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One To Watch | Mar/Apr '19

One to Watch: Doaa Sobeih, MD

Dr. Sobeih is a student at the Harvard Kennedy School at Harvard University, where she studies health policy, global policy, and leadership as part of the mid-career Master of Public Administration program

1. Please share with us your background.

I was born and raised in a middle-class family in a small city called Mansoura, located in the Delta region of Egypt. I was fortunate to be raised by loving parents who prioritized education above all else. I completed medical school in 2008 and an internship year at Mansoura University Hospital prior to starting my residency in ophthalmology at the Ministry of Health. As an ophthalmology resident in a government hospital, I interacted with a large number of visually impaired patients on a daily basis. This experience brought to my attention the importance of public health and clinical efforts to reduce blindness in Egypt.

In 2011, I moved to Matrouh to continue my ophthalmology residency in an underserved area of the country. This city, located in the far western region of Egypt, suffers a significant shortage of physicians and medical facilities as a result of chronic unequal workforce distribution. A desire to broaden my scientific background and research skills led me to seek an opportunity to study abroad. In 2012, I moved to the United States for a research fellowship at the Massachusetts Eye and Ear Infirmary at Harvard Medical School, where I participated in a range of ophthalmic research studies.

I then had my first experience in basic science research working in a retina laboratory at Augusta University. During this time, I served as a first author on a peer-reviewed journal article based on my work. In 2014, I joined Lahey Clinic Hospital in Massachusetts for a 3-month clinical and research fellowship. After that, I returned to Egypt to finish my residency and to obtain a master’s degree in clinical and surgical ophthalmology.

2. What drew you to ophthalmology and, specifically, to your field of interest?

As a medical intern at Mansoura University Hospital, I had the opportunity to volunteer for campaigns to provide health services in underserved areas in Egypt, such as Matrouh, South Sinai, the New Valley, and the Red Sea governates. As a volunteer, I was surprised by the large number of patients with curable blindness such as cataract—people who were blind because of limited access to eye care due to a lack of resources and a shortage of local ophthalmologists. Unfortunately, disease prevention through early detection is a concept that is often neglected and deemed unnecessary in Egypt’s rural and underserved areas. People seek medical assistance once they are blind or have such extreme visual impairment that irreversible blindness is unavoidable.

A few years ago, in Matrouh, I met a patient who presented with complete blindness. He had been living with diabetes for 30 years and had gradually been losing his vision. He, however, thought this visual decline was normal, as he was getting older. He was not aware that diabetes would impair his vision, and he was never instructed to follow up regularly with a retina specialist. Through this experience, I came to realize the complex interaction between health and social factors such as poverty, lack of awareness, deficiency of health education programs, and poor resources. Ultimately, that patient helped me find my calling, and for that I am grateful.

3. Please describe your current position.

I am currently a student at the Harvard Kennedy School (HKS) at Harvard University. I was awarded the Arab Republic of Egypt Public Service Fellowship, which funded my degree. My studies are focused mainly on health policy, public policy, and leadership. Joining HKS for the mid-career Master of Public Administration program has been a transformative experience, through which I have gained a better understanding of the economic, social, political, and demographic aspects of public policy. Studying at HKS will help me to achieve my dream of fighting blindness through the proposal and implementation of policies that address the related public health challenges.

Prior to joining HKS, I was a practicing ophthalmologist at Mansoura Ophthalmic Hospital, Ministry of Health, Egypt. In addition to my clinical work, I am the founder and director of the hospital’s Public Health and Blindness Control unit. It was impossible to convince government officials to allocate part of the Ministry of Health funds for health screening or health education programs, so I had to think of unconventional ways to obtain funding. I recruited volunteers, raised donations, and convinced pharmaceutical companies to sponsor those campaigns. I was privileged to lead such an outstanding group of students and residents, and, in a few months, we were able to run several successful campaigns in Egypt’s Delta region.

The first campaign, directed toward contact lens wearers, was for early screening and education on healthy contact lens usage and lessons in avoiding complications of long-term wear. Our second campaign was for diabetic retinopathy and included a clinical screening examination, health education, and a questionnaire to investigate patients’ awareness of the disease. Our third campaign included a screening of the causes of microbial keratitis among patients living in the Delta.

In collaboration with the Al Maghrabi Eye Foundation for Community Eye Health, we created a training program for primary care physicians working in the Delta on the basics of eye care as a way to combat blindness in rural areas. We conducted three workshops, during which we were able to train 60 local primary care physicians. We also ran other survey-based studies among ophthalmologists working in the Delta to screen the practice pattern for prevention of infection following eye surgery.

4. Who are your mentors?

I am grateful for my parents as my first and lifelong mentors. They will always be my source of inspiration and have been a major asset in my journey and in my personal development. In my career as an ophthalmologist, my friend and first mentor was Mostafa Kabiel, MD, who passed away in 2015. He was the first person who inspired me to be an ophthalmologist during my internship year. He taught me how to be a curious physician and scientist, which I believe has contributed to my success.

