All right, I was originally I was gonna think to count all the women in the room by having you stand up But please let's not do that. It's just too massive. It's it's not gonna work. We don't have the time So please bear with me just for sake of example. I'm gonna assume that 50% at least of all the attendees in this room Were women okay for sake of example bear with me and among these 50% women are like probably Organizers developers marketers bloggers entrepreneurs What not you know that estimation however may be true in English if I was speaking French or Italian or Spanish or Dutch or some other language I don't speak all my mother language German chances are I would not even be speaking of women when I said the word for attendees or bloggers or marketers in that language. I'd be speaking of men only Men are a fact that is exactly what some of the translated WordPress user interfaces out there do and without meaning to offend any of my fellow translators I love you. That is what I call a big little shame It is quite a big issue Almost every second WordPress install out there of the ones we can track Runs WordPress in another language than English and among the most used other languages are the ones I have just mentioned So we are talking about systemic exclusion of probably hundreds of thousands of people women Simply by use of certain languages for many people it seems a Small issue though if any issue at all because it manifests and tiny little details And when you look at each one of them separately, they may not seem very important Until we start looking at the bigger picture, which we're going to be doing in a minute First to begin this tale of empowered user experience through localization Let me introduce you to a couple of friends of mine. This is Jeff Bridges and The only reason Jeff Bridges is in this talk is that when he was interviewed on why he had agreed to star in a gritty old Western movie Title true grid. His reply was the Coins, frankly Now the Coin brothers in case you haven't heard of them gave us movies such as the big Lebowski Oh brother where are now the hot sucker proxy the man who stare at goats and many others And if Jeff Bridges would have lived in the early 1800s He would have wanted to work with the Coins of that time and those were of course the brothers Grimm Jacob and Wilhelm Grimm to be precise if you haven't heard of the Grimm's look them up You certainly have heard of their greatest copycat the father of the most famous mouse ever mr. Walt Disney Disney would later make a movie from the Grimm's tale of Snow White. It did not even come close to what the Coins could have done however By the year of 1819 the Grimm's had had some moderate success with their collection of German folktales such as Snow White Sleeping Beauty, Little Red Riding Hood, Brave Little Taylor, Hansel and Gretel Rumpelstiltskin and many others and Jacob Grimm had set out to publish writings on the German language itself Trying to determine the history of words and grammatical patterns in order to lay out What would become the first descriptive German grammar now? German up to that point had not been anything of the masterpiece of a language. It is today Coded from hundreds of dialects over thousands of years. It was in horrible shape highly complex Inconsistent to an inconceivable degree and in terrible need of documentation Jacob Grimm saw that he could not win trying to refactor German But he was brave enough to take on the documentation part in doing so He unwillingly became the founding father of Woodbrook grow into a movement of hipster linguists by the early 1900s You know men with beards Who had made it their mission to discuss meta German in written debates? Document its development and processing and publish writings on language cultivation a cultivation from which a general codex For German spelling and grammar eventually would emerge in one of these early works Some of the example sentences for specific grammatical cases would speak of a daughter a girl a young woman Whose appearance was a paragon of grace That's the embodiment of grace so to speak Now these examples obviously correlate with common social values back at that time with the decent marriage still at the top of the list of career options for women back then Grace or beauty was considered somewhat a premium asset for a daughter In other words those early example sentences reflect a highly positive picture when put in context With predominant values of a patriarchal society fast forward to the 1960s These examples and sentences are still present in later editions of the same works But that own has slightly changed a daughter who was attributed with grace back in 1917 has now become a manifestation of ugliness who cannot stir any warm feelings amongst men That is less than 50 years from grace to disgrace And if it wasn't for professor of slavic studies ozala dole shell who wrote about this stuff it will probably have gone unnoticed Given that presumably even in the 1960s ugliness was not regarded a common social value And no parent would have wanted for their child to be ugly It seems kind of curious why certain linguists had changed their example phrases to reflect a more negative of their negative picture of their female protagonists now Even more curiously something else had happened around the same time The use of masculine forms to refer to feminine characters later on labeled as the generic masculine gets explicitly mentioned as preferable practice by a philosopher of language and Professor for German studies Henning Brinkmann in his book the Deutsche Sprache Obviously this was not the beginning of the generic masculine in German But for the first time in the history of its written grammar Linguists would declare the use of the masculine gender for female characters best practice in certain scenarios Basically enshrining the disregard of women across the German language into scientific lore So only as late as 1962 had the generic masculine in German transition from verbal habit into an academic guideline From now on female word forms had not only become omissible but straightforward Deprecated in many cases women literally literally were excluded from their own language by default like men only For 30 years until the early 1990s, which probably is when some of you were born This development would take root in official standards and curriculums questioned pretty much only by the feminist movement who would demand consideration for women in language Continuously debated by the dudes pro status quo based on an academic distinction of what they called natural versus grammatical gender now I would prefer to say Personal versus grammatical grammatical gender in the first place and that still is kind of hard to wrap your head around So let me try to explain really quick a woman's personal gender would be Female and her grammatical gender would be feminine However in specific grammatical scenarios for example