A hospital on wings

The world's only `flying hospital', ORBIS, comes to Chennai.

THE DC-10 aircraft stationed at Chennai's Anna International Airport is innocuous from outside. Step inside, and it is a modern eye hospital.

ORBIS, the world's only flying eye hospital with a fully equipped teaching facility, landed in Chennai on November 7 its first visit to the city but the 13th to the country with a 23-member medical team to provide state-of-the-art training to doctors, nurses and technicians on the medical, management and technical aspects of ophthalmology.

With the motto of "saving sight worldwide'', the United States-based ORBIS, an international not-for-profit organisation, has been flying the world over since 1982 on a mission of taking help to 90 per cent of the world's 45 million vision-impaired people and the over 135 million people with low vision, who live in developing countries. Among developing countries, India has the largest number of vision-impaired people. Over 80 per cent of them can be cured with techniques that have become routine in most developed countries. Thus, for ORBIS India is a priority area, and it works closely with major eye hospitals and institutions in the country to enhance their capability through training and education. According to its India director G.V. Rao, during the three weeks that ORBIS will be in Chennai, its doctors, apart from teaching and performing surgical operations inside the aircraft, will perform such procedures in partner institutions, including the TMS Hospital in Salem. According to Dr. S.S. Badrinath, chairperson of Sankara Nethralaya in Chennai, the programme will provide exposure to post-graduate students, and upgrade the skills of nurses and bio-engineers. According to Dr. Ananda Kannan, the president of the Madras City Ophthalmologists Association, the arrival of ORBIS is a great opportunity for Tamil Nadu, already a pioneer in treating various kinds of visual impairments, to learn state-of-the-art techniques in ophthalmology.

Committed to reducing corneal blindness in the country, ORBIS, in conjunction with the Eye Bank Association of India, supports the cause of eye donations in order to supplement the urgent need for corneas. In India, against the demand for over four lakh corneas every year, hardly 16,000 are available. By contrast, the number of vision-impaired persons is rising rapidly. Flying Eye Hospital director Ray Leclair says: "Wherever the ORBIS aircraft goes, it attracts the attention of the media and the government. This exposure enables ORBIS to serve as a catalyst in establishing eye banks and setting up national plans for the prevention of blindness.'' According to Leclair, in India, preventing and treating child blindness is the top priority for ORBIS, which is all set to forge a long-term partnership with Sankara Nethralaya and the Government Regional Institute of Ophthalmology.

The ORBIS aircraft, which covers three to 10 countries every year (in 2002 it touched China, Bangladesh and India), stops in each country for about two weeks and conducts programmes covering treatment, management and technology. Some of the areas that ORBIS covers include the treatment of ocular diseases, childhood blindness, eye bank management, primary eye care, refractive error, nursing and anaesthesia.

ORBIS is the brainchild of Dr. David Paton, a Houston-based ophthalmologist, who, after a visit to some developing countries in the 1970s, was keen on transferring the United States' ophthalmologic expertise to the developing world as, according to him, "blindness and partial blindness are the easiest to prevent and treat''. Giving shape to this idea became his life's mission. He conceived of a "flying hospital" and began to garner support for it in the U.S. Finally, with the help of a grant from USAID and a DC-8 aircraft that was donated by United Airlines, ORBIS was set up. The aircraft was modified extensively, and Dr. Paton managed to convince pilots and doctors to serve the programme as volunteers. ORBIS set off on its first mission to Africa in 1982. In the first two years, it covered 24 countries, which it visited again in 1984. That year, while on a mission to Malawi, ORBIS found just two ophthalmologists serving seven million people. It was then that it expanded its programme to include nurses, health care workers and bio-medical engineers.

Now ORBIS has three modules: a comprehensive, multi-year country programme; short-term country programmes on a need-based approach; and training programmes in ophthalmic sub-specialities.

ORBIS' off-plane programme began in 1986 in Singapore. Since then every year it conducts a three-week, comprehensive ophthalmology course in some country or the other, by rotation. ORBIS realised from experience the need for a comprehensive health care system. In 1986, it started community health projects with a broad spectrum of activities to promote eye care as part of overall health care. Continually expanding and evolving its scope, ORBIS outgrew the DC-8 aircraft. In 1992, with donations from aviation companies, corporations, foundations and philanthropists, ORBIS purchased the DC-10, which has twice the space of the DC-8.

The DC-10 jet, which started operation in 1994, has been converted into a comprehensive hospital with a teaching facility. There are a number of rooms for audio-visual facilities (15 cameras, eight microphones and 54 monitors that help in viewing the surgical procedures done on the aircraft from anywhere in the plane), for editing, laser/examination (contains slit lamps, laser stations and specially designed wetlab stations, where silicone and animal eyes are used to provide hands-on experience), for operating (equipped for any conventional type of eye surgery from simple cataracts to complex retina surgery and oculoplastic techniques), for sub-sterile and scrubbing (used to train nurses), for recovery, communications, and lecture (accommodates 48 doctors and has a two-way microphone system to enable doctors to communicate directly with experts performing surgery in the operation theatre) and so on. The lower level of the aircraft houses a technical training and maintenance centre. All pilots are volunteers, mostly those working with or retired from United Airlines, from where all pilots receive complimentary training to fly the DC-10. The flight deck is maintained by the Union of Myanmar.

With a budget of $25 million every year, ORBIS has clocked thousands of kilometres around the globe, organising some 450 training programmes in 80 countries. Distinguished volunteer ophthalmologists from an international network of eye surgeons have demonstrated surgical and laser procedures to over 50,000 doctors and nurses and treated over 25,000 patients in developing countries.

In developing countries, the need for ORBIS is rising rapidly, with the World Health Organisation (WHO) estimating a doubling of the number of vision-impaired people in such countries by 2020. According to WHO estimates, in the next 25 years the number of vision-impaired could reach 80 million, with over 200 million more at risk an increase that outstrips the rate of growth of population.