Additionally, Paul Cotran, MD, director of the glaucoma service at Lahey Hospital and Medical Center, is a continuous source of inspiration to me, and I believe that meeting him was a turning point in my life. Dr. Cotran and I published a clinical research paper together for which I was the first author. He has helped me with many career decisions and was the first to encourage me when I started to explore the field of public health. His mentorship has never waned, and I am lucky to have his support. Another important mentor of mine is Mohamed Alshabrawey, MD, of Augusta University, who taught me basic lab science from scratch and how to write and publish a paper. He has never stopped supporting me, and I have learned so much through his mentorship. Demetrios Vavvas, MD, PhD, was also a major supporter of me when I worked at Massachusetts Eye and Ear Infirmary, and I felt fortunate to work under the supervision of such an incredible scientist and teacher.

5. What has been the most memorable experience of your career thus far?

Informing patients about their blindness is one of the most challenging aspects of practicing ophthalmology. Their inability to see their loved ones is incredibly painful, and I am driven to help ease this suffering.

One of the most remarkable experiences I have encountered was during my medical internship, before I became an ophthalmologist. I was assisting an ophthalmology attending in a campaign for Bedouins living in South Sinai when I met a young woman who had become blind 6 years earlier due to bilateral corneal opacities. She had a 5-year-old child, and she had never seen him. It was a very emotional moment when the attending told her that her vision could be restored by corneal transplant surgery. It struck me that this woman lost her eye sight due to infections that could have been treated earlier if she had access to adequate eye care. This experience made me feel a sense of responsibility and a sense of purpose and confirmed my interest in ophthalmology.

6. What are some new technological advances that you have found particularly exciting? Which advances in the pipeline are you most enthusiastic or curious about?

I like the new portable fundus cameras for diabetic retinopathy screening and glaucoma evaluation in rural areas and for use in telemedicine consultations with remote eye care providers. However, in my country, we are not yet at the level where the latest technology is always the most appropriate or necessary. We still lack even basic ophthalmic technologies such as OCT, Humphrey Visual Field Analyzer (Carl Zeiss Meditec), and phaco machines in many underserved areas of Egypt.

7. What is the focus of some of your research?

In 2014, I returned to Matrouh to continue my residency training. Through my exposure to ophthalmology abroad, I noticed the high rate of blindness due to cataract versus the extremely low rate of cataract surgeries performed per year. It was evident that the lack of facilities, well-trained physicians, and resources, along with inadequate surgical training for local ophthalmologists, were behind the problem.

The prevalence of blindness can be significantly reduced by strengthening the health care system. Therefore, I have designated a nationwide research project titled “Factors Associated with the Choice of Ophthalmology as a Future Career in Medicine” that aims to address the reasons for the deficiency of ophthalmologists in underserved areas of Egypt. This study will clarify which factors shape the career choice of ophthalmology, will help policymakers better understand the motivations to enter the field, and may improve the availability of ophthalmologists in these areas. It will be an essential step in upgrading the health care services provided in underserved regions of Egypt.

Women’s empowerment in the medical field is necessary to increase their presence in surgical specialties and leadership positions. Recently, a team of colleagues and I created a survey-based study entitled “Egyptian Women in Ophthalmology; Cataract Surgery Training and Subspecialty Preference.” The idea behind this project was to survey Egypt’s female ophthalmologists to determine the factors that interfere with obtaining high-quality surgical training and to investigate their career aspirations. Our findings were presented at the 2018 ESCRS meeting in Vienna. We anticipate that these results will contribute in a meaningful way to the goal of improving ophthalmology training for women in Egypt, which will increase the supply of qualified eye surgeons.

8. What is a typical day in your life? What keeps you busy, fulfilled, and passionate?

I wake up every day ready to be inspired. I remind myself daily that there are 1 million blind and 3 million visually impaired people in Egypt who count on us to improve their quality of life. I also tell myself that every opportunity, every skill I acquire, and every piece of information I learn will help me achieve my goals. My classes at HKS start early in the morning, and I spend the rest of my time studying, listening to speakers in different fields from around the world, and socializing with my incredibly diverse group of fellow students. In the evening, I walk for an hour and then take another hour to read and listen to music before bed.

9. What advice can you offer to individuals who are just now choosing their career paths after finishing residency or fellowship?

I have five tips to share:

1. Pursue your passion, and success will always follow.

2. Live with a sense of purpose to improve others’ lives.

3. Don’t be afraid to take risks and explore places you know nothing about.

4. Don’t wait for the perfect time to do what you aspire to do—it may never come.

5. Move out of your comfort zone and into the learning zone in order to evolve.

When I decided to move to the United States in 2012, I was concerned about leaving my family, friends, mentors, and my country to move to a new place with a different language and culture. If I had allowed my fears to stop me, I would not be where I am now. Also, when I started out in the public health unit in Mansoura, I was not sure I would achieve any success due to the lack of resources and manpower. However, I decided to take the risk, and I now believe it was one of the best decisions I have ever made.

10. Tell us about an innovative procedure you are performing or a new imaging/diagnostic tool that has improved your practice?

Working in the field of community eye health in a country like Egypt, with almost no public health funding, has made it very challenging to move forward with screening programs for remote areas. Therefore, I am grateful for recently developed cell phone technology. The use of free applications for visual functions such as visual acuity, color, and contrast sensitivity, in addition to fundus cameras that can be attached to smartphones, has made it easier to perform quick vision screenings.

Neda Shamie, MD | Section Editor