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Flying at the speed of sight

key.aero looks at the good work that the ORBIS ‘Flying Eye’ hospital does around the world in saving the sight of thousands of people.

30-Dec-2009


Another patient is led from the aircraft following eye surgery. Since its inception back in 1982, ORBIS has flown more than 220 training programmes, flying the equivalent of ten times around the world. Newscast image

Tragically, every five seconds a person goes blind somewhere in the world. Basic eye care could prevent this from happening to the majority of these people - according to the World Health Organisation (WHO), some 45 million people worldwide live with blindness, around 90% of them in developing regions. It is estimated that up to 80% would not have lost their sight if they had been given access to basic medical care. This is where the ORBIS Flying Eye Hospital comes in - it is able to provide an on-site training facility for doctors in developing countries.

In 1949 Howard Ripley, a resident doctor at London’s St Thomas Hospital discovered that it was possible to implant a lens on the eye after studying a number of cases in which RAF pilots had suffered eye injuries when their Perspex windshields had shattered. From this breakthrough, medical procedures developed until by the early 1980s, eye operations had become routine.


Douglas DC-10-10ER N220AU was delivered to ORBIS in November 1991 and has served as its flying eye hospital for the past ten years. It entered service following conversion on June 28, 1994. ORBIS image
However, at about this time Houston-based ophthalmologist Dr David Paton was travelling through some Third World countries and was reportedly horrified by the immense scale of curable, though untreated, eye diseases. The major problem was that all of the necessary expertise was on one side of the world, while most of the people who needed it were on the other. Dr Paton was eager to address this imbalance and his inspired solution was to place all the required technology and skills onto a modified commercial aircraft, thus creating a mobile hospital that could be flown to where it was needed. Once there, volunteer specialists would join the Flying Eye Hospital team and train local doctors in up to date surgical procedures including such cases as cataracts, eye infections and child blindness.

In March 1980 ORBIS – a non-profit global humanitarian organisation – acquired its first aircraft, a Douglas DC-8-21 donated by United Airlines. After 23 months of conversion work, the aircraft had been turned into a fully-equipped eye hospital and teaching centre – it formally entered service with the charity on February 3, 1982, flying its first programme to Panama City and soon after to China, Colombia, Ecuador, Indonesia, Jamaica, Malaysia, Pakistan, Peru, Philippines, Sri Lanka, Thailand and Turkey. Similar itineraries were initiated and in the subsequent years the aircraft completed training work in Africa, Asia, Southern Europe, South America, the Middle East and the Caribbean at the request of local governments.


An overhead view of the DC-10’s general layout - the operating theatre is positioned immediately over the aircraft’s wings, the most stable part of the fuselage. ORBIS image
The project was a great success, but at 30 years of age, the DC-8 was reaching the end of its operational life and in the early 1990s ORBIS was forced to look for a replacement aircraft. Generous donations were forthcoming enabling the organisation to purchase a wide-bodied DC-10-10ER, one of the first few off the production line. It had originally been retained by the manufacturer for use as a test airframe but later saw passenger service with Laker Airways, ATA, Air Hawaii, Omni International, Cal Air International and Novair International.

Having agreed to the $6 million purchase in November 1991, ORBIS still required a further $12 million to refurbish the aircraft and convert it from a passenger configuration into a fully working teaching hospital. This was achieved through ‘gifts in kind’ from various companies within the aviation and medical sectors, or through donations from individuals. Finally, on June 24, 1994, the work at Mobile Aerospace Engineering was complete and the DC-10 Flying Eye Hospital – which offers twice the interior space of its predecessor – was operational, enabling ORBIS to retire the DC-8, which is now on display at the China Aerospace Museum /Datang Shan Airbase in Changping, China.


The First Class cabin has been turned into a lecture room from where local trainee doctors are able to watch the operations live and conduct real time discussions with the surgeons. Classes and discussions can take place during and after ‘live’ operations. Key - Tony Dixon
The ORBIS DC-10 is configured into distinct cabins with standard First Class seating to the front of the aircraft and the medical facilities to the rear, which include a laser room to test patients’ eyes, a conference room, the operating theatre and a three-bed pre-operation and recovery room. The operating room is positioned immediately above the aircraft’s wings as this is the most stable part of the fuselage when the aircraft is on the ground, although the flooring has been strengthened, bringing its panel deflection tolerance to just 0.001 inch to support the laser surgery equipment. “The operating suite is the same as any operating theatre in the world except it is on a DC-10,” said a volunteer Staff Nurse.

The theatre has a microscope fitted with two eye pieces allowing the ORBIS volunteer staff and local surgeons to work side by side on individual cases. From a lecture room in the First Class cabin, an interactive video link enables local trainee doctors to watch the procedures live and discuss what is going on with the surgeons.


The operating theatre onboard the DC-10 is identical to any you will find at your local hospital and is adjoined by a four-bed pre-operation and recovery room. Key - Tony Dixon
To protect the expensive medical equipment during transit, special storage cases had to be created. These boxes are securely strapped to the aircraft’s structure during flight, and have been designed for easy access so that the aircraft can be converted back into a working hospital relatively simply. “We can have the aircraft set up within one hour and 45 minutes of arrival at our final destination,” said Staff Ophthalmologist Dr Carlos Solarte, speaking in 2005. The modifications and specialist equipment have increased the aircraft’s gross weight by 148,800lb (67,500kg) to 300,000lb (171,000kg) - this means that the aircraft requires a minimum runway length of 8,000ft (2,400m) to operate, although Orbis did confirm that this has not been a problem, as the aircraft generally utilises major airports. “We have a high zero fuel weight which limits our range to around six-and-a-half to seven hours flying time,” said a volunteer pilot. “When we returned from India we made a stopover in Cyprus before continuing our journey to London; similarly, we have to make a stop in Bulgaria when we fly from Kashi in China.”

