Professor Ho-Seok Sa of the Department of Ophthalmology

Asan Medical Center (AMC) Professor Ho-Seok Sa of Ophthalmology was invited to Bahrain for the ‘2022 Visiting Doctors Program’ hosted by the Ministry of Health of Bahrain. He visited Salmaniya Hospital in Manama, the capital of Bahrain, from October 30 to November 4, providing medical treatment, conducting surgeries, and presenting lectures. Professor Sa shares his experience in the Visiting Doctors Program to provide information to medical professionals who are interested in international medical affairs.

Bahrain, New Challenge

“I am meeting the ambassador on a business trip to treat patients?!?” I thought the business trip would be simple, but I felt something huge was coming. I planned to do some sightseeing as it was my first visit to Bahrain and perform several surgeries. However, being invited to lunch with the South Korean Ambassador to Bahrain was the last thing I had in mind.

About 6 months ago, working as usual, there was one email that caught my attention while checking my email. In the email, the Ministry of Health of Bahrain was looking for an ophthalmic plastic and reconstructive surgery specialist for visitation, and that I should submit the attached application if I were interested. I thought, ‘Is this some kind of medical missionary? Where is Bahrain?’ As it turned out, Bahrain was a small island country east of Saudi Arabia, which extended an invitation to doctors from abroad for a short period of time for patient treatment and physician training as there was a shortage of ophthalmic plastic and reconstructive surgery specialist at the moment. For this, the Ministry of Health of Bahrain, Global Healthcare Business Center of Korea Health Industry Development Institute (KHIDI) and Asan Medical Center (AMC) were cooperating to encourage the participation in the Visiting Doctor Program. I was not eager to put on extra work because the usual number of patients coming to AMC was more than enough already and surgeries were even backlogged, so I let the thought escape my mind. However, Bahrain kept lingering in my head for several days. ‘It seems there are many patients whose conditions could not be treated for some reason. Shall I go and provide treatment for the betterment of patients?’ I kept thinking. Eventually, I decided to go to Bahrain and attempt new experience by slightly adjusting and adding extra treatment schedules. Thus, I replied, sending my application and resume.

2 to 3 months later, I received an official invitation from the Ministry of Health of Bahrain. With the help of Asan Medical International (AMI), the international affairs team in AMC, the schedule was set to visit Bahrain early November and initiated the overseas business trip process. I was also introduced to the Chief of Ophthalmology in Bahrain and started communication through social media. We communicated constantly about and prepared a rough list of surgeries that Bahrain wanted and instruments and equipment that will be necessary for the surgeries that I planned to perform. I took and sent the photos of surgical instruments and decided to personally obtain several consumables which were difficult to prepare in Bahrain. I was able to proceed the preparation process without much difficulty as AMI supported me in each and every step.

After all preparations were finished, I finally set off. I arrived in Manama, the capital of Bahrain via Dubai on Sunday, October 30. With a size of one third of Jeju Island, Bahrain is the only island country and also the smallest one in the Middle East with a population of 1.7 million. Bahrain is one of the two countries along with Jordan where liquor and pork are sold in the Middle East, and women’s social participation is relatively free. The way people dressed on the streets was relatively free and open compared to other Middle East countries, I thought. Right after checking in to the hotel, I went to a Korean restaurant to meet South Korean Ambassador to Bahrain Hae Kwan Chung. I was able to learn about the local situation in Bahrain, its relationship with South Korea and even historical background over a talk with Ambassador Chung and researcher Jang Hoon Lee. Ambassador Chung mentioned, in particular, that the demand for various private medical exchanges is growing with the increasing positive awareness of South Korea and its medical care in the Middle East. He also encouraged me by saying that he is also interested in such medical exchanges and is expecting a lot from this visit. Researcher Lee added with an explanation that South Korean insurance system was taken as a positive model in establishing the medical insurance policy of the Bahrain government, with exchanges at the government level. While there were a few cases where international physicians came to a national hospital in Bahrain to provide short-term medical care, most of them were from neighboring Middle East countries or Europe. It was the first time for a Korean healthcare professional to visit a public hospital. Upon hearing this, I suddenly felt butterflies in my stomach and lost appetite to the ever so delicious meal. Researcher Lee further expressed his hope that many more healthcare professionals from AMC, as a medical institution representing South Korea, would help medical exchanges with Bahrain. I became more motivated realizing that I should really put all my efforts in having to play a role as a civilian diplomat taking the responsibility of the image of AMC as well as my country.

