Ophthalmology Times Interview

A few weeks ago I was contacted by a writer from Ophthalmology Times, a biweekly nationwide publication that goes to every ophthalmologist in the United States. They wanted to do a story about me -- you know, guy in the middle of nowhere. The story is up on their website. Click here to read the article. I didn't realize how much of the story would be about blogging.

(Edit: Actually, I'm posting the article here in case it disappears from their website.)

Practicing ophthalmology in Saipan

Apr 15, 2008 By:Noelle Creamer Ophthalmology Times

David Khorram, MD, meets many ophthalmologists who wish they could work internationally and make a difference in a society that needs their expertise. Some travel for a week or two every year and find opportunities to help around the world. But Dr. Khorram is living the dream.

He is an ophthalmologist in private practice on the island of Saipan in the South Pacific.

Finding his island

Dr. Khorram grew up in Kentucky and attended Northwestern University, Chicago, then the University of Kentucky for medical school, and then returned to Northwestern for his ophthalmology training.

"This was a very exciting time, and although I had the opportunity to pursue a career in academic medicine, my heart was set on serving a community that needed an ophthalmologist," said Dr. Khorram. "I had always wanted to serve internationally, so I sent letters all over the world, and ended up in the Pacific."

He spent a year as the director of ophthalmology at the Lyndon Baines Johnston Tropical Medical Center in Pago Pago, American Samoa, before going to the Commonwealth of Northern Mariana Islands (CNMI). For his first 5 years in Saipan, he worked at the Commonwealth Health Center before co-founding Marianas Eye Institute in 1998.

Different needs

Running an eye institute on this tropical island is different from doing so in the United States for several reasons, explained Dr. Khorram. "There are no subspecialists nearby for me to refer patients to," said Dr. Khorram. "I'm the only ophthalmologist serving the island. So when something needs to be done, I'm the one to do it.

"I handle a much broader range of cases than I would in the States," he added. "Many people here delay eye care, so I see a lot of end-stage disease. A good chunk of the cataract surgery that I perform is on white lenses. Diabetes is rampant, and a lot of people walk in the door for the first time with a vitreous hemorrhage."

The demographics of the island distinguish the practice, too. Dr. Khorram explained, "There is an indigenous population of about 20,000. People die young, often in their 50s. The rest of the population is made up of young, healthy contract workers from Asia who don't access health-care. I'm doing about 80 or 100 cataracts per year. That's just all there is on the island. Minimum wage is $3.55 per hour, and the average annual income on the island is around $11,000. So there isn't any significant disposable income for people to spend on the elective facets of eye care, which, from what I understand, is driving American ophthalmology—refractive surgery, presbyopic correcting IOLs, and cosmetic procedures. We provide a lot of free care and a lot of indigent care.

"Yet, I love my work because the people I serve are extremely appreciative," said Dr. Khorram. "Economics are obviously not the driving force behind working here."

A wired practice

Technology plays a huge role in Dr. Khorram's practice—in part because he values it and in part because his remote location demands it.

"I think our level of technology is probably not typical for even U.S. mainland practices," he said. "When ophthalmologists from Japan, Australia, and the US have passed through and visited our office, they have commented that the combination of technologies in our office far surpasses typical comprehensive ophthalmology practices in their countries.

"For example, because the people here are more visual learners than verbal learners, we have digital cameras attached to our slit lamps, which project images onto computer screens in the exam rooms. The families can watch the exam, and we can freeze the images and explain to our patients what is going on with their eyes. The pictures make sense to them, and the education helps them understand their condition.

"I'm also an early adopter of new technologies. Even though I'm in the middle of nowhere and not very busy, I still want to practice first-world medicine. Because of the technology, we probably look more like the sort of practice you'd see in an academic center, rather than in this tiny practice on a far-away island. We need the best in diagnostic equipment, because if we don't have it, it isn't available down the street.

"I also rely on telemedicine quite a bit. When I have a challenging case, I send the [images]—OCTs, retinal photos, anterior segment photos, visual fields, fluorescein angiograms, you name it—via the Internet to friends around the country. The digital imaging technology makes this possible. And my friends are a great help."