As a non-profit making organisation ORBIS is reliant upon charitable donations to continue its service. It operates with its own dedicated team of 23 staff, made up of eleven different nationalities, and has established a pool of nearly 400 leading surgeons who donate their time free of charge to train local doctors and nurses and help increase local medical capability. “It is a very intensive but highly rewarding exercise,” explained Ray Leclair. “We are only home around 20% of the time.” “It is really the most gratifying and most satisfying job you can do, especially when you see people arrive at the aircraft without sight and are later able to walk away with the biggest smiles on their faces,” one nurse said.


The ORBIS Flying Eye Hospital would not have achieved such outstanding success without the support of FedEx and United Airlines — their valued support is noted by these additional titles on the forward fuselage. Key - Tony Dixon
ORBIS’ primary aviation sponsor is express transportation company Federal Express (FedEx). It provides full training for all ORBIS flight crew, offers maintenance and technical support for the aircraft, and in addition, ships urgently needed medical supplies to programme sites all over the world, free of charge. The company has even supplied a maintenance technician who has travelled with the flying hospital for the past couple of years to carry out routine aircraft maintenance during the medical programmes.

In 1980 when United Airlines donated the company’s first aircraft, it also provided full technical and service support for the DC-8 and the DC-10 when it first arrived. Although the US major does not play such an active support role following the retirement of its own of DC-10 fleet, a number of the airline’s pilots continue to fly for ORBIS. A team of around 15 flight crew, comprising FedEx, United Airlines and retired pilots and engineers regularly fly the aircraft out on programmes, return to the US to carry on their normal jobs and then go back to the collect the aircraft at the end of its visit.


The audio-visual room is a critical part of the hospital. The Media Producer has control over all 16 of the cameras on board the aircraft, and relays the images to the other areas. Key - Tony Dixon
Naturally, this entails a lot of travel for the crews, although costs are kept to a minimum for ORBIS by using airline passes. It is a similar story for the doctors, although naturally they do not have the perk of staff concessionary travel. However, thanks to the support of a number of airlines, they are able to take advantage of free or heavily discounted travel. These include Virgin Atlantic Airways, whose Chairman and Founder Sir Richard Branson is an ambassador for the project, and United Airlines, which offers an annual $250,000 ticket pool.

In addition to the generosity of its airline partners, ORBIS regularly receives other charitable donations. Most airports waive landing and parking fees for the aircraft, while air traffic control costs are often overlooked by the governments of the countries the aircraft overflies. Yet more donations come from some rather surprising sources… “When we returned from Addis Ababa we made a stopover in Malta before continuing our journey to London; the fuel for the flight from Malta to London-Stansted was paid for by the Government of Libya,” said Gill Chase, a volunteer pilot in 2005.


Young Mehnaj Habib is comforted by her mother following another successful eye operation onboard the DC-10. Newscast image
Since the DC-8 entered service in 1982, ORBIS has completed more than 220 training programmes, flying the equivalent of ten times around the world. Through its work and the training given to local doctors more than 16 million people have had their sight restored.

The flying hospital was the first medical programme ever permitted to enter Mongolia, and the DC-10 was the first Western-registered aircraft to arrive in Chengdu since the Second World War when ORBIS operated a training programme to the Chinese province in 1989.

In 27 years, ORBIS has flown to many places and has many stories to tell, none more heart-rending than in India. “It was an experience I will never forget,” said volunteer nurse Ann-Marie Ablett. “We have had some amazing stories - one boy we treated in Kunming was even talking about selling one of his kidneys to raise money for an operation on his sight.”


ORBIS DC-10 N220AU arrived at London/Stansted on March 29, 2005 following its programme to Addis Ababa, Ethiopia, and was greeted by this water cannon salute from the airport’s fire department. Airport operator BAA is understood to have waved all landing and parking fees during the visit, even allowing the aircraft to complete a flypast at the airport ahead of its arrival. Newscast image
The organisation has established offices in Bangladesh, China, Ethiopia, India and Vietnam and trained over 54,000 healthcare professionals in 81 countries. Although the full-time ORBIS staff and visiting volunteer doctors and surgeons may have only completed around five operations a day during their field visits, their training has enabled local doctors to continue the work once the aircraft has left. “It must be remembered that our focus is for training, not service delivery,” said one Staff Nurse. Now, with nearly 28 years of experience flying programmes to the developing world, ORBIS is confident it can accomplish the goal of eliminating avoidable blindness, rather appropriately by the year 2020 and although the company is operating the oldest DC-10 in the world, the long-term view is that it will see many more years of service yet. Former ORBIS medical director Dr. Carlos Solarte said in 2005 “We have had guarantees from FedEx that due to the low airframe hours we can continue to fly the aircraft until 2015.” However, with both Airbus and Boeing supporting ORBIS, he confirmed that talks could begin soon to find a replacement for the future. “An aircraft of the DC-10’s size is probably the ideal aircraft – anything larger would create too large a noise footprint when we are arriving or departing,” he said. Replacement is now likely by 2011 - see Airliner World for more details.

For more information on the work of ORBIS, or if you are interested in making a donation to support the company’s future work, please visit www.orbis.org

For an update on the ORBIS programme, see the February 2010 issue of Airliner World, out on January 13.


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