SIGHTLINES Episode 3: A New Flight Plan Transcript

Hosted by Hunter Cherwek with guests Maurice Geary and Lucia Nadaf.

Dr. Hunter Cherwek: Welcome to Sightlines. I’m your host, Dr. Hunter Cherwek, Vice President of Clinical Services at Orbis International. In this episode, we’ll be taking a deep dive into one of the most well-known platforms Orbis uses in our fight against avoidable blindness. The Orbis Flying Eye Hospital is a fully accredited surgical eye hospital and teaching facility housed on board an MD-10 aircraft.

For many, the Flying Eye Hospital is synonymous with Orbis. There’s really nothing like it. It travels the globe, delivering hands-on training to local eye health professionals. It has changed the lives of the thousands of people who have been trained on board or had a procedure as a patient of a Flying Eye Hospital. It leaves a legacy of sight wherever it goes. During the COVID-19 pandemic, we had to make the difficult decision to ground the Flying Eye Hospital for the safety of all our staff, patients, partners, volunteers and colleagues.

While the plane itself is getting some down time, the team is not. Some members of our Flying Eye Hospital team, like nurse Xiao Ying, have been using this time to help out with pandemic-related programs in their home countries. Xiao Ying is from China, and there she has been working with local colleagues to safely provide emergency and critical eye health.

Many of our Volunteer Faculty members are also working hard to provide essential eye services during COVID-19. Anesthesiologist Dr. Andrew Choyce, for example, is splitting time between emergency eye care and COVID ICU patients at home in Britain. And Dr. Helena Hurairah from Brunei has been redeployed to do COVID-19 testing, as well as continuing her work providing critical eye care.

Still other team members have been hard at work developing alternative programming to meet the training needs of the local eye health teams who would have joined us on board the Flying Eye Hospital. That’s what we’re going to talk about today. Specifically, we’re going to take a closer look at how we managed to do that in Zambia.

The plane was supposed to visit Zambia during the first half of the year, and 100 Zambian eye health professionals were registered to take part in educational programs on board. And we really wanted to find a way to deliver for these local teams. They’re working to save sight for children and adults in their community, and we need to support them in that work. So what did we do? We pivoted. We used the power of the internet to deliver a customized, remote training program for the Zambian ophthalmologists, nurses, and biomedical engineers.

It takes a pretty big team to pull something like this off. But there are two people in particular who can give us a good behind-the-scenes look at the process.

They are Lucia Nadaf, the Country Director of Orbis Zambia, and Maurice Geary, the Flying Eye Hospital Director. I had a chance to talk with them via Zoom, and we’ll share that conversation in a moment.

But first, a few terms you may hear during today’s episode:

  • FEH: That’s just the abbreviation for Flying Eye Hospital.
  • Hospital-Based Training: These are training projects delivered in partnership with and within a local hospital, without the presence of the Flying Eye Hospital plane.
  • Tertiary Hospital: These are facilities where patients can receive specialized care, or treatment for more severe or advanced cases. As opposed to primary care or secondary care.

And now, here’s my conversation with Lucy and Maurice.


Dr. Hunter Cherwek: Well, welcome to Sightlines. I'm really, really excited, how we've connected the world today. We have team members who are based in Peru, as well as Zambia. We've got Maurice Geary, he is the FEH Director. He leads the Flying Eye Hospital, the entire team, all around the world with our programs as well as Lucy, who's with us from Zambia. She is our Country Director. So Lucy, thank you so much for joining us from Lusaka, Zambia. Maybe you can just tell us a little bit about your country – the history, the people, the cultures as well as the eye problems that you're facing and tackling while leading Orbis Zambia.

