Figures from the World Health Organisation indicate that there are some 39 million blind people in the world and another 246 million visually impaired. These numbers are made all the more shocking when you consider that 32 million of the cases of blindness are avoidable through the application of procedures that are taken for granted in high income countries such as the UK. It is also estimated that 80% of those visually impaired can be prevented with access to existing treatments.
The negative impact of blindness on people, particularly children, in low income countries is hard to overstate. In developing nations 60% of children die within a year of becoming blind. Blind or sight impaired children are less likely to gain an education, dramatically shifting life outcomes.
This state of affairs is the driving force behind international eye charity Orbis. Founded in 1982 by ophthalmologist David Paton, who combined his surgical career with an interest in aviation, the heart of the organisation is the Flying Eye Hospital, a training eye hospital located within a DC-10 plane. This allows Orbis to train local medical professionals as it conducts programmes throughout the world with the help of its 430-strong volunteer faculty of ophthalmologists, anaesthetists, nurses and biomedical engineers.
The current plane, known as the MD-10, is the third the charity has used. The first was a smaller, narrower model that wowed the world’s media by flying to Panama for the charity’s first ever programmes. The second iteration, a more wide bodied jet, took over service in 1992 and was retired in 2015 to take a place of honour in the Pima Air and Space Museum in Arizona, US. Between them, the three planes have visited over 80 countries around the globe.
Located at Stansted Airport for a few days as part of a goodwill tour, the MD-10 betrays little indication, beyond Orbis logos, of its function on the outside despite being significantly heavier than a regular model. Step inside and the difference to a normal passenger plane could not be more pronounced. Moving back from the flight deck, the first area is the Alcon-sponsored classroom, a 46-seat onboard learning hub featuring two-way microphones for interaction with surgeons and screens showing a 3D camera microscopic view of surgeries.
The modular system of the plane continues with a patient care and laser room, where laser treatment training is conducted, followed by the operating room, which is located directly over the centre wing box of the plane for maximum stability. It is in the operating room where hands-on one-to one training is given to local medical professionals by faculty volunteers. Towards the back of the plane is a sterilisation room and a recovery room.
Overall the MD-10 represents a significant step forward for Orbis in several respects.
‘The MD-10 took seven years to build, says Richard Lord, Orbis global medical director. ‘The last plane flew for 23 years and we ran it that long because fundamentally the design was good. However, we knew there were some things to improve with this iteration.
‘On the design of the hospital and its functionality, we’ve improved things like air handling, which is Hepa [High efficiency particulate air] filtered. There is a big air curtain above the patients that meets orthopaedic standards to provide a sterile environment. We have full US accreditation as a hospital. We are the only non-ground based utility ever to achieve this and that’s important because part of what we use the plane for is a display window for best practice.
‘The plane has also improved the training side. We continue to do hands on training but we want to make sure we can also reach a wider audience. So the plane has a classroom with a 3D system donated by Truevision. We can now transmit everything that happens on the plane both in country and out of country. So in China, where we did our first tour with the new plane last year, we connected to over 30 countries with live surgery and lectures. The audience was able to take part in two-way conversations.’
Today the MD-10 is just one component of a wide array of actions by Orbis to combat blindness and sight impairment. The overall focus of the charity is on health system strengthening which is being achieved through more than 40 long term programmes across the world run by regional and national offices.
‘Aside from its training uses, the MD-10 serves as an envoy and advocate for us,’ says Lord. ‘We use it strategically within these projects. The aim is always to understand where a partner is at the moment and how you are going to drive them to the next level. How are you going to engage with them? What can you offer? How are you going to provide the training required? What do we need to help them strengthen the wider health system and tackle avoidable blindness in their country? What we are trying to do is equip our partners with the tools they need for a sustainable long-term service.’
Orbis deals with refractive error as part of a comprehensive approach.
Action from the operating room is broadcast to the adjacent classroom
‘Our work in this field is mainly aimed at paediatrics. We’ve got a very large project in India at the moment and after six months we’ve just celebrated screening our millionth child. It is very important because undetected childhood myopia is a big barrier to education and with changes of modern lifestyle it will become more prevalent. We are unlikely to engage in laser eye surgery in the near future but refractive error is a component of all our projects whether we provide it directly or otherwise.’
Looking to the future of the charity and global eye health, Lord sees challenges to be met.
‘We will continue with the health system strengthening work. Diabetic retinopathy will be a big playing field in the next 30 years and we are formulating our engagement strategy with that. Simulation training of surgery will become a key component and we will do a lot more of this including using the Flying Eye Hospital as a simulation centre. Our cyber site platform will continue to grow and we will connect training institutions in high income countries to those in low income countries through this.’
What it’s like working to bring eye care across the globe
Angela Purcell, head nurse at Orbis Flying Eye Hospital, talks about her experiences with Orbis.
Twenty-five years ago Orbis was doing a goodwill tour at Stansted, just like this one. I was a newly qualified ophthalmic nurse and was really inspired by it. So I decided that one day I would volunteer. Family matters meant it was not the right time for years but when my daughter turned 18, I thought to myself that now is the time.
I was working at Moorfields at the time and in 2012 I went on my first programme and four months after that I was invited to apply for the position of head nurse.
Since then I’ve been on projects to Mongolia, Vietnam, Philippines, Cameroon, India, China and many others. Away from the plane, I’ve travelled to Jamaica to do a hospital programme and to a symposium in Barbados.
Plane trips until 2015 used to be two weeks each time, whereas now three to four weeks. We might fly to fewer countries but stay longer. I manage a core team of staff nurses spread across the globe in places like China and Peru. I try to set up group online meetings to best match everyone’s time zone so it’s not the middle of the night for someone.
On programmes I really enjoy reaching the local nurses and seeing the good outcomes with the patients is very gratifying. The work is very different to the UK where we have students with us at times but they will typically be attending university as well. On a programme you will have students all day every day. Another difference is that there is no quick turnover on the surgical procedures. This is because the emphasis is on teaching and so we perform six to eight surgeries per day. In the UK we have domestic ancillary staff to do the cleaning but on the plane we do this too.
Even after several programmes I still feel emotional about how fabulous the work is. In China recently there was a doctor who had never seen a corneal graft and by the end of the first week he could perform one himself with supervision. Later in the programme, the same doctor taught others while doing a corneal graft on the other eye of the same patient. It was fantastic to witness.