Flight for Sight: How Orbis International is tackling preventable blindness on a global scale

Today, we’re exploring the work of Orbis International, a global nonprofit organization that prevents blindness and restores sight for children and adults in places where eye care is out of reach. So vision problems make it harder to learn, earn a living, and enjoy life. For over four decades, Orbis has trained doctors, nurses, and other health care professionals to provide care in their own communities across Africa, Asia, Latin America, and the Caribbean, bringing world class expertise to the places it’s needed most.

I’m joined by Dr Maria Berrocal, Associate rofessor at the University of Puerto Rico, and Orbis volunteer faculty member, who shares her first experience aboard the Orbis Flying Eye Hospital, a fully accredited ophthalmic teaching hospital onboard an aircraft, and what it means to prevent blindness and restore sight around the world.

So, Dr Berrocal, welcome to Vision Voices.

[Dr Berrocal] Yes. Thank you for having me.

[Nicky] So you’re joining us from Puerto Rico today. I imagine it’s beautiful and sunny where you are.

[Dr Berrocal] It is.

[Nicky] My six year old son, he’s obsessed with geography at the moment, like countries and flags and maps. So when I told him I was talking to someone from Puerto Rico this morning, he was so excited. And he went and got his globe and found where Puerto Rico is, which is a long, long way from Bolton in the UK where we are.

So did you grow up in Puerto Rico?

[Dr Berrocal] Yes. I grew up in Puerto Rico, and I went for medical school in the United States. And my retinal training, I did it there also.

[Nicky] Oh, amazing.

So, I know your your journey into ophthalmology started at a very young age because you have a long family tradition of ophthalmology.
But what inspired you and motivated you to kind of follow that course?

[Dr Berrocal] Well, it’s interesting. My father was the first retina specialist, in Puerto Rico and most of the Caribbean, and he used to go to the Dominican Republic and teach retinal surgery. And when I was little, I used to go around with him in the hospital because we kept patients hospitalized. I also worked in his office. But when I went to medical school, I wanted to try something different. I thought about psychiatry, dermatology. But when I went through the rotations, I realized that the most important thing was the awe that patients got when they got their vision back and the importance of vision and really in life and just survival.
So I decided that even though I was resisting that because it was like, but my father did, this was my true calling.

[Nicky] It’s great that you discovered that. We recently launched touchOPHTHALMOLOGY Future Leaders, to celebrate some of the rising stars in the field. And when I interviewed them, one of the nominees, he mentioned the impact of his first surgery, someone going into surgery unable to see and coming out with sight, just how remarkable that was.

[Dr Berrocal] It’s like a miracle. Yeah. I have patients who just hear me before I do surgery, and then afterwards, they’ll go, oh my god. You’re so little. You’re not like anything I expected. And I said, you expected someone very large and tall and oh, yes.
So it is almost like a miracle. It is as close as we get to miracles, really.

[Nicky] Fabulous. Well, today, we’re talking about the Flying Eye Hospital. So how did you get involved with Orbis, who are the nonprofit organization behind it?

[Dr Berrocal] Yes. My father was an artist volunteer in the eighties, and it was something that I always wanted to do. But when I started my career, I had small small children, and it was something I had in, like, the back of my mind, but I never actually, went through the channels to get it organized. And I was in an Asia Pacific meeting in Bali, with a very good friend of mine who has been very active in Orbis, Dr Paul Chang. And we were talking, with some of the doctors from Mongolia, and Orbis was going to Mongolia.

He was trying to organize some of that. And he tells me, well, you know, you are the one who should be doing Orbis. And I go, well, I’ve always wanted to do Orbis. How do I go about it? You know? And then he said, oh, we’re gonna get this set up. So he instantly called someone. And I gave him my phone number and my email address, and they soon sent me all the things. And the next project was gonna be the Bangladesh project. And the dates were good. I blocked that time, and I went to the project. And it is one of the most rewarding things I have done in my career.

[Nicky] I’m so excited to hear more from someone who’s actually been on the plane. But I just wondered before we start talking in a bit more detail, I know that Orbis are really trying to build strong and sustainable eye care globally. But why do you think preventable blindness is still such a big widespread issue?

[Dr Berrocal] Well, preventable blindness is really an issue of access. We have over a billion people with preventable blue blindness in the world, and that is said to increase by fifty five percent in the next twenty five years. So it is an enormous issue and something we need to tackle. And it is basically a problem with access. Most ninety percent of all preventable blindness is in essentially on, economically challenged countries.

And, they have lack of resources, and they have lack of training. You know? All of these countries have superbly capable surgeons who may be better than any other surgeon, but the part of the education getting all that information to them, it is hard to do. And this is where Orbis is unique because, Orbis does not go and operate people.

Orbis is really like a mini fellowship program. So we go there and we teach people so that they can be empowered with the tools and the resources and the knowledge to actually start providing care to more remote areas.