Lucia Nadaf: So, Zambia is in South Central Africa, basically southern Africa, with a population of 17 million people. We're very lucky when we got the independence. So, as you know, mostly Africa is divided on tribal lines, ethnic and tribal lines, but our first president did a great job of uniting every one of us, so we have this slogan "One Zambia, One Nation", as much as we may have the 64 languages, we do have four common languages with English being our official language. Zambia has 10 provinces, and Orbis works in three of those. I must say, everyone says, Zambia has this warm, friendly people and it is true. [laugh]

In terms of the eye health picture, we basically have, according to the National Eye Health Strategic Plan of 2017 to 2021, we had 24 ophthalmologists listed in the public sector and 6 in the private sector. Basically, this is with 1 ophthalmologist per 1 million citizens, which is a very small number, and, hence, the great need for training more eye health staff. In terms of eye centers as well, in the different districts, we don't have that many; hence, we invest in community outreach where we take services to the people.

Dr. Hunter Cherwek: I think, Lucy, one of the things many people don't know is that the Orbis is not just the Flying Eye Hospital, that you've been working for many years as an established office, working with our long-term partners on multiyear projects. Maybe you can talk a little bit about the long-term, multi-year projects that we do, especially with community outreach?

Lucia Nadaf: So, Orbis has been working in Zambia for the past 10 years. Our priority then was pediatric eye care, and Orbis did help set up a child eye health tertiary facility. So that's been running and what that means is we have a number of children from the northern region as well as, surprisingly, we also have patients coming in from our neighboring countries, from the Congo, the DRC, we've had patients coming in from Angola, children accessing services at the eye health center. We also have been working in the rest of the Copperbelt, in the districts where we've built capacity with local teams at a community level, so these are people that work within their communities and our links to a health facility. They get training from Orbis as well as they are able to identify cases as they see in the communities.

Here in Zambia, we have this challenge of distance to health centers. Over time, we've had a number of rural health centers built, basically bringing services closer to the people. We're also integrating services like maternal and child health and eye health, so we train midwives, for example, in basic eye health so that they can have that knowledge. We also work in the Northern, North Western part of Zambia, so this is a very vast district. It’s quite rural and, also, health centers are very far apart from the communities. Most of the population is poor. We have most of them subsistence farmers, who cannot afford eye health care, and also we have a lot of people who are older and, you know what that means, a lot of cataract cases there as well.

We use a number of community approaches and raising awareness with people and also education about eye health, because, believe it or not, there are also lots of myths and misconceptions. People use all sorts of things in their eyes where they end up being blind and they end up going to the clinic when it’s too late and the health workers themselves – the ophthalmic staff – are trained and they're the ones that go and get this information out, they mobilize these people in the communities and also go back and conduct outreach [comes] and, in this case, for surgery for cataract. So basically we're providing the service where we are saving sight, we are providing this training, we're building future generations of ophthalmologists, and also building the hospital to be at the status where it's supposed to be, as the biggest hospital for the country.

Dr. Hunter Cherwek: And, Maurice, maybe you can tell us a little bit about how the Flying Eye Hospital team has adapted and overcome some of the challenges to COVID to help meet our commitments and help work with our partners in the various countries this year.

Maurice Geary: Sure, yeah, so, I mean, we have had a challenging year, like everybody else, but I've been really proud of the way the team has just shifted so quickly, you know, in sort of very proactively just taken on new challenges and we've really changed the whole way that we deliver training. Traditionally, we deliver hands-on surgical training, but this year we've been forced to do something completely new and, again, I've been really proud about how the team was just really proactively just gotten on board with that and done something which is new and challenging to us. I think that it's really going to change the way that we work in the future, actually, it's going to improve the training that we do in future, where we can combine some remote training through Cybersight together with the traditional hands-on surgical training. So, it's been a challenging year, but I think we've really risen to the challenge and we're going to come at it stronger.

Dr. Hunter Cherwek: COVID is, you know, something we always are talking about, and it is a very dynamic situation, every day we're learning new things about the disease, also how it's contained, how it's impacting travel and work. How is your team been responding and what have you been doing to maintain morale, keep people's attention and talents focused on the programs and the mission, but also making sure as human beings we’re caring for the care providers as healthcare professionals?