For any sort of title or user role or when she's part of a group her personal gender and her grammatical gender would no longer align Her grammatical feminine gender would basically get overridden by a masculine But that masculine is not supposed to be a regular old masculine It's a generic masculine a dedicated grammatical category agnostic of personal gender that gets applied whenever Whenever the trick here is that the human mind should be able to intuitively conceive of men and women when we hear or read a generic masculine other than when we hear or read a regular masculine which should make us rightfully think of men only You can see this gets a little problematic because regular masculine terms and generic masculine terms are identical It's basically like a unisex toilet next to a men's room and some genius put the exact same symbols on the doors But we are still expected to somehow get which toilet is for men only and which is for everyone So this doesn't seem to add up obviously, so science would take its course fast forward again by 2008 a number of psycholinguistic studies have been conducted on the actual effects the general use of the generic masculine on you had on human perception and Cognition including that of children will come to that later But there seems to be strong evidence that just because academic linguistics Claim that women and girls should be understood as included in generic masculine phrasings that does not mean Human perception actually works that way So when I did the research for this talk, I had to think of a friend of mine who is a teacher and he would often tell parents Listen to what your children do not say Meaning you got to listen to what your children do say but also to what they show you and may not be saying and That's a pretty powerful message of compassion when you think about it in experience design and micro copy and localization are crucially important parts of Experience design. We often have to do exactly that listen to what people do not say Yeah, I know the data. We always want the data to build our decisions on but let's be honest in open source We don't always have data. So what do we do? The best I would know is to turn to our support platforms the open forums and the ticket cures or paid customer support for themes and plug-ins We solve issue by issue We listen to people and we try to fast them how they perceive our user interfaces so that using this in that particular feature can Even become a problem for them We listen to what people do say and hopefully help them But at the same time we must listen hard to what they do not say and then try to come up with solutions for those issues as well This is how we design for the majority when we do not have data and This is basically how we need to iterate on localization if we're going to make a difference in that little corner of twenty eight percent Percent of the web I get to talk to you about today I'm speaking of making the difference Do you know that feeling when you want to hug your computer screen because something worked tremendously well in the user interface And you're just thrilled that it worked and you can literally Feel the care of the person who created this coming towards you through the screen. You know that last year at work computer I had a chance to talk about how caring is the coolest thing I've ever seen anyone do by the way I did not make that quote up I found it on the internet and how plug-in providers can make a huge difference For wordpress in general just by how they care for people through their user interfaces inside of wordpress Because I believe successful experience design is all about Paving a way for what many people perceive as a personal relationship. They have with the software they're interacting with and Just like other personal relationships that relationship ideally is characterized by things like kindness awareness compassion consideration respect support humor Where do these things live? They live in the details of everyday life and it can totally live in the design and micro copy of a carefully crafted user interface Just as the saying goes love is not how you feel about a person. It's how you treat them. I believe healthy experience design is about how we the people who make software Consider and treat the people who use it through our user interfaces and just like in other personal relationships Those people are willing to invest, you know, they forgive our imperfections to a certain degree They kindly look away when we make a mess out of ourselves. Oh, you did it again Oh, no, so but people can only take so much if we don't strive enough to improve the experience People have with that terribly amputated representation of ourselves as humans call the user interface Those people who are willing to invest in the relationship in the first place They lose hope and quit Whether they leave us physically abandon our software or just get increasingly frustrated and start heading us makes little difference after all The relationship we create through the user interface will die if we fail to cast the devils out of the details The things we don't usually like to talk about in our relationships is where they go wrong and The wronger something gets the harder it can become to admit So we tend to turn to ignorance or denial as an easy way out Until one day that elephant in the room has grown so big it gets hard to maneuver around Last year I proposed changes to German wordpress to introduce inclusive language instead of male-centric language You know no big deal got an idea throw it into the community pool see if it creates some ripples and it did it rippled I Found myself and unfortunately a couple of dear friends of mine at the center of a veritable shitstorm just hours after my proposal a Blogger had taken on my approach and had framed it as an attack of ideology Against free speech and personal liberty commenters and other bloggers hopped on the bandwagon end of proposal for now However, amongst all the debates there was that very peculiar argument and it really stood out for me that my changes were against official German which was only true if we understand official as Academically documented grammar, but I'm not sure that was the stance matter of fact There seemed to be that notion that language is given official status by its written grammar That is false. The opposite is true Written grammar may receive official status the moment it manages to document most accurately how people actually use a language But that sort of an official version of a language is never written in stone. Jakob Grimm did not make German official back then Linguists document and study and analyze and contribute to the understanding of languages in tremendous ways and sometimes they make like Proposals in written grammar for example declaring the masculine best practice, you know men only but linguists don't make languages People make languages and yes, I know linguists