SIGHTLINES Episode 5: unseen challenges of COVID-19 transcript | Orbis

SIGHTLINES Episode 5: unseen challenges of COVID-19 transcript

Hosted by Dr. Hunter Cherwek and guest host Bulgan Orgilsaikhan, with guests Dr. Carlos Solarte, Carolyn Collantes, and Elisa Urruchi.

Dr. Hunter Cherwek: Welcome to Sightlines! I’m Dr. Hunter Cherwek, Vice President of Clinical Services at Orbis International.

This episode will be a little bit different than our usual format. That’s because I’ve invited my good friend Bulgan Orgilsaikhan to be my co-host –and I’m thrilled to say that she has agreed!Bulgan is actually a former patient, who had surgery on her eyes during an Orbis program in Mongolia when she was a little girl. Now, she supports and volunteers with Orbis in a number of ways, including serving on the board of Orbis Canada.

Bulgan, thank you for joining us. Maybe you can tell us a little bit about where you are in the world right now during COVID, and a little bit about your journey with Orbis?

Bulgan Orgilsaikhan: Thank you. Hunter, for being your co-host. It's my pleasure. I'm actually currently in Canada and working in a technology company right now. To tell you a little bit about my involvement with Orbis is that I was a patient when I was young –and that's about 20 years ago –and I was very lucky to get a treatment with Orbis. So, it just happened that I was able to get introduced back to Orbis in 2014 where I started volunteering and, right now, I'm sitting with you here as your co-host and being an Orbis Ambassador, so it's been a really, really interesting ride and I hope to see more of it.

Dr. Hunter Cherwek: Yeah, I mean, you were born in one of my favorite countries on earth, Mongolia, for those of you who don't know, it’s a landlocked country with Russia and China, kind of on both sides of it. It's one of the coldest places on Earth, but it's also one of the most beautiful. The summers there have the bluest sky and the greenest grasses, and if you're into horseback riding, it's one of the most beautiful places. I love fly fishing and it has some of the largest salmonoid species in the world. So, I really want to thank you for joining me today. We're going to have a great conversation today with Dr. Carlos Solarte.

Dr. Carlos Solarte is an ophthalmologist from Colombia. He was actually at one time in his career an air traffic control tower person who used to help planes land. He is now a pediatric ophthalmologist in Canada. He works very much with our Cybersight program.

Bulgan Orgilsaikhan: I actually met Dr. Carlos last year in Toronto for the Flying Eye Hospital goodwill tour, but, Dr.Carlos, if you could just tell us a little bit more about your background, your role and your involvement with Orbis?

Dr. Carlos Solarte: Bulgan, thank you so much. Yes, fortunately, I'm very, very pleased to be here. I have been—Orbis is an organization that I’m really close to, myself and my family. I'm a pediatric ophthalmologist. I work full-time at the University of Alberta. I'm also an assistant professor and I am the Program Director for ophthalmology and I'm involved with teaching for six, seven years working here in Edmonton.

Bulgan Orgilsaikhan: Can you tell us what it's like during this difficult time, how this whole COVID situation has been impacting your practice? and, in general, how have you been coping with it?

Dr. Carlos Solarte: Bulgan, this has been very difficult. As the world came to a stop, we're just starting to see the huge backlog of cases of those patients that came to a standstill. That is complicated, because, now, we don't have the capacity or the space if we want to continue with the physical distancing rules that we have been doing in order to see all these people and go back and try to catch up with the backlog. And that has affected all those fields of medicine, not only ophthalmology, but I will say every single field of medicine.

Bulgan Orgilsaikhan: I was actually in touch with the local doctors back home in Mongolia and they were saying how they needed to prioritize certain surgeries. Just because of the supplies available, you know, the limited supplies, because of the whole supply chain is [making] difficult for medical operations to continue and they had to prioritize all these surgeries. But then there [are] certain surgeries can only wait for so long, for example, congenital cataract surgeries or the ROP surgeries, that have a very small window of, you know, getting that help needed?

