Doctors on the wing to developing countries
Pippa Wysong

An eye hospital set-up on a DC-10 airplane is just what the doctor ordered, especially in poor parts of the world where eye care is desperately needed. The plane, operated by ORBIS International, is used for more than sending eye doctors out to perform cataract removals and other surgeries, according to Brian Leonard MD, ophthalmologist and pilot. ORBIS's goal is to help poor communities improve their eye care infrastructure and provide training to local ophthalmologists who may not have had the best education in the first place.

Orbis flying hospital in Dar es Salaam Tanzania

Dr. Leonard has done extensive training for ORBIS in various parts of Africa , China , Vietnam and other countries. As a pilot he has literally been behind the wheel on a number of missions. He first became involved with ORBIS in the early 1980s when he flew the plane that was used at that time, a DC-8. "I've done 52 programmes with this airplane in developing countries worldwide," he said. The plane was replaced a decade ago with a DC-10.

Unfortunately, Dr. Leonard cannot fly the newer plane. The ORBIS plane is impressive. It contains a 52-seat classroom, an audiovisual room, an examining room, a room for laser treatments, a patient recovery area, an office and a conference centre. Ophthalmologists, faculty and pilots who go on missions do so as volunteers, but nurses and the anaesthetist are salaried. There has always been heavy Canadian involvement with ORBIS. A third of the nursing staff historically has been Canadian, Dr. Leonard said. The university affiliated faculty fly out to wherever the ORBIS plane is, and stay for two or three weeks at the site teaching and seeing patients.

Helping local doctors learn more

Halima Asman before cataract surgery on board the Flying Eye Hospital

But before the ORBIS plane is sent anywhere, groundwork is done. Crews generally make one to four visits to a location "to catalogue and inventory the infrastructure and existing conditions. The goal isn't to go in and show off high-tech western medicine," he said. Host doctors, the local ministry of health, hospitals and the area's university are all brought in to help ORBIS organisers figure out what sort of programme will best benefit a community. "We study the infrastructure and design with them a three week programme, then pick the visiting faculty according to that," Dr. Leonard explained. Once at a site, ORBIS members go into the local hospital with their host doctors. "We examine patients that they've seen in advance, teaching as we go and select from these the patients that we will operate on with the host doctors on the airplane, or in their local hospitals," he said.

Teaching can include everything from surgical and anaesthetic techniques, to creating a sterile environment and improving bedside manner. Using audiovisual technology, surgeries done on the plane are viewed by people sitting in the classroom, and sometimes to medical and nursing audiences outside the plane.

Surgery on board the ORBIS Flying Eye Hospital

Halima Asman for post op check following succesful surgery

For physicians considering this type of work, he advised going with an agency that has a track record, and to go with a friend or colleague who has done this before. "You have to prepare in advance, think about the equipment you'll need. And, you'll need a flexible attitude," Dr. Harvey said. "Treat it like a holiday, it will probably cost you some money," he added.