are people too But I mean all the people and nobody but people themselves own their language language is a birthright No one can ever take away from a person when it gets taken away though History holds plenty of terrifying evidence that those events pretty much always correlate with the seed violence suppression or even genocide and Maybe maybe in a community like Germany that was what some people reacted to so intensely The objection against an imaginary minister of language trying to dictate how everyone should think and speak I Don't know for sure But I'd like to make it abundantly clear that I'm not advocating for a new set of rules for the language used in wordpress I don't think voluntary localizers need more rules What we do need what I'm proposing is that we choose to put an end to denial because denial is not a strategy If something as big as systemic exclusion of people right lives right there in our translated user interfaces We need to address it now as I found out last year addressing a problem having a decent conversation about it can be tricky When half the people in a room or in a community don't see the problem Enter cognitive bias There was that Twitter thread recently, I don't know if you saw it Where a male employee from a service service agency named Martin Schneider? describes how one day he is emailing with a client back and forth and That client has just been Impossible rude dismissive ignoring questions until Schneider would notice that accidentally He has used the email signature of his team member Nicole Holberg a woman Now he the he then reenters the conversation as a man and While technique and advice never change as Schneider later says there is an immediate change of tone from the client No more arguing the dude chills out virtual handshake apparently just because Martin Schneider has a man's name now So the two of them Schneider and Holberg decide to switch their email email inboxes for two weeks She would email with clients as him and he as her by the time they finish the experiment She later writes she has had one of the easiest weeks of my professional life and according to supervisor Martin her most successful week in that company Brave little Taylor Schneider however has gone through what he describes hell. He said everything I suggested was questions Client I could do in my sleep were condescending one asked if I was single When the two finally decide to tell their boss about it, they hit a wall of denial He simply refuses to believe them despite the obvious correlation between email signatures and client behavior This is Cognitive bias we all behave like that here and there we do and it is not even about boss acting douche and it's not even about Her being a woman and him being a man. This is about a person's privilege Which allows him to have a choice to believe or not that there is a problem and the one thing to acknowledge here is Not everyone has the same choice Okay, she does not have the same choice all that little experiment did was to make her ugly everyday reality tangible for two guys One of which still ops 49 later on Not everyone has the same choice and going back to language that is just as true a study published in 2015 titled yes, I can reveals how gender fair job descriptions Normalized children's perceptions of job status and job difficulty quote the use of pair forms Which means masculine and feminine words next to each other can contribute in shaping more egalitarian gender related perceptions and may encourage girls to consider occupations stereotypically associated with the other gender as A possible option to pursue in their future career and quote This is great news, of course But the study also mentions the impact male-centric language takes on children or on people really because people after all start out As being small the Charlie Brown song says by the time a person has grown up under male-centric language society has sort of Cluster bombed its gender stereotype straight into her soul quote The generic use of masculine plural forms to describe stereotypically male jobs is likely to lead children to restrictive male only Associations and perceptions about stereotypically male occupations and quote So let's try to connect a few dots here Historical linguistics argue for men only in certain languages based on an abstract distinction between personal and grammatical gender How would a child make that sort of abstraction? How would children have any choice to cognitively categorize women and girls as included when the generic masculine and regular masculine terms are identical and Person plus masculine equals men Would the human mind learn to perceive anything more inclusive than men only? That study indicates it would not That academic argument simply seems to ignore what becomes obvious when we apply a little empathy and common sense You know two fingers Two fingers two words for the same role job type person whatever One word describes a woman the other describes a man then speaking of men and women Requires both of these words not only one English has only few of these words like for example actor or actress Most other person in the scriptures like developers users or other ones that we have in Wordpress applied to both women and men grammatically at least but in languages like French German Italian Spanish and many others The translations for developer or also a user are masculine and there are feminine terms Feminine forms of the same terms and those just get omitted, you know But why would a language take shortcuts in the first place? I would say Jimmy Hendricks didn't say just butterflies when he meant to say butterflies and zebras He would not try cut his way around his own poetry he would sing of butterflies and zebras and moonbeams and fairy tales and The richness of detail not the lack thereof would perform its magic and shape its uncompromising beauty of the song We know as a little wing today Now I'm not trying to say that songwriting and experience design require equal measurements of poetry But it is true that sometimes when you're trying to solve and previously unsolvable problem You need to do a little magic and therefore rely on the help of unicorns There are two types of unicorns I would like for you to take a look at with me and they are both part of a much greater zoo of Linguistic beings that can help to enhance user interfaces. These two are gender neutral language and What I call gender fair or gender sensitive language I'm not even sure gender sensitive is a word though While gender neutral language often lives in an English user interface and then happens to appear in other languages just by translation Gender sensitive language is mostly bound to the re-arms of non-English localization We're going to look at them one by one But before we do we need to briefly address the purpose of micro Microcopy for user experience design in general Microcopy are all those little button texts and labels