Dr. Carlos Solarte: So that is an incredibly difficult situation, Bulgan, because when those patients–specifically the oncology. Let's talk a little bit about the oncology first. In my world, in pediatric ophthalmology, retinoblastoma is there. Yes, retinoblastoma, fortunately, the numbers of new retinoblastoma cases are not high, but it's still one patient is too many. And we need to be sure that these people get, or these kids, get the [proper] attention. Fortunately, Canadian Government have determined the oncology as one of those emergencies that must be done despite the coronavirus, so we need to be sure that they have an access.

Dr. Hunter Cherwek: And so we just heard the word retinoblastoma. And let's just take a minute to talk about what is retinoblastoma. Retinoblastoma is actually a cancer in the back of the eye of children. Retinoblastoma is one of the top 10 solid tumor cancers in children, where the back of the eye, the retina, very early on in a child's life develops a tumor.

Dr. Carlos Solarte: We need to prioritize, we need to triage the patients. Now, which ones go first, which ones go second? That is an incredibly difficult decision, because in my world I would like to see all of them right away, but we can't because we don't have the supplies, number one. Although we have supplies, they have not in the abundance or in the numbers that we had before, because also the factories who produce them, they are also in a backlog because they also have to stop in order to protect their own employees.

Dr. Hunter Cherwek: Well, Bulgan just talked about the importance of how COVID is affecting the supplies and the medical care in her home country of Mongolia and that's because it's a landlocked country and it's extremely huge. It's a large landmass and to get supplies in the country they have to either come through China or through Korea and those flights have been shut so that the COVID cases can be contained in her home country of Mongolia. And even once they get to the capital city of Ulaanbaatar, it is a very hard to get those supplies out to some of the outer cities, which could be literally 20 hours away by car. So, Mongolia is a very special country, but because of its special nature being landlocked and such a huge landmass, it's very sensitive to supply chain disruptions, which are now the norm because of COVID.

Dr. Carlos Solarte:This has been one of the biggest public emergencies I can imagine. I am an ophthalmologist—I’m an epidemiologist by training. I have a master's in public health, and I remember reading on the history of epidemics, reading about the Spanish Flu in 1918. I never thought possible, and it never crossed my mind, that I'll be living in worldwide lockdown and declared epidemics in the way that I was reading in the textbooks. That never even crossed my mind that we were going to get to this point where we have right now.

Bulgan Orgilsaikhan: So Dr. Carlos, I was just wondering what would be, what is the situation with patients going [and] coming to the hospital? Are they fearful, are they feeling comfortable in coming back to the hospitals and getting the treatments that they need?

Dr. Carlos Solarte:I am feeling, personally, a lot of changes in my clinics. Even I have sometimes 30 or 40 patients in a day, about five to ten of the ones have decided to cancel or not to come just because of the fear of coronavirus. That’s about 20% in a day. That is too high. We are following people who may be sick, we're following post-ops from previous surgeries or people have been waiting for a long time to see us and the fear is not letting them go in, thinking that if the ygo close to the hospital they're going to get sick. Well, it's not the case because hospitals are taking adequate prevention and I don’t think this is exclusively happening to me and, I think, this is happening everywhere in Canada or even in the world.

Dr. Hunter Cherwek: Obviously we are experiencing extraordinary times and I know your hospital is doing a lot to protect its patients, especially the pediatric patients -that's having checkpoints before they come in the hospital, the social distancing with chairs separated in between the waiting rooms, only allowing one family member with the child during your eye exam, having the mask worn at all times, certainly, cleaning the examination rooms in between patients, and the big thing is that, you know, certainly, we can only have one parent now going with their child into the examination room.

Dr. Carlos Solarte: Now, all of this are being informed to the patient and we provide the patient with all this advanced notifications.

