Heroes of Orbis: Dr Ambati

Cornea specialist, Dr Ambati, has been an Orbis volunteer since 2006, taking part in 9 programmes across 3 continents. Since the pandemic began, Dr Ambati has supported doctors around the world via Cybersight. On the 15th October he delivered a webinar: Cornea on the Cutting Edge, supported by the Qatar Fund for Development.

Dr Bala Ambati, Cornea Specialist at Pacific ClearVision Institution. Dr Ambati is the youngest person to ever qualify as a doctor and has been working in the field of cornea for over 20 years.

You have a truly unique story for your journey into medicine, can you give us a little bit of your background?

My family came to America from India when I was three. I grew up on the East Coast and I think I always wanted to be a doctor. When I was four, I was burned on both of my legs and spent three months in the hospital. It was here that I first started thinking about what doctors do. I had three operations and it was formative seeing how nurses and doctors looked after me, it had a big impact. Growing up I was also always interested in biology, so it was a natural path to becoming a physician.

In terms of why I chose ophthalmology, during medical school you undertake different rotations, for example, general medicine, paediatric care, surgery, emergency etc… With ophthalmology you combine everything and have the ability to take care of patients of all ages. You see all different types of diseases, get to do exquisite procedures, and help support patients of all ages over time. Ophthalmology is dynamic and exciting with constantly evolving technologies.

I had an interesting start to my career. I began school at age six like everybody did, but I completed two years of school each year, finished early and went on to medical school (becoming the youngest person to qualify as a doctor). Everything I’ve achieved has been through God’s grace, my family’s support, parents, and brother. By finishing training early, I was able to finish my fellowship in cornea by 24, and now at 44 I’m pretty well experienced in the fields of cornea and cataract and have learnt a lot of things. I’m fortunate to continue learning and contributing to ophthalmology and working with wonderful people.

How did you become aware of Orbis and what motivated you to start volunteering with us?

I first learned about Orbis through my mentor Dr Roberto Pineda, from Boston. I always wanted to join and then I had the opportunity in 2005 to apply. Soon after I was able to go on my first programme to Ghana in 2006. This was my first time working with my good friend Hunter (VP of Clinical Services, Orbis International) on the Orbis Flying Eye Hospital. I had met him before in training and we’ve been friends ever since.

I’ve undertaken three programmes in India, Indonesia, trips to Panama, the Philippines and Malaysia and worked on both Hospital Based Trainings and Flying Eye Hospital programmes.

Can you tell us what it is like to volunteer on an Orbis programme?

It’s rather nostalgic to think about my work with Orbis with all the big changes we’ve experienced over the last few years. When there were in person programmes, it’s a very impactful week. Its’ high intensity long days. On day one you focus on meeting patients and deciding who are the best surgical candidates. We discuss plans with the medical teams we are training, and on Tuesday, Wednesday and Thursday we operate. Friday is dedicated to post-op work and lectures. This is one of the very good things about Orbis programmes, they’re focused on skills transfer and teaching and sharing knowledge. We’re increasing the capability of local surgeons, but not just the surgeon, the whole eye care team to ensure everyone from the nurses to the anaesthesiologists, the sterilisers, etc… the whole eye care team is supported. This is unique. Orbis programmes are not just about not flying in and out, it’s about leaving a legacy behind.

How has your support of Orbis changed during the pandemic?

Last year I delivered a Cybersight seminar on 'Crosslinking Approaches for Keratoconus' and then I contributed to the distance learning Cameroon paediatric ophthalmology programme. The 'Cornea on the Cutting Edge' webinar, delved into the latest developments in this subspecialty. I consider myself a friend of Orbis and I’m always happy to help in whatever way I can.

What are the benefits of Cybersight?

Having a global forum like Cybersight where you get to interact with fellow ophthalmologists around the world is unique and special. In addition to a platform where we can deliver seminars, Cybersight is also a space where local ophthalmologists can present challenging cases and gain advice from Orbis volunteers, find resources and a community which has become even more important during the pandemic.

Can you tell us about a patient you have treated who has really impacted you?

When I was in the Philippines, I treated a young girl who was 10 years old and had lost her lens in an accident several years before. She hadn’t seen for probably half of her, life yet all we had to do was replace the lens, insert new one, it took ten minutes and was a fast procedure with a huge impact. She could see! She wasn’t missing seeing things to the right of her as that’s where her vision loss was. She could be a normal little girl, and to help somebody like that, it’s amazing to know you’ve now probably affected 60-70 years of their life.

Is there a specific Orbis programme you really enjoyed and why?

Having family in India and through my cultural heritage and ties to the country, those trips with Orbis have always been very special and meaningful. But of all the programmes I have been on with the charity, the most unique and special have been to Panama, Indonesia and the Philippines, where we trained local teams on cornea transplants. I have stayed in touch with many of the doctors and provided on going mentoring. With cornea transplant programmes, when you’re doing transplants together and teaching local surgeons, either with full or partial thickness transplants, these are long surgeries, and the follow up is very in depth, so I think those programmes led to long lasting bonds.

What are the challenges to treating cornea disease / injuries in areas with limited resources?

There are a few difficulties with undertaking cornea focused work in countries with more limited resources. A significant barrier can be a lack of refrigeration. It’s necessary to use a cornea within two to four weeks following the death of a donor and to have a good place to store - an eye bank. This can be a challenge in many low- or middle-income counties alongside the rate of donation. The US is a leader, as is India and Sri Lanka, however much of the rest of the world are not commonly undertaking donations and therefore import corneas. To complete the surgery, there are a lot of visits with the patient, we monitor and take care of them for months and years afterwards. This is another contributing factor as to why I continue to have good connections to so many of those I work with with Orbis, as we do keep in touch and support the patient for the long term.

Are there any conditions you see more often when working on an Orbis programme?

When working on an Orbis programme, the conditions we see are in a much more advanced stage of development. There may also be a lack of imaging, instrumentation, physicians or a lack of medical infrastructure which we often take for granted. In the US, people often have cataract surgery when they can’t drive or read or play golf, but in India, Africa, or other places, it’s sadly when that person can’t see the food on their plate, so the impact of their vision loss has far reaching implications, not only for the patient but their families and communities.

Everything is more challenging, with the advanced stage of eye conditions, the treatment is more technically difficult and you’re not in your home environment. This makes things more complicated but it’s good and shows how we adapt and develop to meet the task at hand.

What does training mean to you?

Orbis and Sight Life, another organisation I support, are oriented on building skills and infrastructure in areas with limited health care investment, that’s how you make the biggest difference. Teaching a man to fish as they say. It’s not only what you do in the week you’re there with Orbis, but trying to make a mark in the local community for many years to come.

I’d like to say thank you to all the peo­ple I’ve worked with, from nurs­es, anaes­thetists, com­mu­ni­ca­tions staff, doc­tors and trainees. It’s been a priv­i­lege work­ing with an organ­i­sa­tion that makes such a huge dif­fer­ence every sin­gle day
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