The Orbis Flying Eye Hospital is a fully accredited ophthalmic teaching hospital on board an airplane. Its first flight took place on March 1, 1982. Over the past four decades Orbis has provided vital eye care to thousands of people worldwide. Using cutting edge technology and the innovative use of avionics, hospital engineering and clinical expertise, Orbis is a leading international non-profit that unites people in the organization’s mission to fight avoidable blindness in over 90 countries throughout the globe.
In the late 1960s, the concept of Orbis began when renowned ophthalmologist Dr. David Paton, a faculty member of the Wilmer Eye Institute at Johns Hopkins, recognized the lack of eye care and ophthalmic teaching in developing nations where blindness was widespread. Concerned that a staggering 90% of avoidable blindness occurred in these countries, Dr. Paton wanted to close the gap.
Given the high costs of tuition and international travel and accommodations that prevented most doctors and nurses in low-income countries from coming to the USA for training, the idea for a mobile teaching hospital was launched in 1973 to deliver training to them at their doorstep and it was appropriately named ‘Project Orbis ‘; Orbis meaning ‘of the eye’ in Latin and ‘around the world’ in Greek.
In 1980 United Airlines donated its oldest DC-8 aircraft to Orbis, which became the very first Flying Eye Hospital (FEH). The airplane’s design allowed for cargo, and in 1982, philanthropist and actress, Dina Merrill christened the FEH before its first mission from Houston to Panama. That same year the Flying Eye Hospital made international news, inspiring the world with sight-saving work that took place on board the DC-8.
“There are few occasions in life when an idea takes off and leads to achievements beyond our wildest expectations – when a mission is driven by a vision so clear and compelling that it literally enables others to see it too…Orbis is one of these.” – Former Kofi Annan, UN Security General
In 1992 the DC-8 was replaced with a second-generation Flying Eye Hospital; a DC-10 aircraft twice the size of its predecessor that provided extra space needed to accommodate the expanding scope of FEH operations, as well as updated facilities.
In 2016 the employees of FedEx donated an MD-10 aircraft to Orbis and with the help of several of their generous partners, equipped it with brand-new facilities. This 3rd generation FEH can fly nearly twice as far as its predecessor and only requires two pilots, rather than three. Inside, the airplane is outfitted with the world’s most advanced ophthalmic training equipment. All this, with the progression of technology, has made training doctors around the world even easier.
As the only accredited hospital inside an airplane, the Flying Eye Hospital is state-of-the-art and unlike a typical large service provider. Orbis’ charter is to teach. Its main goal as a non-profit is to transform lives through the treatment of avoidable blindness. All of this is done through a network of people in different countries, with 15 offices internationally. The cockpit on the MD-10 is typical and there is an all glass flight deck. Behind the deck is a 46-seat classroom with a 3D monitor up front where trainees can view real-time surgeries taking place onboard the FEH. The monitor is connected to all the different stations within the hospital area (much like a teaching university in the U.S. that has an auditorium with a large glass observation area over the O.R.). Other stations include recovery, a sub-sterile area and everything that a regular hospital would have.
Additionally, between the AV and IT stations, a surgical procedure taking place aboard the aircraft can be transmitted live to locations outside the aircraft.
“We started before the internet. Now I do surgery and it’s broadcast in 73 countries, people tune in to see how it’s done, and I can teach them like they’re sitting in the aircraft watching over my shoulder.” – Dr. Rudy Wagner, Orbis volunteer
An example of this technology is Cybersight, which has vastly increased the capacity of eye health professional and health systems to treat and prevent blindness and visual impairment. Cybersight is an online training and mentorship service, launched in 2003, that is designed to be accessible to everyone, including people in remote locations, through computers, laptops, tablets, smartphones and even under conditions of low connectivity. Cybersight allows Orbis to make an impact in places where it does not have a physical presence. This technology has allowed more countries to view surgeries and procedures than the 46 seats that are on the airplane. According to https://cybersight.org/, in 2021, 17,000 eye health professionals from 184 countries have been trained, over 15,000 new users have registered, and over 4 million library videos have been viewed via Cybersight.
Bruce Johnson is Orbis Director of Aircraft Operations & Maintenance. He works in Dallas/Ft. Worth, Texas where the Flying Eye Hospital is based. From 2005 – 2008, he was a volunteer crew member from FedEx. He later became Director of Ops & Maintenance after the FAA changed Part 125, a set of regulations established to provide a uniform set of rules for the operation of large aircraft with a seating capacity of 20+ passengers or a maximum payload of 6,000 lbs or more when an airplane is operated for non-common purposes (private charters). It is governed more closely and includes official pilot & maintenance programs and a weight and balance manual much like an airline.
Johnson is a commercial pilot, as well as an A&P (Airframe & Powerplant) mechanic; he serves Orbis in both roles. He works with anything regarding flight ops and aircraft maintenance, writing engineering and tech data, fuel and flight planning & pilot training, federal regulations on tracking, documentation and scheduling, and oversees 17 volunteer pilots from FedEx. He explained the technical aspects of the aircraft’s makeup, “The actual hospital in the airplane is completely isolated from the rest of the plane. Considered freight, it requires no aircraft certification. None of the aircraft systems are interconnected to the hospital; they are independent of the airplane. All the equipment that runs and powers the FEH is in the belly of the airplane, which is taken off the aircraft by forklift and put on the ground. This includes three generators, a liquid cooling system, a med gas unit and chillers. Fuel from the aircraft is used to run the equipment, and completely self-contained equipment can purify water, kill every bacterium known to man and make its own hospital-grade oxygen. It carries its own spare medical and aircraft parts and is basically a warehouse, hospital, airplane…all wrapped in one.”