Bulgan Orgilsaikhan: So, Dr. Carlos, I wanted to actually ask you about pediatric blindness, because I was a patient when I was really young and pediatric blindness is something that's, in my experience, very, very important. I wanted to know how it the whole COVID-19 situation is affecting pediatric blindness in Canada, as well as throughout the world?

Dr. Carlos Solarte: I personally call it that you are against the clock. This opportunity to treat successfully amblyopia, or lazy eye, or to treat childhood blindness and prevent permanent and unrepairable blindness is time sensitive. Now, COVID-19 may affect this care that we are doing for children and they don't have the proper diagnosis and, unfortunately, we're losing the time. If before, the resources to see pediatric patients were limited, now with COVID-19 they're going to be even more limited. And it will be ideal to make proper diagnosis, proper treatment, get the proper glasses, and start patching or surgeries or whatever we need as soon as possible, because, unfortunately, if this time passes that reversible blindness becomes permanent blindness. And that’s something that we should work towards that, we should work together in order to get these people seen as soon as possible and that requires effort from everyone, and the different resources –either on telemedicine, either online, or either through whatever resource we have –but we cannot lose the momentum.

Bulgan Orgilsaikhan: Yeah, I was actually speaking to a beneficiary of Orbis who had a three year old child, but she had a congenital cataract. And very short window of help she could get, and she had surgery done when she was one month old. So, I know that, that small window of time to get help is super, super important in changing a child's life and future.

Dr. Carlos Solarte: Yeah, let's think of as an example what you just mentioned: the congenital cataracts. It is important, incredibly important, to diagnose and treat them in the first three months of life. Three months only. And that's where the best success rate is. As the children grow, the success rate reduces. When we reach the six months of age, we can remove the cataract but the vision is not going to be restored as it was when he was three months old. That gives you just an example of one disease, how times are so sensitive. How we should be able to get these appointments or these treatments in this very short window, and we need to use that window, it is incredibly important.

So, I guess this pandemic has shown us how adaptable we need to be. We need to be incredibly open minded. We need to—nothing is given for granted, and we need to work hard to get our goals and objectives and go wherever we want. But this pandemic has expanded horizons and understanding that we can reach even farther. We can use many tools that we maybe didn't use before. The tools are there, but only if our desire to learn is there.

Dr. Hunter Cherwek: And thank you for that, Carlos. And certainly these challenging times are going to drive new thoughts, new innovation, and that's really what Orbis is all about. Taking innovation and adapting to a huge challenge like global blindness and finding new tools, whether it's Cybersight or the Flying Eye Hospital. While certainly COVID has disrupted everyone's 2020, I am really excited to see how Orbis comes out of this a stronger, more innovative organization.

I want to thank you both. Not only for all that you do for Orbis and our mission but also your friendship. It's actually really fun getting to talk with you all. And as always, thank you for your time and what you do to help Orbis and our family.

Dr. Carlos Solarte: Bulgan, thank you so much. It has been such a pleasure not only to talk to you, but to be here with Orbis, an organization that I really appreciate, an organization that I am incredibly committed to continue working with.

Dr. Hunter Cherwek: That was Dr. Carlos Solarte helping us explore some of the challenges that the pandemic has presented in eye care.

Next up, we’re talking with two of our team members from Latin America, Carolyn Collantes and Elisa Urruchi, about how COVID-19 impacted the way we deliver eye care training in that region and how people are accessing eye health services.

Bulgan Orgilsaikhan: Carolyn and Elisa,very, very nice to have you on this episode of Sightlines. Can you tell us a little bit more about your background and how you were introduced to Orbis?

Elisa Urruchi: My name is Elisa, I'm living in Lima, Peru. I’m one of the staff nurses of the Flying Eye Hospital. The very first time I met Orbis was in 2006 when I participated as a translator and it was for two weeks, and I never thought that these two weeks will change the direction and the perspective of my life. And after this two weeks, I immediately decided to send my CV. In August 2010, Orbis contacted me and sent me an email saying "Are you are still interested in joining Orbis?" and I said "Yes, I am, I'm still interested" and my heart was beating very hard because it was my dream and still is.