and whatnot if you haven't heard the term I said at the beginning that microcopy and localization are crucially important parts of Experience design why well because think of a user interface without any words in it. That's why Microcopy is all about conveying meaning under extreme conditions screen estate is so limited white space is so necessary Though to keep an all to keep your eye clean and breathing very little space in a user interface is actually left for Copy so that copy better nail it no matter in what language Because we expect for a UI to explain itself while we are using it It must present itself in a way that empowers our brains to pick up a functional element Including the microcopy while we are using it and make sense of it without actually thinking about it too much That's what we mean when we say a user interface is intuitive gender-neutral language Plays an important part here and so far as it can empower a person to identify and act upon the hints coming from the user interface Without having to negotiate Who they are and whether or not they qualify to use a particular feature Gender-neutral basically means to express something in a way so that gender stays out of the picture on Wordpress's internal credits page for example It was not possible to apply two separate translations for the single string lead developer Which had a generic masculine translation in German in the first place So German polyglots chose to switch from a personal to a functional interpretation of that string This could be reverse translated as lead development instead of lead developer quite an example how Localization can be made gender-neutral by changing a core straight So to speak on the fly into something that is easier to translate while it perfectly conveys the general meaning of the original message Two other examples for gender-neutral language straight from wordpress core are the mystery man and a wordpress commenter This is how the default avatar was labeled two years ago mystery man playful by intention Maybe but made centric mystery man would communicate an underlying notion that can come across Exclusive and discouraging you know anyone other than a man doesn't seem to qualify here so along comes lead developer mark jake with and Changes mystery man into mystery person less playful maybe But gender-neutral the strings now communicate something much more inclusive and empowering every human is a person naturally So we don't even have to process any self-evaluation here About a year after marks comet Mika abstein has had enough of seen an imaginary Mr. Wordpress being generated as also of the first comment on each and every new wordpress install So she finds a patch and would rename mr. Wordpress into a wordpress commenter Note how in her ticket description Mika concludes on a list of possible wordings with localization in mind She says a wordpress commenter is the most clear about what the darn thing is and who left it I feel it's both the most understandable and Translatable it may also be worth highlighting on the side note the decision-making on that patch before it gets merged into core Because gender-neutral language sometime is seen as a sort of political endeavor It is not political here not at all the comments on that track ticket Discuss gender-neutral wording strictly in the context of user experience as a matter of humanizing the user interface and Improve the educations around comments. I think Aaron Jobin said that in a comment there now while gender-neutral language tries to neutralize gender and eliminated from the user interface Gender fair or gender sensitive language is all about making gender inclusively visible where it cannot be eliminated. Maybe Okay, this is limited to binary genders and most languages So ultimately a gender-neutral approach would always be Preferable as the most inclusive however, sometimes we have to iterate and reiterate Before we reach an ultimate goal. So for iterations on inclusive localization gender sensitive language can definitely be a powerful Caterpult to help us escape the trap of a male centric mindset Let's look at the word author for an example in English author is perfectly gender-neutral It can be a woman a man. He she they everything Perfectly gender-neutral so it seems to make perfect sense in English to apply author as A single word string in all kinds of context all across WordPress The same string gets used for a user role as a label for posting page creators For commenters for seem and plug-in providers. The question is Does this work for other languages just as fine in? In my mother language German the word for author can be masculine or feminine out or or Autorin articles are gender-specific and so are plural forms. It's a hot mess Similarly in French we have all to her and in very rarely used or to her and the respective plural forms and in Italian for example We have author and to Tori and a treat you and a treaty as the feminine form and in all of these languages And more of them there seems to be that common notion of now. Let's not you know, let's not mention women men only whatever and The fact that this is common does not make it right at all just like the earth is not flat because people commonly used to believe that and Burning a human life is never the right thing to do even if it was common practice in the Middle Ages and Naturally women must make decisions about their own bodies Even when passing legislation on abortion or health care is commonly dominated by men and a company who tries to cover up sexual harassment does not have a problem but a huge Doesn't have a culture but a huge problem even if people commonly still ride Uber and Linguistic theory does not have anything to do with how children start to perceive and make their reality when they learn To use their mother language at the age of two or three and women who use WordPress are not to be labeled as male users male authors or male developers just because that seems to be a common thing in certain languages So how do we fix it? Well, there are hacks at the moment in a past version of this talk I propose to use in line HTML with accessibility Introduce inside of translated strings those may work for certain languages in certain scenarios But as soon as a developer opts for escaping their strings were screwed even if WordPress step forward and With a more gender-neutral approach to user roles for example replacing the current Denominative hierarchy of titles with descriptive labels according to significant functionality and privilege similar to what we have seen earlier with lead developer and Lead development instead that still would not solve the issue for languages with for example gendered warp forms So ultimately we're going to need a new internationalization framework Piece of cake. Yeah, I know. I know it's not a piece of cake But I'm almost willing to bet a framework that gives translators the flexibility They need to provide gender fair