Orbis’s global strategy on programs, communications, fundraising, human resources and finance stems from its New York headquarters. There are 15 country offices representing regions around the world. Those in local regions of Africa, India, South America, Asia, the Caribbean and others, invite Orbis into their country indicating what eye conditions they want to learn about. Examples include cataracts (one of the leading causes of blindness), diabetic retinopathy, glaucoma, retinopathy of prematurity and more. At 12-18 months out, a large advanced team is sent in to look at a region’s facilities so as to make sure they are up to standard, or whether upgrades are needed to be made within their hospitals. A screening process is set up to teach medical staff in regional locales how to screen for the best cases for surgery. Once determined, Orbis flies into the country and performs the service in their local hospital, or on the Flying Eye Hospital itself. Generally, the best cases are found in the needy, low to medium-income parts of the country where 90% of visual impairment occurs.
There are two surgical teams – one at the local hospital and one on the airplane. The work is done in both cases to show medical staff at these different locales that they could do what Orbis is teaching them in their own facility, as well as on the Flying Eye Hospital. Bruce Johnson describes it as ’mentoring and training…a teach a man to fish philosophy.’
Medical personnel not selected to do the hands-on training inside the aircraft can still monitor and communicate and receive training outside of the Flying Eye Hospital O.R. A monitor is connected to a microscope so that you can see the surgery just as if you were looking through it yourself and you can still hear the instructor teaching the person doing hands-on training, and also ask questions while receiving live interactive training.
A team of eight staff are involved in the preparation and operation of every Orbis program – including Bruce Johnson, a logistics manager who sets up on site logistics at different countries, a 3 person staff to handle administrative work, and 3 mechanics (all retired FedEx employees) who travel aboard the FHE every time it goes on a program to monitor and maintain the aircraft, as well as the hospital equipment. Before each program, the advanced logistics team arranges for all security requirements to be done, that all passes and IDs are obtained and that there is a parking spot at the airport that the Flying Eye Hospital could access, with an ambulance for transport back and forth for the transport of patients and participants as well.
In the instance of cataract surgery that would normally take 10-15 minutes, it takes 45 minutes to one hour to teach the procedure, so on any given program day there are approximately 6-8 training cases performed at the locale, or on the Flying Eye Hospital. Hence, volume is done by the network of people that Orbis trains, which mostly happens after the FEH is gone and flown to another program.
In its four decades of service Orbis has conducted millions of eyes screenings and eye surgeries, as well as laser treatments for hundreds of thousands of patients. The organization has also trained thousands of eye care professionals at all levels, including tens of thousands of medical doctors.
Bruce Johnson discussed how the impact of the pandemic affected the Flying Eye Hospital’s ability to carry out its mission due to the international shut down of air travel. “We were in Ft. Worth in March 2020 doing a program with eye care professionals being trained from Latin America and Alcon (one of the FEH’s biggest sponsors), when the first cases of Covid-19 arose in the U.S and we had to make the difficult decision to cancel that program. Knowing that we had commitments with these professionals on the FEH and how vital that was, Orbis thought out how Cybersight could be leveraged to carry out the commitment. We converted 10 programs to a virtual program in 34 countries where FEH programs would have taken place in person. The Cybersight platform then grew in leaps and bounds reaching 184 countries during the pandemic, so a portion of the FEH portfolio will now continue to be a part of the Orbis portfolio forever. The pandemic actually caused it to be bigger. As a result, Orbis reached more countries than we had originally planned to reach in person, resulting in over three dozen countries, with 51,000 hospital trainings and over 3,600,000 screenings and examinations conducted in 2021 alone. And that was a bad year because of Covid. But the network has had a ripple effect and volume has come through those that we teach. Cybersight has become an even larger part of what we are doing now, as we go back to in-person training.”
Johnson is grateful to see a light at the end of the tunnel as Orbis returns to in-person programming in the month ahead, stating that the Flying Eye Hospital will be weighed in the next week and equipment will be put back on the airplane. “We have a program in Ft. Worth this August and then we are going to do a simulation training there, bringing in nurses and doctors from the Caribbean area to train them. Then we are going to Silicon Valley to do training with UC Davis, and then onto Qatar to do a test program with displaced women refugees from the Middle Eastern area. It’s a test program and if it works well, it may become long term.”
In his 15-17 years with Orbis, Bruce Johnson has gone to so many countries and witnessed first-hand how amazing and unbelievable the need for Orbis programs are in underdeveloped countries and how fortunate we are in the U.S., while so many there are not. But today, Johnson warmly remembers two of the Flying Eye Hospital’s most memorable success stories…the eye care received by a Peruvian granddaughter and grandfather who saw each other for the very first time in their lives, and a young woman in Mongolia who received surgery in the 1990s and who is now on the Orbis Board of Directors.