EuroTimes: Step on board the Flying Eye Hospital

This article was originally published on the ESCRS EuroTimes in March 2020.

Orbis is an international non-profit that brings people together to fight avoidable blindness. Its efforts include improving the skills of ophthalmology faculty in underdeveloped regions, establishing wetlabs, launching fellowship training programmes and developing subspecialty education hubs.

As well as long-term sponsorships and training programmes in countries worldwide, in 2019 ESCRS sponsored three young ophthalmologists to travel on the Orbis Flying Eye Hospital Associate Programmes to Vietnam and Myanmar and sponsored two ophthalmologists from Ethiopia to attend their 37th Congress of the ESCRS in Paris, France.

Basak Bostanci Ceran MD first learned of the Orbis Flying Eye Hospital (FEH) when she was completing her fellowship in the United States. Her mentor, Professor Samuel Masket, was a participant and spoke highly of the programme. The FEH had visited her home country of Turkey so it was already an idea she was familiar with, and when she was asked if she would like to apply to volunteer, she didn’t think twice.

“As an ophthalmologist, I want to do the best I know, which is doing surgeries or training other people. Training the trainees and giving education without taking or without expecting something really opened my eyes and opened my heart,” she said.

Dr Basak travelled to Huế in Vietnam for one week, where she worked with local fellows and residents early in their careers. She helped train them using a cataract eye simulator, as well as helping out during postoperative procedures and giving a lecture on cataract surgery.

Upon returning from Vietnam, she reflected on how different her everyday experience was. “It is very easy to complain when you’re just sitting in your home town, thinking that some surgeons from particular universities or surgery centres have more than you do. But when you go to Vietnam and see what they don’t have, you feel very grateful for everything.”

While the hospitals in Vietnam may not be as well-equipped as those in Europe, the visiting hospital more than makes up for any shortcomings.

The FEH is equipped with a classroom that seats 46, with 3D technology on hand to make students feel like they are in the operating room, as well as a fully functional operating room for hands-on training.

For some in fact it’s almost like a second fellowship. Working with a series of experts from around the world, young ophthalmologists can impart their own wisdom as well as absorbing so much more.

“There is a permanent exchange with different parts of the world,” said Mehdi Shajari MD. “It’s just astonishing, it never stops improving when you just talk to the people, because it’s all about details in surgery, right? So, a little change in your incision, a little change in the fluids you use can make a huge difference.”

Dr Shajari also travelled to Huế, where he worked with Professor Jeffrey Caspar MD of the University of Sacramento.

They trained local residents hands on but also walked them through the surgeries in details on a monitor, advising how they could improve technique.

Imran Yusuf, Specialist Registrar in Ophthalmology and PhD student at Oxford, UK, travelled with Orbis to Mandalay in Myanmar. He was most excited about seeing the Flying Eye Hospital itself. “It always seemed to me an audacious idea – to put an eye theatre on a plane.”

He was not disappointed. “I could not believe the quality of the infrastructure: 4K screens with the Ingenuity 3D surgical viewing system (so that all participants can watch the surgery in 3D as if they were the surgeon), live audio interaction with the surgeon in real time, an EyesSi vitreoretinal simulator, indirect ophthalmoscopy simulator, a mini lecture theatre and the supporting components of the Flying Eye Hospital (such as clinic area, anaesthetic room, sterilisation area and recovery).”

Dr Yusuf lectured aboard the FEH as well as training local residents in the use of the indirect ophthalmoscopy and the EyeSi simulator.

Dr Asamere Tsegaw Woredekal has been involved with Orbis for many years. Over the past 15 years he has seen first-hand the work they have done in helping to turn a small unit at the University of Gondar in Ethiopia to a big, tertiary ICU centre.
Dr Asamere’s training in India and Germany was partially supported by Orbis (as well as by international NGO Light for the World), and upon his return to Gondar he established a retina subspecialty clinic. His future plan is to establish a full-fledged vitreoretinal centre; at present, the vitreoretinal subspecialty clinic sees 8,000 patients.

At the ESCRS Congress in Paris, he attended wetlabs in the area of basic phaco training, which he said would help refine his technique. He also attended talks on ocular trauma and manual small-incision cataract surgery (MSICS).

On his return, he hoped to share this new knowledge with his residents and students throughout the course of their interactions. “During lectures, morning seminar presentations, during discussions at the OPDs and in the operation theatre practical training sessions with residents.”

Dr Argaw Aberra Shire is a fourth-year resident at Hawassa University in Ethiopia. Having volunteered alongside European doctors offering medical care to people in the region he saw that there was a lack of eye care provided at a local level. “With little expense you could give sight for a lot of people who need care. That’s how I went to ophthalmology,” he told EuroTimes.

Dr Argaw was most impressed by updates on topics such as Selective Laser Trabeculoplasty as a treatment for open-angle glaucoma; techniques of repair for iridodialysis/traumatic iris defects; and new technology for gonioscopy. He also took the opportunity to try phacoemulsification, as he usually uses MSICS in his practice.

He was most impressed by the scale of the Congress. “I have been to national or sub-regional conferences but this is the largest congregation I’ve been to yet,” he said.

“You have all the experts here from all over the world, not only from Europe – you have people from Asia, especially India, from the United States, from countries in Latin America. So, this is one of the best opportunities for a novice individual like me.”