translations would not only make WordPress user interfaces more inclusive But it will also help to increase adoption and user happiness in the long run after all we're talking about real people Trying to maintain a real relationship with the software they're interacting with When I started working on this topic one year ago friends of mine helped me publish a plug-in for testing your own custom set of Language files for WordPress core. It is called string until against you can still find it on wordpress.org and get up And it is open for everyone to contribute Experimental core translations for your language. However in the course of a year I have been privileged to be able to talk to some very very Talented and knowledgeable people and these people helped me to realize the mistake I had made I had tried to solve that big little shame alone and locally Exclusive language is not anyone's problem alone though that big little shame of six systemic exclusion sits in many wordpress translated user interfaces in many languages So conversation needs to happen on a global scale targeting the core of our translation technology in order for us to create a more inclusive experience in the future Code is poetry says the tagline user interfaces probably don't need to be exactly poetry with butterflies and seabirds and moonbeams and fairy tales But if designed for the majority can be something localizing teams take on as part of their mission and Collaborate with designers and developers in our community wordpress might eventually become an open-source software model For empowered user experience through inclusive localization for everyone The show notes for this talk can be found at my website look press comm slash wcu task to 2017. Thank you It's not great Now again, we have a few minutes for questions if anyone would like to Come to a mic and ask a question. We have a really mic down below here I'm going to ask Casper is anyone doing this well for us to Follow as a role model or is this an area where wordpress can lead Well this little screenshot that I had here. Let me see if I can go back Dominic Schilling Just yesterday Well, it's not there anymore. Okay. There's there apparently there is a JavaScript translation framework named message format J as I'm not a developer in that sense of the word and But Dominic is obviously and he pointed me to that one and I quickly read it yesterday only yesterday and Put it in there because it looked like it could be something because they say right there gender and plural Capable it could be something that we could build on or use But as I say, I'm not a developer. That's for you people to figure out before you developers Do we have any questions from the room? We do just up at the top Thank you. Hi Casper. I'm Alvaro from Portugal We have the Here where is he up top up there? Okay? Yes, we have the Same problems you addressed. I Don't have actually have a question. I just want to thank you for your presentation it was very inspiring And I Maybe I have a question Please go How how do you feel addressing these issues? Being a man. Oh good one. Good question. How do I feel right you these issues as issues as a man being a man? Honestly, I feel yeah, like anyone would feel who Is aware that they are privileged? That's what I am I? grew up on the male-centric language totally and Matter-of-fact language is a topic in my family I had a grandmother who was a journalist and an author and many of the people in my family write in some sort of thing Way, so I was very much used to male-centric language because it was the default and Then a couple of years ago. I started noticing that some of my dear friends women in that case Seemed not very comfortable with the way I spoke and So I approached them about it and we talked about it and I learned about all these things And then I got very interested because I Sensed a problem, and I'm that kind of person. I don't have a classical University degree or anything, but when I sense a problem I go into and So yeah, I mean I don't think it matters if I'm a man or if I'm a woman to raise this question Am I privileged? Yes. Is this am I affected by the problem? Maybe some people would say no, but I say yes because it it has screwed up my worldview for like decades and I consider that a big harm That yeah that I've been suffering from and that I'm trying to overcome to do these things over doing these things Does that answer your question? Folks, I think the one takeaway here is that there is a lot that can be done already I think there is more to be done So if you understand the technicalities of this and you're happy to volunteer your services and help improve things You know listen to the room There is clear desire among the community to make this happen And I really hope that this can be the start of something can we all thank Casper Hoobinger


Good morning, everyone. We're going to get started with our grand rounds for this morning. We have a special grand rounds today. The theme is international ophthalmology, and we have our very own global fellow here in the country, in person now. Avnisha, who's going to talk about her year and her experiences in various countries and projects she's been a part of. Then I heard the food is coming. There's just been a little mix up with the catering, so we'll take a brief intermission. And then Bradley Jacobson, who's our PGY2, will also be talking about his experiences in Mwanza this year and plans for the future as well in Mwanza. And then they'll do a sort of combined presentation, finish up with Avnit then. Thanks, Srav. So for those of you that don't know me, I'm the Global Outreach Fellow, finishing my year here at the Moran. And this is just basically a recap of what outreach has been up to in terms of our partnerships internationally over the last year and sort of my role in some of that. So these are the countries where I spent my year. The blue countries, India and Nepal is where I did some training. Ethiopia and Australia, I went to some conferences. And then Haiti, Tanzania, Sierra Leone, and Micronesia, some teaching and surgery. And then this is just where we've had observers from this year in the outreach department. So I'm going to talk about our existing partnership. So Haiti, Micronesia, and Tanzania, specifically Dodoma and where we are with those. India and Nepal are also partners of ours, but Ereban and Telangar are kind of out of the scope of this talk, so I won't really talk about them. And then new places that we went this year, Sierra Leone and Mwanza. And this is also a new partnership. So in Haiti, just a little background, there's 11 million people there. It's the poorest country in the Western Hemisphere by far. 5% of the population are either blind or vision impaired. And the problem in Haiti is that there are not an insignificant number of ophthalmologists, but the training program there is not very good right now. It suffered a big hit after the 2010 