Bulgan Orgilsaikhan: What about you, Carolyn?

Carolyn Collantes: Yes. First of all, I will say thank you for being invited to participate on this vodcast. I started working with Orbis as a consultant just this year in March, so now I've been focusing with the M&E team (the monitoring and evaluation team) and the Latin American and Caribbean team.

Bulgan Orgilsaikhan: Can you tell us a little bit more about the acronym LAC and the Orbis's work in Latin America,in Bolivia, Guyana, especially in Peru?

Carolyn Collantes: Yeah, absolutely. So that's a phrase we sort of throw around a lot, like, oh LAC programs or LAC projects.LAC stands for Latin American and the Caribbean. So, it's just a quick and easy way to just refer to this big region. And although it's a big region, It's very diverse, it's easy to lump up all these countries and say LAC, oh the LAC projects, but each project is very unique, each country's very unique, and so Orbis has done an incredible job in targeting in and seeing what are the needs that these countries have, what are these specific needs, and how can Orbis come in and just be such a support to the population there. Right now, Orbis has five active projects in the LAC region. One of them is in Guyana, two of them are in Peru, there is one regional one between Peru and Chile, and there is another project in Bolivia and they span over different topics from ROP, working with premature babies, working with DR [diabetic retinopathy] patients, working in advocacy, there is a bunch of research components that different projects touch upon, so it's a diverse portfolio and diverse a number of projects.

In Bolivia, we are partnered with The National Institution of Ophthalmology, also referred as INO, and the project there consists of training the next generation of Bolivian ophthalmologists. So what's been really great about Bolivia and how they've been able to sort of shift their focus is, although a lot of these trainings are in person, Orbis has been able to create these remote, a lot of these trainings are remote settings. So it's been great to see sort of Orbis take that innovation and sort of shift gears a little bit on how to continue the training and how to still be such an asset to these residents that are trying to continue on with the training and continue on with the project.

In Guyana, it's a little bit different. Guyana has a focus on DR. What's really cool about Guyana is that this project sort of tags on a previous project that they had where they were establishing a screening program in the public health system and so their partner down there is the Georgetown Hospital. So this year, not only did they establish this program, but now they're attaching, this year, an artificial intelligence to support the patient care through the screening and through the referral system. So that's been also really exciting to see how to add on this technology and this innovation to programming and projects in the Latin America.

Dr. Hunter Cherwek: I think, you know, one of the things I want all of our viewers to know is in Latin America, we really focus on the retina, the back of the eye with diabetes, and also in premature infants, a disease called retinopathy of prematurity. This is the disease that actually made Stevie Wonder go blind. When the child is born prematurely before 36 weeks of gestation, the back of the eye, the retina, has not been fully vascularized. As you can imagine, your eye is constantly taking pictures and it needs a lot of energy to do that. So the blood vessels are trying to supply the energy, but they haven't fully developed in a child born at 28 weeks or, you know, 29, 30 weeks. So what the body does is start having abnormal changes to the retina, that gets worse if the child is put into a high oxygen incubator, with no monitoring.

So, certainly, we're doing a great job of having children surviving early labor or premature delivery that they did not survive 30, 40 years ago. The problems are, without the right technologies and the right oxygen, the retina can go blind. And so we have to find the right balance of helping the lungs breathe and the eyes see.

One of our longest partners in Latin America, who's on our website and who's a hero during COVID, is Dr. Luz Gordillo. She has been focusing her entire career on pediatric ophthalmology and eradicating this disease, retinopathy of prematurity. One of the ways she does that is checking the children very early after they've been born and every few weeks afterwards to make sure that those blood vessels in the retina are normal. If they're not, they may need laser treatments or they need a medicine injected into the back of the eye to prevent the child from going blind. If we do not screen and intervene during that critical time that child could be blind for the next 60, 70, 80 years.