▲ [Left] Together with Dr. Maitham(center) and Dr. Ali(right) who were very supportive during treatment and surgery

▲ [Center] Professor Ho-Seok Sa(left) performing endoscopic lacrimal drainage surgery

▲ [Right] Professor Ho-Seok Sa(right) performing ptosis correction and blepharoplasty

Treatments, Surgeries, Lectures… ‘Wish I could split myself into two!’

Early the next morning after my arrival, I headed to Salmaniya Hospital, the largest national hospital in Bahrain. The scheduled involved outpatient treatment on the first day and surgeries for the next 3 days. I had a meeting with ophthalmology staff after arriving at the hospital and immediately went on presenting a lecture to ophthalmology professors, fellows, and residents during the morning conference. I introduced various cases and surgical approaches regarding orbital surgery at AMC and also lectured about orbital reconstruction using 3D printing. I was grateful to have many questions probably because it was a lecture on a topic not frequently covered. I took a quick look at the ophthalmology outpatient service area and immediately went into outpatient treatment. Many patients made appointments during my visit, and there were many cases where necessary examinations had been conducted appropriately. The number of patients I treated were about 60% of the patients I had all day at AMC. However, it took longer than usual because all were new patients, most required surgery, and the supporting staff was working with me for the first time. Still, thanks to the dedicated help from ophthalmology fellows and residents who came in as outpatient assistants, everything went well without much difficulty than I had expected. I communicated directly with patients who could speak English, and Bahraini doctors translated English and Arabic for other patients. I also performed procedures in between outpatient sessions at the procedure room in the outpatient office. This was particularly the case for simple procedures because the number of procedures that could be performed for 3 days was limited. While Bahrain is quite a wealthy country with a per capita GDP of 20,000 dollars, many patients came after their disease has become chronic whether due to the gap between the rich and the poor or lack of ophthalmic plastic and reconstructive surgery specialists.

After the outpatient sessions were finished, I discussed with Bahraini doctors to confirm patients for surgery. Thus, 21 cases were selected to be performed within 3 days. Given that most ophthalmic plastic and reconstructive surgeries take at least an hour and up to 2-3 hours, the schedule was a bit hectic. However, I could not ignore patients who obviously needed to undergo surgery. I saw but looked away from the puzzled look on the face of Bahraini doctors for scheduling more surgeries than expected. I confirmed the schedule thinking that it will be a chance to test my physical strength. Surgeries started from 7:30 in the morning and mostly until 7:00 in the evening. I had my lunch at the doctor’s lounge in the operating room, a lunchbox with a Middle Eastern twist. A wide range of surgeries were performed. Surgeries with local anesthesia including ptosis correction, upper/lower blepharoplasty, and entropion/ectropion and major surgeries with general anesthesia including endoscopic lacrimal drainage surgery, orbital tumor removal, exophthalmos correction, and orbital decompression were performed. After each surgery, I wrote down detailed postoperative prescription and management plans and delivered the note to the residents. It was a bit uncomfortable to not have a place to rest when I had free time between surgeries. However, I was able to get adjusted and become comfortable rather quickly because I had a lot of time to socialize not only with the ophthalmologists there but also with anesthesiologists, plastic surgeons, otolaryngologists, nurses, and even the janitor. It seemed that people were amazed to have an Asian doctor work there and some doctors unexpectedly wanted to take pictures with me, which was surprising to me as well. Korean finger heart also never failed to brighten up the faces of those taking pictures, and my rather ridiculous joke that goes, “The most popular sports in South Korea are baseball, soccer, and Squid Game,” worked well even in Bahrain.