[Nicky] Absolutely. And I suppose, you know, training is the way that you build this generation on generation, and the people who all of us train can then go on and train, you know, future ophthalmologists. So it really is the way of building a sustainable system.

[Dr Berrocal] Of course. It’s like teaching someone to fish versus giving the fish.
So it is the same concept, and it was really an amazing experience. They were about my part, which was surgical retina, there were about thirty doctors from all over Bangladesh, who were meeting there.

And, I was lecturing them. They were watching the surgeries. They were asking questions while I was doing surgery, and I was not doing the surgeries myself. I was doing the surgeries with two of the local doctors that were assigned to me, and they were doing parts of the surgery. We were talking about, you know, when, why, what to do, etc.. And, the beauty of it is, you know, I’ve always had issues with just going there and seeing a patient for the first time and doing a surgery, but Orbis is super organized. So there’s a platform called Cybersight, which is unique because any doctors can provide cases, and I can give feedback and tell them, you know, I would do this and that.

But they preselect a whole number of patients, and they send me, you know, the photographs, the history, all this. And I pre screened the ones that I think would be interesting. So they get a variety of cases and who can be helped the most, etc. And after we do that, the day before we start doing surgery, we go to the local hospital, and we see all those patients again. We examine them together with the doctors that will be with me, and then we select the ones that we will be performing surgery on. So it is a really thorough, comprehensive, way of doing this. And we try to pick a variety of cases so that they learn the most. They also have a simulator, which is in the Flying Eye Hospital and also is taken to the local hospital so that the training participants can go in and they can try and learn different parts of the different techniques in all the fields. So the flying hospital was there for two weeks, and we had all many subspecialties, cataracts, retinal surgery. We had oculoplastics.
We had pediatric lymphoma. We had cornea.

So it is a very, very thorough and comprehensive project.

[Nicky] That sounds like it. So how many faculty members such as yourself who are helping to teach, go on a project?

[Dr Berrocal] Oh, many. The Flying Eye Hospital was two weeks. I was for part of the week together with an oculoplastics person and a glaucoma pediatric glaucoma specialist, but they were also anesthesiologists. There were nurses. There were engineers, teaching biomedical engineers. So it is really comprehensive but they were also the volunteer ophthalmologist who were doing the aftercare of the patients when they were examined the next day by Rubor at surgery. So I would say they were easily, like, maybe forty, at the time.

[Nicky] Wow. Yeah. It’s a lot of people. It sounds like a big operation.

So for any of our listeners who aren’t aware of the Fly Nye hospital, it’s a former cargo plane that’s been fitted out as an ophthalmic teaching hospital.

[Dr Berrocal] FedEx plane that has been retrofitted. And what was amazing was that the volunteer pilots and the volunteer engineers, they were all ex retired FedEx employees who were very used to the plane.

So the plane is essentially gutted out internally, and it’s made in two modules. So the first module has seats, and it is the lecture hall.

So while somebody’s doing surgery or putting patients in and out, somebody is lecturing. And this was really amazing because no time is lost. You know? Our days are very, very long, but, you know, nobody’s doing nothing, you know, while, so teaching lectures are going on all the time there. And we had all the ophthalmologists, you know, listening to the lectures, asking questions, etcetera. That is the per first part of the. Then the second part is sort of like a little little room administrative.

Then we have the operating room, which is state of the art operating room with the latest technology, really. And it has cameras so that the surgeries are projected into the lecture. Okay. And, and at that time, we have local nurses, local scrub techs, everybody inside learning. So it’s not just a sentence. We have a volunteer anesthesiologist, which I have to say was superb. I wish I could, you know, take some of them with me.
But, they were teaching other anesthesiologists, other anesthetists to do. And then after that, there’s a section which is the preop and the postop, the recovery room where the patients are while they wait, and after the surgery.

And there were many nurses, local nurses, learning how to do a pre op and a post surgery care. And then the next day, these patients are seen at the local hospital by a team of ophthalmologists, volunteer ophthalmologists there together with the local ophthalmologist just so that they can learn the post op care.
[Nicky] And when I first heard about the Flying Eye Hospital, I just couldn’t picture how so much could fit into one plane. But on the Orbis website, there’s some wonderful photos and tours of the plane. So you can kind of get a feel as to what it’s like, which I’ll share the link below this podcast in case anyone wants to see. But what was it like when you first got onto the plane? Did you feel like you’re on an aircraft, or does it really feel like you’re in a teaching hospital?

[Dr Berrocal] Well, it really feels like a combination of both. You see, the plane is parked at the airport, and the plane is also unique because it basically produces sterile wall water, you know, filters water. It produces its own oxygen.

So, it has its own, like, generators that all fit in the cargo part of the plane. It’s amazing that so many things can fit into a plane. But once you’re there, you feel like you are operating, in essence. So it was a really incredible experience.

