya, Laos, Madagascar, Malawi, Nepal, Nigeria, Papua New Guinea, Philippians, Rwanda, and Zimbabwe. Dr. Haddad explained to Megan Webber, Co-founder of Know the Glow, that three components represent the essence of CBM Global’s focus when targeting inclusive eye health, namely having a global vantage point, ensuring continuity of care, and developing a comprehensive care approach.
Dr. Haddad emphasized to Megan that first, you must start with a focus on the big picture and have that global view. It is vital to consider how your organization plans to work with nonprofits such as the International Agency for the Prevention of Blindness (IAPB) while allowing your program to simultaneously meet the scope parameters of the World Health Organization (WHO). Megan found it very interesting that Dr. Haddad is also careful to consider the national-level access to eye health care for people with disabilities to ensure the visual needs elements of their disability are being met. Dr. Haddad has an intern who has been reviewing national eye health strategies to identify strategies currently in place that consider advocacy needs for people with disabilities as part of their planning process. It is essential to ask questions regarding the infrastructure and the equipment in outpatient units and accessibility, then, for example, for someone in a wheelchair. Providing a slit lamp exam on a patient in a wheelchair is no easy task so planning to be sure all people can receive a complete eye exam without being hindered by any other associated physical disability.
This point led Dr. Haddad to the second CBM Global’s focus element, the importance of continuity of care. He stressed to Megan that regardless of the stage of the patient’s disease, it is imperative that you ensure they will receive the long-term support they need. Often, a person is told that nothing more can be done for them, but Dr. Haddad stressed that this should not be the last thing that a patient hears. Even if a case is advanced or the patient finds themself at the end of medical treatment options, there is a focus needed to ensure for the patient that “we will make sure we can provide or recommend partners for low vision or rehabilitation services to keep the care going.”
CBM Global’s third component is the need for a holistic approach to eye care. Traditionally, curable cataracts have been their primary focus. Still, Dr. Haddad shared that CBM Global wants to expand more broadly into pediatric conditions such as Retinopathy of Prematurity (ROP) as well as diabetic retinopathy, which over the next 10 -20 years is expected to increase dramatically. Screening for both of these conditions needs to be integrated into the process. Additionally, screening for Strabismus is important because if you catch it before the age of five, it is often correctable with good visual outcomes. When Dr. Andrew Blaikie of the Arclight Project introduced Dr. Haddad to Megan and KTG, Dr. Haddad was very interested because there is very little screening from 0-5 years of age in pediatric work. Most of the screening is school-based, and even then, it is not carried out systematically everywhere.
CBM Global has a department which focuses on comprehensive efficacy – assessing eye care plans and how they are being implemented. In line with having a more holistic approach, CBM also offers community mental health programs. A person who is blind is four times more likely to suffer from depression, for example. In addition to patient issues, the whole family needs to be considered. Dr. Haddad lamented to Megan that a parent’s stress and anxiety levels can be high when their newborn is in a neonatal ICU for 4-6 weeks. Dr. Haddad also works closely with CBM Global’s director of community mental health to ensure mental health support in these acute settings.
Seeing so many pilot projects begun and developing a more comprehensive and collaborative global network has Dr. Haddad hopeful and excited for the future. He hopes to have a pilot program, possibly in Madagascar to train midwives there with the Arclight to perform fundal reflex screening. Such a program is possible because they have already trained and are mentoring ophthalmologists there. Dr. Haddad wants to develop a sustainable way to screen these children, catch blinding eye conditions early, and then have a referral system solidly in place for treatment and follow-up. Working alongside Dr. Blaikie, Danny wants to strengthen the primary care countries like Madagascar and identify ways to integrate the Arclight into the primary levels of care where vaccinations occur. There are many possibilities, but CBM Global needs more data to see where screening would be the most effective and efficient.
Dr. Haddad and Megan agreed that there is no point in screening without a referral system in place leading to an equipped resource. Synchronicity is required to have optimal capacity at all system levels, from screening to treatment and through to follow-up. KTG is confident that with Dr. Haddad at the helm of CBM Global’s eye care programs, these global healthcare ideals could become a reality in countries far and wide, regardless of their income levels. With the passion and vision of such global eye health advocates, there is no telling what the world will soon accomplish thanks to organizations like CBM Global and visionaries like Dr. Danny Haddad.
(For more information about Dr. Haddad and CBM, please go to https://cbm-global.org)