Wearing different caps
Young ophthalmologists were among those drafted in to fight the COVID-19 pandemic in Morocco. Imane Tarib MD reports
Imane Tarib MD
The Coronavirus pandemic hit Morocco in early March, I clearly remember the first cases being announced, schools and public places closing up as well as borders, all in the span of a week or less. The lockdown announcement and necessary measures were taken in record time as soon as the first cases appeared.
The country has been dealing with the crisis in an impressively efficient way. Although no one had been through a similar thing before, rapid and wise decision-making that was daily communicated to the nation played a big role in controlling the situation and holding the citizens accountable. The mortality rate on the day I am writing this is around 2%.
As for healthcare, the Ministry of Health deployed outstanding means. In few days only, new facilities were available, hospitals were deployed to receive and take care of COVID-19 patients, various departments, other than infectious diseases, completely switched their settings and activities over night to help control the situation.
And in the midst of this wave, young ophthalmologists played a big role on various levels.
As some fellow residents in different specialties, many ophthalmology residents were assigned to COVID-19 departments full time. After refreshing their ICU training and working along other colleagues, many found themselves making admissions and triage, swab tests, follow-up of patients, care in ICU units…
Certain ophthalmology departments across the country were fully transformed into COVID-19 units, either for isolation, monitoring or life support. In the span of few days only, many ophthalmologists had to wear different caps to take care of patients with a scope of diseases and symptoms that have absolutely nothing to do with their field of expertise, that is the eye.
The Moroccan Society of Ophthalmology guidelines and support were crucial in setting a unified plan to tackle the new situation as ophthalmologists. It directed towards postponing all elective procedures and non-urgent clinics, and maintaining emergency consultations and surgeries.
Young ophthalmologists, both specialists and those in training, were the main providers of all available eye care in the kingdom for a while. Certain ophthalmology departments kept an in-patient activity solely for management of life and sight-threatening emergency cases and surgeries, which was the case in my current department. We kept a daily virtual log with our head of department and the professors, where we discussed emergency cases together and sought guidance for uncertain situations.
The particularity of certain cases was tricky on non-medical levels, I would mention the specific cases of paediatric patients coming from remote regions, and the delicate details regarding companions, and the benefit vs risk balance of in-hospital care in the midst of a pandemic. This virtual mentoring was really helpful, for those reporting duty on the spot, and for those staying at home.
However, like all trainees around the world, young ophthalmologists were faced by many personal challenges depending on where they are in their careers. Residency trainings in the hospital were suspended for a while, and this affected the youngest in a different way than it affected the senior residents. For example, younger residents had all their exams postponed as well as a big part of their training on hold, as they only carried emergency calls. The senior residents, who usually focus almost exclusively on enhancing the surgical training in the last months of residency training, had that taken away from them. Additionally, board examinations were postponed across the country.
Some freshly graduated ophthalmologists had a tough time as well, especially those who had set up their private practices a few weeks or months prior to the lockdown. The first period of private practice, which is usually tough on everyone, was particularly challenging in this pandemic. The financial burden specifically has been a concern to these young ophthalmologists, who usually commit to large loans in order to provide necessary costly equipment for a basic ophthalmology practice. Subsequently, the Moroccan society of Ophthalmology deployed a team to investigate the different effects on practices in the private sector in order to come up with adequate solutions.
On the bright side, when it comes to continuous medical education, this crisis was an opportunity in disguise. Excellent educational content flourished in this period with emergence of virtual grand rounds, scientific webinars and open access to most of what used to be exclusively presented in conferences and meetings.
And although this has been tough on young ophthalmologists, it probably gave a good, arguably needed, push to the incorporation of telemedicine, as many were obliged to explore different means to provide eye care to their patients despite the lockdown.
Imane Tarib is a Senior Resident in Ophthalmology at the Military Teaching Hospital Mohammed V, Rabat, Morocco, as well as being the Founding President of the Young Ophthalmologists of Morocco (YOM)