earthquake in terms of resources, infrastructure, and the teaching is not very good. And so when the two to four residents per year graduate from residency in Haiti, they typically have not done enough surgery to feel comfortable doing cataract surgery. So very few Haitian ophthalmologists actually operate, only about 12, as of the last count. And another issue there is that pay for surgery is not very good. And so Haitian ophthalmologists find that they actually make more money to survive by selling glasses. So they cater their practice more towards refraction than actually doing cataract surgery. So that's a big problem in Haiti. In terms of the residency there, it's a government hospital. It's called HUEH in Port-au-Prince. There have been recent changes in administration there. And like I said, a lack of resources and instruction until very recently, we have better resources there. But about two years ago, there weren't any slit lamps. And the residents were just using direct retinoscopes and pen lights for their exams. And there's no fellowships in Haiti. So if anyone had the ambition to do a fellowship, they'd have to leave the country. So this is HUEH, the hospital in Port-au-Prince. Thankfully, there are a lot of people collaborating there now, a lot of different organizations that are working in Haiti focusing on the residency. Dr. Dan alters a retina surgeon in the Midwest. Who's really invested almost all of his personal time in building up this residency. He's procured a lot of new equipment for the residents. They did recently hire some recent graduates as faculty there. So there was a little more instruction than usual, although questionable caliber, because they also graduated from this program when it wasn't really too good. So four of us went this year, so the two Wills Fellows. And then I went right after them. And then Anna, who's a fellow at the University of Kentucky, medical retina fellow, just recently went along the same time as Dr. Chaya. And we focused a lot on mainly didactics for the residents. So even just someone to staff them in clinic when they're seeing all the disasters that walk in. This is the only public hospital in all of Haiti. And so patients that can't afford to go to a private hospital will come here. And so you really see all sorts of things. And the residents haven't had that much one-on-one teaching. And so it's really everything from here's how you aplinate, here's how you do conioscopy, to making more higher level diagnoses and doing surgery. We did wet labs with them. I had about two or three hours of lecture that I gave every day, surgical teaching. And then they had their first journal club when I was there as well. And that's them talking about the Oates article. So basically for Haiti recently, there's been some exciting changes. The residents are going to start doing a rotation up in Capatian in the north with Dr. Dupuis. That's the partner we've been working with the longest. He's probably the most skilled ophthalmologist in Haiti. He has now gotten glaucoma and retina training as well as being able to do comprehensive ophthalmology. And so the residents are going to go up there. And they're going to get much better surgical experience up in Capatian with him. So that should be good. We're going to develop a wet lab with video capability so that we can do some surgical teaching remotely. And then start, we've been talking about this all year, but really start teleconferencing with academic institutions here in the US so they can be a part of our grand rounds and morning reports and stuff like that as well. This is brand new. A private residency was started by one of the partners, one of the ophthalmologists there, Mike Mangret. There's one resident that he has taken on that's being funded by his hospital. So we'll see how that goes and see if that ends up expanding into something more. And then further subspecialty training for Dr. DePuis, Dr. Shakur is going to go continue his retina training this fall. But there's always a struggle in Haiti. So socioeconomically, there's always unrest and instability. Even when I was there, there were a couple days we couldn't go to work because of riots and people throwing rocks in the street. That's always there. Administrations always change. The residents, for a good six months this year, were not paid anything. So it's really just a question of if the residents, these residents who are very intelligent, very smart, hungry, are getting a lot of good instruction, if they end up going somewhere else for a fellowship, for example, are they going to come back to that kind of environment to work? And that remains to be seen. And one of the best parts of traveling with your attendings is seeing them kind of let loose. So says Dr. Chaya. Don't know what's in that glass there. And having a good time. So Micronesia, Micronesia is an archipelago of several hundred islands. It's divided into four states right here. And Micronesia is a challenge mainly because of geography. So there aren't a ton of people here. It's only about 120,000 people. But because of all of the islands being so distanced apart, it's difficult for the one ophthalmologist who resides in Ponepe and the capital to really deliver care to all of the people on these islands. So that's sort of been our task there is to try and make that easier. So the proposal and what we've started doing is to train nurses from the specific states. So each of the four states sent two nurses to this nurse training we did in the winter of 2018. We basically taught them how to screen for eye disease. And we're going to use them to basically go and they already have been doing this is to go within their state among the many islands and find patients that need Dr. Padwick's care so that they can more easily be brought to him or that he can come to the state and kind of see all of them at once. And so that's worked pretty well to date. We went in the spring to do a surgical outreach and those nurses, a lot of them came with us. They were part of the pediatric screening and they worked in the sort of clinic and OR setting with us, refining their skills. We also brought Dr. Gallin and Ortley Faco machine so that when he does travel to these other states he can actually bring his Faco machine and do Faco surgery as well. We did the first pediatric screening in Micronesia. That was Dr. Sophia Fang organized that and that was excellent. So we basically went to 18 different schools in the Chuuk state, went on a boat island to island and went to elementary schools, screened for eye disease. This was prompted by a question about vitamin A deficiency and possible subjective night blindness in this group. 