So this COVID crisis has really made the already existing crisis of retinopathy of prematurity even more dire in Peru. And if you go on the Orbis website, you'll actually see how Dr. Gordillo gets in her car and into her PPE, and she drives and sees every child.

Carolyn, I know you did a site visit of our work with and have actually worked with Dr. Gordillo, maybe you could talk a little bit about what you saw and some of the memories and the patients you took away?

Carolyn Collantes: You know, I've visited a few hospitals with her and I love seeing just all the respect that the nurses, the doctors have for her, she truly is a hero in her line of work and just watching her interact with the patients with the moms and the young babies, it was definitely a highlight, you know, being in her shadow and just kind of trailing you know behind her and touring some of the hospitals that she works in back at the Institute IDV, which stands for Instituto Damos Vision and translated to Institute We Give Vision in English. I was able to meet some of the patients, some of the moms of the patients that had come back for a follow up visit and so one story sort of stands out a little bit to me as I reflect back on my time there.

There was a mom who had come in with her three lovely daughters, and they were a set of triplets. So, it was a very unique situation, the mom's name was Elisa and she came from a town that was about two hours away from Lima so that involved significant travel time for her to come to Lima and have her babies screened and tested for ROP. And so, Elisa was telling us a little bit about what had happened and she was happy to mention that she has these three beautiful daughters, because she has three sons at home, previous to these three daughters. So, she was happy that now she has this very balanced set in her house. So as I'm learning more about her daughters,learning about Elisa, she mentioned how this is an interesting case, you know, you had three premature babies and as they were screened, one baby was screened and was perfectly fine, the second baby was screened and had a mild case of ROP, and then the third baby was screened and had much more significant ROP presence. So, they had very three different treatments: one of them didn't have a treatment, the second one had more of a follow up to make sure that everything was going to happen and everything was going to, you know, turn out okay, and the third baby did have to have an intervention through a laser treatment.

So, it was wonderful to see this mom come back with her children and just be so happy and so excited that all three of them were doing well. They were happy, they were beautiful daughters and just the immense amount of gratitude that she had. She came with her sister and, I believe, another family member to help because, you can imagine, so many babies to take care of and they also traveled a long distance. This is an example of a family that had to come from, you know, over two hours away from the capital to have access to eye healthcare. So, it was just a beautiful kind of like full circle story that we got to capture at the very end and getting to meet her, and getting to meet her beautiful daughters, and seeing that everything turned out great and turned out as a super success story.

Bulgan Orgilsaikhan: Wow, thank you for sharing that story. I mean, I think when we talk about patients and the beneficiary stories, we often times leave out that effort from the parent or that, you know, children who bring their fathers and mothers to treat to have care or for that mother leaving off everything just so that the child can have a care. I think that is a massive effort, it's just they're leaving everything...

Dr. Hunter Cherwek: Dr. Gordillo and the work she's been doing now is just a perfect example of what we're fighting for during COVID, you know, the helping children and intervening before they go blind for the rest of their lives.

Bulgan Orgilsaikhan: So, what are your concerns of how this pandemic is affecting sight-saving work in Peru and the Latin American region?

Elisa Urruchi: First of all, I will say the that is affecting a lot because people, the population, they don't want to go to hospitals, because they are afraid to be infected. And the professionals, especially ophthalmologists and nurses in the ophthalmic area that are working in general hospitals, they are sent to cover COVID services and then some of them decided to quit. The ophthalmologists and nurses are part of the risk factor and they are not attending patients because, you know, ophthalmologist has to be very close to the patient.

From the patient point of view, I will say like especially in Peru, 70% of the population is informal, have informal jobs. So, right now, that means that a person that doesn't work one day, doesn’t eat that day. And I think they will need to prioritize their needs and probably will be more focusing on food, home, education. And maybe some diseases will be left behind, until it gets worse and maybe it would be too late for them to address that case. I would say consumables as wellin Latin America–most of the consumables we're using in ophthalmology to diagnose and to treat patients are coming from, are imported, and due to the borders that are closed, these consumables are getting expensive, more expensive, and not available sometimes. And I would say as well, the human resources. There are nurses infected, nurses and doctors infected, and they have been in the intensive care units, and some of them passed away.

