Leadership in organized medicine isn't for wimps, but is it as challenging as say, performing delicate surgery on a refurbished airplane in an underdeveloped African nation? Yes it is, says Troy Elander, MD, and he should know. He's done both. The Santa Monica-based ophthalmologist and UCLA assistant clinical professor is on the Executive Committee of the Los Angeles County Medical Association and is president of its Bay District. In August, Dr. Elander became the first surgeon to perform a corneal transplant in Uganda.

What do his twin passions have in common? "They're actually more similar than one might think," Dr. Elander says. "I'm volunteering my time for activities that will help people--and that will help medicine."

Plus, they're both time-consuming, he says. It took about 30 hours just to get to Kampala and Entebbe, the two Ugandan towns he visited, and his mission lasted one week. Similarly, LACMA meetings can last for hours--and they often take place downtown, in the evening, after he's already worked 12 hours providing patient care.

Indeed, organized medicine was almost the extracurricular activity Dr. Elander dropped, although not because of the time commitment. "I had reached a point where I was disappointed and frustrated with organized medicine," he says. But by grappling with whether to stay involved, he realized he hadn't really been committed. Before he abandoned it, he recalls now, he decided he should give it a fair shot.

"I'm glad I did that," Dr. Elander says. "I've seen the good and the bad of organized medicine, and I've learned that it's important for doctors to stick together and to work together."

Given the dramatic changes occurring in medicine, cohesion is critical, he says. "If doctors don't stick together, somebody else is going to make important medical decisions for us. Doctors tend to be independent. We're all problem-solvers, so we're used to taking things like this on ourselves. It's not in our nature to bind together. But that's what we need to do."

Teamwork is what it takes to bring medical advances to a third world country, too. This year, doctors affiliated with ORBIS International focused on Uganda, working with local eye care professionals on cataracts, corneal diseases, glaucoma, oculoplastics, retinal diseases and ultrasound. In Uganda, a nation of roughly 30 million, approximately 420,000 people are blind. The country has fewer than 50 ophthalmologists. That ratio of one specialist for every 600,000 people is especially stunning compared with the U.S. tally of one ophthalmologist for every 20,000 people.

That gap will close a little because of Dr. Elander's efforts. In addition to performing the nation's first corneal transplant, he taught local doctors how to perform the procedure as well. Of Uganda's nearly half-million blind residents, perhaps 70,000 could see again with such a procedure "if they had the knowledge and the resources to do it," Dr. Elander notes. On his visit, he helped with both. The knowledge he imparted so impressed the country's Minister of State for Health, the Honorable Dr. Richard Nbuhura, that laws inhibiting the formation of eye banks will soon be reformed. Here's what happened:

New York-based ORBIS operates what it calls the Flying Eye Hospital, a DC-10 airliner that's been retrofitted as a mobile classroom and operatory. Big-screen TVs allow students to watch procedures as they happen. "I was working with two doctors who'd been assigned to me as students," Dr. Elander reports. "Then they did a procedure themselves. Dr. Nbuhura saw it on the screen and said, 'You mean a Ugandan doctor is doing this now?' At the press conference later, a Ugandan reporter asked if the procedure would ever be widely available, given laws against organ donation designed to curtail the spread of AIDS. Dr. Nbuhura said on the spot, 'I will work to change the laws so we can have eye banks. If this is the only way we can have people's eyesight restored, then we shall go to any lengths to do so. The laws need to be amended so that we can establish eye banks and allow the legal donation of corneas.'" The Ugandan ophthalmologists who worked alongside Dr. Elander have formed a cornea working group to keep the momentum going.

Of course, helping patients and helping populations is what drew Dr. Elander to medicine in the first place. "I knew from a young age that I wanted to be involved in it," he remembers. "Ophthalmology has a lot of versatility to it. You have both the medical problems to help with and the surgeries to perform."

Who was his role model? His father, Carl Elander, MD, also an eye doctor and the younger Dr. Elander's practice partner for the past decade and a half. Father also inspired son to offer services overseas. The elder ophthalmologist worked for a spell in Afghanistan and invited his college-age son on a medical mission to Nigeria. Maybe that's why the man who made medical history in Uganda says "the international opportunities" rank among the high points of his career.