Maurice Geary: Maybe working on the Flying Eye Hospital might be good training for that, because every time we do a project, we're moving the entire project to somewhere new, and dealing with a whole new set of logistical challenges. So, the ability to be resilient and quickly change the way we do things is something that we're trained to do. The FEH team, we very often talk about ourselves as a family, we spend 50-60% of the year on the road together, working together and living together. So the bonds are very, very tight among the team and, with such an international team, it's been really heartwarming to hear stories about people in Zimbabwe being in contact with colleagues in India and Colombia and they're all keeping in touch together. It's amazing that we have the technology available now that we can do that in real time. We have a few staff members who have been working with their local public health teams to support COVID-19 response in their local countries, so we’ve been giving our support where we can talk to those people. The remote courses has also been something great, it’s given us a focus and something to put our energy into and because it's something new, like I said before, we’re also learning a lot, which has made it a really interesting year for us professionally.

Dr. Hunter Cherwek: I could not agree more. It is the compassion, the culture that you drive in bonding the team, you know, it's important for the people to know that so much of what we do on a Flying Eye Hospital involves infection control, handwashing best practices, sterile technique, and that really has just highlighted the importance of those training and the resources especially that our nursing team has made has only been highlighted by COVID.

Well, Lucy you lead such an incredible team in Zambia, maybe you can talk a bit about how they have worked with our partners to address COVID and fight this crisis in the local communities in Zambia?

Lucia Nadaf: So, we have two of our staff, so basically from our partner hospitals, and they went back to their communities, in the districts where there were no eye health services, and set up health centers. Brilliant, very innovative, young people and they're now supporting the COVID response, so one of them is working at the isolation center in Masaiti district, the other one is working into the Chililabombwe District, which is the border between Zambia and the DRC, so we have a lot of traffic coming in, lots of truck drivers and it's one of the hot spots. So, they are very appreciative to just know that the clinical training that they got from Orbis in terms of ophthalmology , I think it's just the vibrancy as well, and also the support that they're getting from Orbis. So we're checking in with them and they're communicating with their colleagues also, one of them actually had to be in isolation, I think because they were exposed, but the support that they got from their colleagues as well, everyone checking on them. They've also built this kind of a family and also very appreciative the isolation center in my Masaiti district is this new hospital and they have an eye center, so they are basically combining screening, they closed it off, but the clinical officer is screening both eyesight, at the checkpoints, as well as for COVID-19. So they're working in integration.

Dr. Hunter Cherwek: And as I said before, I think your team has really knocked it out of the park with community education and I was so impressed with the posters that you were able to quickly make and distribute through our network to talk about COVID, you know, handwashing, signs and symptoms to report, the concepts of isolation and social distancing. So again, I'm just so impressed by not only the team you lead, but the solutions you create. So, thank you for all that you and your team are doing to help Zambia.

Lucia Nadaf: Thank you, Hunter, and I must mention that, apart from the posters as well, the radio programs that we implemented are carrying COVID-19 messaging, we're working with the Ministry of Health, we have someone from the health promotions department, so they talk about COVID-19 and then we talk about eye health, so, again, it's looking at things and basically killing two birds with one stone, so we're integrating.

Dr. Hunter Cherwek: Again, I appreciate your solutions and the extra efforts your team is doing to help those on the front line.

And, Maurice, maybe you can tell us a little bit about how the team works with the in-country partners and the country offices to have a successful program. Maybe you can talk us through that?

Maurice Geary: I believe that one of the things that makes the Flying Eye Hospital such a successful program is the fact that we customize the training plan every time. So we don't go in with a set curriculum and deliver the same curriculum every time. We spend a year planning the program before we're physically there in person. All we do is we go in, we work with Orbis country teams and with the local partners, and we do an assessment of what their training needs are, what resources they have locally, and then we tailor each of our training programs to their specific needs. You know, one of the reasons that we can do that is because we have this enormous pool of Volunteer Faculty, who have all of the different specializations, so we have that ability through those volunteers to tailor the training course and deliver exactly what each individual partner needs.