Carolyn Collantes: There were a number of nurses and different doctors that have passed away. So it's a really big tragedy and deep loss for Peru. Another factor that just made this even much more complicated for people to get access to any sort of care, especially eye care, is just some of the distances that people have to travel to get to a local clinic or to get to hospital and when the country was shut down for months there was no local transportation, there were no buses, there were no taxis, you couldn't be on the road, even if you had your own private car or managed to find transportation, there was no way for you to receive any sort of routine follow up or checkups, or any of that.

The only way that you were getting to a hospital is if it was an emergency situation, you know, if your life was on the line. So I think what we're going to see in the next few months, is that there's going to be many people that haven't had the chance to receive eye care services and that will then need to be attended to, right?So, Peru is going to have this challenge of how do we open up again our services, how do we open up our primary care centers or hospitals, how do we make sure we have enough resources to help these people that needs to come in for routine eye care, another routine health checkups, so that'll be a challenge coming up for them as well.

Elisa Urruchi: I was having a communication with IRO, that is the regional institution in Trujillo, Peru. They are worried about kids because they are not doing any visual acuity for kids, and now the kids are at home using electronic devices and their myopia is going to increase in these cases. And this problem is not going to resolve until the emergency is over and many people, many patients with, especially patients with our chronic diseases like glaucoma or macular degeneration, they are not continuing with that treatment and there is a possibility that they will be worse and, maybe, they will become, there is a risk, that they're losing their sight, so the numbers of blindness per people will increase during the following years, and something we have to work harder onthat.

Carolyn Collantes: You know why vision is so important in a country like Peru --we talked about it a little bit before where about 70% of the population is in the informal economy, meaning they kind of live on what they make day by day --so if their livelihoods depend on them going out every day and working in the tourism sector, working in the transportation sector, in the commerce sector, that, you know, their health is their livelihood and it goes back to them being able to take care of themselves and take care of their family and there's this just extension of a network that you have where you have, maybe, one person supporting many people. So, just to tie in another reason why, specifically in Peru, having access to health care, eye health care, is just so essential.

Dr. Hunter Cherwek: Carolyn, thank you so much. I do think people sometimes don't recognize that sight is directly related to education, is related to equity, it's related to economics both macro-economics and, as you said, the family economics.

That was Elisa Urruchi and Carolyn Collantes.

Dr. Marie-Josée Aubin is an Associate Professor of Ophthalmology at the University of Montreal Faculty of Medicine. We're absolutely thrilled to welcome her to Sightlines.

Dr. Marie-Josée Aubin: I'm thrilled to be here. I regret we cannot do this in person, but really, I'm glad you invited me to participate in this discussion.

Dr. Hunter Cherwek: And where are you at the moment, Dr. Aubin?

Dr. Marie-Josée Aubin: Well, I'm in Montreal in Canada. This is my hometown and this is where I work, at University of Montreal. I work as a surgeon, a physician, I'm an ophthalmologist, so I'm working with patients and my specialty of field is uveitis, which is infectious and inflammatory diseases of the eye.

Dr. Hunter Cherwek: Please tell us a little bit about your sub-specialty, for those of us who don't know what is uveitis, and tell us some examples of the type of patients you see or the type of diseases that it could be associated with?

Dr. Marie-Josée Aubin: Uveitis, I mentioned, is inflammation of the inner part of the eye. So the "itis" is inflammation and "uva" is the Latin word or Greek word for grape, actually. It's all the vascular part of the eye. So, when the eyes are inflamed, it can be inflammation due to infection or it can be inflammation due to other inflammatory diseases, such as sarcoidosis or rheumatic diseases. But in terms of infectious diseases, I see ocular tuberculosis, I see ocular syphilis. There's been a great resurgence in Canada and the since the early 2000 of cases. In 1998, there were only three cases reported and now there are thousands. So we, I used to teach syphilisas,you know, like an old disease, and now we see really, you know, you have to teach students to think of syphilis always in their differential diagnosis and we see a resurgence of other sexually transmitted infections such as chlamydia. It's a different [type ]of chlamydia [than the one] giving trachoma, it's the sexually transmitted disease, but it can lead also to chronic conjunctivitis.