9% of the kids failed. The rest of the kids did actually really well. And of those kids, some of them had some refractive error. Some had subjective nyctalopia but normal exams and then you have corneal scars, macular scars, signs of trauma, things like that. So we're gonna compile that data and kind of analyze it and figure out if there are any specific recommendations or interventions for that population. So that was a neat thing that happened this year. Future direction for Micronesia. So we will plan to visit the other two states that we haven't been to Yap and Costa Rai this year for surgical outreach. And something really cool, the nursing school there in the FSM has asked that we actually put the nurse training that we did in December as part of the curriculum of the nursing school so that nurses if they want can take this ophthalmology elective to try and become ophthalmic nurses. So that's hopefully something we can implement in the next couple of years. And then we want them to find a national eye care coordinator to really help Dr. Padwick deliver care to his patients when we're not there. Some of the challenges that I think we're gonna see in Micronesia. Right now Micronesia is federally supported with grant money from the US directly and that is going to end in 2023. There's a trust that's been established that is supposed to help fund FSM after that. But the preliminary reports don't really show that as being very successful in terms of funding everything that's being funded now. And the hospitals right now are not functioning sustainably at all. There are some patients that have private insurance but the way that it works is that the insurance companies fix an annual agreement with the hospital of we're gonna pay this much money and then patients come, public patients, private patients, anyone, they get free services which is funded by our money from here. So that's gonna have to change a lot in the future when that money runs out. And this is the many game faces of Henry Barrera in Micronesia. So Tanzania, we've been involved into DOMA here for a few years and now we're in Moonsad as well. 50 million people there, 27 ophthalmologists are mostly either in Dar es Salaam or in Moshe. And it's a rather large country and patients here live on three, three and a half dollars a day. So very difficult to travel to these places if they need care. There's two training programs, KCMC and Muhinbili and KCMC currently is not taking new ophthalmology residents which is unfortunate because they're by far the better training program in Tanzania. There's an unfortunate political situation where the current leader is really heavily favoring public institutions and making it very, very difficult for private institutions to continue educational activities. And KCMC is a private institution and they're currently not able to meet the very stringent requirements that the government has newly put upon them. So right now Muhinbili is the only training program. It is a government residency but from what I hear from our partners over there it's very poor training and not comprehensive. So right now if you're in Tanzania and you wanna go into residency you either have to go to Muhinbili or you have to go out of the country which is difficult. So we've been going to the University of Dodoma since 2016. There's one ophthalmologist there that we've been assisting Dr. Frank Sandy, that's him in the picture. And over this time we've really helped furnish his clinic, helped him with surgical training, training for his scrub tech and with his surgical backlog. There are significant challenges here in Dodoma, one being that Frank is the only ophthalmologist has other commitments besides clinical care. He has a big commitment to the medical school in terms of administration and teaching and so he can't always be in the clinic seeing patients. He has limited staff and there's a pretty inefficient flow to his clinic and he doesn't do any outreach. So basically patients that are able to make it to the hospital can get care but patients around there it's very difficult and there's no public transportation taking people to the hospital so it can be tough. So our trip this year, we accomplished a number of things. I went a couple days early and taught Frank how to do Ahmed valves and cook dual blade goniotomy so that he's able to care for some of the glaucoma patients he sees. We did a screening in three different villages in the Dodoma region and then quite a large surgical outreach along with surgical and scrub nurse training for Frank and his staff. Lyco is the capacity building consultancy arm of Aravind and we're very lucky to have Aravind as a partner especially here in Tanzania. So one of the representatives from Lyco actually came with us to both sites in Tanzania both to Doma and Wansa and gave an assessment in terms of how can they build their capacity, improve their efficiency, what are sort of the first steps to doing that and that'll really help guide us in this partnership going forward. And then for the first time, Frank is participating in some outcomes tracking data of post-ops in the villages after we leave. These are just some pictures from that trip. So we did over 300 surgeries, screened a couple thousand patients and I think we gave out like six or 700 pairs of eyeglasses. So in the future here in Dodoma, there's a new ophthalmologist who just started a couple of weeks ago. She was working for the Ministry of Health, hasn't operated in a while, may not be operating for some time but may be able to at least initially take some of that clinical load off of Frank so we'll see how she fits in. We really wanna see those Lyco recommendations implemented as much as possible to improve the OR and the clinic flow and the amount of patients that can be seen at that clinic there. And I will be going actually on Sunday for another week to Dodoma to help him with this as well as help reinforce some of the surgical stuff that we went over in February. And then something we've been talking about doing is a nurse and community health worker training for the Dodoma region. So one of the challenges we saw in the villages was that the community health workers responsible for care of the village citizens really had no ophthalmology training whatsoever, not surprisingly and so it's very difficult to get those patients referred to the right place. And so we wanna do a similar type of nurse training that we did in my Grenesia and kind of adapt it for community health workers in the Dodoma area and kind of create this district hospital referral system. There are six districts within Dodoma where those community health workers can then refer patients to the district hospitals and Frank can do a rotation through the district hospitals every month. So hopefully that's something that we can implement over the next couple of years. He's also been working on a residency curriculum. We're gonna help him hopefully with that. And this is Dr. Petty in his natural state. So Sierra Leone, this is a new country for us. This is a place that I went kind of on my own but I think would be a really good opportunity for collaboration because a lot of other organizations are getting involved here