So that planning, like I said, starts one year out, where we physically send a team in and we start working with the partners. We identify what those training needs are. We start to work with the local Ministry of Health to get their necessary permissions and credentialing for our doctors. We then work with the Orbis team for six months on getting all of those things in place, then we send a team in again, six months out from the program. And, at that stage, what we're doing is we’re confirming who are going to be the doctors and nurses who will receive the hands on training during the program. And then they start to select, after that visit, they start to select who the potential patients will be during the program. So it’s really, a sort of, a stage by stage process which starts one year out and finishes with the plane arriving and the three-week training program.

Dr. Hunter Cherwek: Maybe, Lucy, you can talk about the other side of the equation, kind of, what you're doing while you're in Zambia to prepare for the Flying Eye Hospital. What approvals do you need for the medical aspects, the aviation aspects, the logistics? What are you doing to help get things ready for the plane’s arrival?

Lucia Nadaf: So, like Maurice said, we start out a year before. We start with the team from the Flying Eye Hospital coming. We look at training plans and looking at working at the hospital. So, in terms of permissions, we work with the local Ministry of Health. It also is we have to get permission from them before we even start planning, so we write to them and inform them that we intend to bring the plane in and, also, this is the purpose of the plane, the training, explaining all that to them. So, even that needs time because you have to really explain to them. I mean you're bringing in a plane, it's parking in the airports, you're having all these different nationalities coming in, so they have their questions, so we ask for this permission.

And, obviously, there's a lot of sensitivity. We’re talking about surgery, so they want to ensure that we have safe protocols, basically, and that's why the accreditation comes in. Apart from the Ministry of Health, there is also the airport. So we have to get lots of permissions. It's not just going straight to the airport, they work in a ministry, so writing to the Ministry of Communications and Transport and getting their permission, again, having to explain and let them understand what we're doing. I'm working with the Ministry of Home Affairs for Immigration, because we need all these visas and clearance for the staff that are coming in, working with the Ministry of Communications and Transport again in terms of the media. So there's a lot of multi-sectoral approach that's involved in planning for Flying Eye Hospital visits and getting all these permissions and also working with the hospital itself, ensuring that we’re in line with the training plan and getting the people that need to be trained.

Maurice Geary: I was just going to say, I think Lucy described that really well, that there's so many different ministries that we need to communicate with and get permissions with, and what we're asking from them is so unique. You know, we're asking to bring an airplane into the airport, but we're also asking the Ministry of Health to accredit a hospital at the airport. So it's something which is totally unique and it always takes a lot of work. It's challenging to get all of the correct permissions in place.

Dr. Hunter Cherwek: Right, and you just nailed it, sometimes they don't even believe it exists until you bring out the brochures and they go on the websites and see that Orbis is a real thing and that there is a Flying Eye Hospital.

So, Maurice, maybe you can tell us a little bit about what the project would have looked like if the Flying Eye Hospital program could have taken place this year in Zambia. What was your emphasis, what were your priorities for that program both clinically, but also with the advocacy and other parts that the Flying Eye Hospital programs bring?

Maurice Geary: We were scheduled to go to Zambia in May 2020, and we were going to deliver a three-week project there. So the first week of the project was going to be simulation training, so that was simulated surgical training targeted at resident doctors in their residency and doctors in the earlier stages of their career. So that was going to be doing simulation training in a number of different surgical techniques as well as nursing, ophthalmology, and biomedical engineering. So, that was going to be the first week of the project. The second and third week, then, we were going to transfer into live patient hands-on surgical training. So, again, we always target the full medical team that are involved in surgeries, so we train the ophthalmologists, we also train anesthesiologists, nurses, and biomed engineers.

Dr. Hunter Cherwek: Yeah, and I think you raise a really important point. It takes a village for, you know, a medical team to bring a child’s sight back: an anesthesiologist, a carrying nurse, a biomedical engineer, the ophthalmologist, and you really lead that entire comprehensive, holistic clinical team.

Now, talk about when the plane comes in and lands in Zambia, how you leverage all that talent with the volunteers and the team, but, also, you use the presence of the plane for public awareness and to get with politicians to talk about advocacy and support for the importance of eyecare. Maybe you can just talk about what it's like to host the Flying Eye Hospital?