Dr. Hunter Cherwek: Yeah and, I mean, I can tell you as an ophthalmologist, the uveitis specialists are the people who are kind of like the Sherlock Holmes. You get some very unusual diseases, you're thinking of very rare things, you have to think about the whole body--like you said, someone can have tuberculosis in their lungs, but the first time they really manifest the disease can be in their eye. So I can tell you I've referred many patients to people like you, the specialist in uveitis, and during the COVID lockdown a lot of them can have their inflammation come back, because they're not regularly seeing their doctors, so maybe you can just tell us a little bit about how COVID has impacted your practice and your patients.

Dr. Marie-Josée Aubin: Yes, certainly, it impacted tremendously. I think we cannot foresee how disruptive this pandemic could be, and especially for caring for chronic diseases, such as chronic uveitis. Because of the restrictions there was delay in timely access to care and also access to medication. Like a lot of my patients they they're on immunosuppressive therapy, so we had to make, you know, like special efforts with like sending reminder to all patients who, you know, like keep taking your immunosuppressive treatment you need them, otherwise your disease will reoccur.

There was an impact also in terms of surgeries being delayed, all kinds of surgeries. Cataract surgery, you might think that in the country like Canada, it's not vision threatening, but yes, it is, and we just see patients almost blind by cataracts so we went through all our list of cataract surgery, trying to expedite those that needed the surgery most. So, that was a lot of planning to try to reach and give appointments and surgical care to the one that needed the most. There was a great fear for people to come in and there's been great work from the direction of the hospital to make the environment as safe as possible with physical distancing, but all this brought me to think of them to look into the impacts, the collateral impacts, of COVID on the health, the vision health, the mental status of our ophthalmology patients suffering from chronic conditions such as glaucoma, age macular degeneration, retinal diabetes that need the treatment as well as in chronic uveitis and also to look at the mental health and resilience of eye care professionals and trainees.

Dr. Hunter Cherwek: Most of our participants on this series have not talked about the importance of mental health either during COVID or when patients have eye disease or vision threatening disease.

Dr. Marie-Josée Aubin:In terms of mental health, I've seen so many disruptive cases not only with patients. You know, like I see uveitis patients and out of the blue, you know, one foot out of the doors, a young patient was there and tells me he has suicidal thoughts. You know, I've seen that at least twice since the last month. It's not something we're used to as ophthalmologists. And the same with the eye care professionals, nurses, trainees–you know, like I, again, have seen situations where, you know, like someone just come into my room and break into tears, just from overwhelmed by all that's been asked for. Because some of the professionals have been asked, you know, like to work in COVID wards or [are] being transferred from one activity that they’re comfortable with to go and provide care in intensive care units, for example. So it brought a lot of challenges and anxieties.

Dr. Hunter Cherwek: That's one of the things I love about your sub-specialty because as a uveitis expert you look at the whole person--the human being and the mental health of someone connected to that eye,because a lot of times they're dealing with a chronic disease or a systemic disease. And I think you're exactly right, I think COVID has stretched and really stressed everyone and it's people like you that are able to help and comfort and provide compassion that is going to get us through this. So just a big thank you for that. I just wanted to take a minute and let people realize that you wear so many hats and you're treating so many various diseases all around the world. But I think one thing that unites us with COVID is everyone has been stretched and everyone's been challenged during this year.