More than an ophthalmologist

But this cutting-edge practice is only part of the story, part of what sets Dr. Khorram apart. The rest of the story centers on the fact that Dr. Khorram has come to realize that who he is as a person is much richer as a result of his interests beyond his profession.

In addition to being an ophthalmologist, Dr. Khorram is a husband, a father of four, writer, blogger, stand-up comedian, coach, and more.

"Because the population of the island is relatively small, I'm not very busy. It leaves me a lot of time to pursue other things," he said.

In his blog Marianas Eye, he writes widely about daily life on Saipan, his practice, his travels, family life, politics, religion, history, geography, even the "wacko of the week." He shares beautiful photos of friends and scenery and—also a popular feature—the "gory eye" pictures.

He writes a weekly column for the local newspaper, and his first published book, "World Peace, a Blind Wife, and Gecko Tails: Intriguing thoughts from an island on making life happier and healthier, and laughing along the way," is now available from Amazon and other retailers.

He is also working on a few other books. "One of them is a collection of stories by a few friends about day-to-day life on Saipan, and I think that will be the first one that's completed," he said.

"I'm a writer, so blogging is a way to capture random thoughts and experiences and let others read about them," Dr. Khorram explained. "With blogging, readers can give feedback. Sometimes the pieces that appear on my blog develop into parts of other writing projects. So, in some way, the blog is like a laboratory for my writing.

"My audience is made up of people on Saipan who just want to check in and see what's going on with me and what's on my mind. I also seem to have a following that's scattered around the globe, but mostly in the United States. There aren't too many physicians who are blogging, and certainly not many in the South Pacific, so it all makes for an entertaining story, I suppose. Quite a few people come to my blog via search engines, looking for some specific piece of information that happens to be on my blog."

Dr. Khorram said he is trying his hand at stand-up comedy, too, organizing and participating in a comedy workshop. "I'm enjoying it. It's an opportunity to focus on the funny things in life and to make people laugh. You can't ask for much more than that."

Another way to teach

Another interest of his is education. He and his wife, Mara, founded Brilliant Star School on Saipan in 2000.

"When our first daughter turned 1 year old, she seemed a bit bored at home," Dr. Khorram recounted. "We looked around the island for an enrichment program of some sort, but none existed. So, Mara and I started doing some research and came across the work of Maria Montessori. We had a friend who was a teacher at a public school and was ready for a career change, so we banded together to open Brilliant Star School as a not-for-profit toddler enrichment program.

"The program started with 12 kids. The families liked the curriculum and the philosophy behind it, and so each year, we added more grades. Our goal became to give kids on the island the opportunity for a world-class education. Eventually, the government granted us a public land lease and six buildings, which we renovated."

Now, the school is on a beautiful hillside campus with 7,500 square feet of classrooms. About 100 children represent some 15 ethnicities, from toddler age through sixth grade. Dr. Khorram and Mara continue to serve on the board of trustees but are no longer involved with the day-to-day management of the school.

"Our biggest challenge is that education, particularly high-quality education, is very expensive for the sort of incomes we have on the island," said Dr. Khorram. "We need to recruit dynamic teachers from the States and offer them competitive salaries, which is a challenge.

"Right now, I'm in the process of trying to find 100 benefactors from around the world who are willing to donate $1,000 per year, for 10 years or so, to help continue providing outstanding education to the people of this island, who otherwise might not have the opportunity. A thousand dollars a year is the sort of contribution that isn't much for a U.S. ophthalmologist, but in terms of the education it provides, it can change generations to come."

Homesick?

Dr. Khorram said he considers Saipan home now but does miss things from living in the United States.

"This may sound mundane, but I really miss the variety of fresh fruits and vegetables that are abundant in the United States. I miss things like fresh berries, varieties of lettuce, mushrooms, asparagus, things like that. When I walk into the produce section in a grocery store in the States, and see the abundance, I get choked up. We just don't have that here."

He added, "It's also hard being so far from my sister and her family. If we're lucky, we see each other once a year."

And, occasionally, he misses things such as live blues, trendy restaurants, the super store, comedy clubs, and fall weather.

But, he's happy that he doesn't own a suit.

"Seriously," said Dr. Khorram. "Most of what makes me different is that I took 'the road less traveled.' The differences are focused around having left the United States to practice international medicine—living out here in the South Pacific, exploring, and pursuing a variety of interests."