When a commercial airline upgrades to new planes with better seating and onboard media options, passengers rejoice. But when a nonprofit called Orbis improves its one-aircraft fleet, it changes lives.
The organization flies eye surgeons around the world to train local doctors in vision-saving medical procedures. Orbis has been in the air since 1982 with its Flying Eye Hospital, an airliner converted into what the group says is the only U.S.-accredited hospital not based on land. Orbis lands the plane in poor countries, where surgeon volunteers not only operate on patients but also train local doctors so they can perform the procedures on their own, long after the flying hospital has left the tarmac.
In early June in Los Angeles, Orbis christened its third-generation hospital, a converted Boeing MD-10 donated by FedEx, which will continue to pay for the plane’s maintenance. The jet has an operating room/multi-camera TV studio that can broadcast surgeries online or pipe 3D video of the procedures to doctors wearing 3D glasses in an adjacent 48-seat classroom. “The airplane is the perfect environment to do surgery, perfectly equipped,” says longtime volunteer Dr. Dan Neely, a pediatric ophthalmologist. For instance, the aircraft has two lasers—one for treating glaucoma and another for retina conditions like those caused by diabetes. It can fly twice as long as the DC-10 it replaced (up to 12 hours). A customized air conditioning system keeps the plane livable when it’s stationed in sweltering environments like sub-Saharan Africa.
These high-tech tools address the relatively low-tech causes of most vision loss around the world. In places like the U.S., the intractable causes of blindness and severe vision impairment have decreased to a handful of complex conditions, such as age-related macular degeneration or genetic diseases like retinitis pigmentosa. But according to the World Health Organization, 90% of the blind and visually impaired live in poor countries, where the biggest problem, affecting about 43% of people, is uncorrected refractive error: People need glasses. Cataracts (i.e., clouding of the eye’s lens) are the second biggest cause, accounting for about a third of all preventable blindness. “If you were to deal with refractive error and cataracts, you would take a huge number of those people out of this trap that they’re in,” says Dr. Jonathan Lord, the organization’s global medical director.
Orbis focuses on cataracts and other eye ailments that require surgery. (It also works with organizations like the Brien Holden Vision Institute that specialize in fitting people with glasses.) In developed countries, a 10-minute surgery swaps out a cataract-clouded lens for a synthetic replacement. The latest procedures can cost several thousand dollars, but Orbis is training doctors in a low-tech method called manual small incision that’s nearly as effective and costs as little as $10 to perform. “We’re not training someone on a Rolls Royce when that’s not what they have in their home settings,” says Joni Watson, a former Africa business development manager who’s now a PR consultant for Orbis. Other popular procedures Orbis teaches include cornea transplants, tumor removal, eye muscle surgery, and relief of glaucoma (a buildup of fluid pressure in the eye).
Although it’s the showiest component, the flying hospital represents only a fraction of what Orbis does. “The plane is actually only 20% of our programmatic work,” says Watson. “The other 80% is happening . . . within our long-term country programs.” By that she means the organization’s on-the-ground work in its 14 offices around the world, where it collaborates with governments to get eye care integrated into national health programs. In South Africa, for instance, Watson says that Orbis helped improve training for nurses who do eye testing required by the Road to Health card—a checklist of health procedures, such as vaccinations, that children have to complete before they can start school.
Neely, the pediatric ophthalmologist, has been on 17 weeklong training missions—seven on the flying hospital and 10 at medical facilities in countries including Vietnam, Cambodia, and Zambia. “In the local hospitals, where you’re working one-on-one with the doctors with what they have, the benefit is that, when you leave, they’re still using that same stuff,” he says. “So you have to tailor what you’re doing and what you’re teaching to what they can continue doing.” Often what they have is not much. On his first mission, in Hanoi in 2002, Neely learned that, instead of using an electrical instrument to cauterize blood vessels, doctors had just a small metal poker heated over a Bunsen burner. “That’s also how the operating room caught on fire that first time,” he says. Since everyone was engrossed in watching him perform the procedure, no one noticed that the burner had fallen over, igniting a cloth-covered table.
Even back in Indianapolis, where he’s a professor at the Indiana University School of Medicine’s Glick Eye Institute, Neely continues to volunteer for Orbis. He’s logged 1,000 consultation sessions with doctors around the world on the Orbis Cybersight videoconferencing program. It’s off-the-shelf tech, using the popular Zoom teleconferencing service, and it works even at low bandwidth. (But it won’t work everywhere. In Zambia, Neely says it’s hard to even check email.) He’s also trained doctors who have come to Indianapolis on fellowships.
Wherever he works, Neely credits the plane for making it possible. “When the Flying Eye Hospital rolls into a country, you’re going to have the minister of health [pay a visit]. You might have the president of the country,” he says. “And so you’re bringing to light this public need for vision services.” The jet has similar PR power in the developed world where donors live: At the champagne christening in June, veteran Orbis supporter Cindy Crawford was there to help mark the occasion.
Neely specializes in eye care for children, a field with an especially high number of unmet needs. “Around the world, pediatric ophthalmology is a really, really neglected area,” Lord says. Zambia, a country of about 15 million people, has a single pediatric ophthalmologist, Dr. Chilesea Mboni. His sole counterpart in Cambodia, population 15.7 million, is Dr. Phara Khauv. Neely worked with both doctors in their countries, and they each came on fellowships to Indianapolis to work with him.
“You need very specific training to deal with pediatric eye care. It’s not just small adults,” Lord says. “The children’s eyes behave differently when you operate on them. They require different techniques.” Children also need general anesthesia for surgery, Lord explains, which requires an expertise that’s hard to come by in certain parts of the world and is far riskier than the local anesthesia that suffices for adult surgeries.
Acting fast is critical so that the eyes and the brain’s visual cortex develop properly. “Babies are born with cataracts. You just don’t hear about it as much,” Neely says. Rates are higher in poorer countries because they often lack good prenatal care. In the U.S., newborns’ cataracts are typically discovered and remedied in four to eight weeks from birth. “Every month you wait, the child will lose visual potential,” says Lord.
Pediatric care now makes up about a quarter of Orbis’s work. It benefits not only today’s children, but an entire community’s future. With impaired vision, Lord says, “if they’re a child, they don’t get access to education. They don’t progress in life, they don’t get the jobs they could have attained.”