and it's really ripe. So Sierra Leone's country in West Africa, seven and a half million people. There are four ophthalmologists, only three of which are practicing, a few cataract nurses and almost everyone is in Freetown which is like right there. So if you're anywhere here, you have to go all the way there for your care. There is a rural clinic in Sarabu which is closer to the center of Sierra Leone. This is run by a private ophthalmologist out of Tennessee and she goes there twice a year and does a bunch of fake-go cases but the rest of the year there's really no care there. And the nearest subspecialty care if it's needed is in Ghana so of course not all patients can travel there. So the ophthalmologist that I worked with over there, her name is Jelika Mustafa. She's a young woman, probably my age, recently graduated from residency a couple years ago in Kenya and she's facing some significant challenges working within a government hospital system. It's extremely patriarchal there and so even though she's by far the most skilled and most qualified person there, she basically is at the whim of the other males in the department. They're the ones that order supplies and it can be very erratic. So when I was there we had Alkan lenses and Alkan viscoelastic but there was no tropicomide. There were only size eight gloves. It was just kind of strange. So that's a challenge for her there. Sitesavers is an NGO that's been very involved in Sierra Leone. They've had many, many positive impacts including this department within the Conaut Hospital, the public hospital but it's been very difficult for them to pull out because the government is sort of depending on them to handle all of the eye care needs over there and so the government won't really give much of their resource and so Sitesavers kind of has to stay and be that safety net. Cost of care can be significant. So cataract surgery can be $40 even in this public hospital which is a lot more than a lot of patients can afford and there's no insurance whatsoever so everyone just has to pay that. So Jelika has been an excellent perfect partner I would say to work with. She's extremely intelligent. Has excellent clinical judgment. She's a fantastic surgeon. She's very, very motivated and has interest in glaucoma and oculoplastics and basically functions at the level of a fellowship trained glaucoma surgeon and clinician just from being interested during her residency. So it was really fun to work with her. She's also an amazing chef and baker and so I got to also benefit from that but we did some glaucoma surgery when I was there. I taught her Ahmed valves. Again, dual blade goniotomy and then also trabecuotomy. She sees a lot of pediatric glaucoma there and she just picked it up right away. She did excellent and is doing all of these procedures now even after I've left and they're bringing more supplies for her because she's run out of all her stuff so really just an awesome partner who did really, really well. So again, I think it might be a good place for us to get involved just because of the potential for collaboration. HCP is gonna get involved there. Colorado and Will's already sort of have a relationship with her and the goal is really to help her open up a private clinic so that she can have a tiered payment model, reach more patients and expand the services that she can provide along with the public hospital where she's currently working. She's about to do an ICO fellowship in glaucoma at the University of Colorado. That's a three month training so that'll be great for her and then hopefully down the line some FACO training and a friend of mine is most likely gonna go do some oculoplastics training with her in 2020 so that would really be great.


Hey everybody, welcome back to Magical Orthodoxy. My name is David and this is a deck review. Hey today, we're going to look at the Black Market playing cards from Misery Develop Limited. These cards were printed from the Legends playing card company and they were artistically designed by Nikolai Arorae. If you'd like to learn more about Misery Develop Limited, you can visit their website at mdtsed.com and MiseryMod.com. The Black Market playing cards was a Kickstarter project that was done by Misery Development Limited. Misery Development Limited also makes video games. They're the founders of the award-winning stalker, Misery Mod and the SEED visual novel game. That is where these decks come from. They are inspired from the SEED visual novel game and so fans of that will recognize a lot of these key features. This deck project was three unique limited decks. This black deck is called Zarovka. This is the veteran deck and this is the red bar deck and each deck was limited to a 1000 deck release. Today, we're going to look at the red bar deck from the Black Market playing card series. The front of the tuck case is done in a field of red. It has a white banner and it says red bar right there in the banner and underneath that in really small text is his playing cards and 310 GSM. This side is as premium poker playing cards as does the other side. The bottom has just a little bit of a scroll work and the top design is blank.  That is pretty much it for the tuck case. Let's take a look at these cards.  Now, like I said, this is a three-deck, unique, limited edition deck project that is all under the umbrella of the Black Market playing cards. This was a limited release of 1,000 decks printed from the Legends playing card company. Like I said, they are also all done on Emerald finish, which is great stock, great handling. They are 2x5x3x5 poker sized playing cards. This was a Kickstarter exclusive deck, fully customized deck of cards, which is 54 cards with 2 jokers. The back design is done in a red color. It's very regal looking, very rich, very ornate. You have a thin, micro fine white border and then right next to that you have another red border. Again, you have a diamond pattern there as your field. It has a very Faberge egg kind of look and then you have this oval in the center with an ornate design. The red bar deck has 12 very unique, very highly detailed quartz, very detailed jacks, kings and queens for court cards. Now the numbered cards and the aces, they also are very ornate, but they have a ghostly, very subtle gray background that decorates and reflects the card backs. Your ace of spades is certainly the most ornate of the three in the black market playing cards.  With this deck, you're also going to get two very simple jokers that simply say red bar, red done in red and bar done in black. Well, that is it for this deck review of the red bar playing cards from the black market playing cards and misery development limited. As always, we recommend that you like this video just so other people can find it faster. We also recommend that you subscribe to this channel just to stay up to date on the latest in cards and card magic. Now, if you want to follow me on social media, you can.