In the morning, when ophthalmologists in the operating room still had some energy, I used surgery turnover time to give four short lectures using the materials I had prepared. Many were particularly interested in eyelid plastic surgery and procedures in South Korea, and I got closer with young doctors by kindly answering their jokes of asking the whereabouts of IU and Ye-jin Son. I would say, “Right, they are doing fine, really. I don’t hear from Ye-jin much after she got married…” Although I was physically a bit challenged from 12 hours of intensive work, I felt quickly recharged, pleased and rewarded whenever patients and their guardians shouted out “Asan!” in an unnatural pronunciation and gave me ‘thumbs up’ after surgery. I was having a sort of delusions of grandeur that the image of the Department of Ophthalmology, AMC, and even South Korea somehow depended on me. It was a moment when I realized that people become patriotic when they go abroad. The help of Bahrain ophthalmology fellows and residents were impressive as well. I was told that all business in Bahrain is usually closed at 2:00-3:00 in the afternoon, and hospitals are no exception. During the 4 days I worked there, they had to work 12 hours until late in the evening, which could have been annoying. I was so grateful that they did not once complain and did their best to the last minute. It was fortunate that I could complete quite many surgeries without any incidents thanks to the active help of the local medical team.

▲ [Left] Dinner with the medical staffs of Salmaniya Hospital

▲ [Right] Commemorative photo with the medical staffs and their Korean finger hearts

Meaningful connections made through medical skills

Though this Visiting Doctor Program in Bahrain, I got acquainted with Salmaniya Hospital’s Chief of Ophthalmology Maryam Al Mohsen. We became close quickly because she was about the same age with me and had a good personality. I once had an opportunity to have a dinner at a fine restaurant during my visit to Bahrain with ophthalmology professors, fellows, and residents. I remember well that they were all kind and full of curiosity, and the pleasant conversation went on and on. Dr. Maitham, a fellow in a different department, always supported me like my fellow during my visit and was a good friend with whom I shared a special friendship calling each other ‘brothers.’ Later, as he became interested in doing a fellowship in South Korea, I informed him about international physician training program at AMC. On the last day of my departure, Chief Maryam and Professor Ghada of the cornea unit spent time with me in the morning, and thanks to them, I was able to make a short visit to historical sites of Bahrain and a lively market. I also had an opportunity to visit the Bahrain National Museum which is known for being constructed by Hyundai Engineering & Construction. Although Bahrain is a small country in the Middle East and politically not free from interference from powerful nations nearby, it has a strong sense of pride in its culture and history and the people are kind and warmhearted. All these made me feel that Bahrain and South Korea have great resemblance to each other. Young Bahraini doctors are relatively active in doing fellowship overseas. While the U.K. and Europe were preferred destinations in the past, quite a few doctors are going to Asian countries such as Hong Kong and Singapore recently. In particular, with the soaring interest in K-culture and medical care, it seemed to me that the possibility and potential is great for future human resource exchange in the medical field.

Even though it was a short period, this experience of training medical professionals in Bahrain will stay long in my memory. I once again felt proud about AMC’s high medical standard and South Korea’s efficient medical system which were forgotten for treating patients in familiar surroundings. In addition, I came to hope that more medical professionals of AMC go abroad to have an opportunity to personally feel rewarded and enhance the image of AMC. Such a wish was the reason for me to write this article despite my lack of writing skills. Lastly, I would like to thank AMI team members including Director In-Ho Jeon for their immense support from beginning to end. My Bahraini friends sent me texts and photos after every World Cup match of South Korea, but no more now because of Brazil. Then, my next destination… Brazil?