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November 14, 2019

Three days in Mandalay on the Orbis flying hospital

  • By Dr Nilar Thein (Lin Yaung Thit)
There were 38 ophthalmologists and 7 cabin crew on Orbis this time.

I was pleased when the Orbis Flying Eye Hospital was coming to Myanmar. There are people who are well acquainted with Orbis and there are those who are not. This will be the fifth time Orbis has visited Myanmar and the fourth time landing in Mandalay.
Some of our frequently asked questions include Orbis’ country of origin, what services do they provide, whether it’s free, what benefits do they offer, what diseases do they treat, and whether just anyone can seek treatment from them.
Well, the answer to the first question concerning their origin is not very straightforward. While Orbis is headquartered in New York, USA, it’s not a US company nor is it affiliated with the United Nations. Orbis also has branches in London, Houston and Hong Kong.
The 200 or so people working full-time on Orbis also have different jobs across the globe. The doctors volunteering on the plane include prominent ophthalmologists, physicians and professors. Even the pilots commandeering the plane are captains from different nations volunteering.
Orbis is actually funded by a diverse set of entities. The US Agency for International Development provides the capital, United Airlines donated the DC-8 plane, Alcon Foundation donated the MD-10 aircraft, while philanthropic organizations and major companies provide assistance and donations.
Orbis is an international non-profit non-governmental organization dedicated to saving sight worldwide since its establishment 35 years ago. This is makes it the only airplane hospital that provides treatment for eye disorders and related training as well.
The hospital’s visit this year will last two weeks in Mandalay. Upon the invitation for cooperation from the Ministry of Health and Sports, Orbis worked together with Mandalay Eye, Ear, Nose and Throat Hospital and provided a training course onboard its aircraft from 23 September to 4 October.
This training programme included theoretical and practical training for Myanmar ophthalmologists, exchanging know-how related to eye disorders, and conducting workshops. The courses and surgical operations will be carried out in conjunction with a connection to the Internet and, therefore, the doctors can choose to observe the section that interests them in real-time.
The training programmes will mainly focus on developing the study of strabismus in youths, cataract, glaucoma, corneal diseases, eyelid disorders, tear duct obstructions, and other vision-related topics.
They will also provide practical training for medical engineers, phacoemulsification practice for postgraduate trainees, and the latest surgical method for glaucoma.

The Orbis flying hospital houses a state-of-the-art teaching facility.