[Nicky] So you’ve told us a little bit already about your own experience, from the Bangladesh project. Were there any sort of highlights or things that have really stuck with you from that project?

[Dr Berrocal] First, I have to say many things. The screening day actually was in a way heartbreaking because you wanna operate on everybody you see. You don’t wanna exclude anyone or choose this and that, and that was, you know, very difficult, which cases to include and which was not. And, what is amazing is that everybody there, all the Bangladeshi people were so that Orbis was there. You know?
It was something that you just don’t see the gratitude, how happy they were, that we were, choosing Bangladesh, to do this.
And, that was the hardest part was selecting the patients.

Then, the next day, you know, when we’re doing surgeries every day, it’s different patients. But I remember one patient that had no sight, and then the next day, the patient was crying of happiness because we could, you know, finally see. It was a patient that had vitreous hemorrhage and hadn’t been able to see, you know, for a while. There was another case that was very impactful, and it was an eighteen year old, who lived nine hours away, and he was brought by car by his uncle. He had a trauma in one eye, Had a retinal detachment. And, you know, you would imagine, an eighteen year old would be really, really nervous. And, you know, all these surgeries we did under local anesthesia and station, and these patients were so cooperative. It was really, you know, I don’t know how to say it. The strength of character of these very young patients was incredible.

And just, you know, what they go through to go in. The other thing that I found was very interesting, was that a lot of the ophthalmologists were women.
I would say easily more than fifty percent. And to them, it was very inspiring to have women, ophthalmologists, teaching them. And we created a chat group. I tried I connected them with women in retina and some of the WhatsApp groups that we have where we share cases. So I think all these things, not only empower the ophthalmologist there, but a lot of the women who are up and coming, in medicine. And in many of these countries, you see women, like, being treated by other women.

So having more female ophthalmologists is important, in these places.

[Nicky] Do you know if there’s any future projects planned with the Fly and Eye Hospital?

[Dr Berrocal] Yes. Next year, the projects will be in Africa. And the year after that, it’s gonna be in South America.

So they like to keep it on a continent because it’s easier as far as, you know, the plane goes, and the plane usually stays in different countries in the meantime. And they’re, you know, checked and make sure that everything’s working properly and that makes sense.

[Nicky] So what would you tell other ophthalmologists who’ve heard of all this and are interested in taking part in a project? What would your advice be to them?

[Dr Berrocal] Well, I think there’s many ways to participate in Orbis, not only going to the Flying Eye Hospital. Orbis has all these other projects of teaching with so simply, going different places, not necessarily on the plane, bringing, people from countries to teaching places, in different parts of the world. So just, you know, get into the website, which is orbis.org, which is o r b I s dot o r g, and you’ll have all the information there. You can contact the other people in Orbis. Say, you know, you’re a doctor, you wanna volunteer, you want to help. And, and giving the gift of sight is just, you know, massive. So the reward that you get by volunteering in something like Orbis is unique.

It is not like going someplace and doing ten surgeries and then leaving, and it doesn’t really change the place. Orbis changes countries. Orbis changes the whole infrastructure of the health care system of the places it goes. And this is what makes it unique. What people get from a project like Orbis, is really unreproducible in any other way or form. It’s like providing fellowships to these areas. And, you know, if we train thirty retina specialists in different techniques And by giving them lectures, they’re gonna go out and teach many others.

And, you know, that’s how and that’s how teaching happens. That’s how mentorship has traditionally happened. The learning experience is really the best way to do it and in the most organic way. It’s like going there and doing surgery at their hospital with many of the things they have Yeah.
Bringing things they may have not seen but that are accessible, and basically structuring, our teaching to their environments, their pathologies, all of the things that they face every day. I have always felt a lot of what you achieve in life. You know, we all wanna think that it’s all just, sheer dedication, but it’s a lot of luck. You know? We are lucky to be born where we’re born. We’re lucky to have parents, who maybe, you know, who help us with education or or have resources, etcetera.
So I’ve always felt that I’ve been a very privileged person and that many people, as I said, who may have way more talent surgically or maybe blind, not because they did not put any effort in it, but just because they’re a lot in light. And I think it is our responsibility, by having such privilege to help the ones who don’t and to share our knowledge.

And I think we all have a responsibility to do that. And, you know, why should someone, you know, be blind if we can help them? And blindness is an enormous handicap. In many places, if you’re blind, you will die.

Nobody will help you. We will have no way of earning your living. So the gift of sight is one of the best gifts you can give anyone. And I think in that sense, Orbis is really relieved.

[Nicky] That’s a lovely message. Certainly seems to be making a lasting impact, and it’s wonderful to hear your stories.

Thank you to our listeners for joining us today. If you enjoyed today’s episode, why not subscribe to Visionary Voices on Amazon Music, Spotify, Apple Podcasts, or Podbean. Until next time. Goodbye.