Lucia Nadaf: Basically, obviously, the first thing for us is training, so providing this training to our staff and training ophthalmologists—that is very important and, also, the fact that we have this skill within Orbis, passing on this skill from the Orbis staff and Orbis volunteers on to the local teams, that is something that we were looking forward to and that is very important for us. And, secondly, the plane itself is visibility for eye health. In most countries, eye health is not a priority. When we're running workshops, we're talking to government, to politicians, or basically even just to the Ministry of Health, we do this exercise where we ask people to close their eyes and ask them to walk around the room or do the things that they usually do, which obviously is difficult. As simple as it sounds, we’re hitting a point home where we saying you need sight for everything that you do because there's so much that gets affected when you lose your sight. So for us, the plane is visibility. We have the politicians coming in and seeing how the plane functions, which is actually amazing.

My first time was Ghana, last year November, so for me I was blown away. I see the Flying Eye Hospital in our publications and online, I’ve actually got a video where I was like, oh my goodness, oh my goodness, here it is, I’m seeing it live. You know, for the first time, and I know the work that we do. But then when you see politicians who, you know, okay, we’re just doing something, we’re just officiating at this function, but then when they come in, they appreciate what the Flying Eye Hospital offers, you know, with the training in the lecture theatre, seeing what is going on and the surgery itself, and seeing the results, especially when you have, for example, cataract surgery and the patches removed off someone's eye the following day. They then realized that eye health is something that is important. It’s not just about sight, you know, it's not just about going blind, but there is something bigger that goes on and there's this big thing, basically the visibility with a plane, and it's just in your face, that this is about eyesight.

Dr. Hunter Cherwek: Yes, I could not have said that better. And, you know, one of the things I love is how Maurice and you work together to leverage the plane's presence in the world. Obviously, you all had put a lot of time, as has your team, to design the program and we had to postpone that. Maybe you can talk about how you've revised those plans, how you've kept those relationships and training goals through the new program you're offering virtually through Cybersight?

Maurice Geary: We very quickly decided that our mission and our goal is to deliver high-quality clinical training to our partners and they'll want, in some way, for us to deliver on that promise. We said, Okay, let's look at the tools that we have available through Cybersight to deliver remote training, and then let's sit down with Lucy and her team and the partners in Zambia and look at what their needs are and how we can match the tools we have available with the needs that they have. So through that we've been able to build remote courses, specifically targeted at doctors and nurses in Zambia. So, we are running courses this year on ophthalmology, we're running courses in glaucoma, and phacoemulsification cataract surgery, so those are specifically for ophthalmologists in Zambia. We're also running a course in nursing, for nurses in Zambia, and, of course, in biomedical engineering, which is going to be for the engineers from Zambia. We're also making that one regional, to open it up to participation from our other partners across the African region, so we're going to have participation from Cameroon and Ghana as well in that same course.

Dr. Hunter Cherwek: That's fantastic. And it's hard to believe that a doctor in Iowa can be doing real time teaching with a classroom and participants all over, you know, Zambia. It's just, it's so exciting to see how you are leveraging the tech is just fantastic.

Maybe, Lucy, you can talk about what feedback you've gotten from the participants and the people who are joining these conferences and online trainings. What has been their response and what feedback have you heard?

Lucia Nadaf: I must say that the glaucoma course actually came at the right time. We've just had a glaucoma specialist who came back from training and she had seen all these patients. I saw her a couple of weeks ago and she was showing me her book and she had all these patients that were booked. She told me how much she was learning, and she was taking from the courses and applying this. She talked about pediatrics, and also there was a session on pediatrics, we've also been following up in terms of using Cybersight for consultations, so we're linking her with that.

In terms of, just basically, the whole program, we also didn't want to lose the momentum, just because the Flying Eye Hospital visit was canceled. We wanted something to keep going, to keep the trainees interested and, also, to keep the Ministry of Health alive to the fact that we were serious. We're not just about bringing a fancy plane to the airport and that's it, but we wanted something continuous happening, so this was just perfect.