The phacoemulsification process is a small-incision cataract surgery that involves making an incision in the side of the cornea and inserting a tiny probe into the eye. The probe emits ultrasound waves that soften and break up the lens so it can be suctioned out.
With the help of the Alcon Foundation, the training programmes will be accessible for ophthalmologists, nurses, anesthetists, medical engineers and experts from all over Myanmar. They say this entire visit aims to raise public awareness on the National Eye Health Plan 2017-2021 among Myanmar’s citizens.
The first time Orbis visited Myanmar was in 1991 where it landed in Yangon and then again in 1992, 1993, 1994, 1997 and 1999. I was a postgraduate in ophthalmology during 1999 and all of us postgraduates gained invaluable experiences from their training.
We received practical training for treating cataracts with a wet lab system, which was the most modern method at that time. We copied the latest medical books, journals and CDs on ophthalmology from on board that plane. So, it’s been almost 20 years since Orbis hasn’t visited Yangon. I hope it will come visit the city in the coming years.
Now, I find myself traveling to Mandalay on 23 September. The Flying Eye Hospital only sees patients on Sunday. Since there are so many people wishing to receive treatment, the EENT Hospital reviews the list of patients first and the Orbis team then further reviews the list and gives suggestions, comments and decisions as necessary.
From that list, they pick five people to receive surgery on board the plane and three people to receive laser surgery. They were already reviewing the patients list when I arrived on Sunday.
At 9 a.m. on Tuesday, the selected patients, eye doctors, anesthetists and postgraduate trainees all boarded the Flying Eye Hospital. Security was tight from the entrance of the airport up to the airplane. We were all given ID card with straps.
You will first see an office immediately upon entering the plane. On the left is a classroom with 46 seats. The number of people permitted to board the plane at a time is limited and are rotated by the medical university and date. No food is allowed on the plane. Since there is an operation theater on board, they give the highest regard for keeping it sanitized and free of germs.
I was able to board the plane on Tuesday and Wednesday. I was able to witness a child receive surgery to correct strabismus on my first day. I also observed them using a shunt for treating glaucoma. They continued treating patients with glaucoma in the evening.
They let us on the plane at 9 a.m. the next day. With two patients at 1 p.m. and two more in the evening, the Flying Eye Hospital is only able to operate on 20 patients per week. This may not seem like a big help to the nation for some.
But the true objective of Orbis is to spread the knowledge and training on eye disorders and treatment to postgraduate students and specialists. They begin classes as soon as you board the plane.
A light will go on during class to signal the beginning of an operation and class is halted. The operation is shown on TV and the doctor inside the theater and in the classroom exchange greetings first.
We were given 3D glasses so it felt like we were actually in the operation room and it was like the patient’s eyes were right in front of us. We can ask any questions directly to the doctor performing the surgery.
Then, after the operation is complete, they close the TV channel as they prepare the operation room for the next surgery and our class resumes from where it left off.
Our lunch break is at 1 p.m. and we have our meal at the airport before returning to the plane as a group at 2 p.m. The classes continue until 5 p.m. We had to answer questionnaires before taking the classes. We were each given a remote control to choose the correct answer. Our answers were presented to us in a bar graph. We had to answer the same questions after each class. I could help but feel proud of some Myanmar doctors who had the right answers on both times.
On Wednesday the next day, the performed surgery on a patient with both corneal disease and cataract. The removed the cataract first using the probe and ultrasound process mentioned earlier. Then they replaced the fourth layer of the cornea with a minor incision.
We simultaneously received teaching on the nature of glaucoma, medical treatment, laser surgery and surgical processes. They provided detailed explanations on laser treatments and injections used to treat impaired vision caused by diabetes.
Learning never stops and you are never too old nor too young to start or continue learning. We have to catch up technology advancing from day to day, year to year, era to era. There was always something to learn to emulate from observing the professionals operating on the plane.
They are organized, strategic, punctual and also value time by not wasting a single minute. They are decisive and efficient, and have a wealth of international experience and practice that makes them admirable to everyone.
When selecting patients for treatment on Orbis, they prioritize the poor, those with zero eyesight and those who have chances of successful operations. They also prefer to select patients who have diseases that will provide a good sample for Myanmar’s ophthalmologists and postgraduate students to gain practical training.
I think this will answer the question of who to contact and how much it would cost to seek treatment on Orbis. Some of the patients could be cured by Myanmar doctors while some could not be cured by the doctors on Orbis or other global medical professionals.
I was once asked by a patient if she could give her eyes to her son who was born without any. She asked if they could perform that surgery on the plane. I calmly explained to her that while a mother’s love is strong, no doctor or modern technology yet can help someone who was born without any eyes. I had to tell her there was no cure for someone who lost their vision while in the womb as a result of past karma.
I was unable to peek inside the operation room on the plane but I was busy enough absorbing everything they were teaching and even forgetting to blink sometimes.
There were 38 ophthalmologists and 7 cabin crew on Orbis this time. Among them were Dr Robert Chang who taught and treated glaucoma and is an Assistant Professor from Stanford University, California, Dr Monte from Michigan University who taught and treated eye disorders in children and strabismus, Dr James from the University of Texas Health Science Center for cornea and external diseases, Dr Javier from Colombian University for vitreoretinal simulation, and anesthetists Dr Mark Gunn and Dr Nathan from universities in Texas.
In the classroom was written ‘With support from Alcon Foundation’ and the foundation has been partnering with Orbis to treat eye disorders around the world for over 40 years. In fact, they were already working with Orbis in 1979, way before they initiated the flying hospital project.
Alcon has been donating medical equipment, medicine and other support to hospitals around the world with the Flying Eye Hospital for 40 years, and Alcon’s professionals and engineers also give training for handling machinery, repair and maintenance.
They will be teaching about eyelid and tear duct related diseases, cornea and nervous system disorders next week. My three days in Mandalay were immensely fruitful. It was also a rare opportunity for postgraduate students. I would like to thank the professors and ophthalmologists of Mandalay EENT Hospital for helping me attend the Orbis classes.
Seeing is believing and I was able to witness the positive changes in Mandalay and enjoy its beauty during my time attending the courses on the Flying Eye Hospital.
Translated by Pen Dali

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