Dr. Marie-Josée Aubin: Yes, you're absolutely right! With the COVID pandemic, it's highlighted a lot of the gaps, you know, like healthcare system delivery. And also it shed light on a lot of social inequities, maybe gender based or racial inequities, and the realization that no one is safe until everyone is safe and that the health, it needs something to invest in health and health prevention in terms of economic wealth as well. I think those two key lessons, maybe, like a step forward and actually to push towards better health strategies for the future, for future pandemic or control of infectious diseases and neglected diseases.

Bulgan Orgilsaikhan: I want to ask about your international blindness prevention experience in countries like Nepal or in Africa. Can you tell us a little bit or share s little bit about some of the stories with beneficiaries and how you saw people's lives being changed.

Dr. Marie-Josée Aubin: Yes, I think as a as a surgeon, a cataract surgeon, probably the most rewarding cases of cataract I've operated were the one I did when I was doing outreach and surgical care in Nepal. We would operate more than the hundred patients or they, we were like two or three surgeons operating. And it was amazing, you know, like people bilaterally blind from cataract and the next day they could see and they with such a smile and it was very rewarding, really to see the good, you know, like with a 10-15 minutes time operation, how much we could give to this gift of sight. It was inspiring.

Dr. Hunter Cherwek: No, I love that and I'm sure it's got to be interesting, even during COVID that you're able to do telemedicine to help patients around the world. You're doing consults and working with Cybersight in Haiti or seeing your former residents in Kinshasa, or the Democratic Republic of Congo. It's just amazing even COVID hasn't slowed you down, globally.

Dr. Marie-Josée Aubin: I would like to say that, even during the COVID pandemic, I could pursue the activities and global eye care through the telemedicine network and also through course modules that Orbis organized, actually, to give uveitis and other like sub-specialty teaching for residents in French-speaking countries like Haiti, so I was very glad to be able to contribute to this.

Dr. Hunter Cherwek: I always try to look for the positive in things, and certainly we've had many days that all of us have had dark days during COVID. I have not talked to another human being face-to-face in three weeks, so all of my conversations have been on Zoom. And conversations like this and learning from people like you and listening to Bulgan, it just makes it a little less lonely, right. And you can only imagine, I've lived a very blessed life, I would just say you can imagine how isolating it must be to be in an isolated community, geographically, to be blind, to be vulnerable, and during COVID where everyone is afraid to leave. And I think that's what one of the reasons why we wanted to do this podcast series was to get everyone connected, to give people good things to focus on that, you know, there's nothing more inspiring than giving someone their sight back.

I think you talked about how meaningful, the most meaningful surgeries you've done were the ones in Nepal helping those who need it most and giving the gift of sight is just miraculous. So, you know, really, I just wanted to thank you for taking time today to connect with us. Certainly, that's what Orbis is all about --connecting with patients, connecting with teachers, connecting with technology, and now, you know, the techniques --and I'm sure you've been a better physician for your patients in Canada, having done all the work and trained all around the world because you've seen all different ideas and you've worked with experts who approach problems from different ways. So just thank you for sharing that expertise with us. I can't wait to get you back on Cybersight and, certainly, I want to get you out in the field and on the Flying Eye Hospital. So, again, just a big thank you from Orbis.

Dr. Marie-Josée Aubin:Thank you. Thank you so much.

Dr. Hunter Cherwek: That was Dr. Marie-Josée Aubin! I want to thank Dr. Aubin, Dr. Solarte, Carolyn Collantes, and Elisa Urruchi for joining us today. And, of course, a huge thank you to my special guest host, Bulgan.

Thank you for joining me for Sightlines today. I hope you’ll join us for the next episode and for the entire series.

If you would like to learn more about Orbis and the Flying Eye Hospital, please visit us at orbis.org. If you’ve enjoyed this show, please subscribe to our YouTube channel to watch each episode and check out many other videos about our work around the globe.

If you’re listening to the podcast version of the show, please hit subscribe so you don't miss a future episode, and if you're listening in Apple Podcast, please consider rating or reviewing the show. It really does help others to learn about us, about Orbis, and our sight-saving mission. See you next time!