Dr. Hunter Cherwek: Yes, and I think you and Maurice have worked really well together to tailor those courses and the lectures for the virtual Flying Eye Hospital program, but then introducing them to all that is already on Cybersight with structured courses, the library materials and the e-consultation services. So, certainly, COVID has caused a lot of disruptions and frustrations, but it's also showing people all the resources that are available to them 24 hours a day, seven days a week for free online at Cybersight.

Lucia Nadaf: What is also beneficial is with the courses, the other courses, that they take on Cybersight, it’s part of the continuing medical education and they get the certificate. So that's a plus.

Dr. Hunter Cherwek: Yes, it's really exciting how you've created a great partnership with the Zambian Ophthalmology Society and how they really view Cybersight and Orbis training as kind of a recognized and accredited training session.

Maybe you can talk about some of the moments you've had, seeing a patient have their patch taken off or seeing a doctor come back from training and doing their first-ever procedure and the smile they have at the end of the case and the feeling of satisfaction that you can just feel in the room. Maybe you can talk about some of the memories you've had on Orbis programs?

Lucia Nadaf: I will tell you, I started with Orbis in October 2015 and one of the first things I was given to work on was the Hospital-Based Training, so basically working on a plan and working with the hospital. Everything was new to me, but it was really interesting. First of all, that was learning for me, I was forced to learn the medical terms, I had to read more and that was really interesting and also just working with teams.

I remember the first Hospital-Based Training that we had was a Pediatric Hospital-Based Training, and we had actually a baby have surgery and the following day, in the morning during the post-operative care, the patch was taken off the eye. And just to see the baby see the mother for the first time was just amazing, we all just cried in the room and it was just beautiful, it has a very beautiful moment. And, for me, this is why we do what we do, and this is why investment matters.

Dr. Hunter Cherwek: Maurice, maybe you can talk about some of your experiences coming into the Flying Eye Hospital and how you've seen the plane transform either staff members’ lives or patients’ lives. What have been some of your best memories, while serving on the Flying Eye Hospital?

Maurice Geary: Yeah, something that I think it's very humbling to me to see is every time we do surgical training, it's to see the just the change in the patients and their family members from the moment they arrive on the plane in the morning to a few hours later when they're leaving. So, you know, people arrive in the morning and they're very nervous. You know, they're to have surgery, they're probably coming on the Flying Eye Hospital for the very first time, so there's a lot of things are very new, and it's a very stressful and nerve-wracking situation. But then our clinical staff on the Flying Eye Hospital are amazing. They just bring them in, they make them comfortable and they just form an immediate bond, it's really an amazing thing to see. And then to see a few hours later, after a successful surgery, for that family leaving the plane and they are smiling and they're hugging these people who they just have created this incredible bond with in just a short space of time.

And if I can also just give one example of story that really just stuck out to me.

Last year we went and brought the plane to Mongolia and we had a young lady who was volunteering with us to help with the logistics of the program. She had actually received surgery, she was an Orbis patient on a Flying Eye Hospital project in Mongolia, I think was around 12 years earlier, she was just a teenager. She came back on the plane 12 years later and when she walked on the plane she instantly recognized one of our nurses, who was there the day that she received her surgery. And that was Leo Mercado, who is 23 years with the Flying Eye Hospital this year. And the fact that she was able to come onto the plane, you wouldn't even have known that she had an eye surgery, you know, very successful young lady, and she came on the plane and gave Leo a big hug. It was an amazing moment.

Dr. Hunter Cherwek: Yeah, and to me what you've just described makes all the work, all the planning, all the time away from home worth it, witnessing those moments and just knowing that so much of what we do is not captured because it just happens every day for us. We're helping people, like Lucy, every day they're out in the community, giving people glasses, helping them get eye exams and eye treatment, but when you get that one where you're right there when the patch came off or the mother gets their child back from the operating room and everyone, even our staff, sometimes get choked up in tears. I can tell you, it is a very powerful thing we do.


Dr. Hunter Cherwek: That was Lucy Nadaf and Maurice Geary, two inspirational people who are truly changing the way the world sees.

Thank you for joining me for Sightlines today. I hope you’ll join us for the next episode and for the entire series.

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