On a Mission

Take us back to the beginning…

I have been with Orbis since 1994 – my first mission was to Khartoum, Sudan. I was just an ordinary ophthalmologist who had an interest in overseas ophthalmology, particularly in developing countries. One of the reasons I was interested in Orbis was because I learned to fly when I was very young and Orbis is where you get interdigitation of aircraft and ophthalmology!

My first visit to Khartoum was a revelation to me; we regard ourselves as being well-trained ophthalmologists but when I got there I realized we hadn’t really scratched the surface. It was familiar… yet so very different. You’d see cataracts, but they weren’t the same as what I was used to; the response to surgery could be entirely different; for example, the patient could have a much greater inflammatory response. The burden of disease is absolutely huge – you just don’t realize how gargantuan the work is and how very little there is available with which to do it. There were patients who had walked for days to bring their child to see you in the hope that you could deliver a miracle for them. Sometimes you could, but sometimes you couldn’t.

How does Orbis approach missions?

We are a capacity-building organization rather than a volume-based organization. We’re invited to countries by ophthalmologists who are working there and who’d like us to share our expertise. Then we select the volunteers. One very important point is that the work Orbis does is not about the ophthalmologists alone – it is about the whole team. On my own, I am completely useless. But surrounded by my colleagues – nurses, orthoptists, and the biomechanical engineers who mend and service the equipment – we can help and make a real difference.

Tell us a bit about the new aircraft…

The Flying Eye Hospital is a very important icon for us. It is a state-of-the-art hospital that is internationally registered and recognized, and it can deliver top quality ophthalmic treatment anywhere in the world. It is a very significant investment, and has come almost entirely from donations; the aircraft itself was donated by FedEx. All of this has given us the opportunity to bring on board cutting-edge ophthalmic equipment. We have surgical simulators which are very important as they allow visiting ophthalmologists in the early stages of training to learn the basics of hand-eye coordination and ophthalmic surgery without needing to practice on people. There are many other technical aspects regarding the aircraft; payload, fuel consumption and where it can land – all of which are also much improved. Although its payload is still quite significant, it is a much lighter aircraft than our previous one, which means we can go to more places as we can land and take off on shorter runways. We try to keep it on the road – or rather in the air – as much as possible; there is no base, but there are periods of downtime when the airplane needs to be serviced for which we’ll go wherever we’re offered the best quality and best value maintenance.

The Flying Eye Hospital is only a very small proportion of what we do. The majority of our work is providing country-based programs, and we currently have 15 offices across the world, and we will continue to do so until those countries no longer need us.

What is your current role in Orbis?

Though I still operate in the UK, I no longer perform surgery on missions. I took a decision when I became Chairman of Orbis that I would cease volunteering medically. I am still volunteering, but I am doing different work now; I’m part of the committee that oversees programs to ensure we are achieving what we set out to, I’m involved in medical strategy and what our clinical foci should be, and I check that we’re spending our money appropriately. In 2017, Orbis will be providing eye care treatments for hundreds of thousands of people around the world and treating over six million people at risk of blinding trachoma, so it is a very big organization with a very small number of staff – around 220 worldwide.

What are the main missions of Orbis?

If you look at where we spend most of our money, the three main areas would be in teaching cataract surgery, treating trachoma and pediatric ophthalmology.

No-one can ignore cataract – it represents around 50 percent of the world’s blind people, and I think it is where we can reach out to the most people. Trachoma is a very important part of what we do, and one of our clinical interests is to eliminate it, which  I think it is completely possible – just like smallpox was eradicated. We are incredibly grateful to Pfizer who donate azithromycin to us for the treatment of trachoma. They ship it to the country where we need it and through our in country partners, we distribute it for them. Our pediatric ophthalmology work covers a whole panoply of diseases, and with millions of blind and visually impaired children in the world, needless to say, there is a great deal to be done. We also perform many oculoplastic surgeries, as well as treat eye movement disorders.

Any notable memories?

I do remember being absolutely devastated by the tumor ward in Khartoum. Adults and children had basically been given up on; there were children with huge retinoblastomas and there was no hope for them. We couldn’t help those specific patients, but what we could do was put in place a system that would allow these conditions to be diagnosed earlier so that they were treatable, and teach the healthworkers how to administer treatment. Seeing this ward really drove it home to me: the need for what we can provide and teach was absolutely huge because these people had been sidelined. They had been condemned simply because there wasn’t a system in place to deal with them. It was a very shocking moment for me.

Can you share any highlights?

There are so many wonderful highlights. My first mission in Khartoum was during the civil war between North and South Sudan, and we were visiting a huge refugee camp to find patients who might need us. We came across a 23-year-old woman who was completely blind in both eyes because of cataract and was being led around by a young relative. She had nothing – and she was never going to be able to marry, work, be educated, or contribute to her community in any way. We took her back to the Flying Eye Hospital  and performed cataract surgery. I will never forget the day that the bandage was removed from her right eye – her life had changed. She could now do what all of us do; a life we take for granted. And it just struck me so powerfully that if we hadn’t seen her, she would have never seen again. So what Orbis can do is give individuals and communities hope, where hope didn’t exist before. And that is a wonderful thing.

I have so many similar stories and experiences, but one that particularly sticks in my mind was a woman in Bangladesh who had a divergent squint. Culturally, this meant that no one would marry her, even though she was incredibly beautiful. I performed surgery to correct her squint, and after the surgery, she wrote to me and said: “I wanted to thank you and I thought you’d like to know that I have had three offers of marriage – but I have decided to think about it.” What a wise woman she was!

How are priorities shifting?

Diabetic retinopathy is becoming very important, because diabetes mellitus is an increasingly prevalent disease where ophthalmologists become involved when medicine and the system has failed patients. My own view about  diabetic retinopathy is that, of course, we need to treat it, but we also need to work with the physicians to ensure that the majority of these patients never reach the stage where they need ophthalmological treatment. So we are starting to do a little bit more work on diabetic retinopathy in terms of diagnosis, prevention and treatment.

We also recognize that refractive error is extremely important – and is becoming even more so. Recent research has shown that refractive error, particularly myopia, can be induced by ‘close work.’ So whilst we may not have a direct clinical focus on refractive correction, it is very important we focus on it, and we do this through working with other partners. We work ‘hand in glove’ with partners all round, and although we may, in theory, compete for funds, in practice we collaborate all the time because the power of partnership is how we succeed.